Intensive Phase Research Articles

An Evaluation of Medication Adherence in New Tuberculosis Cases in Ankara: A Prospective Cohort Study

An Evaluation of Medication Adherence in New Tuberculosis Cases in Ankara: A Prospective Cohort Study

Association of the Genotype of TNFα with the Efficiency of the Intensive Phase of Chemotherapy and Formation of the Sizes of Destruction Cavities in Patients with Pulmonary Tuberculosis.

The interrelation between the TNFα gene polymorphism and the effectiveness of the intensive phase of chemotherapy in patients with pulmonary tuberculosis, as well as the formation of diameter of the sizes of destruction cavities was studied. It was revealed that the most adverse course of the disease and a high frequency of formation of destruction cavities are associated with the GG genotype of the TNFα gene.

Durlobactam to boost the clinical utility of standard of care β-lactams against Mycobacterium abscessus lung disease.

β-Lactams present several desirable pharmacodynamic features leading to the rapid eradication of many bacterial pathogens. Imipenem (IPM) and cefoxitin (FOX) are injectable β-lactams recommended during the intensive treatment phase of pulmonary infections caused by Mycobacterium abscessus (Mab). However, their potency against Mab is many-fold lower than against Gram-positive and Gram-negative pathogens for which they were optimized, putting into question their clinical utility. Here, we show that adding the recently approved durlobactam-sulbactam (DUR-SUL) pair to either IPM or FOX achieves growth inhibition, bactericidal, and cytolytic activity at concentrations that are within those achieved in patients and below the clinical breakpoints established for each agent. Synergies between DUR-SUL and IPM or FOX were confirmed across a large panel of clinical isolates. Through in vitro resistant mutant selection, we also show that adding DUR-SUL abrogates acquired resistance to IPM and FOX. Since the use of β-lactam injectables is firmly grounded in clinical practice during the intensive treatment phase of Mab pulmonary disease, their potentiation by FDA-approved DUR-SUL to bring minimum inhibitory concentration distributions within achievable concentration ranges could offer significant short-term benefits to patients, while novel β-lactam combinations are optimized specifically against Mab pulmonary infections, for which no reliable cure exists.

Treatment of Acanthamoeba keratitis with high dose PHMB (0.08%) monotherapy in clinical practice: A case series.

Acanthamoeba keratitis (AK) is a rare sight-threatening infectious disease with no approved pharmacological treatments. Topical polihexanide 0.8 mg/ml (PHMB 0.08%) completed a pivotal clinical trial showing a medical cure rate of 84.9%. The purpose of this study is to evaluate the efficacy and safety of PHMB 0.08%, given as monotherapy, in clinical practice. consecutive cases of AK were included. Diagnosis was confirmed by in vivo confocal microscopy or PCR. Patients were treated with PHMB 0.08% as part of a name-based compassionate use program. Treatment delivery frequency and termination were as advised in the pivotal clinical trial. Medical cure was defined as clinical evidence of healed epithelium and absence of corneal inflammation lasting 3 months after discontinuing all treatments. twelve eyes of 11 contact lens wearers with AK of variable severity were evaluated. Eleven of 12 (91.7%) eyes achieved a medical cure with no surgery. One eye had a corneal perforation and required emergency therapeutic keratoplasty. The median time of treatment with PHMB 0.08% was 100 days (range 35-222). Seven eyes (58.3%) reached a final visual acuity of 20/50 Snellen or better. Two subject reported worsening of conjunctival hyperaemia during the intensive phase of the treatment. No other adverse drug reactions were observed. topical treatment with PHMB 0.08% monotherapy successfully cured AK in 11 of 12 eyes when used in real-world clinical practice, thereby confirming that results observed in the clinical trial could be obtained in this setting.

