Tuberculosis Hospital Research Articles

Analysis of Instrument Development to Evaluate Employee Protection from Tuberculosis in Hospitals

Introduction: Tuberculosis (TB) continues to be a major global public health threat, affecting millions of people annually. Despite efforts to control TB, the number of cases remains high. The situation is exacerbated by the COVID-19 pandemic, which has strained healthcare systems. The increased workload of hospital employees also raises the risk of TB transmission. This study aims to develop an instrument to evaluate employee protection from TB in hospitals. Methods: This study used a qualitative design with an exploratory approach. Data were collected from existing policies and through in-depth interviews with stakeholders, including academics, practitioners, regulators, infection control officers, occupational health and safety officers, and non-government organization representatives for TB. Results: The instrument developed comprised seven components, namely management commitment; program planning; coordination, communication, and education; implementation of TB and other disease management programs in the workplace; handling TB cases in the workforce; training and competence; and monitoring and evaluation. Conclusion: Instrument development is crucial for capturing the current state of TB problems and managing prevention and control programs in hospitals. The terms of reference serve as an effort to protect hospital employees

Treatment Results of Multidrug-Resistant Tuberculosis Patients in the Aegean Region.

We aimed to evaluate 109 rifampicin-resistant or multidrug-resistant tuberculosis patients who are treated in Izmir Chest Diseases MDR Tuberculosis Centre. The patient profile, side effects, treatment success, and mortality of rifampicin-resistant or multidrugresistant tuberculosis patients who were followed up and treated in our hospital's tuberculosis service between 2010 and 2018 were analyzed retrospectively. Of the rifampicin-resistant or multidrug-resistant tuberculosis patients, 83 (76.1%) were male and the mean age was 46.3 ± 16.3 years. Of the cases 13 (11.9%) had rifampicin resistance without isoniazid. Since 5 out of 109 patients diagnosed with multidrugresistant tuberculosis emigrated to other countries, the treatment results of 104 patients were evaluated. As a result of the treatment, the cure was achieved in 81 (77.9%) patients and treatment was completed in 13 (12.5%). Treatment success was found as 90.4%. No patient experienced recurrence. The mortality rate was determined as 9.6%. The cure rate of patients treated with ≥6 drugs (90.9%) was statistically significantly (P = .029) higher than the group treated with ≤5 drugs (71.8%). Multidrug-resistant tuberculosis treatment is a long-term, financially burdensome practice that may cause serious side effects and complications, and it requires strict discipline. The fight against tuberculosis can be successful with tuberculosis control programs that are pursued with determination.

Impact of Deprivation on the Incidence and Severity of Tuberculosis in Children: A Retrospective Study from 2007 to 2020 in a Tertiary Care Center in Paris, France

To assess the association between deprivation and the incidence and clinical severity of tuberculosis (TB) in children. Children ≤18years old who were admitted for TB between 2007 and 2020 at a tertiary hospital were included in this retrospective study. Deprivation was assessed using the French Deprivation Index. TB severity was assessed using the Wiseman classification. Multivariate analyses were carried out. In total, 222 patients were included. The median age was 10.8years (IQR 4.5-14.4). TB was considered severe in 126 patients (56.8%), with 50% of the patients included in the 2 most deprived groups. The most-deprived children had a TB incidence that was 58 times greater than that of the least-deprived children (95% CI 28.49-119.40). There was no significant association between deprivation and severity in the multivariable analysis after adjusting for age and circumstances of diagnosis. Deprivation was associated with an increased length of stay in the most-deprived groups (OR3.79, 95% CI 1.55-10.23). There was a trend toward a greater proportion of symptomatic children in the most-deprived group. TB incidence and hospital length of stay increased with deprivation levels but not with the severity of TB.

