Treatment Of Tuberculosis Patients Research Articles

Prevalence of multidrug-resistant tuberculosis in East Africa: A systematic review and meta-analysis.

The rate of multidrug-resistant tuberculosis is increasing at an alarming rate throughout the world. It is becoming an emerging public health problem in East Africa. The prevalence of multidrug-resistant tuberculosis among pulmonary tuberculosis positive individuals in the region has not been thoroughly investigated. The aim of this systematic review and meta-analysis is to estimate the pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed and previously treated pulmonary tuberculosis cases in East African countries. English published articles were systematically searched from six electronic databases: PubMed, EMBASE, Scopus, Science direct, Web of Science, and Google scholar. The pooled prevalence of multidrug-resistant tuberculosis and associated risk factors were calculated using Der Simonian and Laird's random Effects model. Funnel plot symmetry visualization confirmed by Egger's regression asymmetry test and Begg rank correlation methods was used to assess publication bias. A total of 16 articles published from 2007 to 2019 were included in this study. STATA 14 software was used for analysis. Out of 1025 articles identified citations, a total of 16 articles were included in final meta-analysis. The pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed tuberculosis cases and previously treated tuberculosis patients was 4% (95%CI = 2-5%) and 21% (95%CI: 14-28%), respectively. Living conditions, lifestyles (smoking, alcohol use, and drug abuse), previous medical history, diabetes history, and human immunodeficiency virus infection were risk factors contributing to the higher prevalence of multidrug-resistant tuberculosis in East Africa. The review found a significant prevalence of multidrug-resistant tuberculosis in the region. An early diagnosis of tuberculosis and rapid detection of drug-resistant Mycobacterium tuberculosis is a critical priority to identify patients who are not responding to the standard treatment and to avoid transmission of resistant strains. It is also very important to strengthen tuberculosis control and improve monitoring of chemotherapy.

Studi Penggunaan Obat Anti Tuberkulosis (OAT) Tahap Lanjutan pada Pasien Baru BTA Positif

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Tuberculosis will cause pain and death if not treated properly. OAT (Antituberculosis Drugs) is a treatment for tuberculosis patients. OAT has different dosage regimens and types of drugs. Treatment of TB patients consists of two phases (intensive and continuation phases). The continuation phase was at to kill dormant bacteria to prevent recurrence in patients. The purpose of this study was to determine and evaluate the pattern of using OAT in patients newly diagnosed rwith smear-positive at the continuation phase. This study is an observational descriptive study with results showing that the pattern of using OAT-KDT in patients was 89% and OAT-Separated was 11%. The pattern of using the OAT-KDT dose was 1x3 2KDT tablets. Another combination of antibiotics given to the patient is cotrimoxazole at a dose of 1x960mg. The side effect of OAT is an increase in serum transaminase and nausea each with a percentage of 23%. Based on the research, it can be concluded that the pattern of using OAT in Tuberculosis patients has followed the guidelines for the management of Tuberculosis treatment.

An Old Defence Against New Infections: The Open-Air Factor and COVID-19.

Outdoors, the risks of transmission of COVID-19 and many other respiratory infections are low. Several environmental factors are known to reduce the viability of viruses and other infectious pathogens in the air. They include variations in temperature, relative humidity, solar ultraviolet radiation, and dilution effects. But one agent that reduces the viability of both viruses and bacteria outdoors, the germicidal open-air factor (OAF), has not been properly recognized for decades. This is despite robust evidence that the OAF can influence both the survival of airborne pathogens and the course of infections.The germicidal effects of outdoor air were widely exploited during the late 19th and early 20th centuries. Firstly, in the treatment of tuberculosis patients who underwent 'open-air therapy' in sanatoria; and secondly by military surgeons during the First World War. They used the same open-air regimen in specially designed hospital wards to disinfect and heal severe wounds among injured soldiers. It was also used on influenza patients during the 1918-19 pandemic. Later, in the 1950s, open-air disinfection and treatment of burns were proposed in the event of nuclear warfare. During the 1960s, the OAF briefly returned to prominence when biodefence scientists conducted experiments proving that open air has a potent germicidal effect. When this work ended in the 1970s, interest in the OAF again fell away, and it remains largely ignored.The COVID-19 pandemic has revived interest in understanding the transmission dynamics and survival of viruses in the air. The pandemic has also stimulated research in the science and practice of improved ventilation to control respiratory infections. Such work is incomplete without an appreciation of the inactivation of viruses and other pathogens by the OAF, but this needs further investigation as a matter of urgency. Research to better understand the conditions under which the OAF can be preserved indoors is urgently needed. We need to review building design with better regard to infection control and patient recovery. But we need to act without delay, as there is already sufficient evidence to show that public health generally would improve if more emphasis was placed on increased exposure to outdoor air.

