Laboratory Reporting of Tuberculosis Test Results and Patient Treatment Initiation in California

Background. Identifying febrile children with invasive bacterial infection is difficult in the absence of telltale physical findings. Urine latex agglutination (ULA) tests have been used for rapid, on-site identification of such children. Objectives. To study the performance of ULA tests in identifying children with Haemophilus influenzae, Streptococcus pneumoniae, and group B streptococcus infection and to examine how the results of ULA tests affect patient treatment. Design. Retrospective review. Setting. Urban children's hospital. Patients. All emergency department and hospital patients tested by ULA in 1990, excluding patients in the neonatal units. Results. Of 1629 patients, 36 had positive tests (20 H influenzae, 5 S pneumoniae, and 11 group B streptococcus). Thirteen of these were false positive based on culture results. Although ULA tests demonstrated excellent specificity, their sensitivity was poor. Positive predictive values for bacteremia ranged from 0.346 to 0.600, and negative predictive values ranged from 0.972 to 0.997. The decision to treat with antibiotics was made before ULA test results were available in 19 (53%) of the 36 patients with positive test results. Of 1593 patients with negative test results, 1211 (76%) were admitted to the hospital, and approximately 81% were empirically treated with parenteral antibiotics. Conclusions. In clinical practice, treatment and disposition decisions are frequently made without regard to ULA test results.

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COMPARISON OF FOURTH GENERATION ELISA AND RAPID DIAGNOSTIC TEST FOR DIAGNOSIS OF HEPATITIS C VIRUS(HCV) INFECTION IN A TERTIARY CARE HOSPITAL.

10.36106/2000717 ◽

2021 ◽

pp. 15-17

Author(s):

Stuti Kansra Arora ◽

Mala Chhabra ◽

Anuradha Anuradha ◽

Arvind Achra ◽

Nandini Duggal

Keyword(s):

Diagnostic Test ◽

Rapid Diagnostic Test ◽

Sensitivity And Specificity ◽

Treatment Initiation ◽

Tertiary Care ◽

Hcv Infection ◽

Fourth Generation ◽

World Population ◽

Test Results ◽

Blood Samples

Introduction:Hepatitis C virus (HCV) infection has emerged as one of the major global health challenge affecting about 2 - 3% of the world population. Epidemiological studies have shown that HCV infection is a major risk factor for development of Acute hepatitis,chronic liver disease,cirrhosis and Hepatocellular carcinoma (HCC).Early diagnosis of HCV is important to link hepatitis testing to care and treatment initiation. Aim:To compare sensitivity and specificity of rapid diagnostic test (RDT) with fourth generation ELISA Material and Method: This study was conducted in the Department of Microbiology at Atal Bihari Vajpayee Institute of Medical Sciences (formerly Post Graduate Institute of Medical Education and Research) and Dr Ram Manohar Lohia Hospital from January 2018 to December 2018.Blood samples of patients suspected with hepatitis were tested using ELISA and rapid diagnostic test Results: In our study 26378 blood samples were tested for HCV,using fourth generation ELISA.Of these,581(2.20%) samples were found to be positive by ELISA.These HCV positive samples along with equal number of ELISA negative samples were tested by rapid diagnostic test. Sensitivity and specificity of the rapid diagnostic test was found to be 72.98 % and 100% respectively. Discussion:Rapid diagnostic test can be used during emergency hours but their results must be followed by ELISA test results in a tertiary care hospital.Reporting of false negative results should be minimized for rapid linkage to treatment initiation and to avoid silent transmission of infection.

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Treatment Initiation, Program Attrition and Patient Treatment Outcomes Associated with Scale-Up and Decentralization of HIV Care in Rural Malawi

PLoS ONE ◽

10.1371/journal.pone.0038044 ◽

2012 ◽

Vol 7 (10) ◽

pp. e38044 ◽

Cited By ~ 28

Author(s):

Megan McGuire ◽

Loretxu Pinoges ◽

Rupa Kanapathipillai ◽

Tamika Munyenyembe ◽

Martha Huckabee ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Initiation ◽

Scale Up ◽

Hiv Care ◽

Patient Treatment ◽

Program Attrition

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Inconsistencies in the planning of the duration of anticoagulation among outpatients with acute deep-vein thrombosis