They do not have symptoms – why do they need to take medicines? Challenges in tuberculosis preventive treatment among children in Cambodia: a qualitative study

BackgroundLatent tuberculosis (TB) infection has been known as a seedbed for TB disease later in life. The interruption from latent TB infection to TB disease can be done through TB preventive treatment (TPT). In Cambodia, only 40.0% of children under five years old who were the household contacts to bacteriologically confirmed TB cases were initiated with TPT in 2021. Scientific studies of context-specific operational challenges in TPT provision and uptake among children are scarce, particularly in high TB-burden countries. This study identified challenges in TPT provision and uptake among children in Cambodia from the perspective of healthcare providers and caregivers.MethodsBetween October and December 2020, we conducted in-depth interviews with four operational district TB supervisors, four clinicians and four nurses in charge of TB in referral hospitals, four nurses in charge of TB in health centers, and 28 caregivers with children currently or previously on TB treatment or TPT, and those who refused TPT for their eligible children. Data were audio recorded along with field notetaking. After verbatim transcription, data analyses were performed using a thematic approach.ResultsThe mean age of healthcare providers and caregivers were 40.19 years (SD 12.0) and 47.9 years (SD 14.6), respectively. Most healthcare providers (93.8%) were male, and 75.0% of caregivers were female. More than one-fourth of caregivers were grandparents, and 25.0% had no formal education. Identified key barriers to TPT implementation among children included TPT side effects, poor adherence to TPT, poor understanding of TPT among caregivers, TPT risk perception among caregivers, TPT’s child-unfriendly formula, TPT supply-chain issues, caregivers’ concern about the effectiveness of TPT, being non-parental caregivers, and poor community engagement.ConclusionFindings from this study suggest that the national TB program should provide more TPT training to healthcare providers and strengthen supply chain mechanisms to ensure adequate TPT drug supplies. Improving community awareness of TPT among caregivers should also be intensified. These context-specific interventions will play a crucial role in expanding the TPT program to interrupt the development from latent TB infection to active and ultimately lead to ending TB in the country.

Influencing factors of the adverse outcome of pulmonary tuberculosis among adolescents in Hangzhou City between 2005 and 2020: a school-based retrospective cohort study

Objective: To explore the influencing factors of the adverse outcome of pulmonary tuberculosis (PTB) among adolescents in Hangzhou City between 2005 and 2020. Methods: A retrospective cohort study was used to collect the information of adolescent PTB patients with the onset of PTB occurring from January 1, 2005 to December 31 in 12 designated tuberculosis hospitals in Hangzhou, mainly including demographic, epidemiological, clinical manifestations, bacteriological characteristics and other data, through the China Management Information System for Infectious Disease Surveillance and Reporting and the follow-up survey. All patients were followed up and the end time was December 31, 2021. Multivariate Cox regression model was used to analyze the factors affecting the adverse outcome of these patients. Results: The mean age of 4 921 adolescent PTB patients was (18.9±3.6) years old, and the number of male and female patients were 3 074 and 1 847 respectively. The adverse outcome accounted for 14.7% (725) of all patients. Multivariate Cox regression model showed that eight risk factors, including management model from patients themselves or family members (HR=5.87, 95%CI: 4.55-7.64), molecular biology examination positive for PTB (HR=4.62, 95%CI: 2.98-7.19), the number of sputum smears-positive≥1 (HR=3.72, 95%CI: 2.87-4.83), non-standardized therapy regimens of PTB (HR=3.69, 95%CI: 2.95-4.64), history of retreated PTB (HR=2.22, 95%CI: 1.46-3.36), migrant adolescents (HR=1.89, 95%CI: 1.54-2.34), the number of chest X-ray scan (HR=1.83, 95%CI: 1.65-2.04), and severe PTB (HR=1.38, 95%CI: 1.02-2.05), were associated with the adverse outcome of adolescent PTB patients. Age (HR=0.94, 95%CI: 0.92-0.96), as the only protective factor, was associated with the adverse outcome of these patients. Conclusion: The management mode, molecular biological examination, chemotherapy program, history of tuberculosis, sputum smear examination, severity of tuberculosis, household residence, chest X-ray examination and age are associated with the adverse outcomes of adolescent PTB patients in Hangzhou.

