Pulmonary Tuberculosis Treatment Outcomes Research Articles

4298 Prediction models for pulmonary tuberculosis treatment outcomes: a systematic review

OBJECTIVES/GOALS: Many clinical prediction models have been developed to guide tuberculosis (TB) treatment, but their results and methods have not been formally evaluated. We aimed to identify and synthesize existing models for predicting TB treatment outcomes, including bias and applicability assessment. METHODS/STUDY POPULATION: Our review will adhere to methods that developed specifically for systematic reviews of prediction model studies. We will search PubMed, Embase, Web of Science, and Google Scholar (first 200 citations) to identify studies that internally and/or externally validate a model for TB treatment outcomes (defined as one or multiple of cure, treatment completion, death, treatment failure, relapse, default, and lost to follow-up). Study screening, data extraction, and bias assessment will be conducted independently by two reviewers with a third party to resolve discrepancies. Study quality will be assessed using the Prediction model Risk Of Bias Assessment Tool (PROBAST). RESULTS/ANTICIPATED RESULTS: Our search strategy yielded 6,242 articles in PubMed, 10,585 in Embase, 10,511 in Web of Science, and 200 from Google Scholar, totaling 27,538 articles. After de-duplication, 14,029 articles remain. After screening titles, abstracts, and full-text, we will extract data from relevant studies, including publication details, study characteristics, methods, and results. Data will be summarized with narrative review and in detailed tables with descriptive statistics. We anticipate finding disparate outcome definitions, contrasting predictors across models, and high risk of bias in methods. Meta-analysis of performance measures for model validation studies will be performed if possible. DISCUSSION/SIGNIFICANCE OF IMPACT: TB outcome prediction models are important but existing ones have not been rigorously evaluated. This systematic review will synthesize TB outcome prediction models and serve as guidance to future studies that aim to use or develop TB outcome prediction models.

Early discontinuation of ethambutol in pulmonary tuberculosis treatment based on results of the GenoType MTBDRplus assay: A prospective, multicenter, non-inferiority randomized trial in South Korea.

No studies have investigated whether discontinuation of ethambutol (EMB) based on the susceptibility to isoniazid and rifampin as determined by the GenoType MTBDRplus assay would be appropriate. We aimed to determine the feasibility of discontinuing EMB before the end of intensive phase treatment based on the result of MTBDRplus assay in patients with pulmonary tuberculosis (PTB). This prospective, multicenter non-inferiority randomized trial was conducted at 12 referral centers in South Korea in drug-susceptible PTB patients who initiated the standard four-drug regimen for PTB. Based on the results of the assay, EMB was discontinued in the MTBDRplus group after the confirmation that M. tuberculosis isolate was susceptible to isoniazid and rifampin. The timepoint for EMB discontinuation in the Guideline group was determined using the results of the phenotypic drug susceptibility test based on the Korean National TB Guidelines. The primary outcome was treatment success. Secondary outcomes included the 1-year rates of recurrence and adverse events. Of 600 randomized patients, the treatment outcome analysis was performed for 493 patients (MTBDRplus group, 244; Guideline group, 249). Treatment success rates were 93.9% (229/224) in the MTBDRplus group and 93.6% (233/249) in the Guideline group and did not differ between groups; relative risk 1.00 (95% CI 0.95-1.06). The 1-year recurrence rate between the two groups (0.9% vs. 0.5%, respectively) and differences in adverse drug reactions did not differ between groups. In conclusion, early discontinuation of EMB based on the results of the MTBDRplus assay did not affect the treatment outcomes in PTB.

Pulmonary tuberculous cavities in diabetic patients: Glycemic control is still the dominant factor despite the emerging role of metformin.