Hematological Changes in Newly Diagnosed Pulmonary Tuberculosis Patients on Standard Anti-TB Treatment Regimen and their Influence on Smear Conversion

Pulmonary tuberculosis (PTB) mortality remains high despite the availability of effective anti-TB therapy. Disease and treatment-associated hematological derangements at diagnosis and during therapy might contribute to this high TB mortality rate. This paper aims to determine hematological changes in newly diagnosed pulmonary tuberculosis patients on standard anti-TB treatment regimen and their influence on smear conversion. The study adopted a longitudinal design in which 55 newly diagnosed HIV negative PTB patients were followed up to the fifth month of anti-TB therapy. Blood samples (5ml) were collected for diagnosis during the second and fifth months and analyzed using automated HumaCount 5D hematology analyzer. Data was analyzed using Kruskal-wallis test with Dunn’s multiple comparisons test in Graph-Pad prism version 6.0. Throughout therapy, there was a statistically significant time-dependent decrease in median total white blood cell counts from 6.82x103/ uL at diagnosis to 5.87x103/ uL at the fifth month (P=0.0358). This decrease in total WBC count was majorly driven by significant decrease in the neutrophil numbers from 4.31x103/ uL at diagnosis to 2.97x103/ uL at the fifth month. The proportion of patients who had anemia at the fifth month of treatment increased compared to the second month post intensive phase. There was also a significant decrease in MCV, MCH and MCHC at the second month compared to diagnosis. Moreover, the median platelet count, MPV, PDW and PCT% decreased from 314x103/ uL, 8.9 fL, 10.4 fL and 0.273 at diagnosis to 232x103/ uL, 10.15 fL, 12.5 fL and 0.235 at the fifth month, respectively. High WBC count, high platelet count, low lymphocyte count and low HGB at the end of month two of therapy were shown to increase the likelihood of sputum non-conversion (OR-2.42 (95% Ci 2.07-2.82)), (OR-1.5 (95% Ci 1.01-2.22)), (OR-1 (95% Ci 1-1)) and (OR-2.58 (95% Ci 1.68-3.95)), respectively (P<0.05). A significant number of PTB patients presented with anemia, thrombocytosis and leukocytosis. The proportion of patients with anemia increased over time. The study recommends screening for hematological abnormalities in patients for tailored patient interventions for better clinical outcomes.

Out-of-pocket payment and catastrophic health expenditure of tuberculosis patients in accessing care at public-private mix clinics in Myanmar, 2022

BackgroundThe financial burden of tuberculosis (TB) can hinder patients and their families, creating obstacles throughout the care cascade, despite TB prevention and control being provided free of charge. In Myanmar, patients can visit private providers operating under public-private mix (PPM) schemes, where TB services (diagnosis and treatment) are typically offered at no cost. The study focused on quantifying the financial burden faced by TB patients seeking care from Myanmar's PPM providers.MethodsThis cross-sectional telephone survey included 695 adults seeking TB treatment [drug-susceptible TB (DS-TB) and retreatment TB] from various private providers in four states and regions with high TB burden in Myanmar. Telephone interviews were conducted in May and June 2022. Both direct and indirect costs incurred from the patient and their household perspective were valued in 2022 and estimated throughout pre- and post-TB treatment episodes. The TB-affected households were defined as experiencing catastrophic health expenditure if their expenditure due to TB exceeded 20% of their capacity to pay, as recommended by the World Health Organization. All cost data were collected in Myanmar Kyats (MMK) and converted to USD (1 USD = 1850 MMK as of July 20, 2022). Logistic regression analysis was done to identify the determinants of catastrophic health expenditure.ResultsThe findings showed patients made a median of 7 times for clinic visits throughout their treatment, with the median total cost for the entire TB treatment being 53.4 US dollars (USD), including direct medical and testing costs (11.9 USD) and direct non-medical patient expenditure (11.6 USD). Pre-treatment costs were higher compared to post-treatment costs (the intensive phase and continuation phase). During the intensive phase, TB care cost was nearly free, but during the continuation phase, it was a median of 2.6 USD. About 34.5% of patients experienced catastrophic health expenditure due to TB treatment, with expenses exceeding 20% of their capacity to pay. Multivariate regression analysis revealed that patients with a history of hospitalization (aOR = 14.84; P < 0.01), seeking care from regions other than Yangon (aOR = 2.6; P < 0.01), and using coping strategies (aOR = 12.53; P < 0.01), were more likely to face catastrophic financial burdens. Higher monthly household income (over 162 USD) was associated with a decreased risk of incurring catastrophic health expenditure (aOR = 0.38; P < 0.01).ConclusionsTB patients and their households in Myanmar faced risk of catastrophic costs, even when treated in the private sector with free diagnostic charges and anti-TB medicine. The study highlighted the need for additional strategies or policies to make TB care affordable and mitigate the financial burden of TB-affected households.Graphical