Overdiagnosis of Tuberculosis in Patients Referred for Hospitalization to TB Unit

The objective: to establish the reasons of discrepancy between the preliminary and final clinical diagnoses in patients admitted to TB inpatient unit, to determine ways to improve the diagnosis of tuberculosis at the pre-hospital stage.Subjects and Methods. We studied 130 medical records of patients (77 HIV negative patients - Group 1, 53 HIV positive patients – Group 2) admitted to the inpatient unit of TB hospital in 2014-2022, in whom tuberculosis (TB) was excluded after examination.Results. In Group 1, all patients were preliminary diagnosed with pulmonary tuberculosis, in Group 2, 29 patients were preliminary diagnosed with pulmonary tuberculosis and 24 patients - with tuberculous meningitis (TM). Primary examination and analysis of medical records caused doubts about the diagnosis of 60 (77.9%) patients in Group 1, and 40 (75.5%) patients in Group 2. When pulmonary tuberculosis was suspected, pneumonia and cancer were most often verified: 33.8% and 27.3% in Group 1, 51.7% and 24.1% in Group 2, the causes of diagnostic errors at the pre-hospital stage included insufficient attention to medical history and clinical manifestations; outcomes of treatment with broad-spectrum antibiotics were ignored; no control radiological examination was performed; diagnostic fibrobronchoscopy, chest computed tomography, consultations of medical specialists were not provided. Often HIV negative individuals 25/47 (53.2%) had false positive results of sputum microscopy. In Group 2, in 24 patients with suspected tuberculous meningitis, the final diagnosis was cerebral toxoplasmosis (41.7%) and mycotic meningitis (25.0%). Poor coverage with neuroimaging, genetic molecular and serological tests led to diagnostic errors.

The Determinants of Treatment Delay and Quality of Life among the Newly Diagnosed Pulmonary Tuberculosis Patients in Northeastern Thailand: A Cross-Sectional Study.

Delays in diagnosing pulmonary tuberculosis (PTB) are linked to financial difficulties, employment limits, dependency, and symptomatic treatment, all of which have an impact on the patient's quality of life. Patients' psychological, economic, and social well-being are also harmed by delayed therapy. The goal of this research was to evaluate sociodemographic characteristics and quality of life in new pulmonary TB patients and determine the associated factors with delayed TB diagnosis. This was a cross-sectional study conducted in the Choke Chai Community Hospital, in Northeastern Thailand between 2016 and 2018. The information related to the patient's medical history and laboratory tests were gathered from 332 newly diagnosed tuberculosis patients at the hospital's tuberculosis clinic; of those 15 died and were excluded from the final analysis. Data were analyzed using SPSS version 17.0. The cases included new cases (94%) and those returning to receive treatment after discontinuation of treatment, relapse, or recurrence of the disease (6%). The sample consisted of 68.7% males and 31.3% females. The average age was 52.7 years (S.D = 15.64). The majority of patients were married (60.5%), employed (68.6%), received a low income (66.6%), had a history of chronic diseases (73%), drank alcohol (31.7%), and smoked (85.7%). Approximately half of PTB experienced treatment delay and had a low quality of life (QoL) (46.6%). The treatment delay was associated with age > 50 years (p <0.05), low self-care (p <0.05), long distance to facility (p <0.05), unavailable caretaker to treat (p <0.05), no caregiver in family (p <0.05), high expenses (p <0.01), and lack of information (p <0.001). It appeared that the patients' health-related quality of life could be deteriorated as a result of pulmonary tuberculosis. Treatment delays can be significantly reduced by changing the understanding of family caregivers, increasing awareness, providing adequate support for patients, and guaranteeing early diagnosis and treatment by implementing an efficient surveillance system.

Diagnosis and Management of Adult Tuberculosis Patients Admitted to a Rural Hospital in Ethiopia.