Tuberculosis reinfection and relapse in eastern China: a prospective study using whole-genome sequencing

ObjectivesTuberculosis recurrence after an initial successful treatment episode can occur from either reinfection or relapse. In a population-based sample and whole genome sequencing in eastern China, we aimed to evaluate risk factors for tuberculosis recurrence and assess the proportion of recurrence because of either reinfection or relapse. MethodsSuccessfully treated pulmonary tuberculosis patients with sputum culture positive results were recruited from five cities in Jiangsu Province from 2013 to 2015 and followed for 2 years for tuberculosis recurrence. Among patients developing a second tuberculosis episode, whole genome sequencing was performed to distinguish relapse or reinfection through a distance threshold of 6-single-nucleotide polymorphisms. We analyzed risk factors for recurrence and epidemiological characteristics of different types of recurrent patients. ResultsOf 1897 successfully treated tuberculosis patients, 7.4% (141/1879) developed recurrent tuberculosis. Compared with nonrecurrent tuberculosis, patients were at higher risk of recurrence in older age (adjusted odds ratio, 1.02 for each additional year; 95% CI, 1.01 to 1.03, p = 0.003), patients previously treated for tuberculosis (adjusted odds ratio = 2.22; 95% CI, 1.52 to 3.26, p < 0.001), or with bilateral cavities (adjusted odds ratio, 1.56; 95% CI, 1.05 to 2.32, p = 0.029). Among 27.0% (38/141) recurrent tuberculosis patients with successfully sequenced pairs, relapse was substantially more common than reinfection (71.1% vs 28.9%, p = 0.014). DiscussionEndogenous relapse was significantly more common than exogenous reinfection in the first 2 years after treatment in eastern China. Prioritization of high-risk groups for recurrence, such as the elderly, with a previous tuberculosis diagnosis, or with bilateral cavities, may provide opportunities to reduce post-tuberculosis morbidity.

Efficacy of using bedaquiline in treatment of tuberculosis patients with multiple and extensive drug resistance

The objective: to compare treatment efficacy of pulmonary tuberculosis patients with multiple (MDR) and extensive drug resistance (XDR) using a standard chemotherapy regimen and the regimen containing bedaquiline.Subjects and Methods. A retrospective study was conducted to analyze treatment outcomes in 219 patients with pulmonary tuberculosis and MDR/XDR of Mycobacterium tuberculosis (MTB) aged 18-75 years old who were treated in in-patient and out-patient facilities of St. Petersburg from 2016 to 2019. Treatment outcomes were analyzed by subgroups formed taking into account resistance patterns and addition of bedaquiline to the treatment regimens: Ia – n = 94 (MDR TB; Bq-) and IIa ‒ n = 80 (XDR TB; Bq-); Ib ‒ n = 22 (MDR TB; Bq+) and IIb ‒ n = 23 (XDR TB; Bq+). Clinical and laboratory parameters of patients, the severity of comorbidity were assessed before the start of treatment, after 3, 6, 12-14 and 18-24 months of therapy, as well as after therapy completion and during the follow-up period. Statistical analysis was carried out using Statistica 10.0 and methods of parametric and nonparametric statistics and the SPSS 16.0 software, where p ≤ 0.05 was considered significant.Results. XDR TB patients in Subgroup IIb were significantly more likely to have a high level of comorbidity according to Charlson index (from 5 to 6 points) – in 34.7% of cases versus 5.0% in Subgroup IIa. At all stages of treatment in MDR TB patients with Bq+ (Ib), sputum conversion was recorded significantly more often versus patients of Subgroup Ia with Bq- when examined at all stages, with maximum effectiveness achieved by 18-24 months of treatment (90.9%). Treatment efficacy of XDR TB patients (IIb, Bq+) was also significantly higher versus treatment regimen containing no bedaquiline (60.8% (IIb, Bq+) versus 25.0% (IIa, Bq-), χ2 = 4.61, p &lt; 0.05).Conclusions. Achieved high efficacy of therapy in Subgroups Ib and IIb containing Bq provided a positive impact on treatment default rates, that were recorded in a low percentage of cases in those subgroups. An ineffective course of treatment in MDR TB patients treated with regimens containing no Bq was observed in 42.5% in Subgroup Ia, while this rate made only 0.09% in Subgroup Ib. Treatment effectiveness was the highest in XDR TB patients of Subgroup IIb when Bq was added to the treatment regimen.