Previous studies have reported an increased risk of cavities in diabetic patients with pulmonary tuberculosis (PTB), which may be associated with poor glycemic control. Cavities have a negative impact on PTB treatment outcomes; however, the possible interaction of other potentially confounding diabetes-related variables regarding pulmonary cavities have not been fully evaluated. We conducted a retrospective cohort study of diabetic patients with culture-proven PTB. The patients' chest X-rays (CXRs) and computed tomography (CT) scans were reviewed to assess the effects of clinical factors, glycosylated hemoglobin (HbA1c) levels, and antidiabetic agents on cavitary lesions. Among 128 diabetic PTB patients, those with pulmonary cavities on CXRs and CT scans presented younger ages, lack of metformin treatment, and significantly higher HbA1c levels than those without cavities. Multivariate logistic regression analysis revealed significantly higher HbA1c levels in patients with cavities than in those without cavities on CXRs (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.12-1.61) and CT scans (OR, 1.36; 95% CI, 1.13-1.64). Patients with multiple cavities had significantly higher HbA1c levels than those with a single cavity on CT scans (p = 0.002). No significant differences in other variables, including metformin treatment, were noted between the groups. This study suggests that despite multiple potential confounding variables, including metformin use, poor glycemic control is still the dominant risk factor for cavitary lesions in diabetic patients with PTB. Efforts to improve glycemic control in diabetic PTB patients may be of considerable value in facilitating antimycobacterial treatment.

Respiratory health status is associated with treatment outcomes in pulmonary tuberculosis.

<sec id="st1"> <title>BACKGROUND</title> The association between respiratory impairment and tuberculosis (TB) treatment outcomes is not clear. </sec> <sec id="st2"> <title>METHODS</title> We prospectively evaluated respiratory health status, measured using the Saint George's Respiratory Questionnaire (SGRQ), in a cohort of new adult pulmonary TB cases during and up to 18 months following treatment in India. Associations between total SGRQ scores and poor treatment outcomes of failure, recurrence and all-cause death were measured using multivariable Poisson regression. </sec> <sec id="st3"> <title>RESULTS</title> We enrolled 455 participants contributing 619 person-years at risk; 39 failed treatment, 23 had recurrence and 16 died. The median age was 38 years (interquartile range 26-49); 147 (32%) ever smoked. SGRQ scores at treatment initiation were predictive of death during treatment (14% higher risk per 4-point increase in baseline SGRQ scores, 95%CI 2-28, P = 0.01). Improvement in SGRQ scores during treatment was associated with a lower risk of failure (1% lower risk for every per cent improvement during treatment, 95%CI 1-2, P = 0.05). Clinically relevant worsening in SGRQ scores following successful treatment was associated with a higher risk of recurrence (15% higher risk per 4-point increase scores, 95%CI 4-27, P = 0.004). </sec> <sec id="st4"> <title>CONCLUSION</title> Impaired respiratory health status was associated with poor TB treatment outcomes. The SGRQ may be used to monitor treatment response and predict the risk of death in pulmonary TB. </sec>.

Using simultaneous amplification and testing method for evaluating the treatment outcome of pulmonary tuberculosis

BackgroundTo evaluate the utility of Simultaneous Amplification and Testing (SAT-TB) Method for monitoring anti-TB treatment response.MethodsSerial morning sputum specimens were obtained from 377 active pulmonary tuberculosis (PTB) cases at baseline, weeks 2, months 2, 5 and 6 (newly diagnosed patients) or 8 (previously treated patients) for AmpSure assay, smear fluorescence microscopy (FM) and BACTEC MGIT 960 culture assay.ResultsAfter treatment of 2 weeks, sputum culture was positive in 280 patients (74.27%). Among whom, 219 patients tested positive for SAT-TB assay and 143 patients smear FM positive. The detection rate of SAT-TB (78.21%) was significantly higher than sputum FM (51.07%, χ2 = 45.128, P < 0.001). At the end of the second month of treatment, 157 patients (41.64%) were still culture-positive, 115 patients of them SAT-TB positive and 79 smear FM positive. The difference of detection rate between SAT-TB (73.25%) and sputum FM (50.32%) was significant (χ2 = 17.480, P < 0.001). When patients underwent five months of treatment, 65 patients (17.24%) with sputum culture positive was defined as treatment failure. Among whom, 60 patients (92.31%) were SAT-TB positive and 38 patients (58.46%) were smear FM positive. The detection rate of SAT-TB assay was significantly higher than sputum FM (χ2 = 17.333, P < 0.001).ConclusionResults of AmpSure assays for monitoring treatment responses can be obtained without waiting for the results of BACTEC MGIT 960 assays and most patients with treatment failures could be detected after 5 months.

Impact of smoking on sputum culture conversion and pulmonary tuberculosis treatment outcomes in Brazil: a retrospective cohort study.

