Retreatment Of Patients Research Articles

Treatment outcome of the retreatment tuberculosis patients under RNTCP in eastern Uttar Pradesh

Background: India has the highest tuberculosis (TB) burden in the world. The directly observed treatment strategy is the most systemic and cost-effective approach to the disease. Furthermore, understanding the reasons for treatment outcome is important for the improvement of treatment systems. The objective was to study the treatment outcome of retreatment tuberculosis patients under RNTCP in eastern UP.Methods: A longitudinal cohort study was undertaken among total 205 patients registered in category II under DOTS from June 2015 to May 2016. These patients were followed up to November 2016 till the completion of treatment. At the end of study period, treatment outcomes were analysed. The chi-square test was used to assess the statistical significance of each ratio. P<0.05 was considered significant.Results: Out of 205 re-treatment patients, 174 (84.4%) had pulmonary tuberculosis while 31 (15.1%) had extra-pulmonary TB. In the cohort of category II patients 93 (45.3%) were relapse, 58 (28.2%) belonged to others category, 31 (15.1%) were treatment after loss to follow-up and 23 (11.2%) were on treatment after failure. Maximum patients were male 133 (64.8%) and most of the patients were belonged to the age group of 20-40 years. Among retreatment cases the cure rate for relapse, treatment after failure, treatment after loss to follow-up and others cases were 74.1%, 60.8%, 35.4% and 55.1% respectively.Conclusions: The relapse cases were the most commonly found in the re-treatment category however these patients were more likely to be cured with the category II regimen and treatment after loss to follow-up had high risk of retreatment failure. Continuous monitoring, adherence and treatment completion are essential for controlling the need of retreatment as well as improvement of tuberculosis control programme.

Profil De Résistance Des Mycobabcterium Tuberculosis Des Malades En Retraitement Dans La Région De Haute Matsiatra, Madagascar

Introduction: Relapse, failure and defaulted treatment are a risk factor for Mycobacterium tuberculosis resistance to anti-tuberculosis. The objective of our study is to determine the resistance profile of Mycobacterium tuberculosis of patients in retreatment at the Haute Matriatra area. Method: This is a retrospective, descriptive study carried out on the basis of the data contained in the register of the Haute Matsiatra Regional Tuberculosis Laboratory of the University Hospital of Fianarantsoa, from May 2014 to December 2016 (31 months). We included patients with retreatment in the study. Results: We found 138 patients in retreatment. The average age was 39.32 years with a sex ratio of 2.11. Resistance to Rifampicin and Isoniazid was respectively 2.17% and 2.82%, The prevalence of multidrug-resistant tuberculosis was 0.72%. Conclusion: Tuberculosi resistance, monoresistance or multidrug resistance is a reality in the region of Haute Matsiatra with a prevalence that is still low, reflecting the effectiveness of the tuberculosis control program. However, monoresistances require special attention and monitoring to avoid the emergence of multidrug resistant strains.

FACTORS ASSOCIATED WITH TB/HIV CO-INFECTION AMONG DRUG SENSITIVE TUBERCULOSIS PATIENTS MANAGED IN A SECONDARY HEALTH FACILITY IN LAGOS, NIGERIA.

Background:This study assessed factors associated with TB/HIV co-infection among TB patients managed in a secondary health facility in Lagos Nigeria.Materials and Methods:A retrospective review of treatment cards of patients seen at a secondary referral hospital between January 1 2014 and December 31 2014 was conducted. Treatment outcomes and factors associated with TB/HIV co-infection were assessed.Results:Of the 334 records of patients reviewed, the proportion of patients with TB/HIV co-infection was 21.6%. The odds of having TB/HIV co-infection was 2.7 times higher among patients above 40 years than patients less than 25 years (AOR 2.7 95% CI 1.1 – 6.5, p =0.030). In addition, the odds of having TB/HIV co-infection was 3.3 higher among extra-pulmonary TB cases (AOR 3.3; 95% CI 1.2 – 9.5; p = 0.026) and 2.1 times higher among retreated patients (AOR 2.1; 95% CI 1.1 – 3.9; p = 0.017) than pulmonary TB and new patients respectively. The chance of having TB/HIV co-infection was 2.7-fold more in patients with poor treatment outcomes than patients with treatment success (AOR 2.7; 95%CI 1.3 – 5.4; p =0.006).Conclusion:TB/HIV co-infection rate was high in the study area. There is need to put measures in place to improve treatment outcomes of TB/HIV co-infected patients.

