Pulmonary Tuberculosis
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Author(s):  
T. Nanthini ◽  
Karaline Karunagari

Tuberculosis is an infectious disease which spreads from one person to another which has a devastating impact on the economic well-being of the individual, their families, and the entire community. The effective engagement of all health care providers especially nursing personnel, play an important role to scale up and commensurate to their presence to achieve universal access to tuberculosis care. Majority of times, the nursing personnel were the first person to be contacted, to take care of the patients with tuberculosis. The aim of the study is to evaluate the effectiveness of intensive health education on Pulmonary tuberculosis among patients with newly diagnosed Pulmonary tuberculosis from the four primary health centres as Mettupalayam, Lawspet, Reddiarpalayam and Mudaliarpet under RNTCP (April 2017-February 2018), in Puducherry. The objectives of the study is to assess the tuberculosis awareness, attitude and practice of the subjects among the experimental and control group before and after the intervention, to evaluate the effectiveness of intensive health education and to find out the association between the pretest level of tuberculosis awareness, attitude and practice of the subjects with selected demographic variables. Pre experimental study was adopted. For the purpose of this study, a total of 126 subjects of newly diagnosed pulmonary tuberculosis were under RNTCP(October 2016 to February 2018) selected from the four primary health centres by using cluster stage sampling technique. The investigator explained the purpose of the study to the subjects. The pretest was conducted by using the interview method for all the subjects following that implementation of nursing strategies as intensive health education on health promotion and management of pulmonary tuberculosis, distribution of self-instructional module. Continuous follow up of the subjects every week till 2 months and the posttest-I was conducted by using the same questionnaire after 2 months i.e. end of the intensive phase and again posttest-II was conducted by using the same questionnaire after 6 months i.e. at the end of the continuous phase. The findings of the study as out of 126 subjects, the mean score of tuberculosis awareness score was 9.04±3.65 in the experimental group and 8.32±3.13 of them in the control group. The mean score of attitude towards tuberculosis was 28.38±4.60 and 29.72±5.05 of them in the control group. The mean level of tuberculosis awareness score in the experimental group was 9.04 during pretest and increased to 19.13 in posttest I and further increased to 21.57 in posttest II. But in the control group, the mean tuberculosis awareness score was 8.32 during the pretest and increased to 14.50 in posttest I and 14.84 in posttest II which indicated that there was an increase in the level of tuberculosis awareness score from pretest to posttest II in the experimental group which was significant at p<0.001 level. The mean attitude score in the experimental group was 28.38 during the pretest and increased to 46.80 in posttest I and 57.41 in posttest II and in the control group 29.72 during the pretest and increased to 29.19 in posttest I and 32.24 in posttest II which indicated there was increase in the level of attitude score which was statistically significant at p<0.001 level. The mean practice score in the experimental group was 13.97 during pretest and increased to 20.51 in posttest I and 24.51 in posttest II and in control group 13.51 during the pretest and increased to 18.69 in posttest I and 17.53 in posttest II. The mean values clearly indicated that there was an increase in the practice score which was statistically significant at p<0.001 level. The increased level of Knowledge, attitude and practice score which confirmed that the intervention was much effective in the experimental group when compared to the control group. The Kruskal-Wallis test revealed that there was a significant association between the tuberculosis awareness score of the subjects with selected demographic variables such as the source of information heard about DOTS was statistically significant at p<0.05 level, attitude score of the subjects with selected demographic variable as a marital status which was significant at p<0.05 level than other variables and the practice score of the subjects with gender which was highly significant at p<0.05 level. They concluded that the treatment outcome of the subjects under RNTCP was cured and the cure rate is 100% both in the experimental group and in the control group. Nursing strategies as intensive health education, self-care module along with anti tuberculosis drugs were found to be more effective in improving the tuberculosis awareness, attitude, practice of the subjects in the experimental group than the control group.


2021 ◽  
Vol 14 ◽  
Author(s):  
Jeyakumar Shanmugam Murugaiha

: The liver plays a crucial role in endogenous metabolic activity and homeostasis of macro and micronutrients. Further, it acts as a metabolic hub in mammals, where the ingested food-derived nutrients and xenobiotics or drugs are metabolized for utilization and/or excretion through its enzymatic and non-enzymatic machinery. Nutritional deficiency, one of the major public health problems, is associated with global disease burden, including pulmonary tuberculosis (PTB) caused by Mycobacterium tuberculosis (Mtb) infection. Though it is a curable and preventable infectious disease, millions of people succumb to death, and people in numbers larger than this are still suffering. This scenario is further complicated by the addition of new cases, disease recurrence, and the emergence of drug-resistant, all of which contribute to the spread of this epidemic. Though the manifestation of TB disease has multiple aetiologies, poor nutritional status and sub-optimal therapeutic concentrations of first-line anti-TB drugs are considered as potential contributors to its widespread prevalence. Among various factors, the pharmacokinetic variability of anti-TB drugs is one of the main causes for sub-optimal therapeutic drug concentration in TB patients, which is influenced by the host’s genetic make-up and nutritional status, besides several others. However, the role of epigenetic changes in hepatic drug metabolic pathways and their transcript levels is largely unexplored. Therefore, in this review, an attempt has been made to understand the role of micronutrient deficiencies with special reference to fat-soluble vitamins, namely vitamin A, D, & E in pulmonary TB, their possible impact on epigenetic changes on the drug-metabolizing pathway genes, thus their expression levels and plausible influence on pharmacokinetic variability of anti-TB drugs, besides discussing the limitations and emerging potential opportunities. Eventually, this would help in developing the host-directed/personalized therapeutic strategies for the elimination of pulmonary tuberculosis (PTB).