The relationship between vitamin D level and second acid-fast bacilli (AFB) smear-positive during treatment for TB patients was inferred by Bayesian network.

BackgroundVitamin D is related to human immunity, so we used Bayesian network model to analyze and infer the relationship between vitamin D level and the acid-fast bacilli (AFB) smear-positive after two months treatment among pulmonary tuberculosis (TB) patients.MethodsThis is a cross-sectional study. 731 TB patients whose vitamin D level were detected and medical records were collected from December 2019 to December 2020 in XinJiang of China. Logistic regression was used to analyze the influencing factors of second AFB smear-positive. Bayesian network was used to further analyze the causal relationship among vitamin D level and the second AFB smear-positive.ResultsBaseline AFB smear-positive (OR = 6.481, 95%CI: 1.604~26.184), combined cavity (OR = 3.204, 95%CI: 1.586~6.472), full supervision (OR = 8.173, 95%CI:1.536~43.492) and full management (OR = 6.231, 95%CI:1.031~37.636) were not only the risk factors and can also be considered as the reasons for second AFB smear-positive in TB patients (Ensemnle > 0.5). There was no causal relationship between vitamin D level and second AFB smear-positive (Ensemnle = 0.0709).ConclusionsThe risk factors of second AFB smear-positive were baseline AFB smear-positive, combined cavity, full supervision and full management. The vitamin D level in TB patients was not considered as one of the reasons for the AFB smear-positive.

Impact of Vitamin D in Prophylaxis and Treatment in Tuberculosis Patients.

Vitamin D plays a crucial role in many infectious diseases, such as tuberculosis (TB), that remains one of the world’s top infectious killers with 1.5 million deaths from TB in 2021. Vitamin D suppresses the replication of Mycobacterium tuberculosis in vitro and showed a promising role in TB management as a result of its connection with oxidative balance. Our review encourages the possible in vivo benefit of a joint administration with other vitamins, such as vitamin A, which share a known antimycobacterial action with vitamin D. However, considering the low incidence of side effects even at high dosages and its low cost, it would be advisable to assess vitamin D level both in patients with active TB and high-risk groups and administer it, at least to reach sufficiency levels.

Coexistence of tuberculosis and COVID-19 pneumonia: A presentation of 16 patients from Turkey with their clinical features.

Coronavirus disease 2019 (COVID-19) and tuberculosis are serious and mortal diseases worldwide. There are few studies about the association between tuberculosis and COVID-19 pneumonia. We aimed to describe the characteristics of tuberculosis and COVID-19 co-infection cases in light of the literature. Tuberculosis patients who applied to the tuberculosis outpatient clinic between September 1-September 30, 2020, and patients hospitalized in the COVID-19 service between June 1- September 30, 2020, were retrospectively screened. Patients with tuberculosis and COVID-19 co-infection were recorded. Clinical, radiological, laboratory data, and treatments were recorded and analyzed. For the diagnosis of tuberculosis, sputum acid-resistant bacillus (ARB) smear or culture positivity or pathological diagnosis were used. For the diagnosis of COVID-19, positive real-time reverse transcription-polymerase chain reaction and/or typical radiological findings were sought. Seven hundred and fifty-one patients' data at the tuberculosis outpatient clinic, 229 patients' data at the COVID-19 clinic were screened. Sixteen patients meet the criteria. COVID-19 infection rate in tuberculosis patients was 2.1%. Sixty-nine percent of the patients had received COVID-19 disease during diagnosis or initial tuberculosis treatment phase. There were no drugdrug interactions between anti-tuberculosis drugs and COVID-19 treatment. During the COVID-19 treatment, one patient (6%) died, 15 (94%) patients completed the treatment. : In our study, no effect of the coexistence of TB and COVID-19 on morbidity or mortality was observed. Although the number of patients is small, it can be said that patients with early TB disease and with widespread involvement may be riskier for COVID-19 infection. Frequent hospital visits by TB patients may be a risk for COVID-19. It may be beneficial to carry out the diagnosis and treatment of tuberculosis patients by tuberculosis dispensaries as in our country or authorized units to reduce the risk of hospital admissions and COVID-19 transmission.