ABSTRACTObjective:To evaluate the impact of smoking on pulmonary tuberculosis (PTB) treatment outcomes and the two-month conversion rates for Mycobacterium tuberculosis sputum cultures among patients with culture-confirmed PTB in an area with a moderate incidence of tuberculosis in Brazil. Methods:This was a retrospective cohort study of PTB patients diagnosed and treated at the Thoracic Diseases Institute of the Federal University of Rio de Janeiro between 2004 and 2012. Results:Of the 298 patients diagnosed with PTB during the study period, 174 were included in the outcome analysis: 97 (55.7%) were never-smokers, 31 (17.8%) were former smokers, and 46 (26.5%) were current smokers. Smoking was associated with a delay in sputum culture conversion at the end of the second month of TB treatment (relative risk = 3.58 &091;95% CI: 1.3-9.86&093;; p = 0.01), as well as with poor treatment outcomes (relative risk = 6.29 &091;95% CI: 1.57-25.21&093;; p = 0.009). The association between smoking and a positive culture in the second month of treatment was statistically significant among the current smokers (p = 0.027). Conclusions:In our sample, the probability of a delay in sputum culture conversion was higher in current smokers than in never-smokers, as was the probability of a poor treatment outcome.

A study of treatment outcomes of pulmonary tuberculosis and extrapulmonary tuberculosis patients in a tertiary care centre

Background: Directly observed treatment remains one of the most widely-accepted global health interventions for tuberculosis. Tuberculosis treatment outcome is one of the performance indicators of the programme set by World Health Organization.Methods: This study was conducted in a tertiary care centre Chennai. A retrospective analysis of the profile and treatment outcome of all tuberculosis patients registered from January 2015 to December 2015 at DOTS centre under RNTCP was conducted. Data on treatment outcomes was analysed using appropriate statistical methods and percentages were calculated.Results: Out of 118 TB cases, 59.3% had pulmonary while 40.7% had extra-pulmonary TB. Sputum positive PTB is more common than sputum negative which is 74.2% and 25.8% respectively. Frequency of TB lymphadenitis is being the common presentation among extra pulmonary TB cases, followed by TB pleurisy. Success rate (cure rate plus treatment completion rate) for new cases was 63.1% and for retreatment cases was 36.9% while the overall success rate was 81%.Conclusions: Effective measures have to be taken in the programme to move forward to help in the eradication of TB. Tuberculosis mostly affects males of the economically productive age group and causes economic losses. The success rate of new cases was higher compared to retreatment cases though the overall success rate was lower compared to the RNTCP norms. Proper education on DOTS can help in improving the success rate and cure rate.

Effect of Intermittency on Treatment Outcomes in Pulmonary Tuberculosis: An Updated Systematic Review and Metaanalysis.

Intermittent regimens offer operational advantages in tuberculosis treatment, but their efficacy has been questioned. We updated a systematic review and metaanalysis to examine the efficacy of different intermittent dosing schedules in first-line pulmonary tuberculosis therapy. An updated search included randomized control trials (RCTs) that reported on first-line pulmonary tuberculosis therapy between June 2008 and March 2016. We pooled proportions of failure, relapse, and acquired drug resistance (ADR) for 4 dosing schedules: daily throughout, thrice weekly throughout, daily (intensive phase) then thrice weekly (continuation phase), and daily (intensive phase) then twice weekly (continuation phase). Metaregression was performed using a negative binomial regression model. After screening 5874 citations, 7 RCTs with 10 arms were added for a total of 56 RCTs with 110 arms. The pooled proportion of relapse was significantly higher in arms with thrice weekly therapy throughout (6.8; 95% confidence interval [CI], 3.8-9.9) and twice weekly therapy in the continuation phase (7.3; 95% CI, 3.5-11.1) when compared with daily therapy (2.5; 95% CI, 1.8-3.2; P < .01). Metaregression revealed higher rates of relapse (2.2; 95% CI, 1.2-4.0), failure (3.7; 95% CI, 1.1-12.6), and ADR (10.0; 95% CI, 2.1-46.7) in arms with thrice weekly throughout and higher rates of failure (3.0; 95% CI, 1.0-8.8) with twice weekly in the continuation phase when compared with daily therapy. Thrice weekly dosing throughout therapy, and twice weekly dosing in the continuation phase appear to have worse microbiological treatment outcomes when compared with daily therapy.