Thrombosis and Haemostasis ◽

10.1160/th10-08-0506 ◽

2011 ◽

Vol 105 (02) ◽

pp. 239-244 ◽

Cited By ~ 7

Author(s):

Torsten Willenberg ◽

Martin Banyai ◽

Ulrich Frank ◽

Thomas Baldi ◽

Beatrice Amann-Vesti ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Treatment Initiation ◽

Anticoagulation Therapy ◽

Interquartile Range ◽

Patient Treatment ◽

Vein Thrombosis ◽

Acute Deep Vein Thrombosis ◽

Deep Vein ◽

Limited Duration ◽

Made In

SummaryThree-month anticoagulation is recommended to treat provoked or first distal deep-vein thrombosis (DVT), and indefinite-duration anticoagulation should be considered for patients with unprovoked proximal, un-provoked recurrent, or cancer-associated DVT. In the prospective Out-patient Treatment of Deep Vein Thrombosis in Switzerland (OTIS-DVT) Registry of 502 patients with acute objectively confirmed lower extremity DVT (59% provoked or first distal DVT; 41% unprovoked proximal, unprovoked recurrent, or cancer-associated DVT) from 53 private practices and 11 hospitals, we investigated the planned duration of anticoagulation at the time of treatment initiation. The decision to administer limited-duration anticoagulation therapy was made in 343 (68%) patients with a median duration of 107 (interquartile range 91–182) days for provoked or first distal DVT, and 182 (interquartile range 111–184) days for unprovoked proximal, unprovoked recurrent, or cancer-associated DVT. Among patients with provoked or first distal DVT, anticoagulation was recommended for <3 months in 11%, ≥3 months in 63%, and for an indefinite period in 26%. Among patients with unprovoked proximal, unprovoked recurrent, or cancer-associated DVT, anticoagulation was recommended for <6 months in 22%, 6–12 months in 38%, and for an indefinite period in 40%. Overall, there was more frequent planning of indefinite-duration therapy from hospital physicians as compared with private practice physicians (39% vs. 28%; p=0.019). Considerable inconsistency in planning the duration of anticoagulation therapy mandates an improvement in risk stratification of outpatients with acute DVT.

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Interferon-beta: the neutralizing antibody (NAb) titre predicts reversion to NAb negativity

Multiple Sclerosis Journal ◽

10.1191/1352458504ms1074oa ◽

2004 ◽

Vol 10 (5) ◽

pp. 507-510 ◽

Cited By ~ 45

Author(s):

C Gneiss ◽

M Reindl ◽

A Lutterotti ◽

R Ehling ◽

R Egg ◽

...

Keyword(s):

Neutralizing Antibodies ◽

Interferon Beta ◽

Treatment Initiation ◽

Protein A ◽

Neutralizing Antibody ◽

Test Results ◽

Resistance Protein ◽

Antibody Levels ◽

Mean Time ◽

Support Treatment

Background: It has been reported that in some patients with MS who develop neutralizing antibodies (NAbs) against interferon beta (IFNb), antibody levels can initially increase and then decrease thereafter even when treatment is continued. Objective: To determine whether NAb titre correlates with time to reversion to NAb negativity in patients with multiple sclerosis (MS). Methods: Twenty-eight patients with MS who were NAb-positive during treatment with one of the currently available IFNbs were included in this retrospective study. NAb titres were determined by the myxovirus resistance protein A induction assay. Patients were considered NAb-positive if they had at least two consecutive samples with titres of]/20 neutralizing units (NU). Reversion to NAb-negative status was defined as two consecutive negative samples (NAb titre of B/20 NU) after NAb positivity. Results: When measured two years after treatment initiation, a NAb titre of B/75 NU had a 91.7% sensitivity and a 87.5% specificity for reversion to NAb negativity in the following two years (after a total of four years of treatment). In addition, somewhat surprisingly, patients whose serum converted to NAb-negative generally developed peak NAb titres earlier than patients who remained NAb-positive (mean time of first detection was 21 versus 38 months, respectively). Conclusion: The NAb titre might support treatment decisions in patients with MS whose test results are positive for NAbs.