Alcohol use disorder and tuberculosis treatment: A longitudinal mixed method study in Thailand.

ObjectiveThe relationship between tuberculosis (TB) treatment and alcohol use disorders over time is under-researched. The aim of this investigation was to study alcohol use and TB medication adherence and its predictors among TB patients over a period of 6 months.MethodsA longitudinal investigation was carried out with new TB and TB retreatment patients systematically selected from two hospitals and had screened positive for hazardous or harmful alcohol use in Sisaket Province in Thailand. Alcohol use disorders were measured with Alcohol Use Disorder Identification Test (AUDIT)-C at baseline, 3 months and 6 months.ResultsOf the 295 TB patients who were screened with AUDIT-C, 72 (24.4%) tested positive for hazardous or harmful alcohol use. At 6 months, 72 TB patients had completed the follow-up. At the 6-month follow-up, hazardous or harmful drinking was reduced by 84.7%. Multivariate logistic regression analysis using generalised estimation equation modelling found that alcohol use significantly reduced over time, whereas there was no change in current tobacco use.ConclusionThe prevalence of alcohol use disorders significantly reduced over a period of 6 months.

The application of expanded nursing management in improving the medication compliance of re-treatment patients with pulmonary tuberculosis

Objective To ananlyze the application effect of expanded nursing management in improving the medication compliance of re-treatment patients with pulmonary tuberculosis. Methods A total of 92 cases of re-treatment patients with pulmonary tuberculosis treated in our hospital were selected and were randomly divided into experimental group and control group, 46 cases in each group. The control group received routine nursing management, while the experimental group received expanded nursing management. After 3 months' intervention, the relevant observed indicators of the pulmonary tuberculosis patients of the two groups were compared. Results The score of master degrees of medication knowledge and the medication adherence rate of the re-treatment pulmonary tuberculosis patients of the experimental group was significantly higher than that of the control group(P<0.05). Conclusion To implement expanded nursing management for the re-treatment pulmonary tuberculosis patients to carry out drug intervention can improve the patients' medication adherence, so as to promote the rehabilitation of disease. Key words: Extensification; Nursing; Re-treat pulmonary tuberculosis; Medication; Adherence

Predictors of treatment efficacy and ALT non-normalization with sofosbuvir/ribavirin therapy for patients with hepatitis C virus genotype 2.

The tolerability and efficacy of sofosbuvir and ribavirin in patients infected with hepatitis C virus (HCV) genotype 2 were investigated under actual clinical conditions. A total of 208 patients with chronic HCV genotype 2 infection were treated with sofosbuvir 400 mg and ribavirin (weight-based dosing) for 12 weeks. Treatment discontinuation and sustained virological response 12 (SVR12) were evaluated. Moreover, factors associated with SVR12, hemoglobin decreasing to less than 10 g/dL during treatment, and alanine aminotransferase (ALT) non-normalization after treatment were evaluated. In all patients, SVR12 responses were 96.1% (200/208). About 6 of 8 patients (3.8%) who did not achieve SVR12 were re-treatment patients, and eight patients who did not achieve SVR all had liver cirrhosis. Multivariate analysis also identified body mass index (OR = 0.79; P < 0.001), platelet count (OR = 0.88; P = 0.003), and estimated glomerular filtration rate (eGFR) (OR = 0.96; P = 0.007) as independent contributing factors associated with hemoglobin decreasing to less than 10 g/dL during treatment, and only Mac-2 Binding Protein Glycosylation isomer (M2BpGi) (OR = 2.46; P = 0.017) as an independent contributing factor associated with ALT non-normalization after treatment. Cirrhotic patients may have a relatively high rate of treatment failure. In patients whose M2BpGi levels are elevated, their ALT tended to not normalize after treatment completion. These patients who did not achieve normalization of ALT after sofosbuvir plus RBV treatment need more careful observation for emergence of hepatocellular carcinoma even after achievement of SVR.

