Outcomes in patients of pulmonary tuberculosis treated under RNTCP & follow up after 6 months

Tuberculosis (TB) is, one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent.This Prospective study was conducted at Santosh medical college Ghaziabad from 1 April 2018 to 30 September 2019. All diagnosed PTB patients above 12yrs were taken. Patients with EPTB, HIV positive, MDR TB, XDR TB were excluded from the study. At the end of study treatment outcome was evaluated.Total of 208 patients diagnosed as tuberculosis were enrolled in the study. 6 patients died during course of study, 10 were treatment failure, 4 were lost to follow-up, 3 transferred out & 1 shifted to private treatment. 184 patients completed treatment successfully. Out of 184, only 152 patients were available for interview at 6 months follow up after completion of treatment. 19 could not be traced, 11 patients refused and 2 died. Out of 152, 110 were asymptomatic, 1 relapsed & rest 41 patients were symptomatic. All symptomatic patients were subjected to Chest X-Ray. Fibrosis was seen on CXR of 30 patients, bronchiectasis was seen in 3 patients, 1 patient had destroyed lung, nothing abnormal detected in 7 patients.Even after successful treatment under RNTCP, these patients need to be followed up as many of them relapse or suffer from sequelae of tuberculosis.

Therapeutic effect of cycloserine combined with anti-tuberculosis drugs in the treatment of multidrug-resistant tuberculosis

Purpose: The present study analyzes the comprehensive therapeutic effect of cycloserine, in combination with anti-tuberculosis drugs using chest X-ray and chest CT (computed tomography) scan techniques. Methods: A total of 90 patients, diagnosed with multidrug resistant tuberculosis (MDR TB) were subjected to chest x-ray and CT scan before and after treatment in the two groups. Different views such as sagittal, coronal, lung window and multiplanar imaging of mediastinal window were taken. Some parameters such as case detection rate (CDR) in chest X-ray and CT scan and comprehensive curative effect were observed in two groups. Further, the changes in chest CT signs in addition to absorption of focus, cavity closure and changes in CT extra pulmonary signs were also observed. Results: The clinical profile of the patients and the course of disease were statistically insignificant (p > 0.05). Total effectiveness rate and case detection rate (CDR) values exhibited a significant difference between the groups (p < 0.05). Lung consolidation, nodules and cavities significantly improved in both groups before and after the treatment (p < 0.05). Both groups showed significant improvements in extrapulmonary signs in CT scan (p < 0.05) after the treatment. Conclusion: Based on the study outcomes, the CT scan method has good potentials for diagnosing and treating MDR TB at the early stages. Further, it can clarify the signs and outcomes of the disease at early stages, thus providing the medical fraternity a great opportunity to cure the disease.

Tuberculosis Situation in Volga Federal District in 2016-2020

The objective of the study: to assess changes in the incidence and prevalence of multiple drug resistant tuberculosis (MDR TB) and TB/HIV coinfection (TB/HIV) in Volga Federal District (VFD) and its regions during 2016-2020.Subjects and Methods. Data from FGSN Forms No. 8, 33, and 61, and analytical reviews of main statistical TB rates in the Russian Federation have been studied. The number of those died is presented as per the Rosstat data.Results. An increase in the incidence and prevalence of MDR TB and TB/HIV coinfection has been detected in certain region of Volga Federal District. Perm Region, the Republic of Bashkortostan, the Republic of Udmurtia, and Orenburg and Samara Regions have the highest prevalence of MDR TB and TB/HIV coinfection. In 2020, the Republic of Bashkortostan was the only region where the incidence and prevalence of MDR TB were growing (164.7% and 47.3%, respectively). The highest incidence and prevalence of TB/HIV coinfection was reported in the Republic of Bashkortostan, Perm Kray, Orenburg Region, the Chuvash and Udmurt Republics. Over the last 5 years, the maximum increase in TB/HIV incidence and prevalence was observed in the Republic of Bashkortostan (38.8% and 41.3%, respectively).

Insights into transmission dynamics of Mycobacterium tuberculosis complex in Nepal

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex (MTBC) in humans and animals. Numbers of multi drug resistance TB (MDR-TB), extrapulmonary TB (EPTB) and zoonotic TB cases are increasingly being reported every year in Nepal posing a major public health problem. Therefore, the Government of Nepal should act immediately to strengthen the screening facilities across the country to be able to identify and treat the TB infected patients as well as detect zoonotic TB in animal species. Endorsement of One Health Act by the Government of Nepal is an opportunity to initiate the joint programs for TB surveillance among human and animal species using one health approach to reduce the TB burden in Nepal.