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An assessment of patient perspectives on pharmacogenomics educational materials

Pharmacogenomics ◽

10.2217/pgs-2019-0175 ◽

2020 ◽

Vol 21 (5) ◽

pp. 347-358 ◽

Cited By ~ 1

Author(s):

Gladys B Asiedu ◽

Lila J Finney Rutten ◽

Amenah Agunwamba ◽

Suzette J Bielinski ◽

Jennifer L St. Sauver ◽

...

Keyword(s):

Patient Perspectives ◽

Patient Treatment ◽

Qr Code ◽

Educational Video ◽

Think Aloud ◽

Test Results ◽

Cover Letter ◽

Educational Materials ◽

Case Vignettes ◽

Improve Patient

Aim: Pharmacogenomics (PGx) holds potential to improve patient treatment; yet, effective patient educational materials are limited. Materials & methods: Using a ‘think aloud’ technique, we sought to understand comprehension and perceptions of a multimedia PGx results packet including a cover letter with QR code to an educational video, brochure and prototype report in the context of PGx case vignettes. Results: The cover letter and video components were viewed less favorably due to excess detail, complex jargon and technology challenges. Recommendations were to enhance comprehension and utility and to customize materials to each patient’s medications or disease conditions. Conclusion: Educational materials were revised to improve comprehension and usability, and diminish concerns to better prepare patients to understand the importance of discussing test results with their provider.

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The Analysis of Complications of Tuberculosis Sufferers Due to History of Drug Breakup in The Area of Puskesmas Puri Mojokerto Regency

Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery) ◽

10.26699/jnk.v8i2.art.p166-170 ◽

2021 ◽

Vol 8 (2) ◽

pp. 166-170

Author(s):

Lutfi Wahyuni ◽

Inna Octavia ◽

Norma Cindy Erlina

Keyword(s):

Immune System ◽

Infectious Diseases ◽

Nutritional Status ◽

Treatment Period ◽

Early Stage ◽

Sampling Technique ◽

Patient Treatment ◽

Test Results ◽

Pulmonary Tb ◽

History Of

Pulmonary TB disease is one of the priorities of eradication of infectious diseases. Early-stage drug breakup occurs if the patient does not take medication 2 months in a row or more before the treatment period is complete. Drug breakups result in patients being resistant to OAT (Anti-Tuberculosis Drugs) and can lead to complications. This study aimed to analyze the occurrence of complications of tuberculosis sufferers due to a history of drug breakup. The design in this study was Correlation Analytics with Retrospective approach methods. The population in this study was all TB sufferers who had a history of drug breakups and complications. The sampling technique in this study was Non-Probability Sampling with purposive sampling type. The sample was 30 respondents. The instruments were interview for the history of drug breakup and patient treatment cards and observation and status of patient as the instruments of complications. Spearman Rho test results showed that value = 0.055 or more than α (0.05) which meant there was no correlation between the history of drug breakup with complications of tuberculosis. Based on this study, it could be concluded that the complications of tuberculosis that occur not only because of drug breakup factors but can be due to the spread of increasingly widespread germ infections, the immune system of the sufferers who are lacking, tuberculosis concomitant diseases, nutritional status of tuberculosis sufferers, and also knowledge from TB sufferers who lack the awareness to maintain health.

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Interpretation of Discordant Rifampicin Susceptibility Test Results Obtained Using GeneXpert vs Phenotypic Drug Susceptibility Testing

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa279 ◽

2020 ◽

Vol 7 (8) ◽

Cited By ~ 1

Author(s):

Fengmin Huo ◽

Yifeng Ma ◽

Rongmei Liu ◽

Liping Ma ◽

Shanshan Li ◽

...

Keyword(s):