Cytogenetic biodosimetry and dose-rate effect after radioiodine therapy for thyroid cancer.

This study set out to investigate chromosomal damage in peripheral blood lymphocytes of thyroid cancer patients receiving 131I for thyroid remnant ablation or treatment of metastatic disease. The observed chromosomal damage was further converted to the estimates of whole-body dose to project the adverse side effects. Chromosomal aberration analysis was performed in 24 patients treated for the first time or after multiple courses. Blood samples were collected before treatment and 3 or 4days after administration of 2-4GBq of 131I. Both conventional cytogenetic and chromosome 2, 4 and 12 painting assays were used. To account for dose-rate effect, a dose-protraction factor was applied to calculate the whole-body dose. The mean dose was 0.62Gy (95% CI: 0.44-0.77Gy) in the subgroup of patients treated one time and 0.67Gy (95% CI: 0.03-1.00Gy) in re-treated patients. These dose estimates are about 1.7-fold higher than those disregarding the effect of exposure duration. In re-treated patients, the neglected dose-rate effect can result in underestimation of the cumulative whole-body dose by the factor ranging from 2.6 to 6.8. Elevated frequency of chromosomal aberrations observed in re-treated patients before radioiodine therapy allows estimation of a cumulative dose received from all previous treatments.

The Safety and Feasibility of Re-treating Patients with Severe Emphysema with Endobronchial Coils: A Pilot Study

ABSTRACTSevere emphysema patients who have been treated with endobronchial coils have been shown to initially benefit, but slowly decline in the years thereafter. Re-treating a patient with endobronchial coils could potentially lead to new improvements and may again reduce the rate of further decline. To our knowledge, until now, no results are published about patients who are re-treated. The primary aim of this study is to investigate the safety and feasibility of re-treating severe emphysema patients with endobronchial coils, using the PneumRx coil system. Furthermore, as secondary aim, we will evaluate the efficacy of re-treating these patients. Patients who at least 2 years ago were treated with endobronchial coils and responded clinically meaningful to this treatment were included in the study and re-treated. Safety was evaluated by the number of reported adverse events. Efficacy was evaluated 6 months after re-treatment, and measured by the change in quality of life, exercise capacity and pulmonary function testing. Eight patients were re-treated at a median of 1382 days (range 849–1545) after initial coil treatment with a median additional of 12 (10–15) coils per patient. During treatment, and until 6 months of follow-up, no unexpected adverse events occurred. Quality of life, exercise capacity and lung function did not change significantly 6 months after re-treatment. The results of this pilot study suggest that re-treating patients with endobronchial coils is feasible and safe. However, larger studies are needed to confirm these results and to investigate the efficacy and thus the clinical relevance.

Clinical characteristics and therapeutic effect of drug-resistant tuberculosis in children

Objective: To explore the clinical characteristics of drug-resistant tuberculosis (TB) in children and to study the effectiveness of second-line anti-TB therapy for children and to examine the incidence of adverse drug reactions. Method: Retrospective research was conducted. The clinical records of children in West China Second Hospital diagnosed as drug-resistant TB from January 2010 to June 2014 were investigated.The clinical characteristics and risk factors were analyzed retrospectively. Treatment effect at discharge was examined as a short-term outcome indicator to evaluate the effectiveness of second-line anti-TB therapy and the incidence of adverse drug reactions. χ(2) test was used. Result: Forty-six patients were diagnosed as drug-resistant TB in 443 children infected with TB, with a 10.4% resistance rate. The 46 children included 26 male and 20 female patients, aged from one month and 28 days to 17 years and 5 months, with the average age (8.4±4.5) years, >7 to 14 years old patients as the biggest part(25 patients, 54.3%). Among the 46 children, 20 patients(43.5%)had close contact with TB patients, of whom 12 patients (60.0%) contacted with family members (including parents, brothers and sisters and grandparents living together) and 8 patients(40.0%) contacted with patients from outside family (such as relatives or neighbors). Moreover, 11 cases (23.9%) were under initial treatment and 35 cases (76.1%) were retreated.From 2010 to 2014, the number of cases of initial and retreated patients had no significant difference(0 and 1, 1 and 13, 4 and 7, 4 and 11, 2 and 3 cases, χ(2)=3.255, P=0.196). Among retreated patients, 31.4% (11/35) had irregular treatment before.Until discharge, the effective rate was 87.0% (40/46), while the incidence rate of adverse drug reaction was 10.9%(5/46). Conclusion: The therapy for drug-resistant TB is effective and the incidence of adverse drug reaction is relatively low.

