Tubercular Mycotic Aortic Aneurysm: Complication of Tubercular Spondylodiscitis due to Treatment Default

We have reported rare case of tubercular aortic aneurysm which has developed as complication of spinal tuberculosis. Imaging of patient is available prior to starting of antitubercular treatment which showed vertebral tuberculosis with absence of aortic aneurysm. However, patient defaulted on treatment after taking antitubercular chemotherapy only for 2 months. Patient again reported after 14 months with chest pain. At this stage, imaging showed progression of spinal tuberculosis with development of pseudoaneurysm in adjacent descending thoracic aorta. This contiguous spread of tuberculosis from spine to aorta may have been prevented if patient had completed complete course of antitubercular therapy with regular follow-ups. Patient of spinal tuberculosis need to be counselled and informed regarding its various complications, so that they remain adhered to antitubercular chemotherapy and timely follow-ups to prevent complications.

Characteristics and Determinants of Treatment Default Among Smokers With Tuberculosis in an Industrial State of Malaysia: A Registry-based Study of the Years 2013-2017

Background: The increased risk of treatment default among smokers raises concern over the secondary spread within the community. This study aimed to determine the prevalence and factors associated with treatment default among TB patients who smoke.Methods: A retrospective cohort of all registered TB patients who smoke in the state of Selangor between 2013 and 2017 via the Malaysian National MyTB database was included for analysis. TB patients who smoke were considered those with an active smoking status during the notification, while treatment default was defined as a TB patient who had interrupted treatment for 2 months or longer. There were 4 main variable domains included for analysis: sociodemographic profiles, disease profiles, treatment profiles, and comorbidities. Logistic regression analysis was used to identify determinants of treatment default among TB patients who smoke.Results: A total of 27.6% (N=6278) of the TB patients registered in Selangor were active smokers, and 15.1% (N=813) of the TB patients who smoke experienced defaulted TB treatment. The determinants of treatment default among TB patients who smoke were patients staying in an urban area (AOR 1.47; 95% CI 1.11,1.96), median income level less than RM2160 (AOR 2.0; 95% CI 1.34,2.99), no formal education (AOR 2.12; 95% CI 1.31,3.44), previously treated cases (AOR 2.78; 95% CI 1.99,3.88), active TB case detection methods (AOR 2.05; 95% CI 1.21,3.47), treatment duration of less than 6 months (AOR 7.56; 95% CI 5.74,9.92), and patients not on DOTS during the continuation phase (AOR 27.96; 95% CI 21.1,37.1). All the significant factors gave rise to the final model of determinants, with a predictability of 92.9% (95% CI 92.0,93.7).Conclusions: Our findings highlighted the high prevalence of treatment default among TB patients who smoke compared to the general TB population. Early risk detection that examines the two main domains of risk factors (socioeconomic factors and treatment profiles) should be provided for those who smoke in the TB population. Interventions should aim to reduce the prevalence of smoking among TB patients, together with close supervision during DOTS.

Why Do Patients with Mental Disorders Default Treatment? A Qualitative Enquiry in Rural Kwazulu-Natal, South Africa

Although treatment default by psychiatric patients or mental health care users is a global challenge, this behavior is reported to be higher in South Africa. The Manguzi District Hospital in rural Kwa-Zulu Natal Province, South Africa, experiences high rates of treatment default by psychiatric patients. The objective of this study was to determine the reasons for treatment defaulting at Manguzi Hospital, KwaZulu-Natal Province, South Africa. An explorative qualitative design, using in-depth interviews, was conducted with mental health care users who had defaulted out-patient psychiatric treatment. Twenty-one mental health care users were interviewed before data saturation was reached. Nvivo version 11 was used to analyze the qualitative data. Major themes that emerged confirmed that social factors are key contributions to treatment defaulting, and these include denial of the mental disorders; belief that they are cured; lack of, or disintegration of social support; preference for traditional medicine; and flaws in the health care system. Social determinants of treatment outcomes for mental disorders require tailor-made support systems for patients in these rural communities, which include increase in health literacy and attention to the cultural understanding of mental disorders.

Development of a nomogram for predicting treatment default under facility-based directly observed therapy short-course in a region with a high tuberculosis burden

Background: Poor adherence to tuberculosis (TB) treatment is a substantial barrier to global TB control. The aim of this study was to construct a nomogram for predicting the probability of TB treatment default. Methods: A total of 1185 TB patients who had received treatment between 2010 and 2011 in Peru were analyzed in this study. Patient demographics, social, and medical information were recorded. Predictors were selected by least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram for predicting TB treatment default was constructed by using multivariable logistic regression analysis. Bootstrapping method was applied for internal validation. Calibration and clinical utility of the nomogram was also evaluated. Results: The incidence of TB treatment default among the study patients was 11.6% (138/1185). Six predictors (secondary education status, alcohol use, illegal drug use, body mass index, multidrug-resistant tuberculosis, and human immunodeficiency virus serostatus) were selected through the LASSO regression analysis. A nomogram was developed based on the six predictors and it yielded an area under the curve (AUC) value of 0.797 [95% confidence interval (CI), 0.755–0.839]. In the internal validation, the AUC achieved 0.805 (95% CI, 0.759–0.844). Additionally, the nomogram was well-calibrated, and it showed clinical utility in decision curve analysis. Conclusion: A nomogram was constructed that incorporates six characteristics of the TB patients, which provides a good reference for predicting TB treatment default.