Simple and high-resolution method for displacement sensing using self-mixing interferometry

Self-mixing interferometry (SMI) is widely used for vibration, velocity, and displacement measurement applications. Many complex and computationally intensive phase unwrapping algorithms have already been proposed to obtain high-resolution measurements, but there remains a requirement for a high-resolution yet simple method for displacement measurement. In this work, a high-resolution yet simple improved unwrapping method (IUM) is proposed, which addresses the limitations of the previously proposed simple but low-resolution method, consecutive sample-based unwrapping (CSU). IUM shows a remarkable improvement of 49% over CSU. IUM was assessed for a broad range of SMI signals, and results revealed that IUM is capable of processing SMI signals from all three main feedback regimes with an average RMS and peak error of 37.7 nm and 113.3 nm, respectively. Such a high-resolution method with a straightforward processing methodology is a vital step towards real-time independent displacement sensors capable of performing high-resolution measurements.

Identification of Urinary Glucose and Urinary Ketones in Pulmonary Tuberculosis Patients Receiving Anti-Tuberculosis Drug Therapy (OAT) at the Tlogosari Wetan Health Center

Tuberculosis is a contagious infection caused by Mycobacterium tuberculosis. Anti-Tuberculosis Drug Therapy (OAT) given also has side effects, one of which is hepatotoxicity. Laboratory examination of urine glucose identification can show if there is damage to the kidney glomerulus in the filtration process. OAT such as isoniazid can affect the breakdown of fat and cause increased ketone production, especially in individuals who have low carbohydrate intake so that if the excess amount will be excreted through urine (ketonuria). The purpose of this study was to identify urine glucose and urinary ketones in non-DM pulmonary TB patients with OAT treatment at the Tlogosari Wetan Health Center based on treatment phase, gender, and age. This type of research is descriptive observational with a cross sectional approach. The study sample was a urine sample from a non-DM pulmonary TB patient. The examination method used is dyeing using a reagent strip test. The results of the study from a total of 30 non-DM pulmonary TB patients with OAT therapy (100%). A total of 6 (20%) patients identified urinary glucose, with details of intensive phase treatment 2 (7%) trace urine glucose patients (±), while in advanced phase 2 (7%) patients identified trace urine glucose (±) and 2 (7%) low urine glucose patients (+1). The majority of positive urine glucose results were experienced by men with vulnerable elderly age (46-65 years) as many as 4 patients (14%). The results of urine ketone identification showed that 2 (6.6%) patients were identified with urine ketones, namely trace (±) in the intensive phase treatment, while 15 patients in the advanced phase of urine ketones were all negative.The majority of positive urinary ketone results were experienced by vulnerable men of adult age (26-45 years) as much as 2 caseins (14%). Conclusion: Of the 30 non-DM pulmonary TB patients with OAT therapy who met the inclusion criteria, there were 6 (20%) patients identified with urinary glucose and 2 (6.6%) patients identified with urinary ketones. The impact of this study is expected to encourage non-DM pulmonary TB patients to take OAT and do regular medical check-ups.