Evaluation of serum inflammatory biomarkers as predictors of treatment outcome in pulmonary tuberculosis.

To evaluate C-reactive protein (CRP), globulin and white blood cell (WBC) count as predictors of treatment outcome in pulmonary tuberculosis (PTB). An observational study of patients with active PTB was conducted at a tertiary centre. All patients had serum CRP, globulin and WBC measured at baseline and at 2 months following commencement of treatment. The outcome of interest was requirement for extension of treatment beyond 6 months. There were 226 patients included in the study. Serum globulin 45 g/l was the only baseline biomarker evaluated that independently predicted requirement for treatment extension (OR 3.42, 95%CI 1.597.32, P 0.001). An elevated globulin level that failed to normalise at 2 months was also associated with increased requirement for treatment extension (63.9% vs. 5.1%, P 0.001), and had a low negative likelihood ratio (0.07) for exclusion of requirement for treatment extension. On multivariable analysis, an elevated globulin that failed to normalise at 2 months was independently associated with requirement for treatment extension (OR 6.13, 95%CI 2.2316.80, P 0.001). Serum globulin independently predicts requirement for treatment extension in PTB and outperforms CRP and WBC as a predictive biomarker. Normalisation of globulin at 2 months following treatment commencement is associated with low risk of requirement for treatment extension.

Smoking cessation interventions for pulmonary tuberculosis treatment outcomes.

Active smoking increases the risk of tuberculosis (TB) infection 2 to 2.5 times and is significantly associated with recurrent TB and TB mortality. Observational studies have shown associations between smoking and poor TB treatment outcomes such as increased loss to follow-up rate, severity of disease, drug resistance and slow smear conversion. Since most smoking-related immunologic abnormalities are reversible within six weeks of stopping smoking, smoking cessation may have substantial positive effects on TB treatment outcomes, TB relapse and future lung disease. To analyse the effect of tobacco smoking cessation interventions (SCIs) on the treatment outcomes of people with adult pulmonary TB. We searched the Cochrane Tobacco Addiction Group Specialised Register using free-text and MeSH terms for TB and antitubercular treatment. We also searched MEDLINE and EMBASE using the same topic-related terms, combined with the search terms used to identify trials of tobacco cessation interventions from the Specialised Register. We also searched reference list of articles and reviews, the Conference Paper Index, clinicaltrials.gov and grey literature. The searches are current to 29th July 2015. Individual and cluster-randomised controlled trials (RCTs), regardless of date, language and publication status, studies of adults with pulmonary TB on first-line anti-tubercular drugs, with interventions at either an individual or a population level, delivered separately or as part of a larger tobacco control package. This included any type of behavioural or pharmaceutical intervention or both for smoking cessation. Using the eligibility criteria, two authors independently checked the abstracts of retrieved studies for relevance, and acquired full trial reports of candidates for inclusion. The authors resolved any disagreements on eligibility by mutual consent, or by recourse to a third author. Two authors intended to independently extract study data from eligible studies into a data extraction form and compare the findings, synthesise data using risk ratios, and assess risk of bias using standard Cochrane methodologies. However, we found no eligible trials. There were no randomised controlled trials that met the eligibility criteria. A number of potentially eligible studies are underway, and we will assess them for inclusion in the next update of this review. There is a lack of high-quality evidence, i.e. RCTs, that tests the effectiveness of cessation interventions in improving TB treatment outcomes. There is a need for good-quality randomised controlled trials that assess the effect of SCIs on TB treatment outcomes in both the short and long term. Establishing such an evidence base would be an essential step towards the implementation of SCIs in TB control programmes worldwide.

Evaluation of a radiological severity score to predict treatment outcome in adults with pulmonary tuberculosis.

To refine and evaluate a recently published radiological disease severity score for the prediction of month 2 and end of treatment outcomes in pulmonary tuberculosis (TB). Radiological extent of disease has been linked to early and late outcomes of anti-tuberculosis treatment, but no validated tools are available to quantify this parameter. We enrolled 449 adult, human immunodeficiency virus negative participants with smear- or culture-proven TB from three TB biomarker studies in Cape Town, South Africa. Full-size posteroanterior baseline chest X-rays (CXRs) were evaluated by two clinicians after standardising the published scoring method and the predictive ability assessed for month 2 and final treatment outcomes. Baseline CXR scores were significantly different in the favourable and unfavourable outcome groups; however, the predictive ability for outcomes at all time points was poor (ROC area under curve ⩿0.68). Inter-reader reliability was high (r = 0.86, P < 0.001), but agreement in cavity identification was modest. Standardised application of a CXR score derived from the presence of cavities and overall extent of parenchymal disease in active TB showed good inter- and intrareader reliability. Scores differed significantly in treatment outcome groups, but did not allow accurate outcome prediction.