Optimizing choice of oral interferon-free treatment for genotype 1 hepatitis C virus using testing for NS5A resistance: a cost-utility analysis from the perspective of the Italian National Health Service.

BackgroundPatients with genotype-1 hepatitis C virus infection who have failed to respond to standard therapy or who relapse following treatment may be considered for an interferon-free regimen incorporating a nonstructural protein 5A (NS5A) inhibitor. Sustained virologic response (SVR) with these regimens is typically >90%, but this is reduced in patients with NS5A resistance. European Association for Study of the Liver guidelines recommend simeprevir + sofosbuvir ± ribavirin (SMV+SOF±R) for re-treating patients failing an NS5A inhibitor-containing regimen. An alternative strategy would be to test for NS5A resistance prior to treatment, with therapy optimized based on the results. This study investigates the cost-effectiveness of this strategy.Materials and methodsA Markov model was used to estimate disease progression for treatment-experienced genotype 1 patients with severe fibrosis or compensated cirrhosis. Targeted treatment with either SMV+SOF±R or sofosbuvir + ledipasvir ± ribavirin (SOF+LDV±R) based on pretreatment NS5A resistance testing was compared to routine SOF+LDV±R without testing. Treatment duration was 12 or 24 weeks for patients with severe fibrosis or compensated cirrhosis (Metavir F3/F4). SVR data for the treatment options were based on the results of published clinical trials. The analysis was carried out from the perspective of the Italian National Health Service.ResultsOptimized treatment using NS5A resistance testing yielded 0.163 additional QALYs and increased costs of €2,789 per patient versus no testing. The incremental cost-effectiveness ratio (ICER) was €17,078/QALY. Sensitivity analysis identified the SVR attributable to each of the treatment regimens as the most sensitive determinant of ICER (range: €10,055/QALY–€43,501/QALY across plausible range). Probabilistic sensitivity analysis demonstrated that, at a willingness-to-pay threshold of €30,000/QALY, the probability that NS5A-directed treatment will be cost-effective is 81.4%.ConclusionOptimizing therapy with either SMV+SOF±R or SOF+LDV±R based on pretreatment NS5A resistance testing was cost-effective from the perspective of the Italian National Health Service, in treatment-experienced patients with severe fibrosis or compensated cirrhosis.

Lifestyle changes among Tuberculosis patients attending the Central Chest Clinic Colombo

Background Tuberculosis (TB) is an infectious air borne disease and it is a major public health problem. The disease is more commonly seen in under developed countries. Association of TB with stigmatization and its impact on lifestyle of the patient is an important aspect that worth exploring. Objective To describe the influence of the disease on their lifestyle among tuberculosis patients attending the Central Chest Clinic Colombo Methods This was a descriptive cross sectional study. The study population consisted of all diagnosed tuberculosis patients, who were above the age of 15 attending to Central Chest Clinic Colombo. The total sample size comprised of 266 Tuberculosis patients, who have completed the first two months of treatment course to assess the impact of the disease on their lifestyle. Systematic sampling was conducted by considering the total number of clinic attendees and the duration of data collection. An interviewer administered questionnaire was used to collect data. Results Tuberculosis is associated with the lower socio economic status and linked with poverty. It is common in people with lower level of education and unemployment. More negative lifestyle changes were commonly seen in the socially disadvantaged group of patients which could further worsen their social status. More lifestyle changes had significant associations with male sex, low education level, employment, low income level, retreatment and infective patients, residing within the CMC area and substance abuse (alcohol, smoking, narcotic drug use). The stigma associated with the disease had a major impact on patients’ lifestyles as it has influenced to the family interactions, marital status and social interactions. Conclusion Tuberculosis is associated with poverty, low socio economic status; they change their lifestyle more negatively making them more vulnerable to social disadvantages. Not only the medical treatment, but also the lifestyle aspects of the TB patients need to be considered in patient management.