The relationship between the length of treatment for pulmonary tuberculosis patients in the intensive phase and hemoglobin levels

Background: Tuberculosis (TB) medication can alter hematological parameters, including hemoglobin levels. Hemoglobin levels due to anti-TB drugs have the potential to cause anemia. Therefore, it is important to know the risk of anemia during intensive phase TB treatment therapy. Objectives: This study aims to determine the relationship between the length of treatment for TB patients in the intensive phase and hemoglobin levels. Materials and Methods: The sample was selected using the accidental sampling method. The number of samples obtained was 31 consisting of 17 respondents from the Kedungmundu Community Health Center, 14 respondents from the Bangetayu Community Health Center. EDTA blood was analyzed using a KX21-N hematology analyzer. The relationship between the duration of treatment and hemoglobin levels in TB patients was statistically tested using Pearson correlation test. Results: Most of the intensive phase TB patients are in the 15-24 years age group. The percentage of female patients is 54.8%, and 45.2% male. TB patients with a treatment duration of 5-8 weeks are 34.1% and a treatment duration of 1-4 weeks is 65.9%. Normal hemoglobin levels are 51.6%, and low hemoglobin levels are 48.4%. The results of the Pearson correlation test have a significance level of 0.862. Conclusion: There is no correlation between the duration of treatment of intensive phase TB patients and hemoglobin levels. The importance of monitoring hemoglobin levels during intensive phase treatment, in order to monitor the effectiveness of treatment or the presence of complications such as anemia.

Impact of Various High Intensity Earthquake Characteristics on the Inelastic Seismic Response of Irregular Medium-Rise Buildings

In the twenty-first century, the seismic design of buildings seems to have become a fully recognized topic. There are guidelines and standards which should be taken into account by designers in seismic areas. Designers using modern international guidelines have ascertained that the behavior of structures is not as expected. New challenges in the construction industry result in the construction of structures with new, unusual shapes. These are structures that do not meet the assumptions of safe construction in seismic areas. Contemporary buildings are also characterized by their irregular distribution of structural elements. Such solutions are not beneficial from the point of view of seismic engineering and can lead to reduced dynamic resistance and damage in such structures. In this paper, a five-storey, irregular-shaped reinforced concrete (RC) building model was subjected to different earthquakes with varying magnitudes, PGA (peak ground acceleration) and PGV (peak ground velocity) values, and durations of the intense shock phase. Once the model was verified using previous in situ measurements, the building model was subjected to five earthquakes. A numerical nonlinear analysis of the building was performed using a verified FEA (finite element analysis) model in the time domain through non-linear time history analysis with the Broyden–Fletcher–Goldfarb–Shanno (BFGS) method. The building’s dynamic properties were measured using various methods of excitation. The model was influenced, among others, by two far-field representative events caused by the last earthquake in Turkey, which resulted in strong ground motion. The analysis results identified the locations of structural damage and allowed for the assessment of the structure’s dynamic resistance. The results of the calculations prove that the duration of the intensive phase of extortion is one of the reasons for building damage in earthquake-prone areas. Building damage occurs with earthquakes that are characterized by an intensive phase of excitation with a long duration and high values of velocity in the earthquake components. The article highlights the inadequate dynamic resistance of the building, leading to excessive displacements and unfavorable structural solutions. Damage to buildings at this earthquake intensity caused damage to the load-bearing structure, which was not designed for such intensities. This paper is a research report with a specific case study of medium-rise irregular RC buildings.

Formation of treatment regimens in newly diagnosed patients before the diagnosis of pulmonary tuberculosis verification

Abstract. One of the basic principles of treatment of tuberculosis patients is the appointment of treatment taking into account the drug resistance of Mycobacterium tuberculosis (MBT). However, during treatment, it may be necessary to change the intake regimen when new data on drug resistance become available. The search for ways to choose the optimal treatment method seems relevant.Aim: To analyze the prescribed regimens and the reason for their correction in newly identified patients before verifying the diagnosis of tuberculosis.Material and Methods. The following methods were used to detect MBT: luminescent microscopy, molecular genetic methods and seeding on liquid and solid media. Tests for drug sensitivity were conducted in parallel. The study group consisted of patients with established bacterial excretion (n = 79), whose diagnosis was confirmed by cultural methods. A retrospective method was used in the analysis.Results. At the beginning of treatment with bacterioscopy and polymerase chain reaction methods MBT was detected in 65/79 (82.2%) cases, the remaining 14 cases were detected only by culture methods. Forced change of the therapy regimen during treatment after receiving the results was in 25/79 (31.6%) cases, of which 1/25 (4%) with isoniazid resistance, 7/25 (28%) with multidrug-resistant tuberculosis, 17/25 (68%) with the pre-extensive drug resistance regimen. The latter was prescribed only after receiving results of tests for drug sensitivity on liquid and solid media after 1–3 months. The multidrug-resistant tuberculosis treatment regimen decreased after receiving data on resistance to fluoroquinolones in accordance with the seeding data, but the largest number of patients still remained on this regimen – 41/79 (51.9%). Among these patients a change in chemotherapy regimen from multidrug-resistant tuberculosis to pre-extensive drug resistance during the intensive phase of treatment occurred in 17/25 (68%).Conclusion. When prescribing a regimen, it is recommended to assess the risk of changing the regimen and, if there are predictors, apply a chemotherapy regimen before treatment.