Recurrent tuberculosis in the Netherlands - a 24-year follow-up study, 1993 to 2016.

BackgroundNot all treated tuberculosis (TB) patients achieve long-term recovery and reactivation rates reflect effectiveness of TB treatment.AimWe aimed to estimate rates and risk factors of TB reactivation and reinfection in patients treated in the Netherlands, after completed or interrupted treatment.MethodsRetrospective cohort study of TB patients with available DNA fingerprint data, registered in the Netherlands Tuberculosis register (NTR) between 1993 and 2016. Reactivation was defined as an identical, and reinfection as a non-identical Mycobacterium tuberculosis strain in sequential episodes.ResultsReactivation rate was 55/100,000 person-years (py) for patients who completed, and 318/100,000 py for patients who interrupted treatment. The risk of reactivation was highest in the first 5 years after treatment in both groups. The incidence rate of reactivation was 228/100,000 py in the first 2 years and 57/100,000 py 2–5 years after completed treatment. The overall rate of reinfection was 16/100,000 py. Among those who completed treatment, patients with male sex, mono or poly rifampicin-resistant TB and a previous TB episode had significantly higher risk of reactivation. Extrapulmonary TB was associated with a lower risk. Among patients who interrupted treatment, directly observed treatment (DOT) and being an undocumented migrant or people experiencing homelessness were associated with a higher risk of reactivation.ConclusionsBoth patients who completed or interrupted TB treatment should be considered as risk groups for reactivation for at least 2–5 years after treatment. They patients should be monitored and guidelines should be in place to enhance early detection of recurrent TB.

In-Depth Immunophenotyping With Mass Cytometry During TB Treatment Reveals New T-Cell Subsets Associated With Culture Conversion.

Tuberculosis (TB) is a difficult-to-treat infection because of multidrug regimen requirements based on drug susceptibility profiles and treatment observance issues. TB cure is defined by mycobacterial sterilization, technically complex to systematically assess. We hypothesized that microbiological outcome was associated with stage-specific immune changes in peripheral whole blood during TB treatment. The T-cell phenotypes of treated TB patients were prospectively characterized in a blinded fashion using mass cytometry after Mycobacterium tuberculosis (Mtb) antigen stimulation with QuantiFERON-TB Gold Plus, and then correlated to sputum culture status. At two months of treatment, cytotoxic and terminally differentiated CD8+ T-cells were under-represented and naïve CD4+ T-cells were over-represented in positive- versus negative-sputum culture patients, regardless of Mtb drug susceptibility. At treatment completion, a T-cell immune shift towards differentiated subpopulations was associated with TB cure. Overall, we identified specific T-cell profiles associated with slow sputum converters, which brings new insights in TB prognostic biomarker research designed for clinical application.

