Factors Associated with Treatment Outcomes in Patients with Pulmonary Tuberclosis

Background and Aim: Tuberculosis (TB) is one of the major sources of health problems in developing countries. An effective strategy for tuberculosis treatment can be evaluated with key indicators known as TB control program with their treatment outcomes. Hence, the purpose of this study was to evaluate the factors associated with the treatment outcome of pulmonary tuberculosis in patients. Methods: This cross-sectional study was carried out on 129 Tuberculosis patients in the department of Pulmonology, Gulab Devi Hospital Lahore from November 2020 to April 2021. Demographic details, clinical examination, and treatment outcomes were evaluated. All the data were extracted from the hospital medical records. Successful treatment outcomes predictors were assessed using bivariate and multivariate regression. SPSS version 20 was used for data analysis. Results: Of the total 129 tuberculosis patients, 59 (46%) were male and 70 (54%) were females. The overall mean age was 26.54±5.62 years. The overall prevalence of successful treatment rate was 113 (87.6%). Out of 113, the prevalence of cured and complete treatment patients was 57 (50.4%) and 56 (49.6%) respectively. Based on logistic regression models, various parameters with their respective adjustment odds ratio (AOR) were as follows; age 21-40 years (AOR= 2.67, 95% CI=1.32-6.12, p-value=0.003), treatment category (AOR=4.62, 95% CI=1.12-16.74, p-value=0.027), and smear-positive pulmonary tuberculosis (AOR=3.47; 95% CI=1.76-6.69, p-value<0.001) were significantly related with treatment outcomes. Conclusion: Our study reported that the overall prevalence of successful treatment was 87.6%. Though, the rate of overall successful treatment was found satisfactory, but, to meet international standard strategy for tuberculosis, still, improvement needs to be achieved. Age, treatment category, and tuberculosis types were significantly correlated with treatment outcomes. Keywords: Pulmonary Tuberculosis; Treatment Outcomes; TB Smears

Pulmonary TB in Pregnancy

Objective : To report a case of pulmonary TB in pregnancyMethod : A case reportCase : Presented a case of cpulmonar TB in pregnancy on 33-year-old patient. This is fifth pregnancy with twice history of abortion, malnutrition and pulmonary TB (in treatment). The result of chest x-rays was pulmonary TB. The patient was on treatment for anti-tuberculosis drugs for second month. Patient had BMI was 16,88 kg/m2 which is underweight category. There were bronchovesicular and ronchi from both side of lung from auscultation examination. From laboratory findings there was decrease of albumin serum levels to 2,1 gr%. From ultrasound got impression 16-17 weeks of pregnancy. Patient got anti tuberculosis drugs treatment category I incentive phase (2HRZE). During hospitalization treatment, patient was given some nutrition consultation and high calories and high protein diet and also extra 3 egg whites per day. Total calories are 2250 kcal. Patient also got 1 infuse bottle of albumin and albumin supplementation.Discussion : The incidence of TB in pregnancy was 1/10,000 pregnancies. Provision of an appropriate and adequate chemotherapy regimen will improve the quality of life of the mother, reduce the side effects of anti-tuberculosis drugs (OAT) on the fetus and prevent infection in newborns. Patient got anti tuberculosis drugs treatment category I incentive phase (2HRZE) which is no difference theraphy with no-pregnant patient. Patient was not given pyridoxine as adjuvant drugs along with the anti- tuberculosis drugs. Pyridoxine supplementation must be given with the dose of 50 mg/day and is suggested for every pregnant woman who consumes isoniazid because the deficiency often happens in pregnancy than general population.Conclusion The diagnosis of this patient was correct based on anamnesis, physical examination, and supporting test . Active TB treatment in pregnancy doesn’t have any difference with non-pregnant. The management of this patient is not correct because the patient didn’t get pyridoxine supplementation, didn’t undergo sputum test in second month, and wasn’t done culture M. Tuberculosis as a gold standard.Keywords: tuberculosis, pulmonary TB, pregnancy, anti tuberculosis drugs, pyridoxine

Treatment of Mild Hyperkalemia in Hospitalized Patients: An Unnecessary Practice?