Correlation between total animal and plant protein intake, with body mass index in tuberculosis patients during the intensive phase in Dili and Oecusse

Correlation between total animal and plant protein intake, with body mass index in tuberculosis patients during the intensive phase in Dili and Oecusse

Essential components of the maintenance phase of complex decongestive therapy.

Complex decongestive therapy is the current gold standard for non-surgical clinical lymphedema management and consists of manual therapy, compression exercise, skincare, and education. Complex decongestive therapy involves an intensive volume reduction phase (Phase I) followed by a maintenance phase (Phase II). The aim of the maintenance phase is to promote life-long control of lymphedema through use of self-management strategies and the provision of ongoing reduction therapies as needed. Compression therapies are the mainstay of lymphedema self-management. Poor adherence to self-management practices has been associated with increased volume and progression of lymphedema to more advanced stages, supporting the importance of education and regular monitoring to promote adherence to the Phase II maintenance recommendations. In this editorial, we provide consensus recommendations on the essential components of the maintenance phase, including education, skin care practices, managing infection/cellulitis, compression therapies, health and weight management, exercise, and ongoing follow-up care.

Psychological morbidity and quality of life of patients with pulmonary tuberculosis.

Tuberculosis (TB) is associated with psychological distress, poor coping, deterioration in health-related quality of life (HRQL), and stigma. However, these issues have never received sufficient attention as a part of routine care. The healthcare workers and physicians of primary contact are not sensitized to use discrete screening questionnaires to identify and address these issues. A longitudinal study was hence conducted in the Department of Pulmonary Medicine in collaboration with the Department of Psychiatry. 75 microbiologically confirmed 'new' pulmonary TB patients were enrolled. Socio-demographic and clinical details were noted. The patients were then evaluated for psychological distress using the General Health Questionnaire-12-Hindi version (GHQ-12) and Patient Distress Thermometer (PDT); coping strategies using the Coping Strategy Check List-Hindi Version (CSCL); HRQL using the World Health Organization Quality of Life-Brief-Hindi version (WHOQOL-Bref), and stigma using the Explanatory Model Interview Catalogue-affected persons Stigma Scale (EMIC-SS), at the start of treatment. Those having a GHQ-12 score ≥3 were labeled as 'screen positive' for psychological distress and referred to a consultant psychiatrist for detailed psychological assessment. Treatment was given by the psychiatrist if diagnosed with a psychiatric illness. All those without the diagnosis of a psychiatric illness were counseled by a pulmonologist. All patients were called for a follow-up visit and repeat assessments on the 15th day at the end of the intensive phase, using the same instruments employed at baseline. The patients already on treatment by the psychiatrist were again evaluated for their psychiatric illness. 32 (42.7%) patients had psychological distress (GHQ-12≥3) at baseline. 20 of them (26.7%) were diagnosed with a psychiatric illness. However, only 2 (2.7%) patients had psychological distress and psychiatric illness at follow-up (p<0.001). Mean scores of GHQ-12, PDT, CSCL, WHOQOL-Bref-26, and EMIC-SS at baseline were 3.000±1.9590, 2.333±1.2980, 3.480±2.2017, 311.63±30.201 and 5.267±1.8478, respectively. All the scores improved significantly at follow-up (p<0.001). The scores of the various instruments used in the study significantly correlated with each other. Comprehensive screening for psychological distress and assessment of HRQL should be part of routine TB care. The healthcare workers under the program should be sensitized to use the various screening tools on a day-to-day basis to identify patients who require expert psychiatrist care. The majority of the patients with distress, but without a psychiatric illness, can be handled well with dedicated counseling sessions by the healthcare workers themselves. The ancillary staff should be encouraged and trained to meet the demands in resource-constrained settings. A multidisciplinary approach, with close integration of TB programs with mental health services, is urgently required to eliminate TB.

