TB Diseases Research Articles

Clustering of under-five mortality in Rufiji Health and Demographic Surveillance System in rural Tanzania

Background: Less than 5 years remain before the 2015 mark when countries will be evaluated on their achievements for the Millennium Development Goals (MDGs). The MDG 4 and 6 call for a reduction of child mortality by two-thirds and combating malaria, HIV/AIDS, TB, and other diseases, respectively. To accelerate the achievement of these goals, focused allocation of resources and high deployment of cost-effective interventions is paramount. The knowledge of spatial and temporal distribution of diseases is important for health authorities to prioritize and allocate resources.Methods: To identify possible significant clusters, we used SatTScan software, and analyzed 2,745 cases of under-five with 134,099 person-years for the period between 1999and 2008. Mortality rates for every year were calculated, likewise a spatial scan statistic was used to test for clusters of total under-five mortalities in both space and time.Results: A number of significant clusters from space, time, and space–time analysis were identified in several locations for a period of 10 years in the Rufiji Demographic Surveillance Site (RDSS). These locations show that villages within the clusters have an elevated risk of under-five deaths. The spatial analysis identified three significant clusters. The first cluster had only one village, Kibiti A (p<0.05, the second cluster involved five villages (Mtawanya, Pagae, Kibiti A, Machepe, and Kibiti B; p<0.05), the third cluster involved one village, Jaribu Mpakani (p<0.05). A space–time cluster of 10 villages for the period between 1999 and 2002 with a radius of 14.73 km was discovered with the highest risk (RR 1.6, p<0.001). The mortality rates were very high for the years 1999–2002 according to the analysis. The death rates were 33.5, 26.4, 24.1, and 24.9, respectively. Total childhood mortality rates calculated for the period of 10 years were 21.0 per 1,000 person-years.Conclusion: During the 10 years of analysis, mortality seemed to decrease in RDSS. The mortality decline should be taken with caution because the Demographic Surveillance System is not statistically representative of the whole population; therefore, inference should not be made to the general population of Tanzania. The pattern observed could be attributed to demographic and weather characteristics of RDSS. This should provide new insights for further studies and interventions toward reducing under-five mortality.

Role of fine-needle aspiration cytology in evaluating mediastinal masses

Background:Fine-needle aspiration cytology is an important and useful investigation and is considered next to imaging in the diagnosis of mediastinal lesions. We carried out this study in the Department of TB and respiratory diseases JNMC Aligarh from March 2000 to March 2002 with the following aims.Objectives:To make etiological diagnosis of mediastinal lesions, determine the pathological type of the tumor in cases of malignancy and evaluate the role of fine-needle aspiration cytology in staging of bronchogenic carcinoma.Materials and Methods:A total of 56 patients were included in this study who had mediastinal mass with or without lung lesions on chest X-ray or computed tomography scan. Of these patients, 36 had mediastinal mass only and 20 had mediastinal mass with parenchymal lesion.Results:In the present study, of 56 patients, 36 had mediastinal masses and 20 had pulmonary mass.Conclusion:Percutaneous fine-needle aspiration is an easy and reliable method for reaching a quick tissue diagnosis in pulmonary and mediastinal masses.

TO ANALYZE RELATIVE AND ADDITIONAL BRONCHODILATOR RESPONSE OF SALBUTAMOL AND IPRATROPIUM IN SMOKER AND NONSMOKER ASTHMATICS

PURPOSE: This study was conducted in the department of TB & Respiratory Diseases, J. N. Medical College, Aligarh, from Jan. 2006 to Dec. 2007. The fact that smoker asthmatics can behave like COPD patients, one is encouraged to therapeutically exploit the important cholinergic influence in these patients. To clarify the issue for its clinical importance, the present study was aimed at relative bronchodilator response to adrenergic vs. cholinergic agents.

