National Tuberculosis Center Research Articles

Ritual healing in suburban America

One of the more provocative studies of why middle America is making increasing use of ritual healing and what that choice tells us of problems with biomedical care in technological institutions...A welcome addition to anthropological studies of ritual healing in other societies, and it illuminates a huge component of our health care system that is poorly understood.--Arthur Kleinman, M.D., Harvard University An all too rare volume, namely a scholarly work on the practice of healing in suburban or what we might call middle-class America. McGuire, perhaps uniquely, has set out the religious or 'ritual' healing beliefs and practices that are usually strictly segregated and kept apart...Anyone who takes seriously the need to understand 'healing' ...should obtain this book.--Health and Healing The power of the book is in the larger cultural analysis it offers ...a valuable contribution to medical sociology.--Sociological Analysis This welcome study of nonmedical healing among upper-middle-class and middle-class persons in Essex County, New Jersey, clearly shows how individuals become attracted to and influenced by alternative healing techniques. --Choice Develops an innovative sociological approach to the study of alternative healing practices through a methodologically sound qualitative study...The high quality of research and conceptualization and the meticulous documentation of the relevant literature make [this book] essential reading for those interested in the sociology and anthropology of religion and of medicine, and in the study of health and illness in contemporary America.--Contemporary Sociology A major contribution.--The Christian Century The remarkable strength of this book about the exotic in the commonplace is that it demonstrates both that ritual healing is widespread in the heartland of medical technology, and that the wide variety of ritual healing practices are based on similar structures.--Culture, Medicine, and Psychiatry Meredith B. McGuire is professor of sociology at Trinity University, San Antonio, Texas, and the author of Pentecostal Catholics and other books. Debra Kantor is acting director of education and training for the New Jersey Medical School National Tuberculosis Center.

Evaluation of Nitrate Reductase Assay (NRA) for rapid detection of druc resistant tuberculosis at National Tuberculosis Centre, Nepal

Background: Treatment of drug-resistant tuberculosis is often based on drug susceptibility testing results. Thus simple, rapid and economic test is very important for diagnosis of drug resistant tuberculosis and such method aids in TB control effectively. One such method is a Nitrate Reductase Assay (NRA). Objective: To evaluate feasibility and performance of Nitrate Reductase Assay in the screening of drug-resistant tuberculosis. Setting: National Tuberculosis Centre and SAARC TB and HIV/AIDS Centre, Thimi, Bhaktapur, Nepal from April 2008 to March 2009. Methods: A prospective study comparing the sensitivity and specificity of the Nitrate Reductase Assay with the gold standard Lowenstein Jensen proportion method in determining drug susceptibility pattern to four primary anti-tubercular drugs i.e. isoniazid, rifampicin, streptomycin and ethambutal among clinical isolates.Results: Among 121 specimens , the sensitivity and specificity of the Nitrate Reductase Assay for detection of Isoniazid resistance was 100% and 91%, for rifampicin was 100% and 98.95%, for streptomycin was 96% and 91.66% and for ethambutal was 100% and 98% respectively.Conclusions: The Nitrate Reductase Assay is sensitive and specific enough for the detection of drug resistant tuberculosis. It is rapid, easy to use and inexpensive, making it suitable for developing countries. Its usefulness for national drug resistance surveys should be assessed. Keywords: diagnosis; drug resistance; sensitivity; specificity; NRADOI: 10.3126/saarctb.v7i1.3960SAARC J. TUBER. LUNG DIS. HIV/AIDS 2010 VII(1) 26-30