Tackling fashion waste from inside the wardrobe: The influence of personal factors on sustainable clothing use practice

Fashion consumption seems predestined for disenchantment, demarcated by low utilization levels and a consumption cycle that is too short to foster emotional attachment. To be sure, what occurs after purchase when clothing is taken home for use is a carbon intensive phase of the product's lifespan that is squarely within the clothing user's control and responsibility. Decreasing the purchase of new garments has the greatest potential to reduce the global carbon emissions associated with fashion consumption, and prolonging clothing's utilization are consumer habits considered critical to this aim. Clothing use, manifest in the wear, care, and repair practice, are a linchpin in determining how much and how quickly fashion becomes waste. Though these use behaviors clearly advance sustainable clothing consumption, the least is known about what occurs between purchase and disposal or why. It is also important to develop a method to measure sustainable use practice and explore the influence of personal factors that determine engagement in such. This research study examined how personal factors (including fashion trend sensitivity, style orientation, frugality) influence sustainable clothing use practices (wear, care, and repair). A quantitative questionnaire was administered online to a representative sample of 420 U.S. consumers. A multi-level path analysis was used to test a proposed model. The results indicate that fashion trend sensitivity, style orientation, and frugality positively influence sustainable clothing use practices. Further, findings reveal that these personal factors explain 80% of the variance in sustainable clothing use, highlighting the critical role of use practice in shaping sustainable clothing behavior.

ASPECTS OF SURFACE ENAMEL MINERALIZATION IN PERMANENT TEETH OF CHILDREN FROM DIFFERENT AGE GROUPS

The purpose of our study was the examination of external surface enamel mineralization in permanent teeth of children from different age groups. We examined sections of 50 extracted for orthodontic indications premolars in patients from different age groups. A study of 16 teeth was conducted in 11-13 years old children, 8 teeth were investigated in each group of 13-15 years old, as well as 9 teeth in 15-16-year-old patients. All patients were appointed with remineralization therapy during the first six months after tooth eruption fallowed by application of “Tooth Mousse” ones a day for 2 weeks every six months with appropriate monitoring. The comparison group, on the other hand, consisted from extracted teeth taken from children who were not subjected to any preventive remineralization measures. The distribution by age and the studied material was identical to the main group. Segmentation of the teeth was carried out after the tooth extraction with separation of the crown structure and further polishing of the crown using polishing brushes without pastes. Sections 0.3-0.5 mm thick were formed with a diamond disc. The enamel samples were cleaned and degreased and then examined in a polarizing microscope (Optika B-150POL-B 40x-640x Bino) at a magnification in 500 times. The description of the enamel microscopic surface was carried out according to the following parameters: surface heterogeneity, surface opaqueness/shininess, surface roughness/smoothness. The surface homogeneity was assessed by calculating the ratio of identified surface areas that visually differed from the overall enamel texture, which was characteristic of the predominant investigated surface enamel. There were criteria for evaluating the enamel surface heterogeneity according to the research data in a polarizing microscope : the presence of numerous well-defined cracks, the visualization and number of areas from which the enamel prisms extend, the presence and number of enamel surface irregularities confirmed by a change in the direction of the light beam, the percentage of surface homogeneity, which was calculated as the ratio of the area of ​​the visually homogeneous enamel surface to the area with ​​any microscopically detected changes. To assess the opacity of the enamel surface by the microscopic polarization study, the criteria of visual assessment of shiny and dark areas of interest were used. The study suggested that microscopic changes are characterized by a decrease of total number in enamel surface irregularities and an increase of its glossiness and smoothness at the approach of structural compositional stabilization at 15-16 years. The analysis also revealed that there were marked microscopic differences observed in enamel of 15-16 years old after remineralization with the "Tooth Mousse" gel and a comparison group (without remineralization therapy).The difference between them is reliable (p&lt;0.01) according to the indicators of the relative average level of surface heterogeneity, and also statistically different from similar indicators that were registered in the age groups 11-13 and 13-15 years old (p&lt;0.01). The gained results can be considered as the expediency grounds for implementation of dental caries prevention at the early stages of secondary mineralization (immediately after eruption) and throughout the entire period of its intensive phase, which will further contribute to the stabilization of the caries-resistant enamel.