Evaluation of antimycobacterial activity of some Piper species

Searching for new TB drugs from plant sources of India is a promising approach as India provides a rich tradition in medicinal plants combined with a high biodiversity [1]. As a part of the project to identify antimycobacterial natural products from Indian medicinal plants, three Piper species viz., P. cubeba, P. longum and P. retrofractum are being studied with the aim to isolate and characterize antimycobacterial compounds. These species are reported to be used for treating TB or TB-related diseases in ethnomedicine in India [1].

Specific T-cell responses to Mycobacterium tuberculosis protein ESAT-6 in Chinese HIV positive individuals

To detect TB specific T cell responses by using the recombinant ESAT-6 protein as stimulus in Chinese HIV infected patients. ELISPOT-IFN-gamma assay by using the recombinant ESAT-6 protein as stimulus to detect specific T cell responses in HIV+ patients with or without clinical manifestation of TB diseases. Recombinant ESAT-6 protein specific T cell responses show significant high frequencies in both of TB patients with or without HIV infection than that in the healthy control and HIV+ group without clinical TB diseases. The ELISPOT-IFN-gamma assay by using recombinant ESAT-6 protein as stimulus could be used in diagnoses of TB infection in Chinese HIV infected patients.

National Program of Early Detection and Prevention of COPD in the years 2000-2002

COPD is a highly prevalent disease and ranks 4th among main causes of death in Poland. To control the disease national program of early detection and prevention of COPD was proposed. Program, under the auspices of the Ministry of Health, was implemented by the National TB and Lung Diseases Research Institute in Warsaw and run in out-patient chest clinics all over the country. Smokers aged more than 40 years were proposed a free spirometry and antismoking advice. During three years 91 859 subjects were screened, mean age 53.2&plusmn;11.5 years, 57.9% males. There were 61.6% of current smokers, 26.7% of former smokers and 9.7% of never smokers. Spirometric measurements were: in 71.8% normal, in 19.9% showed airflowlimitation,andin8.3%showed restrictive pattern. Severity of air flow limitation was mild in 7.7%, moderate in 6.7% and severe in 5.6%of all investigated subjects. In smokers older then 40 years and a history of more than 10 pack-years AL was diagnosed in 22,75%. Airflow limitation was found in 14.5% of never smokers. In summary. Program resulted in a very high (20%) diagnosis of airflow limitation. Subjects screened were not aware of their disease. Even subjects who presented with severe form of airflow limitation were not diagnosed earlier. Pneumonol. Alergol. Pol. 2005, 73, 116-121

P456 Nocturia in middle-age males and females with obstructive sleep apnea (OSA)

P456 Nocturia in middle-age males and females with obstructive sleep apnea (OSA) Robert Plywaczewski , Przemyslaw Bielen , Michal Bednarek , Luiza Jonczak , Justyna Czerniawska , Dorota Gorecka , Pawel Sliwinski 1 1 National TB and Lung Diseases Research Institute, Department of Respiratory Failure, Warsaw, Poland 2 National TB and Lung Diseases Research Institute, Department of Respiratory Medicine, Warsaw, Poland

P312 Neck circumference was not a better predictor of obstructive sleep apnea (OSA) severity than BMI in males

P312 Neck circumference was not a better predictor of obstructive sleep apnea (OSA) severity than BMI in males Robert Plywaczewski , Przemyslaw Bielen , Michal Bednarek , Luiza Jonczak , Justyna Czerniawska , Dorota Gorecka , Pawel Sliwinski 1 1 Department of Respiratory Failure, National TB and Lung Diseases Research Institute, Warsaw, Poland 2 II Department of Respiratory Medicine, National TB and Lung Diseases Research Institute, Warsaw, Poland