Background Ethiopia is one of the countries in the world with the highest rate of tuberculosis (TB). The aim of this study is to describe the characteristics of the patients with TB admitted to a rural hospital in Ethiopia in terms of both diagnosis and clinical management. Methods A retrospective descriptive observational study was conducted. Data were collected from patients older than 13 years who were admitted to the Gambo General Hospital for TB between May 2016 and September 2017. The variables studied were age, sex, symptoms, human immunodeficiency virus (HIV) serology, nutritional status, presence of anemia, chest x-ray or other complementary tests, type of diagnosis (smear microscopy, Xpert MTB-RIF (Cepheid, Sunnyvale, California, USA), or clinical diagnosis), treatment received, outcome, and days of admission. Results One hundred eighty-six patients, aged 13 years and older, were admitted to the TB unit. About 51.6% were female, and the median age was 35 years (interquartile range (IQR) 25-50). Cough was the most frequent symptom on admission (88.7%), and contact with a TB patient was only recognized by 22 patients (11.8%). HIV serology was performed in 148 patients (79.6%); seven were positive (4.7%). About 69.3%met the criteria for malnutrition (body mass index (BMI) <18.5). Most patients, 173 (93%), presented with pulmonary TB and were new cases (94.1%). Patients were diagnosed by clinical parameters in 75% of cases. Smear microscopy was performed in 148 patients, of which 46 (31.1%) were positive, and Xpert MTB-RIF results were only obtained in16 patients, of which 6 (37.5%) were positive. Chest x-rays were performed in most patients (71%) and were suggestive of TB in 111 (84.1%). The average length of hospital stay was 32 days (confidence interval (CI) 13-50.5). Women tend to be younger than men, have more extrapulmonary TB, and were admitted longer. Nineteen patients died during admission (10.2%). Patients who die were more frequently malnourished (92.9% of those who die were malnourished compared to 67.1% of those who did not die, p = 0.036), tend to be admitted for a shorter time than the survivors and receive more concomitant antibiotic treatment. Conclusions In this rural Ethiopian setting, patients admitted to the hospital for TB are often malnourished (67.1%), the main presentation is pulmonary, mortality is one in 10 admissions and very often receive antibiotics in association with TB treatment (40%).

Optimizing Moxifloxacin Dose in MDR-TB Participants with or without Efavirenz Coadministration Using Population Pharmacokinetic Modeling.

Moxifloxacin is included in some treatment regimens for drug-sensitive tuberculosis (TB) and multidrug-resistant TB (MDR-TB). Aiming to optimize dosing, we described moxifloxacin pharmacokinetic and MIC distribution in participants with MDR-TB. Participants enrolled at two TB hospitals in South Africa underwent intensive pharmacokinetic sampling approximately 1 to 6 weeks after treatment initiation. Plasma drug concentrations and clinical data were analyzed using nonlinear mixed-effects modeling with simulations to evaluate doses for different scenarios. We enrolled 131 participants (54 females), with median age of 35.7 (interquartile range, 28.5 to 43.5) years, median weight of 47 (42.0 to 54.0) kg, and median fat-free mass of 40.1 (32.3 to 44.7) kg; 79 were HIV positive, 29 of whom were on efavirenz-based antiretroviral therapy. Moxifloxacin pharmacokinetics were described with a 2-compartment model, transit absorption, and elimination via a liver compartment. We included allometry based on fat-free mass to estimate disposition parameters. We estimated an oral clearance for a typical patient to be 17.6 L/h. Participants treated with efavirenz had increased clearance, resulting in a 44% reduction in moxifloxacin exposure. Simulations predicted that, even at a median MIC of 0.25 (0.06 to 16) mg/L, the standard daily dose of 400 mg has a low probability of attaining the ratio of the area under the unbound concentration-time curve from 0 to 24 h to the MIC (fAUC0-24)/MIC target of >53, particularly in heavier participants. The high-dose WHO regimen (600 to 800 mg) yielded higher, more balanced exposures across the weight ranges, with better target attainment. When coadministered with efavirenz, moxifloxacin doses of up to 1,000 mg are needed to match these exposures. The safety of higher moxifloxacin doses in clinical settings should be confirmed.