Factors affecting successful treatment outcomes in pulmonary tuberculosis: a single-center experience in Turkey, 2005-2011.

We aimed to describe the treatment outcomes in patients with bacteriologically confirmed pulmonary tuberculosis (PTB) and identify factors associated with successful treatment outcome. The medical charts of patients with smear and/or culture-positive PTB who were treated between 2005 and 2011 at the Kocaeli Tuberculosis Dispensary, Turkey, were reviewed. Patients were categorized as having a successful (cured or with a completed treatment) or poor (treatment default, treatment failure, death) treatment outcome. The association of demographic and clinical factors, including gender, age, education, occupation, insurance, family size, living area, smear and culture positivity, retreatment, comorbidity, drug resistance, and cavity on radiography, with the success of treatment, was evaluated by univariate and multivariate analyses. Of 738 patients (258 females, 480 males) with bacteriologically confirmed PTB, 683 (92.6%) had successful treatment outcomes. Of those with a poor outcome, 29 (3.9%) had treatment default, 18 (2.4%) died, and 8 (1.1%) had treatment failure. Young age, no previous treatment, no comorbidity, no drug resistance, and high education level were factors significantly associated with successful PTB treatment outcome (p < 0.05 for all). Treatment outcome was successful in young and educated PTB patients who had drug resistance, previous treatment history, and no comorbidities. Knowledge of the factors affecting treatment success will lead to the undertaking of specific measures in the management of PTB, which may help to decrease treatment failure.

Advanced stage of chronic kidney disease is risk of poor treatment outcome for smear-positive pulmonary tuberculosis.

Chronic kidney disease (CKD) is an increased risk for the development of active tuberculosis, but few studies have analyzed the treatment outcome of pulmonary tuberculosis among CKD patients. A retrospective cohort study was conducted at Chiba-East Hospital in Chiba, Japan. Our study estimated the treatment outcomes in smear-positive pulmonary tuberculosis in relation to CKD and its stages. Total subjects were 759 patients (12-99 years) hospitalized between 2007 and 2012. Patients suffering from multi-drug-resistant tuberculosis were excluded. Patients with CKD were 19.3% aged <65 years (n=384), and 49.6% aged≥65 years, respectively (P<0.001). Successful treatment was 52.7% in CKD (n=260) and 67.3% in non-CKD (n=499) (P<0.001). Death was 25.4% in CKD and 12.4% in non-CKD (P<0.001). Treatment outcome was especially poor in patients with low estimated glomerular filtration rate (eGFR) of <30ml/min/1.73m(2), as successful treatment was 20.0%, and death was 50.0%, significantly lower than in other CKD and non-CKD patients. After multivariate logistic regression analysis, eGFR<30ml/min/1.73m(2) was an independent factor affecting successful treatment and death, and its adjusted odds ratios (aOR) were 0.20 (95% confidence interval (CI) 0.07-0.50) and 2.99 (95%CI 1.20-7.51), respectively. Other factors affecting successful treatment were serum albumin <3.0mg/dl, steroid therapy for underlying disease and cardiovascular disease, with aOR (95%CI) of 0.28 (0.20-0.39), 0.32 (0.16-0.63) and 0.49 (0.28-0.86), respectively. Several factors were associated with poor treatment outcome of smear-positive pulmonary tuberculosis. Advanced stage of CKD with eGFR of <30ml/min/1.73m(2) was a risk factor for poor treatment outcome.