Modelling the potential impact of adherence technologies on tuberculosis in India

BACKGROUND: For patients taking standard first-line tuberculosis treatment, missing 10% or more of their doses increases the risk of relapse six-fold. Digital technologies offer new approaches to adherence support for TB patients. We estimated the potential impact of new adherence technologies in India.METHOD: We developed a mathematical model of TB transmission dynamics in India, capturing the independent effects of missed doses and treatment default on post-treatment recurrence. We simulated the impact of interventions to address both missed doses and treatment default in the public and private healthcare sector.RESULTS: Adherence interventions, if deployed optimally in the public sector alone, would reduce cumulative TB incidence by 7.3% (95% credible intervals [CrI] 4.7–11) between 2020 and 2030, and by 16% (95% CrI 11–23) if also deployed in the private sector. This impact is roughly proportional to the effectiveness of the interventions. Reducing missed doses reduced incidence by 12% (95% CrI 7.0–18), while reducing treatment default reduced incidence by 7.9% (95% CrI 3.2–13).CONCLUSION: Minimising missed doses is at least as important as promoting treatment completion. Our results suggest that emerging technologies to improve treatment adherence could have a substantial impact on TB incidence and mortality in India.

Mobile health to improve adherence to tuberculosis treatment in Khartoum state, Sudan

Although tuberculosis is a treatable disease, the high frequency of treatment default remains a challenge. The use of mobile phones structurally in a TB program has the potential to lower the frequency of default. However, it’s impact on treatment outcome in Sudan has not yet been evaluated. The aim is to evaluate the potential use of cell phones for lowering treatment default. We conducted a controlled intervention pilot study during the period from 1st of May 2017 to 31st of March 2018, in eight TB treatment units in Khartoum state, Sudan. Newly diagnosed patient with positive sputum smear on DOTS therapy were enrolled in intervention and control groups. SMS reminder were sent to the intervention group.Assessments were done at the beginning and at the end of the treatment. One hundred and forty-eight patients were enrolled, seventy-four patients in each group.The participants in the two groups were similar in demographic characteristics and behavioral and knowledge related factors about TB disease at baseline. The patients in the intervention group had a lower default rate (6.8%), higher documented cure rate (78.4%), better knowledge compared to control group. SMS reminder was useful and facilitated good interaction between patients and health personnel. Mobile texting seemed useful and was highly accepted by participants. Further evaluation of it’s potential benefit was warranted.

Faktor Risiko Gagal Konversi BTA pada Pasien Tuberkulosis Paru Fase Intensif di Kota Yogyakarta

Sputum smear conversion at the end of the intensive phase of tuberculosis treatment is positif of the patients response to treatment. This study aimed to determine factors associated to sputum smear non-conversion at the end of the intensive phase treatment. This cross sectional study was perform in Yogyakarta distric by collecting medical record in primary health care, from 2011-2016. Of 722 pulmonary tuberculosis (PTB) patient, 21,05 % patients were identified as non-converted of the intensive phase of treatment with the median age was 41 years and 58.5 % were male. The factors were associated with sputum smear non-conversion of insentive phase treatment : male, age ≥50, pre-treatment smears graded ≥2+, nonadherence to tuberculosis after 2 months treatment. Multivariate analysis indicated that Pre-treatment smears graded ≥2+and nonadherent to tuberculosis after 2 months treatment were a count highest contribution with sputum smear non-conversion. Patients with these factors non-conversion after two months of treatment should be given a fully supervised treatment to prevent in treatment default. Abstrak Konversi BTA pada akhir pengobatan fase intensif merupakan salah satu indiaktor respon pasien terhadap pengobatan TB. Tujuan penelitian adalah menentukan faktor risiko yang berhubungan dengan kegagalan konversi BTA setelah pengobatan TB fase intensif. Penelitian ini merupakan penelitian cross sectional berdasarkan data rekam medis di puskesmas, Kota Yogyakarta tahun 2011-2016. Dari 722 pasien TB paru, sebanyak 21,05% adalah gagal konversi setelah pengobatan fase intensif dengan median umur adalah 41 tahun dan sebanyak 58,5% adalah laki-laki. Faktor yang berhubungan dengan gagal konversi setelah pengobatan fase intensif adalah jenis kelamin laki-laki, umur ≥50 tahun, gradasi BTA ≥2+, ketidakteraturan menelan obat. Analisa multivariable menunjukkan gradasi BTA sebelum pengobatan ≥ 2+ dan ketidakteraturan pengobatan sebagai faktor yang paling berkontribusi dengan gagal konversi. Pasien dengan gagal konversi setelah 2 bulan .