COVID-19 diseases, understanding and treatments

Seobuk Hospital is a hospital directly operated by the Seoul Metropolitan Government and has mainly served as a tuberculosis hospital. It is a Seoul city governmental public hospital which primarily provides inpatients and out patients treatment to the elderly, many of them suffering from dementia patients and the marginalized, such as the homeless and the disabled. From March 2nd, 2020, to May 31th, 2022 Seobuk hospital was appointed to treat COVID-19 patients that required stationary treatment. South Korea’s COVID-19 mortality rate has below 0.1% while in other countries such as the United States and in Europe the mortality rate varies between 1 and 2 %. We believe that it is due to the quarantine system which was put in place right from the start of the COVID-19 pandemic in Febuary 2020. Patients testing positive for COVID-19 were hospitalized free of charge and they were hospitalized usually in early period (2 - 3 days after COVID -19 testing) of COVID-19 disease. In this paper we analyzed the disease patterns of patients hospitalized with COVID-19 using the data from the 4,531 patients charts which received treatment in Seobuk hospital between March 2nd, 2020 and May 31st, 2022 by looking at their clinical features and medication history and medications for treatment. The key element of the guideline of our treatment was to administer Veklury (Remdesivir) or Paxlovid despite its high cost in the early period of the COVID-19 disease when oxygen saturation dropped below 94%. Nowadays we administer Veklury and Paxlovid right after COVID-19 is daignosed free of charge for the proper patient. It is believed that the current quarantine system in South Korea which allows patients to be treated with Veklury (Remdesivir) in hospitals at the initial stage of the infection and with an early Paxlovid administration in home treatment has contributed to lowering the death rate in South Korea.

MORTALITY OF TUBERCULOSIS PATIENTS IN THE METROPOLIS IN THE CONDITIONS OF EXTERNAL AND INTERNAL MIGRATION

The study analyzed the data of the register of the tuberculosis monitoring system in Moscow on total 3372 cases of death of TB patients from all causes that occurred in the city in 2017-2022, including 1239 deaths from tuberculosis, 1144 deaths from HIV-TB (B20.0/ B20.7) and 989 deaths from other causes. The relationship between the distribution of causes of death and the group of the population to which the deceased belonged was shown, among which 56.9% were from the resident population, 20.8% of homeless people, 16.0% of residents of other regions of Russia (Moscow nonresidents) and 6.3% of foreigners. The importance of controlling the mortality of TB patients from other causes was noted, among which, for those who died from the permanent population, Moscow non-residents and foreigners, more than 80% were associated with concomitant diseases, the course of which is aggravated in the presence of tuberculosis. The most important epidemiological characteristics of cases of death of TB patients are considered - the age and sex structure, the place of death and the status of the patient’s lifetime registration as a TB patient. Among the dead TB patients, about 75% were men and 53.6% were over 45 years old. The proportion of deaths outside a tuberculosis or infectious diseases hospitals, totaling 37.0%, largely depended both on the causes of death of TB patients and on the population group: 24.7% – for Moscow non-residents, about 40% – for homeless people, for cases of those who died from other causes, the proportion of these cases was 50% or more, and for those who died from HIV-TB – from 5.8% among Moscow non-residents to 21.9% among foreigners. In general, the proportion of deaths less than 1 month after registration as a TB patient (including post-mortem detection) was 37.1%, with 30.8% for the permanent population and almost 50% for homeless people and foreigners. Multivariate analysis showed that dying before registration or less than 1 month after registration as a TB patient was 3.5 times more likely to occur in a non-TB or infectious diseases hospital, and 2.6 times more likely to occur in patients with generalized severe forms of tuberculosis, and 1.5 times in foreigners. Belonging to the resident population was a «protective» factor in terms of the fact that death will occur earlier than 1 month after registration as a TB patient, that is, the chance of belonging to TB patients from the resident population in this group of deaths is 1.3 times lower compared to homeless people, Moscow non-residents and foreigners. Having confirmed that there is a generally favorable situation with tuberculosis in the Moscow, it is shown that for its further effective control it is necessary to constantly monitor the mortality of tuberculosis patients from all causes in the context of various population groups residing in the city, with an assessment of the proportion of deaths not in tuberculosis or infectious hospitals and the proportion of those diagnosed posthumously and up to a month after registration as a TB patient.