Antibiotic Susceptibility Pattern of Mycobacterium tuberculosis

Background: The emergence and spread of DR and MDR-TB threat global TB control. The susceptibility patterns of M. tuberculosis isolates against anti-tuberculosis drugs informs an important aspect of TB controls and surveillance and analysis of local rates of TB drug resistance helps in the detection and monitoring of the extent of DR and MDR strains, indicating the quality of TB control in the country. Methods: A cross sectional study was conducted to find out antibiotic susceptibility pattern of Mycobacterium tuberculosis in pulmonary tuberculosis patients at national tuberculosis center. All the samples were stained by auramine fluorochrome method; processed by NaOH Ogawa Method; primary cultured; subcultured in 2% Ogawa media; cultured in drug LJ media and finally results observed and interpreted. Here Drug susceptibility test was done on M. tuberculosis isolate from each patient by Proportion method as standard protocol. Results: Ethambutol (66.10%) was found to be the most effective anti-TB drug according to the susceptibility test followed by RMP (60.33%), SM (59.66%) and INH (41.69%) against M. tuberculosis. Among 45 isolated untreated patients, primary drug resistance was observed in 20%, to two drugs in 17.77%, to three drugs in 11.11%, to four drugs in 6.66% and primary Multi-drug resistant in 22.22%. Among 250 isolated from previous treated patients, acquired resistance to one drug was found in 23.60%, to two drugs in 12.40%, to three drugs in 16.40%, to four drugs in 18.80% an acquired Multi-drug resistant in 37.20%. Among 250 treated 68.40% (n=171) were relapse,18% ( n=45) were chronic, 7.6% (n=19) were follow-up, 3.2% (n=8) were defaulter, and 2.8% (n=7) were treatment failure. MDR-TB was found the highest in chronic cases (64.44%) followed by follow-up case (47.36%), treatment failure cases (42.85%), relapse cases (27.48%) and default cases (12.5%). A statistical analysis reveals significant relationship between prior history of treatment and the development of drug resistance. However, no significant relationship between age and sex with the emergence of drug resistance isolates. Conclusion: MDR-TB was found the highest in chronic cases (64.44%) followed by follow-up case (47.36%), treatment failure cases (42.85%), relapse cases (27.48%) and Default cases (12.5%). Key words: multi drug, relapse, resistant, sensitivity, tuberculosis DOI: 10.3126/jnhrc.v7i1.2277 Journal of Nepal Health Research Council Vol. 7, No. 1, 2009 April 33-41

The Study of Drug Induced Hepatotoxicity in ATT Patients attending in National Tuberculosis Center in Bhaktapur

The drug-induced hepatotoxicity is a significantly increasing problem worldwide, but it is of more concern in the treatment of tuberculosis (TB) infection, especially in a third world country like Nepal, where tuberculosis is still endemic. Liver has a central role in drug metabolism and detoxification, and is consequently vulnerable to toxic effects of the drugs. The study was carried out from August 2006 to May 2007. The ATT patients, who visited the chest clinic, were sent to the laboratory for analysis of Liver enzymes (ALT, AST) and bilirubin level. During the period of August 2006 to May 2007 total of 114 patients; 114 blood samples were collected for liver enzymes analysis. It was found that among114 ATT patients; 41 patients (35.0%) had abnormal parameters with the elevation of serum bilirubin level, AST level and ALT level. It showed that drug induced hepatotoxicity due to anti TB drugs is relatively higher rate among lower socio-economic status group. Out of 114 cases, the marked elevation of total bilirubin level (>5.0mg/dl) was found in 15 (13.0%) and mild elevation of bilirubin level (1.1-5.0mg/dl) was found in 25 (22.0%) patients while 74 (65.0%) patients were found to have normal level of bilirubin. Similarly, 17 (15.0%) patients were found to have moderate elevation of ALT level (above 51.0IU/L), 5 (4.0%) patients were found to have slight elevation of ALT level (36-50IU/L) and 92(81.0%) patients had normal level. Likewise 10 (9.0%) patients were found to have moderate elevation of AST level (above 51.0IU/L); 8 (7.0%) had slight elevation of AST level (41-50 IU/L); and 96 (84.0%) were found to have normal level. The facts associated behind these findings are probably poverty, malnourishment, alcohol consumption, illiteracy of people and poor health management system. Hence, for the treatment of TB, with ATT regimens, a baseline laboratory testing and monitoring system should be adopted before starting treatment which might help to reduce drug induced hepatotoxicity in ATT patients. Keywords : ATT patient; Rifampicin; Ethambutol; Hepatotoxicity; AST; ALT; Enzymes. DOI: 10.3126/saarctb.v6i2.3053 SAARC J. Tuber. Lung Dis. HIV/AIDS 2009 VI (2) 17-21

Clinical profiling and use of loop-mediated isothermal amplification assay for rapid detection of <i>Mycobacterium tuberculosis</i> from sputum