Better care provided to patients with tuberculosis at county designated TB hospitals (CTD) compared to non-CTDs in rural China

BackgroundThe primary unit of tuberculosis (TB) medical care in China is the county TB dispensary or county designated hospital (CTD), where patients can receive free diagnosis and treatment. However, a substantial number of patients seek their anti-TB treatment from general health facilities (Non-CTDs). This study aimed to investigate the first anti-TB treatment experience and choice of health facilities of retreated TB patients and their determinants.MethodsA cross-sectional study was conducted in Jiangsu, Shandong and Sichuan provinces. All registered re-treated TB patients were investigated using a structured questionnaire covering information on demographics, socio-economic characteristics, and previous anti-TB treatment experiences.ResultsTotally, 75.3% of 544 patients visited CTD directly for initial treatment. Patients who were female (OR:1.71, 95% CI: 1.01-2.87), over 40 years of age (OR:2.80, 95% CI: 1.24-6.33), from Jiangsu (OR:3.07, 95% CI: 1.57-6.01) and Sichuan (OR:4.47, 95% CI: 2.29-8.73) and those diagnosed before 2005 (OR:6.87, 95% CI: 4.24-11.13) had a significant higher risk receiving their initial treatment at a non-CTD. Patients were more likely to have standardized diagnosis and treatment regimens in CTD (89.8%) than in non-CTDs (65.9%). Patients treated in non-CTDs versus in CTD had a lower possibility to complete their treatment course during first TB episode (χ2 = 3.926, P = 0.048), but there was no significant difference in the cure rate between different facilities (CTD 60.8%, Non-CTDs 59.1%). Patients in non-CTDs incurred higher costs (1,360 CNY) than those treated in CTD (920CNY).ConclusionCTD play a key role in the National Tuberculosis Control Program. Patients should be guided to seek health care in county designated hospital, where they are more likely to receive appropriate examinations, treatment regimens and rigorous supervision, and to bear a lighter economic burden.

Pulmonary tuberculosis in Patna, India: Durations, delays, and health care seeking behaviour among patients identified through household surveys

BackgroundDelays in accessing effective health care plays a pivotal role in increasing Tuberculosis (TB) transmission within the community. Patna, North India, with high levels of poverty and weak public health system, faces huge challenges for achieving effective TB control. The study aims to determine delays that occur from onset of TB symptoms until initiation of pulmonary TB (PTB) treatment among patients in Patna. MethodsOf the 109 self-reporting TB patients identified through an active household survey, 64 PTB patients were interviewed. First care seeking, TB diagnostic and treatment initiation durations were calculated and delays defined for new and retreatment patients and minors and adults. Outliers exhibiting extreme delays were additionally identified. ResultsA cross sMean total pathway duration for TB care was 40days, with diagnostic duration contributing to 58% of the duration. No significant differences were noted between new and retreatment patients. Minors, comprising of 30% of total PTB patients accessed care faster than adults, but showed significantly higher diagnostic duration (38days vs. 17days). Preference for private sector, chemists and allopaths was seen throughout the pathway. DiscussionPatna requires a more effective harnessing of the private sector augmented with reliable diagnostic investigations and a focus on quality.

Telaprevir-based triple therapy for re-treatment Chronic HCV patients with Genotype 1, including the Null-Response: A single center experience from Turkey

Telaprevir-based triple therapy for re-treatment Chronic HCV patients with Genotype 1, including the Null-Response: A single center experience from Turkey

Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014.

BackgroundAlthough Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the “blank” countries without systematic data.MethodsBetween 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance.ResultsA total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs.ConclusionThe drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2060-7) contains supplementary material, which is available to authorized users.

The emerging threat of pre-extensively drug-resistant tuberculosis in West Africa: preparing for large-scale tuberculosis research and drug resistance surveillance.