Analysis of drug resistance in pulmonary tuberculosis patients with positive sputum tuberculosis culture in Northeast China.

Objective: The objective of this study is to determine the drug resistance status of pulmonary tuberculosis patients in Jilin Province. Methods: A retrospective survey was conducted on 395 sputum culture TB-positive patients admitted to the tuberculosis hospital in Jilin Province in 2019. Sputum samples were cultured in acidic Roche medium. Drug sensitivity testing was conducted using the proportional method. Sensitivity was reported if the percentage of drug resistance was less than 1%, and resistance was reported if the percentage was ≥1%. Statistical analysis was performed using SPSS 22.0. Results: 395 tuberculosis patients with positive sputum tuberculosis culture were included in the study, with 102 being initially treated and 293 being retreated. The study population consisted of 283 males and 112 females. Sex, age, nationality, occupation, marital status, diabetes comorbidity, initial treatment, normal health status, BCG vaccine vaccination, smoking, and alcohol consumption were considered as factors that may affect the rate of multidrug resistance. And only the history of treatment (initial treatment) was associated with multidrug resistance (p = 0.032). This indicates that retreatment is the most significant risk factor for the occurrence of multidrug resistance in tuberculosis. The multidrug resistance rate in retreated patients is 3.764 times higher than that in initially treated patients. Conclusion: The prevalence of multidrug-resistant is higher in retreated patients compared to initially treated patients in the study population. Multidrug resistance is only associated with the treatment history (initial retreatment) and not with other factors.

A Ten-Year Survey of Treatment Outcome in a Tuberculosis and Leprosy Referral Hospital Implementing Directly Observed Therapy Short (DOTS) Course

A Ten-Year Survey of Treatment Outcome in a Tuberculosis and Leprosy Referral Hospital Implementing Directly Observed Therapy Short (DOTS) Course

Risk Assessment of Major Adverse Cardiovascular and Cerebrovascular Events and Bleeding for Acute Myocardial Infarction With or Without Active Tuberculosis

PurposeThe underlying ischemic and bleeding risks of acute myocardial infarction (AMI) with active tuberculosis (TB) are unknown. The goal of this study was to explore the ischemic and bleeding risks, as well as treatment strategies during hospitalization, in patients with AMI with or without active TB. MethodsPatients were recruited from a tuberculosis hospital from 2014 to 2021. The primary outcomes were major cardiovascular and cerebrovascular events (MACE) and Bleeding Academic Research Consortium (BARC)-defined type 3 or 5 bleeding. Multivariate logistic regression and propensity score matching were performed for risk adjustment. Subgroups were defined according to AMI with active pulmonary TB and AMI with active TB undergoing percutaneous coronary intervention (PCI). FindingsA total of 242 patients were enrolled. Compared with AMI without active TB, AMI with active TB had a higher risk of MACE and BARC type 3 or 5 bleeding (P < 0.001 and P = 0.002, respectively). Multivariate logistic regression analysis showed that, compared with AMI without active TB, the odds ratio (OR) was 6.513 (95% CI, 2.195–19.331) for MACE in patients with AMI with active TB, and the OR was 16.074 (95% CI 3.337–77.436) for BARC type 3 or 5 bleeding in patients with AMI with active TB. After propensity score matching, AMI with active TB tended to increase the risk of MACE, although not statistically significantly (P = 0.189), and increased BARC type 3 or 5 bleeding (P < 0.001), compared with AMI without active TB. Results of subgroup analyses showed that active TB had outcomes consistent with those of the total cohort. AMI patients with active pulmonary TB who underwent PCI had a lower risk of MACE without an increase in the risk of bleeding compared with those not undergoing PCI. ImplicationsPatients with AMI with active TB have a higher risk of MACE (or severe MACE) and bleeding than patients with AMI without active TB. However, AMI patients with active TB are still advised to undergo PCI for a high net clinical benefit.