PULMONARY TUBERCULOSIS TREATMENT OUTCOME AMONG FOREIGN NATIONALS RESIDING IN OSAKA CITY

Abstract In this study, we analyzed pulmonary tuberculosis treatment outcomes among foreign nationals of different backgrounds. The research was conducted between January 2006 and December 2011. One hundred fifty nine foreign nationals residing in Osaka city had pulmonary tuberculosis during this period. Patients were grouped according to treatment outcomes. We conducted three different types of comparisons. First, we compared backgrounds of patients with treatment success or default. Second, backgrounds of patients who continued treatment in Japan or who moved overseas (transfer out) were compared. Third, treatment outcomes of foreign nationals between 20 and 39 years of age were compared with those of age-matched Japanese patients registered between 2010 and 2011. (1) The treatment outcomes were as follows: cured, 53 cases (33.3%); treatment completed, 55 cases (34.6 %); treatment failure, 0 cases (0.0%); treatment default, 14 cases (8.8%); moved overseas, 17 cases (10.7%); moved to another location inside Japan, 13 cases (8.2%); died, 6 cases (3.8%); and under treatment, 1 case (0.6%). (2) Comparison of treatment success and default among foreign nationals with pulmonary tuberculosis revealed a default rate among smear-negative cases of 14.5%, significantly higher than in smear-positive cases (2.1%; P < 0.05). (3) We compared backgrounds between foreign nationals with pulmonary tuberculosis who continued taking treatment in Japan and those who moved abroad (transfer out). The rate of overseas transfer out (44.4%) was higher among patients not covered by health insurance. This was significantly higher than among patients covered by public insurance or assistance (9.0%; P < 0.01). (4) Comparison of foreign and Japanese nationals between 20 and 39 years of age revealed a default rate in foreign nationals with pulmonary tuberculosis of 13.6%. This was significantly higher than that of Japanese patients (4.0%; P < 0.01). The rate of transfer out among foreign nationals with pulmonary tuberculosis was 19.1%, also significantly higher than that of Japanese patients (5.3%; P < 0.001). The rates of treatment default and transfer out among patients between 20 to 39 years of age were significantly higher among foreign nationals than in Japanese patients. Lack of knowledge about treatment and language problems may contribute to this finding. This suggests that adequate support and definitive directly observed treatment short-course programs are needed for foreign nationals. Patients who moved abroad (overseas transfer out) may also be ultimately categorized as treatment default. However, it is difficult to determine final treatment outcomes of patients who moved abroad. Further measures are needed to ensure that foreign nationals continue to receive treatment when they transfer overseas.

Predictors of pulmonary tuberculosis treatment outcomes in South Korea: a prospective cohort study, 2005-2012.

BackgroundTuberculosis remains an important health concern in many countries. The aim of this study was to identify predictors of unfavorable outcomes at the end of treatment (EOT) and at the end of study (EOS; 40 months after EOT) in South Korea.MethodsNew or previously treated tuberculosis patients were recruited into a prospective observational cohort study at two hospitals in South Korea. To identify predictors of unfavorable outcomes at EOT and EOS, logistic regression analysis was performed.ResultsThe proportion of multidrug-resistant tuberculosis (MDR-TB) was 8.2% in new cases and 57.9% in previously treated cases. Of new cases, 68.6% were cured, as were 40.7% of previously treated cases. At EOT, diabetes, ≥3 previous TB episodes, ≥1 significant regimen change, and MDR-TB were significantly associated with treatment failure or death. At EOS, age ≥35, body-mass index (BMI) <18.5, diabetes, and MDR-TB were significantly associated with treatment failure, death, or relapse. Among cases that were cured at EOT, age ≥50 and a BMI <18.5 were associated with subsequent death or relapse during follow-up to EOS. Treatment interruption was associated with service sector employees or laborers, bilateral lesions on chest X-ray, and previous treatment failure or treatment interruption history.ConclusionsRisk factors for poor treatment outcomes at EOT and EOS include both patient factors (diabetes status, age, BMI) and disease factors (history of multiple previous treatment episodes, MDR-TB). In this longitudinal, observational cohort study, diabetes mellitus and MDR-TB were risk factors for poor treatment outcomes and relapse. Measures to help ensure that the first tuberculosis treatment episode is also the last one may improve treatment outcomes.Trial registrationClinicalTrials.gov ID: NCT00341601

Impact of diabetes on clinical presentation and treatment outcome of pulmonary tuberculosis in Beijing