Pharmacological treatment of multidrug-resistant tuberculosis (MDR-TB) in patients co-infected with HIV and its incidence in Federal District – Brazil

People living with HIV (PLHIV) are at greater risk of infection and development of tuberculosis, caused by Mycobacterium tuberculosis. In Brazil, the high mortality rate is identified precisely on the occasion of coinfection and it can actively lead to severe complications. This study aimed to analyze the treatment of multidrug-resistant tuberculosis in patients co-infected with HIV and the incidence of this condition in the Federal District, Brazil. We reviewed the literature via the databases PubMed, Embase, and Biblioteca Virtual em Saúde between September and October of 2021, and selected 15 studies fitting the eligibility criteria. The unified health system provides the first-line treatment and recommends using the Directly Observed Treatment. However, when there is resistance or significant intolerance to first-line drugs, second-line drugs are needed. Drug repositioning may be a promising strategy to improve tuberculosis treatment through new therapeutic options and to overcome these problems. The risk of interactions and their complications in PLHIV in antiretroviral therapy and second-line treatment of tuberculosis is even more concerning, which can result in reduced efficacy or increased toxicity of both treatments. Nevertheless, children show better outcomes among patients in TB/HIV co-infection studies, even after second-line treatment fails. These results demonstrate the complexity and seriousness of co-infection epidemiology, treatment, follow-up, and margin of success. Aggravated by factors such as increasing resistance to M. tuberculosis in Brazil and the world, the challenge of monitoring patients' treatment and keeping their adhesion, and the high rate of adverse effects caused by drugs.

Changes in Pattern and Multifocal Electroretinogram in Tuberculosis Patient with Ethambutol Therapy

Introduction: Tuberculosis (TB) is a world health problem, especially in Indonesia as the third biggest country for new emerging TB patients. Ethambutol is one of the standard therapies to treat TB patients in Indonesia. Ethambutol has a side effect called ethambutol optic neuropathy which is hard to diagnose due to normal fundus appearance in most cases and therefore often detected late. Early detection is necessary so that permanent damage can be prevented. Examination pattern electroretinography (pERG) and multifocal electroretinography (mfERG) have the advantage to detect and confirm ocular toxicity by ethambutol after the clinical problem had emerged. It is not yet known neither pERG nor mfERG could detect any changes to detect ethambutol ocular toxicity before the clinical problem emerged. Methods: This study was a prospective clinical trial with 40 eyes samples and analyzed with paired t and Wilcoxon tests. The ocular examination was conducted using the Snellen chart, HRR Richmond Plates, Pelli Robson, pERG, and mfERG in tuberculosis category 1 patient with 2 months follow-up. Result: Visual acuity, color, and contrast sensitivity were normal in all patients for 2 months follow-up period. In pERG examination, the mean implicit time wave P50 was shortened by -1.27± 4.71 mS (p=0.049), and the mean amplitude wave N95 was reduced by -0.93± 4.49 ?V (p=0.038). Both were statistically significant. In the mfERG examination, we did not find any statistically significant changes in both wave N1 and P1. Conclusion: Changes in pattern ERG presented earlier compared to mfERG after ethambutol therapy for 2 months.

Safety and Efficacy of Multiple Drug Resistant Tuberculosis Treatment in Patients with Different HIV Statuses

The objective: to analyze and compare frequency and variety of adverse events (AEs) and their impact on outcomes of tuberculosis therapy when treating patients with multiple drug resistant tuberculosis (MDR TB) and different HIV statuses.Subjects and Methods: retrospective observational case-control study of patients registered for treatment with the 4th regimen of chemotherapy for tuberculosis in the city of Vladimir and Vladimir Region in 2014-2016.Results. The proportion of patients who reported any AE during the MDR TB treatment was similar among HIV positive and HIV negative patients and made 85.5%. In patients with concurrent HIV infection and MDR TB, hematopoietic AEs such as anemia, thrombocytopenia were more frequent, while neutropenia was significantly more frequent when comparing groups by the cumulative event probability method. Elevated eosinophil level during treatment was more typical of MDR TB patients. Treatment outcomes in the group of patients with HIV and MDR TB were statistically significantly worse due to the higher frequency of fatal outcomes. At the same time, there was no correlation of AE with unfavorable treatment outcomes. The early initiation of combination therapy with thorough monitoring of hematologic parameters in patients with HIV and MDR TB was safe and effective.

Reevaluating Rifampicin Breakpoint Concentrations for Mycobacterium tuberculosis Isolates with Disputed rpoB Mutations and Discordant Susceptibility Phenotypes.