Dna Sequences ◽

Susceptibility Testing ◽

Bacterial Load ◽

Rpob Gene ◽

Drug Susceptibility ◽

Drug Susceptibility Testing ◽

Susceptibility Test ◽

Patient Treatment ◽

Common Mutation ◽

Test Results

Abstract Background The 3-month difference in turnaround time between Xpert and conventional phenotypic drug susceptibility testing (pDST) causes patient treatment challenges when pDST rifampin (RIF) susceptibility results and earlier Xpert results disagree, resulting in unnecessary tuberculosis (TB) patient exposure to toxic second-line drugs. Here, the prevalence of discordant RIF susceptibility test results, specifically Xpert (resistant) vs pDST (susceptible) results, was determined. Methods Tuberculosis patients enrolled between January 2015 and June 2018 at Beijing Chest Hospital who consecutively tested positive for RIF resistance using Xpert then negative using pDST were studied. DNA sequences and minimal inhibitory concentration (MIC) results provided insights for understanding discordant results. Results Of 26 826 patients with suggestive TB symptoms undergoing Xpert MTB/RIF testing, 728 diagnosed as RIF-resistant were evaluated. Of these, 118 (16.2%) exhibiting Xpert RIF resistance and phenotypic RIF susceptibility yielded 104 successfully subcultured isolates; of these, 86 (82.7%) harbored rpoB gene RIF resistance–determining region mutations and 18 (17.3%) did not. The Leu511Pro (25.0%) and Leu533Pro (17.3%) mutations were most frequently associated with discordant RIF susceptibility test results. Of the 86 isolates with rpoB mutations, 42 (48.8%) with MICs ≤1.0 mg/L were assigned to the RIF-susceptible group, with Leu511Pro being the most common mutation observed. Isolates with a very low bacterial load were most frequently misdiagnosed as RIF-resistant by Xpert. Conclusions Approximately one-sixth of RIF-resistant TB isolates identified via Xpert yielded discordant pDST results due to questionable interpretation of specific “disputed” mutations. Thus, a diagnostic flowchart should be used to correctly interpret Xpert RIF resistance results to best guide patient treatment.

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Pathways to care and preferences for improving tuberculosis services among tuberculosis patients in Zambia: A discrete choice experiment

PLoS ONE ◽

10.1371/journal.pone.0252095 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0252095

Author(s):

Andrew D. Kerkhoff ◽

Mary Kagujje ◽

Sarah Nyangu ◽

Kondwelani Mateyo ◽

Nsala Sanjase ◽

...

Keyword(s):

Discrete Choice ◽

Symptom Onset ◽

Choice Experiment ◽

Treatment Initiation ◽

Tertiary Hospital ◽

Wait Times ◽

Hiv Positive ◽

Care Seeking ◽

Test Results ◽

Hiv Negative

Background Delays in the diagnosis of tuberculosis (TB) contribute to a substantial proportion of TB-related mortality, especially among people living with HIV (PLHIV). We sought to characterize the diagnostic journey for HIV-positive and HIV-negative patients with a new TB diagnosis in Zambia, to understand drivers of delay, and characterize their preferences for service characteristics to inform improvements in TB services. Methods We assessed consecutive adults with newly microbiologically-confirmed TB at two public health treatment facilities in Lusaka, Zambia. We administered a survey to document critical intervals in the TB care pathway (time to initial care-seeking, diagnosis and treatment initiation), identify bottlenecks and their reasons. We quantified patient preferences for a range of characteristics of health services using a discrete choice experiment (DCE) that assessed 7 attributes (distance, wait times, hours of operation, confidentiality, sex of provider, testing incentive, TB test speed and notification method). Results Among 401 patients enrolled (median age of 34 years, 68.7% male, 46.6% HIV-positive), 60.9% and 39.1% were from a first-level and tertiary hospital, respectively. The median time from symptom onset to receipt of TB treatment was 5.0 weeks (IQR: 3.6–8.0) and was longer among HIV-positive patients seeking care at a tertiary hospital than HIV-negative patients (6.4 vs. 4.9 weeks, p = 0.002). The time from symptom onset to initial presentation for evaluation accounted for the majority of time until treatment initiation (median 3.0 weeks, IQR: 1.0–5.0)–an important minority of 11.0% of patients delayed care-seeking ≥8 weeks. The DCE found that patients strongly preferred same-day TB test results (relative importance, 37.2%), facilities close to home (18.0%), and facilities with short wait times (16.9%). Patients were willing to travel to a facility up to 7.6 kilometers further away in order to access same-day TB test results. Preferences for improving current TB services did not differ according to HIV status. Conclusions Prolonged intervals from TB symptom onset to treatment initiation were common, especially among PLHIV, and were driven by delayed health-seeking. Addressing known barriers to timely diagnosis and incorporating patients’ preferences into TB services, including same-day TB test results, may facilitate earlier TB care engagement in high burden settings.

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