HUBUNGAN PENGETAHUAN, SIKAP DAN PERILAKU PENGAWAS MINUM OBAT (PMO) TERHADAP KEJADIAN TUBERKULOSIS (TBC) BERULANG DI KABUPATEN MUARA ENIM

The discovery of repeated TB cases is a problem in TB control in Muara Enim Regency. One of the causes of failure and lack of discipline of TB patients in taking medication is influenced by the role of the drug taking supervisor (PMO). The role of PMO is very important in monitoring, reminding and ensuring regularity of treatment for TB patients in order to achieve optimal treatment results. This study aims to examine the relationship between the role of the family as a supervisor for taking medication on the incidence of recurrent tuberculosis in Muara Enim district. This study used a case-control design with a retrospective approach. The research subjects were PMO in patients with recurrent TB/MDR TB as a case group and PMO in former TB patients who recovered on schedule as a control group. The comparison of case samples (46 samples) and controls (92 samples) was one to two (1:2). Data on the level of knowledge, attitude and behavior variables were assessed using a scoring system. The analysis uses the chi square test to get the odds ratio (OR) value. The results of the analysis show that the level of PMO knowledge is still below the program's expectations. The level of knowledge, attitudes and behavior of PMO are not related to the occurrence of recurrent TB cases. To increase the role of PMO, health workers can conduct counseling by changing the extension technique using more varied and communicative extension media.

Model-based efficacy and toxicity comparisons of moxifloxacin for multi-drug-resistant tuberculosis

Background Moxifloxacin (MOX) is used as a first-choice drug to treat multi-drug-resistant tuberculosis (MDR-TB), however, evidence-based dosing optimization should be strengthened by integrative analysis. The primary goal of this study was to evaluate MOX efficacy and toxicity using integratvie model-based approaches in MDR-TB patients. Methods In total, 113 MDR-TB patients from five different clinical trials were analyzed for the development of a population pharmacokinetics (PK) model. A final population PK model was merged with a previously developed lung-lesion distribution and QT prolongation model. Monte Carlo simulation was used to calculate the probability target attainment (PTA) value based on concentration. An area under the concentration-time curve (AUC)-based target was identified as the minimum inhibitory concentration (MIC) of MOX isolated from MDR-TB patients. Results The presence of human immunodeficiency virus (HIV) increased clearance by 32.7% and decreased the AUC by 27.4%, compared with HIV-negative MDR-TB patients. A daily dose of 800 mg or a 400 mg twice daily dose of MOX is expected to be effective in MDR-TB patients with an MIC of ≤ 0.25 µg/mL, regardless of PK differences resulting from the presence of HIV. The effect of MOX in HIV-positive MDR-TB patients tended to be decreased dramatically from 0.5 µg/mL, in contrast to the findings in HIV-negative patients. A regimen of twice-daily doses of 400 mg should be considered safer than an 800 mg once-daily dosing regimen, because of the narrow fluctuation of concentrations. Conclusions Our results suggest that a 400 mg twice-daily dose of MOX is an optimal dosing regimen for MDR-TB patients because it provides superior efficacy and safety.

Risk Factors and Treatment Outcome Analysis Associated with Second-Line Drug-Resistant Tuberculosis

The present study aimed at analyzing the treatment outcomes and risk factors associated with fluoroquinolone drug resistance having mutations in the gyrA and gyrB genes. A total of 258 pulmonary tuberculosis samples with first-line drug-resistant (H, R, or HR) were subjected to GenoType MTBDRsl assay for the molecular detection of mutations. Among the 258 samples, 251 were drug-resistant tuberculosis and seven were sensitive to all first-line TB drugs. Out of 251 DR-TB cases, 42 cases were MDR TB, 200 were INH mono-resistant and nine cases were RIF mono-resistant tuberculosis. Out of 251 DR-TB cases performed with a MTBDRsl assay, 14 had Pre-XDR-FQ, one patient had pre-XDR-SLID, one had extensively drug-resistant tuberculosis (XDR-TB) and 235 cases were sensitive to both FQ and SLID drugs. The study group had a mean average of 42.7 ± 16.4 years. The overall successful treatment outcomes among the MDR, INH mono-resistant, and pre-XRD patients were 70.6%, 82.0%, and 51%, respectively. The percentage of risk for the unfavorable outcomes in the pre-XDR, INH -mono-resistant, and XDR cases were 113.84% increased risk with RR 2.14; 95% CI 0.7821–5.8468. The independent risk factor associated with the unfavorable outcomes to failure was 77.78% increased risk with RR 1.78; 95% CI 0.3375–9.3655. Logistic regression analysis revealed that the percentage relative risk among MDR-TB patients for gender, male (RR: 1.85), age ≥ 61 years (RR: 1.96), and diabetics (RR: 1.05) were 84.62%, 95.83%, and 4.76%, respectively. The independent risk factors associated with INH mono-resistant cases of age 16–60 (RR: 1.86), ≥61 year (RR: 1.18), and treated cases (RR: 5.06). This study presaged the significant risk of INH mono-resistant, pre-XDR, and MDR among males, young adults, diabetics, and patients with previous treatment failure. Timely identification of high-risk patients will give pronounced advantages to control drug resistance tuberculosis diseases.