ABSTRACTIn this study, rifampicin resistance breakpoints based on MICs of disrupted rpoB mutants of Mycobacterium tuberculosis (MTB) were explored using the Mycobacteria Growth Indicator Tube (MGIT) system and microplate alamarBlue assay (MABA). Sixty-one MTB isolates with disputed low-level rifampicin resistance-associated rpoB mutations and 40 RIF-susceptible wild-type isolates were included. Among the 61 resistant isolates, 25 (41.0%) had MICs ≥2.0 mg/L via MABA, while 16 (26.2%) were identified as RIF resistant via MGIT. Epidemiological cut-off (ECOFF) values obtained using MABA and MGIT were 0.25 and 0.125 mg/L, respectively. Based on 0.125 mg/L as a tentative critical concentration (CC), MABA RIF resistance-detection sensitivity was 93.4%, prompting the reduction of the MGIT CC to 0.125 mg/L, given that only a single isolate (1.6%) with the borderline mutation would be misclassified as susceptible to RIF based on this CC. Based on DNA sequencing of RRDR as the gold standard, the diagnostic accuracy of MGIT (99.0%) was significantly higher than that of MABA (91.1%). MICs of Leu511Pro mutant isolates were negatively correlated with time to liquid culture positivity (TTP) in our analysis (R = 0.957, P < 0.01). In conclusion, our results demonstrated missed detection of a high proportion of rifampicin-resistant isolates based on the WHO-endorsed CC. Such missed detections would be avoided by reducing the optimal MGIT RIF CC to 0.125 mg/L. In addition, MGIT based on reduced CC outperformed MABA in detecting borderline RIF resistance, with MABA MIC results obtained for isolates with the same mutation correlating with MTB growth rate.IMPORTANCE Tuberculosis (TB) is still one of the world's leading infectious disease killers. The early and accurate diagnosis of RIF resistance is necessary to deliver timely and appropriate treatment for TB patients and improve their clinical outcome. Actually, a proportion of MTB isolates with disputed rpoB mutations present a diagnostic dilemma between Xpert and phenotypical drug susceptibility testing (pDST). Recently, WHO reported a pragmatic approach by lowering critical concentration (CC) to boost sensitivity of resistance detection of pDST. Therefore, a detailed analysis of the association between RIF susceptibility and disrupted mutations within rpoB gene would lay a foundation to assess the diagnostic accuracy of pDST with lowering RIF CC. In this study, we aim to determine the MICs of MTB isolates with disrupted mutations by MGIT and microplate alamarBlue assay (MABA). We also aimed to determine the optimal breakpoints for MTB isolates with these mutations.

Клінічна ефективність фітоентеросорбенту в комплексному лікуванні хворих із вперше діагностованим деструктивним туберкульозом легень

Актуальність. Пошук патогенетичних методів лікування, що спрямовані на нормалізацію імунного статусу хворого на туберкульоз без призначення специфічних імуномодуляторів, залишається актуальним. Це стало основою для планування нашого дослідження. Ентеросорбенти є безпечними препаратами, що мають імуномодулюючі властивості, і ці властивості забезпечуються не прямим, а опосередкованим їх впливом на стан системного імунітету завдяки детоксикаційній дії. Мета дослідження — вивчити вплив фітоентеросорбенту на показники системного імунітету та ефективність застосування його в комплексному лікуванні хворих на вперше діагностований деструктивний туберкульоз легень. Матеріали та методи. У рандомізованому контрольованому дослідженні брали участь 125 пацієнтів. Це були хворі на лікарсько-чутливий туберкульоз органів дихання з розпадом легеневої тканини та без розпаду і 25 здорових добровольців. Вивчали стан гуморальної, клітинної ланок імунітету, нейтрофільного та моноцитарного фагоцитозу. А також проводили дослідження впливу використання фітоентеросорбенту в комплексній терапії хворих на туберкульоз на концентрацію протитуберкульозного препарату ізоніазиду в крові хворих. Результати. Використання в комплексній терапії хворих на лікарсько-чутливий вперше діагностований деструктивний туберкульоз легень фітоентеросорбенту не вплинуло на показники клітинного імунітету, але сприяло нормалізації показників його В-ланки — вірогідному зниженню кількості CD22+-лімфоцитів, рівня IgG, IgA та циркулюючих імунних комплексів у крові хворих, нормалізації фагоцитарної активності фагоцитуючих клітин. Використання фітоентеросорбенту в комплексному лікуванні хворих на туберкульоз не призвело до зниження концентрації протитуберкульозного препарату ізониазіду в крові хворих, а, навпаки, підвищило її и не сприяло появі побічних реакцій від прийому ізоніазиду. Висновки. Комплексне лікування хворих на лікарсько-чутливий вперше діагностований деструктивний туберкульоз легень з використанням фітоентеросорбенту призвело до підвищення ефективності лікування за темпами загоєння деструкцій на 21,4 %.