Impact of isoniazid monoresistance on overall and vulnerable patient populations in Taiwan

ABSTRACT Isoniazid is an early bactericidal anti-tuberculosis (TB) agent and isoniazid mono-resistance TB is the most prevalent drug-resistant TB worldwide. Concerns exist regarding whether resistance to isoniazid would lead to delayed culture conversion and worst outcomes. From January 2008 to November 2017, adult culture-positive pulmonary TB patients receiving isoniazid, rifampicin, pyrazinamide, and ethambutol were identified through Taiwan Center for Disease Control database and were followed until the end of 2017. Primary outcomes included time to sputum culture conversion (SCC) within two months. Secondary outcomes included death and unfavourable outcomes at the end of 2nd month. A total of 37,193 drug-susceptible and 2,832 isoniazid monoresistant pulmonary TB patients were identified. Compared with no resistance, isoniazid monoresistance was not associated with a delayed SCC (HR: 0.99, 95% CI: 0.94─1.05, p = 0.8145), a higher risk of 2-month mortality (HR: 1.19, 95% CI: 0.92─1.53, p = 0.1884), and unfavourable outcomes at 2nd month (OR: 1.05, 95% CI: 0.97─1.14, p = 0.2427). Isoniazid monoresistance was associated with delayed SCC (HR: 0.90, 95% CI: 0.83─0.98, p = 0.0099) and a higher risk of unfavourable outcomes (OR:1.18, 95% CI: 1.05─1.32, p = 0.0053) in patients aged between 20 and 65, and delayed SCC in patients without underlying comorbidities (HR: 0.90, 95% CI: 0.81─0.98, p = 0.0237). Isoniazid mono-resistant TB had a comparable outcome with drug-susceptible TB at the end of the intensive phase. Healthy, and non-elderly patients were more likely to had culture persistence, raising concerns about disease transmission in these subgroups and warranting early molecular testing for isoniazid resistance.

A Study to Assess Anti-TB Treatment Compliance, Factors Predictive for Poor Adherence and Perpetual Defaulting among Patient Living with TB in Namuseche Chipata Eastern Province–Zambia

Background of the Study: Tuberculosis (TB) is the ninth leading cause of death worldwide. According to WHO at least 1.5 million people each year succumb to TB, thus making it the world's top infectious killer as well as the leading cause from a single infectious agent, ranking above HIV/AIDS. Zambia is one of the top 30 high TB burden countries. People with active TB can infect 5– 15 other people through close contact over the course of a year. TB patients with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill. Without proper treatment, 45% of HIV-negative people with TB on average and nearly all HIV-positive people with TB will die. Defaulting on TB medication is a major barrier to both local and global TB control. Defaulting increases, the risk of drug resistance, treatment failure, relapse and death, and may prolong infectiousness. Poor adherence to treatment means that patients remain infectious for longer and are more likely to relapse or succumb to tuberculosis. The rate of anti-TB treatment compliance, adherence and perpetual defaulting TB treatment was and is still high during the intensive phase of treatment. Most people who are called “lost to follow up” don’t have adequate information as to why they should continue and finish their TB medication.  Methodology: A qualitative, phenomenological cross-sectional research design was used. Namuseche Prison Clinic and surrounding compounds of Chipata Township in Eastern Province Zambia. A total of 141 participants was recruited through purposive sampling. In-depth interviews were conducted. The SPSS package version 23 was applied to conduct quantitative analysis. The proposal was approved by the Chreso University Ethics Clearance Committee and National Health Research Authority. Researcher ensured confidentially and voluntary participation with informed consent.  Results: The age of the respondents in this study ranged from 18 years to 50 years. Knowledge on TB related questions was very high in this study and stood at 87.3%. TB treatment default was found in 34 (32.7%) respondents and was associated with distance to the facility and transport costs, feeling unwell and the drug side effects.  Conclusion: TB treatment default was found in 34 (32.7%) respondents and was associated with distance to the facility and transport costs, feeling unwell and the drug side effects.