Whole-Genome Sequencing Reveals Recent Transmission of Multidrug-Resistant Mycobacterium tuberculosis CAS1-Kili Strains in Lusaka, Zambia

Globally, tuberculosis (TB) is a major cause of death due to antimicrobial resistance. Mycobacterium tuberculosis CAS1-Kili strains that belong to lineage 3 (Central Asian Strain, CAS) were previously implicated in the spread of multidrug-resistant (MDR)-TB in Lusaka, Zambia. Thus, we investigated recent transmission of those strains by whole-genome sequencing (WGS) with Illumina MiSeq platform. Twelve MDR CAS1-Kili isolates clustered by traditional methods (MIRU-VNTR and spoligotyping) were used. A total of 92% (11/12) of isolates belonged to a cluster (≤12 SNPs) while 50% (6/12) were involved in recent transmission events, as they differed by ≤5 SNPs. All the isolates had KatG Ser315Thr (isoniazid resistance), EmbB Met306 substitutions (ethambutol resistance) and several kinds of rpoB mutations (rifampicin resistance). WGS also revealed compensatory mutations including a novel deletion in embA regulatory region (−35A > del). Several strains shared the same combinations of drug-resistance-associated mutations indicating transmission of MDR strains. Zambian strains belonged to the same clade as Tanzanian, Malawian and European strains, although most of those were pan-drug-susceptible. Hence, complimentary use of WGS to traditional epidemiological methods provides an in-depth insight on transmission and drug resistance patterns which can guide targeted control measures to stop the spread of MDR-TB.

Laboratory evaluation of the efficacy of Liastene application in complex therapy of multiresistant pulmonary tuberculosis

OBJECTIVE. Evaluating according to laboratory tests the effectiveness of Liasten in the treatment of patients with multidrug-resistant pulmonary tuberculosis (MDR-TB). MATERIALS AND METHODS. Evaluation of the effectiveness of etiotropic and etiopathogenetic therapy in 57 patients with MDR-TB was performed. According to the treatment schemes, patients were divided into groups. The control group (n=22) received individualized antimycobacterial therapy (AMBT) regimens. The experimental group (n=35) received AMBT in combination with Liasten. Evaluation of the effectiveness of treatment regimens was performed on the basis of indicators of general clinical blood tests, immunological and bacteriological studies. RESULTS AND DISCUSSION. In patients of the experimental group, compared with the control in 1.5 times more often found positive changes in the hemogram of blood and ESR (p<0.05-0.001), the establishment of a dynamic balance between the pools of lymphocyte cells CD4+ and СD8+ (immunoregulatory index, p<0.05), an increase in the number of phagocytosis active cells (phagocytic index, p<0.05), the content of cationic lysosomal proteins of granulocyte leukocytes (p<0.05), a 1.4-fold decrease in the cytochemical coefficient of neutrophils (p<0.05), the number of proliferated under the action of PPD-L lymphocytes (p<0.05), normalization of phagocytic counts and total redox activity of neutrophils (p<0.05), increase in frequency and reduction of anesthesia was stated. CONCLUSIONS. Restoration of the body’s immune status, blood hemogram, increase in frequency and reduction of the time of decontamination were more active and occurred 1.5 times more often in patients receiving a complex combination of AMBT with Liasten.

Technology And Its Role In Supporting Tuberculosis Treatment Adherence

Compliance with TB treatment has now become a problem that must be handled seriously because the high non-adherence rate will give a bad contribution to the success of TB treatment, including MDR-TB and also morbidity and mortality. Many innovations have been made to improve TB treatment adherence, one of which is using mobile-based technology. This article aims to explore the effectiveness of the technology used to improve treatment adherence in TB patients: types, ways of working, advantages, and limitations of each application. This is a systematic review through searching 3 databases, namely Scopus, WoS, and Science Direct. Some of the advantages in applying technology to improve TB treatment adherence are easy to use if you understand how to operate tools/applications are cost-effective because they reduce transportation costs in reaching remote areas or in conditions of transportation difficulties such as after a disaster, the use of this technology provides patient satisfaction in treatment and facilitates the involvement of the family/support system in the treatment of patients. Several things must be considered (limitations) of the technology to be used, including experts, patient knowledge and skills, economic condition, electricity availability, and whether the technology used will not increase the burden on patients related to the stigma of TB disease. We can conclude that the use of technology is indeed very good in supporting the improvement of TB treatment adherence, but the selection of this application must pay attention to the characteristics of the population as well as the advantages and limitations of each application. Keywords: Technology, Adherence, Tuberculosis