Diabetes mellitus (DM) is currently known to be one of the risk factors for pulmonary tuberculosis (PTB) and the proportion of DM in PTB is rising along with the increased prevalence of DM in countries with high PTB burden. This study was designed to explore the impact of DM on clinical presentation and treatment outcome of PTB in China. In an urban setting in Beijing, 1126 PTB patients, 30·6% with positive sputum smear, registered in two PTB dispensaries from January 2010 to December 2011 were screened for DM and were followed up prospectively during PTB treatment. DM was observed in 16·2% of patients with PTB. PTB with DM appeared to be associated with older age and a higher proportion of re-treatment. On presentation, DM was associated with more severe PTB signs with higher proportions of smear positivity [odds ratio (OR) 2·533, 95% confidence interval (CI) 1·779-3·606], cavity (OR 2·253, 95% CI 1·549-3·276) and more symptoms (OR 1·779, 95% CI 1·176-2·690). DM was also associated with non-TB deaths (OR 5·580, 95% CI 2·182-14·270, P < 0·001) and treatment failure (OR 6·696, 95% CI 2·019-22·200, P = 0·002). In Beijing, the findings of this study underlined the need to perform early bi-directional screening programmes and explore the underlying mechanism for different treatment outcomes for PTB with DM.

Treatment outcome of pulmonary tuberculosis in a teaching referral clinic, in Iran

Background: Tuberculosis is an endemic infection in Iran. Despite improved living standards and availability of free drugs, tuberculosis remains a major health problem here. In this study, we have assessed the treatment outcome of tuberculosis patients. Materials and Methods: In this descriptive study, all new cases of pulmonary tuberculosis with a smear or culture that is positive, admitted in Nikopoor Referral Clinic, in Yazd, Iran, were studied. Results: Of the 280 patients, 148 (52.9%) were males and 132 (47.1%) were females. Among these patients 202 (72.2%) had pulmonary smear-positive tuberculosis and 78 (27.8%) patients had smear-negative pulmonary tuberculosis. The treatment outcome was, 247 (90.8%) had successful treatments, there were three (1.1%) treatment failures, 10 (3.7%) treatment defaulters, nine (3.3%) died, and three (1.1%) transferred to a different area. Conclusion: In our study, the cure rate among the new smear-positive patients was more than the rate recommended by the World Health Organization (WHO).

Treatment outcomes of pulmonary tuberculosis in the past decade in the mainland of China: a meta-analysis

Due to the implementation of directly observed treatment strategy (DOTS), China has made a significant achievement in tackling the tuberculosis (TB) epidemic in the 1990s. However, only half of regions in China met or exceeded the 85% rate of treatment success target. The aim of the present study is to summarize the treatment outcomes of smear-positive pulmonary TB in the mainland of China in the past decade using metaanalysis based on systematic review of published observational studies. A total of 50 eligible articles (58 studies) were identified and included in this study. The summarized treatment success rates were 93.9% (95% CI, 92.8%-94.7%) for new cases and 85.4% (95% CI, 83.0%-87.6%) for previously treated cases, and the summarized cured rate were 92.2% (95% CI, 90.9%-93.3%) and 81.2% (95% CI, 79.1%-83.1%), respectively. A remarkable increase of rates for treatment success and cure was observed in the 1990s. After 2000, the summarized treatment outcomes were tending towards stability. In addition, geographic areas, type of the data and administrative level of the hospital were also found to influence the estimates of the treatment outcomes. Results of the present study clearly show, in general, that the pulmonary TB treatment achieved significant success in the past decade in the mainland of China. However, it needs to be further strengthened in the central and west areas.

Assessment of the efficacy of Directly Observed Treatment with short course (DOTS) for pulmonary tuberculosis in Sharkia governorate