2021 ◽  
Vol 99 (11) ◽  
pp. 43-46
Author(s):  
E. M. Zhukovа ◽  
L. G. Vokhminovа

Clinical testing of the forced oscillation test (FOT) yielded criteria for bronchial obstruction: an increase in viscous respiratory resistance (VRR) (Rfo, Rin, Rex); the frequency dependence of VRR. The study of VRR promoted detection of bronchial malpatency in additional 20% of pulmonary tuberculosis patients who had no lung ventilation disorders, as evidenced by spirometry.


2021 ◽  
Vol 99 (11) ◽  
pp. 66-71
Author(s):  
I. A. Burmistrovа ◽  
E. V. Ezhovа ◽  
Kh. B. Dаdаshevа ◽  
E. V. Vаniev ◽  
O. V. Lovаchevа ◽  
...  

The article describes a clinical case of a female patient with respiratory tuberculosis exposed to several cases of extensive drug resistance in their family. Tuberculosis progressed in this patient due to the late initiation of adequate treatment. Therefore, the total duration of chemotherapy made 5 years till cure was achieved and an endobronchial valve was used to heal persisting (for 3 years) lung destruction.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuanyuan Wang ◽  
Xiaoqian Shang ◽  
Liang Wang ◽  
Jiahui Fan ◽  
Fengming Tian ◽  
...  

Abstract Aim This study mainly evaluates the clinical characteristics and chest chest computed tomography (CT) findings of AFB-positive and AFB-negative pulmonary tuberculosis (PTB) patients to explore the relationship between AFB-positive and clinico-radiological findings. Methods A retrospective analysis of 224 hospitalized tuberculosis patients from 2018 to 2020 was undertaken. According to the AFB smear results, they were divided into AFB-positive pulmonary tuberculosis (positive by Ziehl–Neelsen staining) and AFB-negative pulmonary tuberculosis and patients’ CT results and laboratory test results were analyzed. Results A total of 224 PTB patients were enrolled. AFB-positive (n = 94, 42%) and AFB-negative (n = 130, 58%). AFB-positive patients had more consolidation (77.7% vs. 53.8%, p < 0.01), cavity (55.3% vs. 34.6%, p < 0.01), calcification (38.3% vs. 20%, p < 0.01), bronchiectasis (7.5% vs. 1.5%, p < 0.05), bronchiarctia (6.4% vs. 0.8%, p < 0.05), and right upper lobe involvement (57.5% vs. 33.1%, p < 0.01), left upper lobe involvement (46.8% vs. 33.1%, p < 0.05) and lymphadenopathy (58.5% vs. 37.7%, p < 0.01). Conclusion The study found that when pulmonary tuberculosis patients have consolidation, cavity, upper lobe involvement and lymphadenopathy on chest CT images, they may have a higher risk of AFB-positive tuberculosis.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
João Almeida Santos ◽  
Andreia Leite ◽  
Patrícia Soares ◽  
Raquel Duarte ◽  
Carla Nunes

Abstract Background Early diagnosis and treatment of pulmonary tuberculosis (PTB) is essential for an effective control of the tuberculosis (TB) epidemic. Delayed diagnosis and treatment of TB increases the chance of complications and mortality for the patients, and enhances TB transmission in the population. Therefore, the aim of this study was to characterize patient, healthcare and total delay in diagnosing PTB and assess the effect of clinical and sociodemographic factors on the time until first contact with healthcare or reaching a PTB diagnosis. Methods Retrospective cohort study that included active PTB patients notified in the National Tuberculosis Surveillance System (SVIG-TB), between 2008 and 2017. Descriptive statistics, Kaplan-Meier estimates, logrank test and Cox proportional hazards model were used to characterize patient, healthcare and total delay and estimate the effect of clinical and sociodemographic variables on these delays. Significance level was set at 0.05. Results Median patient, healthcare and total delays was 37 days (Interquartile range (IQR): 19–71), 8 days (IQR: 1–32) and 62 days (IQR: 38–102), respectively. The median patient delay showed a constant increase, from 33 days in 2008 to 44 days in 2017. The median total delay presented a similar trend, increasing from 59 days in 2008 to 70 days in 2017. Healthcare delay remained constant during the study period. More than half of the PTB cases (82.9%) had a delay > 1 month between symptom onset and diagnosis. In the final Cox model, alcohol abuse, unemployment and being from a high TB incidence country were factors significantly associated with longer patient delay, while being female, having more than 45 years, oncologic and respiratory diseases were associated with longer healthcare delay. Being female, having more than 45 years and being from a high TB incidence country were associated with longer total delay. Conclusions Patient delay and total delay have increased in recent years. Older patients, patients with alcohol problems, other comorbidities, unemployed or from countries with high TB incidence would benefit from the development of specific public health strategies that could help reduce the delay in TB diagnosis observed in our study. This study emphasizes the need to promote awareness of TB in the general population and among the healthcare community, especially at ambulatory care level, in order to reduce the gap between beginning of symptoms and TB diagnosis.


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