The efficacy of drug resistant tuberculosis treatment in patients with different comorbidity status

Introduction. The efficacy of multidrug resistant (MDR) and extensive drug resistance (XDR) tuberculosis (TB) therapy is not yet resolved up to now. New regimens including tioureidoiminomethylpyridinium perchlorate (Tpp) and bedaquiline (Bq) can improve the efficacy of treatment, but due to the growing comorbidities and lack of comprehensive assessment of their severity it is difficult to define the impact of such comorbidities on the efficacy of treatment in this cohort of patients. Ма-terials and methods. Retrospective study has been conducted to review the efficacy of therapy in MDR and XDR TB patients from 18 years of age and with bacteri-al excretion (n=303), who received therapy from 2016 tо 2019. Patients were divided into two main groups: Group I — patients with MDR TB (n=153); Group II — pa-tients XDR TB (n=150). Statistical analysis of the results was carried out via Statistica 10.0 and SPSS 16.0 &amp; Graph-Pad Prism 6 software. Spearman’s correlation coefficient was applied, with meaningful p≤0.05. Results. Theeffi-cacy of therapywas statistically significant higher in MDR TB patients (66.7% vs 40.7%, where χ2=20.6, р&lt;0.01), meanwhile XDR TB patients on the background of low efficacy of treatment show significantly high percent of defaulted treatment (16.7% vs 3.9%, where χ2=13.4, р&lt;0.01). Comorbidity impacts of therapy in XDR TB pa-tients’ treatment especially chronic liver pathology and gastrointestinal diseases (GIT). However, applying Tpp and Bq in scheme of therapy, the treatment outcomes in XDR TB patients with Charlson comorbidity index (ChI) from 3 to 4 improved in 44,8 и 41,1% of cases respec-tively. Conclusions. XDR TB patients are the most severe group of patients in terms of comorbidities that contrib-ute to the low efficacy of treatment. Applying of Tpp and Bq in scheme of therapy allows to efficacy of treatment in 44,8 и 41,1% of cases respectively in severe comorbid-ity patients. It is recommended to use in scheme of ther-apy new anti-TB drugs (Tpp and Bq) after examination of chronic liver pathology and GIT diseases.

Bronchial Hyper-responsiveness in Post-tubercular Patients: A Case-control Study

Introduction: Bronchial hyper-responsiveness is the manifestation of excessive bronchoconstriction in response to diverse types of stimuli both physical and chemical. It is the most characteristic feature of bronchial asthma; it also occurs in a spectrum of other diseases like Chronic Obstructive Pulmonary Disorders (COPD) and reactive airway syndrome and may be provoked by a variety of stimuli like histamine and methacholine. Patients of healed pulmonary Tuberculosis (TB) show varying extent of lung impairment such as fibrosis, collapse, emphysema and broncho alveolar destruction. Aim: To assess the incidence and severity of obstructive airway diseases in previously treated TB patients. Materials and Methods: This was a prospective case control study, carried out in the Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from September 2017 to September 2019, this study included 120 patients of previously treated TB, who were divided into two groups. The case group (71) included patients who completed treatment for TB and had dyspnoea. The control group (49) consisted of patients who completed the treatment but did not have dyspnoea. The patients were subjected to spirometry, histamine bronchial challenge test and computed chest tomogram along with routine investigations including sputum for Acid Fast Bacilli (AFB). Results: The present study showed significant histamine hypersensitivity among post TB patients. In the case group, 34 (56%) patients showed positive response to bronchial challenge test with histamine; while in control group only 7 (14%) showed a positive response (p-value=0.004). Pulmonary function test (spirometry) showed an obstructive pattern in 35 (49%) case group patients, while normal pattern was the most common finding seen in 23 (47%) in the control group followed by obstruction in 10 (21%) patients. Among the cases, the mean Forced Expiratory Volume in the first second (FEV1) was 65.77±15.98, while among the controls, it was 80.02±8.81. The case group had a mean Forced Expiratory Volume in the first second/Forced Vital Capacity (FEV1/FVC) of 78.09±15.75, as against 81.33±16.79 in the control group. Conclusion: Airway bronchial hyper-reactivity is a prominent feature in previously treated tubercular patients. This underlines the need for proper attention towards post-tubercular lung function impairment and proper treatment of such patients so as to lessen the impact of bronchial hyper-reactivity on patient symptoms and their quality of life.