BackgroundDOTS remains one of the most widely-implemented and longest-running global health interventions in tuberculosis control. Aim of the workTo evaluate DOTS strategy based on WHO guidelines on pulmonary tuberculosis in both Chest and Zagazig University Hospitals. Patients and methodsThis study was carried out at both Chest Department, Zagazig University Hospitals and Zagazig Chest Hospital, in the period from October 2008 to October 2009. One hundred and twenty patients with smear positive tuberculosis were included in this study. Group I: This group included 60 patients; 48 (80%) of them were males and 12 (20%) were females. Their ages ranged from 16 to 75years old, with a mean age of 46.0±11.1. Those patients were receiving antituberculous drugs according to DOTS guidelines suggested by the national tuberculosis control program (NTP) in Egypt (2008) at the health facility nearest to their home. Group 2: Included 60 patients, they were 52 (86.7%) males and 8 (13.3%) females, their ages ranged from 20 to 70years old with a mean age of 48±12.3. Those patients were receiving self administration therapy (SAT) by the same regimens as in Group I. All patients were subjected to; Medical history taking, Clinical examination, Routine laboratory investigation, Radiological examination, Sputum analysis by Ziehl Neelsen stain for acid fast bacilli at the time of diagnosis, at the end of initial phase, at the end of the 5th month and at the end of the course. ResultsThere were 38 patients (63.3%) cured in group I versus 20 (33.3%) in group II, with a highly significant difference between the two groups, as P<0.005. There were 42 patients (70%) regular in receiving the treatment in group I versus 24 (40%) in group II with a significant difference between the two groups as P<0.05. There were 6 patients (10%) defaulters in group I versus 20 (33.3%) in group II, with a significant difference between the two groups, as P<0.05. There were 22 patients (36.7%) failed in the treatment in group I versus 40 (66.7%) in group II, with a highly significant difference between the two groups, as P<0.005. Conclusions1 – DOTS yields more cure rate in the treatment outcome of pulmonary tuberculosis and decreases the rate of failure and defaulting. 2 – Defaulting and non-adherence of the patients could be considered as important factors for increased incidence of failure in the treatment outcome of TB either under DOTS or SAT.

Evolutionary Trends for Pulmonary Tuberculosis Treatment Using DOTS in Sierra Leone: 1992-2010 Database Study

Background: Sierra Leone started the Direct Observation Treatment Strategy (DOTS) for the treatment of pulmonary tuberculosis in 1992. The country’s pulmonary tuberculosis (PTB) treatment program is now standardized according to international scale. Under the national standardized PTB treatment system, the regimen for new PTB patients consists of a 2-month intensive treatment phase with isoniazid, rifampicin, pyrazinamide and ethambutol, followed by a 4-month continuation phase with rifampicin and isoniazid. Aims: To determine and analyse the annual PTB treatment success and incidence rates, treatment defaulters’ rate, and pulmonary tuberculosis mortality from 1992 to 2002 under the DOTS program at the Germany Leprosy Relief Association’s (GLRA) 13 regional diagnostic centers and chest clinics in Sierra Leone and to compare this data with the annual national tuberculosis data stored in WHO tuberculosis database covering the period 1992-2010. Study Design: The study retrospectively analysed pulmonary tuberculosis annual incidence rates for study subjects who registered for diagnosis and later for treatment at the GLRA 13 regional diagnostic centers and chest clinics from 1992 to 2002. From Research Article British Journal of Medicine & Medical Research, 3(4): 2076-2084, 2013 2077 these data we were able to determine the treatment success and defaulters’ rates, and PTB mortality for these subjects. We also analysed data of the annual national tuberculosis incidence and success rates, and mortality rates retrieved from World Health Organisation (WHO) TB data for Sierra Leone for the period 1992-2010. Twenty six (26) healthcare service providers were also interviewed for additional information about the main cause of mortality and reasons for treatment defaults among pulmonary tuberculosis patients during the period under investigation. Study Subjects: A total of 2,958 (1,881 men and 1,077 females) mostly adults of age range 15-65 years were diagnosed and later treated for pulmonary tuberculosis from 1992 to 2002 at the various GLRA diagnostic and treatment centers in the country. Setting: The study was a multicenter study conducted at the Germany Leprosy Relief Association’s (GLRA) main referral diagnostic center and chest clinic at Lakka in Freetown and the Department of Environmental Health Sciences, Njala University in Bo, Sierra Leone. Pulmonary tuberculosis treatment outcomes data used in this study were obtained from TB patients who were admitted at various GLRA chest clinics in Sierra Leone from 1991-2002. Data analysis and literature reviews were done at the Department of Environmental Health Sciences, Njala University in Bo, Sierra Leone from 2011 to 2012. Results: The most important finding of this investigation was that the annual pulmonary tuberculosis incidence and treatment success rates (% cured rate and % completed treatment rate) rose significantly during the period under review for both the GLRA’s study subjects and the cases stored in the WHO tuberculosis database. Conclusion: The significantly high and growing number of annual PTB incidence rates during this HIV/AIDS epidemic reinforces the need for routine PTB treatment monitoring and supervision as well as compulsory HIV testing for tuberculosis patients seeking treatment.