Hierarchy of labor motives of different professional groups of employees of medical institutions

Improving the productivity, quality and availability of medical services directly depends on the effectiveness of motivational mechanisms for personnel management. Despite the sufficient empirical and practical experience in the field of health workforce management, data on the comparison of labor motivation among different professional categories of medical personnel are not often found. The article analyzes the main labor motives of nurses and doctors, reveals the differences in the motivational profiles of these categories of workers.Purpose of the study. Is to study and compare the motivation of doctors and nurses from budgetary healthcare institutions providing TB care to the population.Materials and methods. A sociological survey was conducted using a questionnaire form containing questions to study the labor motivation of healthcare workers. The study involved employees of various professional categories of public medical institutions – the Republican Clinical Tuberculosis Hospital and the Makeyevka Municipal TB Dispensary. Labor motives are structured into 3 blocks: material, socio-psychological and individual.Results. In the overwhelming majority, doctors and nursing staff of public health care institutions with a phthisiology profile are equally satisfied with the work they do. The most significant labor motives were identified for each category of medical personnel. For paramedical personnel, the factor of material motivation came out on top, but a convenient work schedule, relationships with superiors and a favorable psychoemotional climate made up the five most significant work motives. Physicians are more influenced by individual and socio-psychological motives: self-realization and professional interest are in the lead, remuneration, relationships with colleagues and patient care have a complex effect on the activities of doctors.Conclusion. This study confirms the principle of polymotivation of all categories of employees, therefore, the modernization of the motivational environment should be carried out taking into account group affiliation, individual characteristics, preferences and personal qualities of employees. Personnel-oriented system of motivation of medical personnel will solve most of the problems faced by the healthcare sector in today's changing market relations.

A Retrospective Study of Seasonal Variation in the Number of Cases Diagnosed at a Tertiary Care Tuberculosis Hospital

To study the seasonality of tuberculosis (TB) in a tertiary care tuberculosis and respiratory hospital in Delhi. Data from a tertiary care respiratory hospital in south Delhi over a six years period from April 2002 to March 2008 were analysed. Symptomatics: A total of 192,863 patients were registered newly in the hospital during this period. Maximum number of symptomatic patients reported to the out-patient department during April-June and the minimum during October-December. An increase of about 25% in symptomatics was observed (p < 0.05) in the period from April to June in comparison to October to December. The amplitude of seasonal variation was estimated as 11% of the annual mean symptomatics. Tuberculosis cases: The maximum sputum-positive TB cases were diagnosed during the period from April to June and the number was least during October to December. There was an increase of about 34% in sputum-positive cases (p < 0.001) during the period from April to June against October to December. The amplitude of seasonal variation was estimated as 14.4% of the annual mean smear-positives per quarter. The extra-pulmonary TB (EPTB) cases were the maximum during April-June. Chest symptomatics of all types of TB cases were the lowest in January. A seasonal pattern of TB was observed for pulmonary TB and EPTB cases. This information would be useful for administration and managers to take extra care to arrange and provide extra facilities during the peak seasons.

Levofloxacin Use in Patients with Suspected Tuberculosis in a Community Hospital, Thailand: A Pilot Study.

Background Levofloxacin is one of the broad-spectrum antibiotics that is indicated for the second-line treatment of tuberculosis (TB). However, using levofloxacin as an empirical therapy for patients without confirmation of TB could still be observed. This descriptive retrospective study, therefore, aimed to investigate the number of levofloxacin use in patients suspected TB in a community hospital in Thailand. Methods Patient medical charts of all patients who were admitted to a community hospital in Nakhon Si Thammarat, Thailand, from 2016 to 2017, were reviewed. Patients who were suspected TB and received any levofloxacin-containing regimens were included. Data on patient characteristics and the received regimens were descriptively analyzed and reported as percentage and frequency. Results There were a total of 21 patients who received levofloxacin in the hospital. Six of them (28.57%) had the diagnosis of hepatitis. The most prescribed regimen as empirical therapy was levofloxacin, ethambutol, and amikacin (66.67%). After the confirmation of TB using acid-fast bacilli (AFB) test, ten patients (47.62%) still received levofloxacin-containing regimens. Conclusion The results from this study indicated high usage of levofloxacin despite no evidence of drug-resistant TB or negative AFB results in a community hospital in Thailand. The results from this study will be further used for the investigation of the prevalence of antibiotic resistance and clinical outcomes of using second-line regimens for TB treatment.