POSC146 Cost-Effectiveness of Adherence in Newly Treated Tuberculosis Patients Using Discrete Event Simulation

Despite the national efforts to reduce Tuberculosis (TB) patients, the number of patients in South Korea is considered the largest among OECD countries. Poor adherence to anti-tuberculosis treatment is an obstacle to tuberculosis control. Therefore, we evaluate the cost-effectiveness of adherence to TB treatment by comparing adherent patients and non-adherent patients using simulation techniques.

Analytical Method Development and Validation for the Simultaneous Estimation of Rifampicin and Isoniazid in its Bulk and Pharmaceutical Dosage Forms by RP-HPLC

Background A combination of Rifampicin and Isoniazid is the drug of choice to treat tuberculosis patients in sustenance or those travelling to a region where there is a probability of being infected with tuberculosis.Objective The main objective of the simultaneous estimation of combined drug was to establish identity purity physical characteristics and potency of the drugs.Methodology The chromatographic environment was fortunately evolved for the partition of Rifampicin and Isoniazid by using column thermosil RPC18 4.5times100 nm 5.0 microm flow rate was 1 mLmin mobile phase ratio was 7030 vv methanolsodium acetate buffer. A pH of 3 was adjusted with Ortho phosphoric acid wavelength was detected at 240 nm. Column dimensions were Thermosil C184.6times100mm 5.0 microm.Results The results were in good agreement with those obtained with official HPLC with absorption maximum at 240 nm by preparing mobile phase 7030 methanolsodium acetate buffer with a flow rate 1 mLmin and it ran for 5 minutes by selecting thermosil RPC18 4.5times100 nm of ambient temperature. All the results obtained were precise accurate and robust as per international conference on Harmonization ICH guidelines.Conclusion It can be concluded that the proposed Reverse Phase High Performance Liquid Chromatographic RPHPLC method is accurate precise sensitive specific robust and reproducible for the simultaneous analysis of Rifampicin and Isoniazid with less tailing factor and is also economical. Thermosil RPC18 4.5times100 nm 5.0 microm flow rate was 1 mLmin. Both the samples were in the range of 200 to 400 nm and maximum wavelength was identified at 240 nm.

STUDI MANFAAT INOVASI PELAYANAN OBAT DENGAN KOPI TB (KOTAK PENGINGAT MINUM OBAT TB) DI PUSKESMAS BANJARMASIN INDAH KOTA BANJARMASIN

TB (Tuberculosis) is an infectious disease caused by Mycobacterium tuberculosa. Treatment of patiens with regular administration of drugs is done for six months to get healed. The cause of TB treatment failure is the patient forgets to take medication which results in dropping out. Drug service using KOPI TB is a method of TB drugs administration with reminder box to remind patient to take TB medicines that are taken home. This study aims to determine the benefits of innovative drug services using KOPI TB. This research is in the form of quantitative descriptive with prospective data collection using 13 TB patient treatment data in year 2018. The results of this study indicate that there was an increase in the patient cure rate which is 93%, while the rate before innovation was only 86%. The use of KOPI TB also increases the efficiency of TB drugs which the need for TB patient is 13 boxes, while the drugs used was only 12 boxes which is saving 1 box of TB drugs. The conclusion of this study is the innovation of drug services using KOPI TB increases the cure rate of patients and the efficiency of the number of TB drugs used in the Puskesmas.