BackgroundDrug-resistant tuberculosis (TB) is a global public health problem. Adequate management requires baseline drug-resistance prevalence data. In West Africa, due to a poor laboratory infrastructure and inadequate capacity, such data are scarce. Therefore, the true extent of drug-resistant TB was hitherto undetermined. In 2008, a new research network, the West African Network of Excellence for Tuberculosis, AIDS and Malaria (WANETAM), was founded, comprising nine study sites from eight West African countries (Burkina Faso, The Gambia, Ghana, Guinea-Bissau, Mali, Nigeria, Senegal and Togo). The goal was to establish Good Clinical Laboratory Practice (GCLP) principles and build capacity in standardised smear microscopy and mycobacterial culture across partnering laboratories to generate the first comprehensive West African drug-resistance data.MethodsFollowing GCLP and laboratory training sessions, TB isolates were collected at sentinel referral sites between 2009–2013 and tested for first- and second-line drug resistance.ResultsFrom the analysis of 974 isolates, an unexpectedly high prevalence of multi-drug-resistant (MDR) strains was found in new (6 %) and retreatment patients (35 %) across all sentinel sites, with the highest prevalence amongst retreatment patients in Bamako, Mali (59 %) and the two Nigerian sites in Ibadan and Lagos (39 % and 66 %). In Lagos, MDR is already spreading actively amongst 32 % of new patients. Pre-extensively drug-resistant (pre-XDR) isolates are present in all sites, with Ghana showing the highest proportion (35 % of MDR). In Ghana and Togo, pre-XDR isolates are circulating amongst new patients.ConclusionsWest African drug-resistance prevalence poses a previously underestimated, yet serious public health threat, and our estimates obtained differ significantly from previous World Health Organisation (WHO) estimates. Therefore, our data are reshaping current concepts and are essential in informing WHO and public health strategists to implement urgently needed surveillance and control interventions in West Africa.

Using Survival Analysis to Identify Risk Factors for Treatment Interruption among New and Retreatment Tuberculosis Patients in Kenya.

Despite high tuberculosis (TB) treatment success rate, treatment adherence is one of the major obstacles to tuberculosis control in Kenya. Our objective was to identify patient-related factors that were associated with time to TB treatment interruption and the geographic distribution of the risk of treatment interruption by county. Data of new and retreatment patients registered in TIBU, a Kenyan national case-based electronic data recording system, between 2013 and 2014 was obtained. Kaplan-Meier curves and log rank tests were used to assess the adherence patterns. Mixed-effects Cox proportional hazards modeling was used for multivariate analysis. Records from 90,170 patients were included in the study. The cumulative incidence of treatment interruption was 4.5% for new patients, and 8.5% for retreatment patients. The risk of treatment interruption was highest during the intensive phase of treatment. Having previously been lost to follow-up was the greatest independent risk factor for treatment interruption (HR: 4.79 [3.99, 5.75]), followed by being HIV-positive not on ART (HR: 1.96 [1.70, 2.26]) and TB relapse (HR: 1.70 [1.44, 2.00]). Male and underweight patients had high risks of treatment interruption (HR: 1.46 [1.35, 1.58]; 1.11 [1.03, 1.20], respectively). High rates of treatment interruption were observed in counties in the central part of Kenya while counties in the northeast had the lowest risk of treatment interruption. A better understanding of treatment interruption risk factors is necessary to improve adherence to treatment. Interventions should focus on patients during the intensive phase, patients who have previously been lost to follow-up, and promotion of integrated TB and HIV services among public and private facilities.

Different adjuvant chemotherapies for the retreatment patients with advanced primary hepatic carcinoma: an efficacy and survival analysis

Objective To study the significance of treating advanced primary hepatic carcinoma by using the different methods combined with chemotherapy. Methods One hundred and fifteen cases with advanced primary hepatic carcinoma were divided into 5 groups by accepting different chemotherapy: the groups of interventional-chemotherapy (group A, 40 cases), whole body hyperthermia combined with chemotherapy (group B, 16 cases), only chemotherapy (group C, 9 cases), local heat chemotherapy (group D, 26 cases), symptomatic supportive (group E, 24 cases) for comparing response rate (RR) and survival time between each other. Results The RR in group A,B,C were 30.5 % (12/40), 12.5 % (2/16), 11.1 % (1/9) respectively, and there was no significant difference among three groups (P>0.05). The mid-survival time of five groups were 7.7, 9.2, 7.9, 6.0, 4.7 months, and there was significant difference between group B and group E (P<0.05). The 0.5-, 1-, 2-year survival rate in group B were higher than those in group E with significant difference (81.2 % vs. 29.1 %, 37.5 % vs. 12.5 %, 12.5 % vs. 0, all P<0.05). Conclusions The RR of only routine chemotherapy is low, while the RR of interventional-chemotherapy and local heat chemotherapy is high with non-prolonged survival time. Whole body hyperthermia combined with chemotherapy have active effects in helping to improve the efficacy and prolong the survival time in retreatment patients with advanced hepatic tumor. Key words: Liver neoplasms; Interventional-chemotherapy; Hyperthermia combined with chemotherapy; Conventional chemotherapy