An oily, sustained counter-regulatory response to TB

Lipoxins are potent antiinflammatory lipid mediators that restrain and promote the resolution of a wide variety of inflammatory processes. Recent studies implicating deficient lipoxin production in the pathogenesis of diverse inflammatory diseases, along with numerous reports of the beneficial effects of lipoxin analog administration in animal models of inflammatory pathology, have suggested that harnessing the pleiotropic activities of the lipoxins is a strategy with considerable therapeutic promise. In this issue of the JCI, Bafica et al. address the other side of the coin, reporting that endogenous lipoxins compromise immune-mediated control of Mycobacterium tuberculosis infection in mice. In addition to providing novel insight into the mechanisms that interfere with the development of protective immune responses to M. tuberculosis, the study raises the possibility that pharmacological inhibition of lipoxin synthesis may provide a method of augmenting inefficient immune responses in TB and other important chronic infectious diseases.

Identification of preadmission predictors of outcome of noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease

Background: Noninvasive ventilation (NIV) has been shown to be an effective treatment for ventilatory failure, particularly resulting from acute exacerbations of chronic obstructive pulmonary disease (COPD). However, NIV is associated with significant failure rates. Hence, there is a need for identifying preadmission predictors for outcome of NIV in patients for acute exacerbation of COPD, thereby sparing the discomfort of a trial of NIV on these patients. Aim: The study was carried to identify the preadmission predictors of outcome of NIV in acute exacerbation of COPD with respiratory failure. Material and Methods: The study was carried in the Department of TB & Chest diseases at the Jawaharlal Nehru Medical College, AMU; 250 patients with acute exacerbation of COPD were enrolled in the study. These patients were grouped on the basis of six different independent variables, viz. age, performance status, pH, late failures, SaO2, and presence or absence of pedal edema. Analysis was done by z-test, P Observation: Age had no impact on the outcome of patient on NIV ( z = 0.3).The risk for endotracheal intubation was found to be increased by the presence of pedal edema ( z = 6.2; P z = 4.7; P z = 10.6; P z = 3.2; P z = 8.3; P Conclusion: Patients' COPD with poor baseline performance status, pedal edema, low oxygen saturation, and academia carry a high likelihood of failure and should be spared a prolonged trial of NIV.

Inside View

Change, a constant everywhere, seems particularly prevalent in the World Health Organization (WHO), and is coming again. On 21 July 2003, 57 year-old Dr Jong-Wook Lee of the Republic of Korea, took his place as the sixth WHO Director-General. He inherits a swollen organization that has put health on the political agenda and made many commitments for the next 12 years. He faces an or-ganization often described as underfunded, overcommitted, burdened with bureaucracy, and decades behind in its approach to management and governance. And he faces an organization that has seen many faces and much corporate history disappear in the past few years; one in which many of us now know few others. Tremendous challenges lie ahead, but Dr Lee is well qualified to address them. To begin with, he has spent 19 years inside WHO, in a variety of positions at country, national and headquarters levels. He has held tough portfolios in leprosy, polio, TB, and vaccine preventable diseases of children, as well as working in chronic care. And he is known as a patient listener, a sound administrator and a strong alliance builder. Dr Lee understands that to sustain an organization or a program requires stable resources, be they finances, staff, buildings, or technology. Among his priorities he cites his plans to: better use resources to serve countries more effectively, to run WHO more efficiently, to ensure that WHO becomes more accountable, and to strengthen human resources both inside WHO and within its member states. Committed to achieving tangible and measurable health outcomes, he plans to move more resources closer to the people needing them. He also promises to enhance transparency and communications so that people can work effectively together. What is most exciting is that these intentions imply strong support for the concepts of Primary Health Care, and a renewed commitment to Health For All. These are ideals close to the heart of nurses – ones for which we work and advocate daily. Today more than 12 million nurses stand ready to help advance a WHO agenda that addresses the ideals of primary health care, values the contributions all health professionals can make, and encourages nurses, midwives and others to work to their full potential in achieving the vision of healthy nations in a healthy world. But the real challenge for Dr Lee is internal. The challenge is not change itself, but managing the transitions that accompany successful change – the ‘psychological orientation’1 people must go through before the change can work. Managing the organizational and personal transitions – helping shift the internal culture as fluidly as possible – takes time and energy, and real belief in the importance of a positive work environment. Transitions should never be underrated. Today we have much evidence that managing them is worth the effort and much more to show that, without transitions, change simply doesn’t work. Dr Lee, we wish you highly successful transitions.