Tuberculosis is a global health problem and the situation is worsening with newer incidences of drug resistance and HIV association. Diagnosis of tuberculosis can be done by many methods and test, culture of sputum being the ideal one. Nucleic acid amplification (NAA) assay are more time efficient one, that amplify and detect specific nucleic acid sequences allows rapid, sensitive and specific detection of M. tuberculosis in sputum samples. The present study intends to compile the clinical presentations of the pulmonary tuberculosis (PTB) patients and to evaluate the efficacy of in-house loop-mediated isothermal amplification (LAMP) in detecting Mycobacterium tuberculosis in sputum samples by comparing with microscopy and culture. Two hundred two sputum samples were collected from 202 patients at National Tuberculosis Center, Bhaktapur, Nepal. Complete clinical profiling, epidemiological data and record on BCG vaccination were noted and the samples were subjected for microscopy, culture and in-house LAMP with six primers specific for 16S RNA gene of Mycobacterium tuberculosis. Of the 176 cases of clinical profiling, productive cough was most common symptom in 147 (83.52%), followed by chest pain 136 (77.27%), fever 133 (75.56%) and haemoptysis 61 (34.66%). There was a statistically significant association between BCG vaccination and development of TB (chi(2)=5.33, P=0.02). Of 202 cases, 115 (56.93%) were chest X-ray positive, 101(50%) were direct smear-positive and 100 (49.51%) were culture positive. LAMP had a sensitivity of 97% and specificity of 94.12% while comparing with culture. In addition, its sensitivity and specificity were 91.09% and 89.11% respectively with reference to microscopy. As in our previous study, overall, the result of present study further confirms that the in-house LAMP is a simple, rapid, sensitive and specific DNA amplification technique for PTB diagnosis. Because of rapidity of microscopy and specificity of culture, in-house LAMP assay can be used as a very powerful and useful supplementary tool with complete clinical profiling of the patients for rapid diagnosis of TB in both AFB-positive and negative cases who are suspected as PTB in disease endemic country like Nepal.

Tuberculosis Treatment and Private Practitioners, Kathmandu Valley

SETTING: An urban municipality of 150,000 citizensin Kathmandu valley where approximately650 TB patients annually start treatment in thepublic sector.OBJECTIVE: To determine the caseload of TBpatients, treatment practices used in the privatesector and professional characteristics of privatepractitioners involved in TB care.DESIGN: A self-administered questionnaire wasdistributed to private practitioners in the area.RESULTS: Forty-three (73%) of 59 private practitionersreturned the questionnaire, and form thebase for the analysis. Twenty-eight (65%) wereworking also in government clinics. Thirty-nine(93%) were treating tuberculosis patients. duringthe previous month, 68 suspected cases of pulmonarytuberculosis and 78 suspected extrapulmonarycases had been seen. A total of 97 patients werestarted on anti-TB treatment, 24 (25%) of thosemanaged by surgical specialists. Twenty (51%) ofthe doctors prescribed internationally or nationallyrecommended regimens (i.e. 2 EHRZ/4HR or2 EHRZ/6HE) to new pulmonary TB patients.Thirty-three (85%) reported referral of certain categoriesof TB patients to governmental or non-governmentalfacilities. Twenty-six (79%) referredtheir patients primarily to the National TuberculosisCentre. The main reason for referral mentionedby doctors (61%) was the patient’s inability to affordtreatment in the prevate sector.CONCLUSION: There quarters of the privatepractitioners used sputum smears for diagnosis, butonly about half prescribed appropriate treatmentregimens. Extrapulmonary TB cases form a substantialpart of the case-load and approximatelyone fourth of all TB patients are being treated bysurgical specialists. The cost of TB treatment inthe private sector is too high for many patients.Informal links are already evident between thepublic and private sector but collaborative effortsneed to be increased.

The Value of Chemotherapy for Active Pulmonary Tuberculosis in Out-patient Clinic

1.The results of chemotherapy at the end of one and two years on 1,014 and 276 patients among 5,793 proved active tuberculosis patients in 7,020 who visited two of Korea's tuberculosis Clinics of National Tuberculosis Center and Severance Chest Clinic during the period between January 1, 1955 and August 31, 1957 are reported. 2.Forty-eight and 39 per cent of total investigated were moderately or far advanced cases respectively. 3.Sputum negative conversion rate was 37 and 38 per cent at 12 and 24 months chemotherapy respectively. 4.Roentgenographic improvement was seen in 75 and 80 per cent at 12 and 24 months respectively. 5.It is believed that adequate bed rest is important in pulmonary tuberculosis patients given chemotherapy on ambulatory basis. 6.In general, more favorable therapeutic effects were observed in the less advanced, more recent, previously untreated cases. 7.There was not much difference between the results obtained at 12 and 24 months chemotherapy. Therefore, at the end 12 months of chemotherapy, a complete evaluation will be necessary. 8.Ambulatory chemotherapy on pulmonary tuberculosis is a proper therapeutic measure, especially in the region where sufficient hospital facilities are not available for all the active pulmonary tuberculosis patients.