Chất lượng cuộc sống của người bệnh lao điều trị ngoại trú tại phòng khám Bệnh viện Lao bệnh Phổi Đăk Lăk và một số yếu tố liên quan, năm 2021

Objectives: To describe and to determine some related factors to the quality of life among tuberculosis patients beeing treated at the Clinic Dak Lak Tuberculosis and Lung Disease Hospital in 2021. Methods: A cross-sectional study was conducted among 143 TB patients beeing treated at the Clinic Dak Lak Tuberculosis and Lung Disease Hospital. The QoL of patients was assessed through the SF-36 questionnaire. A survey of 143 TB patients beeing treated showed that the average life score of TB patients was 49,9±6,6 points. There were 53,8% of TB patients with poor average QoL and 46,2% with moderate average QoL. Of the eight health issues mentioned in the QoL SF-36 scale, the CLCS score for mental well-being was the highest with 54,8± 1,3 points, and the QoL score for social activities was lowest with 43,3±1,7 points. The study showed a relationship between ethnicity and the QoL score of TB patients (p=0,04). The ethnic minority group of TB patients had higher QoL scores than the Kinh ethnic group. Conclusion: The QoL of TB patients was relatively low, especially their mental health. Assessing the QoL of TB patients requires further and more specific studied on target groups to evaluate the QoL of TB patients comprehensively.

Clinical and laboratory specific parameters of COVID-19 in patients with TB/HIV co-infection

The objective: to study clinical and laboratory specific parameters of the COVID-19 course in patients with TB/HIV co-infection, to analyze changes in the lungs caused by COVID-19 in patients with pulmonary tuberculosis and concurrent HIV infection.Subjects and Methods. 68 HIV-infected patients aged 18-66 years old were included in the study, they all were admitted to the Novosibirsk State Regional Clinical Tuberculosis Hospital, Novosibirsk, with confirmed COVID-19 from May 2020 to May 2021. Clinical manifestations, CD4 count and HIV RNA level, and the presence of secondary infections were assessed.Results. In patients with severe and profound immunodeficiency, coronavirus infection was more often mild to moderate, and in immunocompetent patients – moderate to severe. However, patients with profound immunodeficiency were at greater risk of an adverse outcome due to lymphohematogenic progression of tuberculosis and concurrent opportunistic infections.Conclusion. When diagnosing and treating COVID-19 in patients with comorbid HIV infection and tuberculosis, it is important to consider the form of tuberculosis and CD4+ count.

Clinical characteristics and outcome analysis of COVID-19 patients with pulmonary tuberculosis

Coronavirus disease (COVID-19) and tuberculosis (TB) are two respiratory infectious diseases with a high incidence of transmission, mainly via respiratory droplets and both can weaken the immune system and lower the number of CD4+T cells in patients. COVID-19 can occur before, at the same time or after the diagnosis of TB. Patients with pulmonary TB are more likely to have co-infection when they have a history of epidemiological exposure to COVID-19. At present, many cases of nosocomial infection of COVID-19 caused by ineffective prevention and control measures in tuberculosis hospitals have been reported successively at domestic and overseas. Therefore, it is urgent to strengthen the prevention and control of nosocomial infections in tuberculosis hospitals. The superposition of the two diseases can lead to a worsening prognosis, aggravating the patient's condition and making treatment more difficult. In addition, in the context of the new coronavirus epidemic, early recognition of co-infection with new coronavirus should be made when TB patients in chest hospitals present with symptoms such as aggregated fever or progressive disease. At the same time, we should focus on identifying the clinical and imaging manifestations of TB and COVID-19 co-infection. At present, research on COVID-19 complicated with pulmonary TB is scarce, and there are disputes on many aspects. As a country with a high prevalence of tuberculosis, it is of great practical significance to identify the clinical characteristics, outcomes, and treatment of the two infectious diseases in China.