Intra-urban health differentials in London - urban health indicators and policy implications

The paper describes health differentials between small areas within three boroughs (local government areas) in London - including the incidence of TB, asthma and respiratory diseases - and their associations with deprivation, unemployment and poor housing conditions. It also discusses the value of measuring such intra-urban health differentials for policy- making and illustrates how addressing social inequalities and economic disadvantages may be among the most effective interventions to improve health.

Intra-urban health differentials in London - urban health indicators and policy implications

The paper describes health differentials between small areas within three boroughs (local government areas) in London - including the incidence of TB, asthma and respiratory diseases - and their associations with deprivation, unemployment and poor housing conditions. It also discusses the value of measuring such intra-urban health differentials for policy- making and illustrates how addressing social inequalities and economic disadvantages may be among the most effective interventions to improve health.

The Spatiotemporal Dynamics of AIDS and TB in the New York Metropolitan Region from a Sociogeographic Perspective: Understanding the Linkages of Central City and Suburbs

Empirical and theoretical analyses based on observed patterns of incidence of AIDS and tuberculosis, on rates of poverty, and on statistics describing a ‘Markov infection’ driven by the ‘commuting field’ around Manhattan, strongly suggest that urban and suburban epicenters within a twenty-four-county metropolitan region, covering eighteen million people and more than 7600 square miles, may be significantly and increasingly linked to outlying affluent areas through a process driven by fundamental social, geographic, and economic structures. AIDS and TB rates outside the epicenter of New York City are found to display similar patterns of spread in space and time, and have been strongly coupled to rates of infection within it for some time, a circumstance which will continue and may intensify as ‘heterosexual AIDS’ becomes more predominant and as multiple drug-resistant forms of TB evolve within disintegrating inner city minority communities. The work reported here, involving a relatively large area and a high population, strongly contradicts the findings of a recent National Research Council report on the social impact of AIDS, which, based on a severely constrained scale of analysis, concluded that the concentration of disease within marginalized urban communities implies many geographical areas and strata of the population are and will remain untouched by the AIDS epidemic. The hyperconcentration of infection in urban epicenters is not containment, but rather a principal force behind further spread. This work, in part a technology transfer from community ecology of ideas on refugia and reservoirs, adds significantly to a growing body of evidence which strongly implies that wide-spread urban reform is an essential, but largely unrecognized, component for any realistic national programs to control AIDS, multiple-drug-resistant TB, and other infectious diseases.

IgG-type antibodies against antigen A60 of M. tuberculosis in TB and other lung diseases

IgG-type antibodies against antigen A60 of M. tuberculosis in TB and other lung diseases

Controlling resurgent tuberculosis: public health agencies, public policy, and law.

The reappearance of tuberculosis as a serious public health threat points up the fallacy of the widely held assumption that medical science had conquered the communicable diseases that were once leading causes of morbidity and mortality. In devising a strategy to prevent the spread of TB, public policymakers must adapt traditional TB control measures to reflect the current problem. Such a strategy can and should include the appropriate use of governmental coercion to compel observance of public health TB control measures. Public health approaches to control of human immunodeficiency virus, with their emphasis on the voluntary cooperation of those infected and at high risk for infection, are not a model for effective TB control. Additional resources, while needed, will not alone enable public health agencies to bring TB and other communicable diseases under control. In the present debate over health care reform, little attention has been paid to the importance of public health agencies in protecting the public health. The resurgence of TB is a warning of the consequences of neglecting public health agencies and ignoring the socioeconomic problems that underlie it and other communicable diseases.