Exploring the mechanisms of collaboration between the Tuberculosis and Diabetes Programs for the control of TB-DM Comorbidity in Ghana

Objectives To explore the mechanisms of collaboration between the stakeholders, including National Tuberculosis Control Program (NTP) and the Non-Communicable Disease Control and Prevention Program (NCDCP) at the national, regional, and local (health facility) levels of the health care system in Ghana. This is one of the objectives in a study on the “Barriers and Facilitators to the Implementation of the Collaborative Framework for the Care and Control of Tuberculosis and Diabetes in Ghana” Results The data analysis revealed 4 key themes. These were (1) Increased support for communicable diseases (CDs) compared to stagnant support for non-communicable diseases (NCDs), (2) Donor support, (3) Poor collaboration between NTP and NCDCP, and (4) Low Tuberculosis-Diabetes Mellitus (TB-DM) case detection.

Allelic and Genotypic Frequencies of NAT2, CYP2E1 and AADAC genes in a cohort of Peruvian Tuberculosis Patients

BackgroundWe determined the frequency of genetic polymorphisms in three anti-TB drug metabolic proteins previously reported: N-acetyltransferase 2 (NAT2), cytochrome P450 2E1 (CYP2E1) and arylacetamide deacetylase (AADAC) within a Peruvian population in a cohort of TB patients. We included 395 participants completed their anti-tuberculosis treatment.Results∼74% of the participants are carriers of slow metabolizer genotypes: NAT2*5, NAT2*6 and NAT2*7, which increase the sensitivity of INH at low doses and increase the risk of drug-induced liver injuries. ∼ 64% are homozygous for the wild-type CYP2E1*1A allele, which could increase the risk of hepatotoxicity. However, 16% had a NAT2 fast metabolizer phenotype which could increase the risk of acquiring resistance to INH, thereby increasing the risk of multidrug-resistant (MDR) or treatment failure. The frequency of rs1803155 (AADAC*2 allele) was higher (99.9%) in Peruvians than in in European American, African American, Japanese, and Korean populations.ConclusionsThis high prevalence of slow metabolizers for Isoniazid in the Peruvian population should be further studied and considered to help individualize drug regimens, especially in countries with a great genetic diversity like Peru. These data will help the Peruvian National Tuberculosis Control Program develop new strategies for therapies.

Factors that influence the recovery of TB patients using Cox proportional hazard regression

Tuberculosis (TB) is an infectious disease which is one of the biggest health problems in the world, including Indonesia. The government, through the National Tuberculosis Control program, has made various efforts to control tuberculosis. However, this problem was exacerbated by the dramatic increase in the incidence of tuberculosis. This study aimed to determine the Cox proportional hazard regression model and the factors that affect the cure rate of TB patients. We used medical record data for inpatient TB patients for the period July-December 2017 at dr. Zainoel Abidin Hospital. The results showed that with α = 0.1, the factors that influenced the recovery of TB patients were the type of cough, the symptoms of bloody cough and symptoms of sweating at night. There were 33.93% of patients who did not work. This category included students, domestic helpers, and those who did not work until they suffered from tuberculosis and were treated at dr. Zainoel Abidin Hospital. The hazard ratio (failure ratio) showed that the tendency or cure rate for TB patients who did not experience cough symptoms was 70% greater than patients who experienced phlegm cough symptoms. The cure rate for TB patients who experienced coughing up blood symptoms was 53% greater than patients without these symptoms. The cure rate for TB patients who experienced symptoms of sweating at night was 54% greater than patients who did not sweat at night.

Tuberculosis Coexistence in Pediatric Hodgkin’s Lymphoma: A Tropical Country Experience

Introduction Hodgkin’s lymphoma (HL), being one of the common cancers among children, may occasionally masquerade as an infectious illness. Similarly, an underlying infection like tuberculosis (TB) may be missed in cases of HL because of similarity in clinical and radiological features. Here, we present our data of association of HL with histopathologically proven TB lymph node, their clinical presentation, treatment details, and outcome. Materials and Methods A retrospective review of all the cases of HL diagnosed between January 2007 and December 2016 was done. The cases which had an association of TB, based on the histopathology, were reviewed separately. Results A total of 262 children with HL were treated at our institute from January 2007 to December 2016. Of these cases, 42 children had received empirical antitubercular therapy (ATT) (due to suspicion of TB) before presenting to us, and only five cases had histopathologically proven TB lymph node. Ziehl–Neelsen (ZN) stain for acid-fast bacilli (AFB) was positive in the biopsy specimen of all the five cases, proving TB lymph node coexistence with HL. They were treated with six-drug ATT as per the Revised National Tuberculosis Control Program (RNTCP) guidelines along with chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine regimen. All the five patients are healthy and disease free until their last follow-up. Conclusion A high-end suspicion for concomitant TB and HL is needed, especially in our country where TB is still rampant. Biopsy with immunohistochemistry and demonstration of AFB can enable a definite diagnosis of both the entities.

Tuberculosis, difficulties and facilities for Nurses

The study proposed to analyze the amenities and difficulties faced by nurses’ professionals in the fight against tuberculosis within the field of primary health care. This was a cross-sectional study with a qualitative approach. The sample consisted of 36 participants, all of whom were nurses. The statistical program IRaMuTeQ was applied and we also applied Laurence Bardin and Minayo content analysis to discuss both aprioristic and non-aprioristic categories. In the study it was clear that the difficulties are diversified, such as: personal matters from the professionals, physical and organizational structure, awareness of patients and family about the therapeutic process and the administration, the latter being the one most pointed out as difficult; regarding the amenities, the multi-professional work and protocols defined by the National Tuberculosis Control Program were pointed out. The study proves that the administrative question is the key to the function of the entire process of fighting tuberculosis, serving as a reference for improvements and adjustments.