Experience of Using Delamanid in the Treatment of Multiple Drug Resistant Tuberculosis

The objective: to evaluate treatment results in MDR TB patients when delamanid is added to the treatment regimen.Subjects and Methods. 91 patients with multiple drug resistant pulmonary tuberculosis were included in the study, of which 36 people (39.6%) were HIV positive. Patients were divided into four comparison groups depending on HIV status and inclusion of delamanid in the treatment regimen. Groups receiving delamanid included only patients in whom bedaquiline or linezolid had been discontinued due to adverse reactions.Results. The results of treatment of MDR TB when delamanid is added to the chemotherapy regimen during the intensive phase, indicate its high effectiveness and safety including HIV positive patients.

Effectiveness of new antituberculosis drugs in the treatment of children and adolescents with chemoresistant tuberculosis

BACKGROUND. There is a significant decrease the effectiveness of antituberculous (anti-TB) treatment on the background of multidrug and extensive drug resistance (MDR/XDR) of Mycobacterium tuberculosis. Therefore, in order to increase the effectiveness of treatment MDR-/XDR-TB a new antimycobacterial drugs such as bedaquiline (Bdq), delamanid (Dlm) and pretomanid have been introduced both for adults, children and adolescents in recent years. MATERIALS AND METHODS. On the basis of a retrospective cohort analysis of the data of patients' medical records the evaluation of the clinical effectiveness of chemotherapy with Bdq and Dlm was carried out. The main group: 40 children and adolescents with MDR-/XDR-TB of lungs, who received complex antimycobacterial therapy (AMBT) with Bdq and Dlm. The control group consisted of 27 patients who received complex AMBT without Bdq and Dlm. Age range – from 3 to 18 years. RESULTS AND DISCUSSION. On the background of AMBT during the first 3 months of treatment was established stopping bacterial secretion among all patients of main and control groups. However, in control group compare to main one stopping bacterial secretion was significant slowly (p&lt;0.05). At the stage of completion of the intensive phase of AMBT, the normalization of immunological indicators occurred in 29.6±2.8 % of control group and in 43.4±4.5 % of main one. A significant difference between the groups among the immunoregulatory index CD3+CD4+/CD3+CD8+, IgM and circulating immune complexes was obtained. Among children and adolescents of the main group positive dynamic of immunological changes were observed 1.5 times more often. Among all patients of main group the resolution of the infiltration, consolidation of the focus and the absence of decay cavities were ascertained at the end of the anti-TB course. Anti-TB treatment with the formation of small residual changes into lung tissue ended in 77.5 % patients of main group. In 12.5 % cases of control group destructions persisted and bacterial excretion resumed. A large residual changes such as multiple dense foci, fibrosis and residual decay cavities in control group were observed 2.3 times more often (51.9 % vs 22.5 %), p&lt;0.05, than in main one. Using Bdq and Dlm among children and adolescents with MDR-/XDR-TB significantly increased efficiency of complex treatment. Among main group (72.5 %) compare to control (33.3 %) one the results of treatment to be considered “cured” were 2.2 times more likely and 1.5 times less often – “completed” (27.5 % vs 51.8 % respectively). The success rate of treatment among children and adolescents who received Bdq and Dlm was 100.0 % and among patients without these new drugs – 85.2 %. CONCLUSIONS. The criteria used show that AMBT combined with Bdq and Dlm is 1.5-2.2 times more effective (according to a separate criterion) than AMBT without these drugs.