Evaluation of treatment failure outcome and its predictors among pulmonary tuberculosis patients in Sharkia Governorate, 2013–2014

BackgroundPicking up tuberculosis (TB) treatment failure cases and its determinants is urgently needed in resource-limited developing countries. This work shows incidence and probable leading factors of TB treatment failure among patients who were managed by a TB control program. Aim and objectivesThis study aims to promote the TB control program at the ministry of health and population (MOHP) chest hospitals, Sharkia Governorate with the following objectives: (1) Determine the incidence of TB treatment failure. (2) Assess probable factors of TB treatment failure. Patients and methodsA retrospective cohort study was carried out at MOHP chest hospitals, Sharkia Governorate. The study sample included all registered TB patients (n=480) during the study period (2013–2014). There were 30TB patients (Failed cases) with a positive sputum smear after 5months of treatment (Group 1). Cured cases were 384TB patients whose sputum smear was positive at the beginning of the treatment but became smear-negative at the end of treatment and on at least one previous occasion (Group 2). Both groups were compared to evaluate leading factors of treatment failure. ResultsOf the 480TB patients registered during the study period (2013–2014), the incidence of treatment failure was 6.25%. Treatment failure cases were significantly more likely to have: positive sputum smears at 2months of TB treatment (p<0.01), cavities on the baseline chest radiograph (P<0.01), extensive disease on the baseline chest radiograph (P<0.001). Also, retreatment case (P<0.01) and CAT 11 treatment category were (p<0.001). ConclusionThis study showed that the treatment failure rate in our locality is relatively high. Positive sputum smear at 2months of TB treatment, radiological findings and retreatment patients were found to be predictors of TB treatment failure that should be recognized early and closely followed up.

Standard triple therapy versus sequential therapy for eradication of Helicobacter pylori in treatment naïve and retreat patients

Background and study aimsUntreated Helicobacter pylori infection causes increased risk of gastric cancer, GI morbidity and mortality. Standard treatment for eradication of Helicobacter pylori infection, is the triple therapy which consists of a proton pump inhibitor; together with two antibiotics (amoxicillin 1000mg with clarithromycin 500mg or metronidazole 400mg) given twice daily for 7–14days. Recent evidence revealed, that cure rates of Helicobacter pylori infection with triple therapy had fallen below satisfactory targets. Sequential therapy consisting of a twice daily dose of a PPI for ten days with Amoxicillin given at 1000mg twice daily in the first 5days followed by clarithromycin 500mg and Metronidazole 400mg given twice daily in the subsequent 5days, was recommended to improve eradication rates. We performed a randomised open label study to compare the efficacy of sequential against triple therapy in Helicobacter pylori naive and retreat patients. Patients and methodsIn a randomised open label observational study 485 patients fulfilling inclusion and exclusion criteria were randomly assigned to be treated with triple therapy (n=231) or sequential therapy (n=254). Eradication of Helicobacter pylori was documented with 14C Urea breath test (UBT) performed 6weeks after the treatment. ResultsThe intention-to-treat eradication rate was better in sequential therapy group 84.6% than triple therapy 68% (p<0.001). Eradication rates were significantly higher for treatment naive than retreat patients in triple therapy group (70.5% and 58.3%, respectively, p<0.01). A trend of a better response was observed in eradication rate for treatment naive 88.55% versus retreat 74.6% in sequential therapy group but was not statistically significant (p=0.76). Compliance was similar in the two groups, however side effects were less and the clinical response was better in the sequential therapy group.