Background: Sodium polystyrene sulfonate (SPS) is one of the most commonly used treatments for mild hyperkalemia. Other treatments include insulin, sodium bicarbonate, and salbutamol, which may be given alone or in combination. The results of research examining treatment effectiveness for mild hyperkalemia (e.g., the ability of SPS to achieve normokalemia) thus far have been inconsistent. Given that the effectiveness of treatment for mild hyperkalemia is debatable, new research is needed. Objective: To determine whether treatment of hospitalized patients with mild hyperkalemia (using SPS or another approach, relative to no treatment) was associated with achievement of normokalemia (serum potassium < 5.1 mmol/L). Methods: For this retrospective, quasi-experimental study, hospitalized patients with index serum potassium level between 5.1 and 6.4 mmol/L were identified. Post-index serum potassium level within 24 hours was dichotomized (< 5.1 or ≥ 5.1 mmol/L). Pre-index serum creatinine and serum potassium levels were recorded as the average of the first 5 values immediately before the index potassium value. For each patient, treatment was categorized as no treatment, SPS treatment, or other treatment strategy. Results: Among the 1944 patients included in the analysis, the average age was 66.8 (standard deviation 13.5) years; 605 (31.1%) of the patients were women and 1339 (68.9%) were men. Logistic regression results indicated that patients who were female and/or had higher pre-index serum potassium were less likely to return to normokalemia within 24 hours after the time of the index serum potassium value. Treatment category was not a statistically significant predictor of the achievement of normokalemia. Most patients with mild hyperkalemia (> 74.5% in each treatment category) achieved normokalemia, whether or not they received treatment. Conclusions: The findings of this study suggest that although follow-up is required for mild hyperkalemia in hospitalized patients, active treatment may be unnecessary. RÉSUMÉ Contexte : Le sulfonate de polystyrène de sodium (SPS) est l’un des traitements les plus communément utilisés pour l’hyperkaliémie légère. D’autres traitements comprennent l’insuline, le bicarbonate de sodium et le salbutamol, qui peuvent être administrés seuls ou ensemble. Les résultats des recherches se penchant sur l’efficacité des traitements de l’hyperkaliémie légère (p. ex., la capacité du SPS à rétablir la normokaliémie) sont contradictoires jusqu’à présent. Étant donné que l’efficacité du traitement de l’hyperkaliémie légère est discutable, de nouvelles recherches sont nécessaires. Objectif : Déterminer si le traitement des patients hospitalisés, présentant une hyperkaliémie légère, (à l’aide de SPS ou d’une autre approche, comparativement à l’absence de traitement) était associé à l’atteinte de la normokaliémie (potassium sérique < 5,1 mmol/L). Méthodes : Des patients hospitalisés, dont l’indice de concentration sérique de potassium se situait entre 5,1 et 6,4 mmol/L, ont été identifiés pour participer à cette étude rétrospective quasi expérimentale. La concentration sérique de potassium mesurée dans les 24 heures après le diagnostic d’hyperkaliémie légère a été dichotomisée (< 5,1 ou ≥ 5,1 mmol/L). Les indices de concentrations sériques de créatinine et de potassium avant le diagnostic d’hyperkaliémie légère ont été obtenus par la moyenne des cinq premières valeurs situées immédiatement avant celle de la concentration de potassium. Le classement du traitement de chaque patient était le suivant : Aucun traitement, Traitement par SPS ou Autre stratégie de traitement. Résultats : L’âge moyen des 1944 patients inclus dans l’analyse était de 66,8 ans (écart type 13,5); 605 (31,1 %) d’entre eux étaient des femmes et 1339 (68,9 %) des hommes. Les résultats de la régression logistique indiquaient que les patientes, donc les femmes, qui avaient un indice sérique de potassium plus élevé au moment du diagnostic, avaient moins de chances de retourner à la normokaliémie dans les 24 heures après l’instant de la mesure de la valeur de l’indice sérique de potassium. La catégorie de traitement n’était pas une variable prédictive statistiquement significative de l’atteinte de la normokaliémie. La plupart des patients présentant une hyperkaliémie légère (> 74,5 % dans chaque catégorie de traitement) atteignaient la normokaliémie, qu’ils aient reçu ou non un traitement. Conclusions : Les résultats de cette étude laissent entendre que, malgré la nécessité d’un suivi des patients hospitalisés en cas d’hyperkaliémie légère, un traitement actif pourrait s’avérer inutile.

COVID-19 treatment combinations and associations with mortality in a large multi-site healthcare system

Introduction During the early months of the COVID-19 pandemic, mortality associated with the disease declined in the United States. The standard of care for pharmacological interventions evolved during this period as new and repurposed treatments were used alone and in combination. Though these medications have been studied individually, data are limited regarding the relative impact of different medication combinations. The objectives of this study were to evaluate the association of COVID-19-related mortality and observed medication combinations and to determine whether changes in medication-related practice patterns and measured patient characteristics, alone, explain the decline in mortality seen early in the COVID-19 pandemic. Methods A retrospective cohort study was conducted at a multi-hospital healthcare system exploring the association of mortality and combinations of remdesivir, corticosteroids, anticoagulants, tocilizumab, and hydroxychloroquine. Multivariable logistic regression was used to identify predictors of mortality for both the overall population and the population stratified by intensive care and non-intensive care unit admissions. A separate model was created to control for the change in unmeasured variables over time. Results For all patients, four treatment combinations were associated with lower mortality: Anticoagulation Only (OR 0.24, p < 0.0001), Anticoagulation and Remdesivir (OR 0.25, p = 0.0031), Anticoagulation and Corticosteroids (OR 0.53, p = 0.0263), and Anticoagulation, Corticosteroids and Remdesivir (OR 0.42, p = 0.026). For non-intensive care unit patients, the same combinations were significantly associated with lower mortality. For patients admitted to the intensive care unit, Anticoagulation Only was the sole treatment category associated with decreased mortality. When adjusted for demographics, clinical characteristics, and all treatment combinations there was an absolute decrease in the mortality rate by 2.5% between early and late periods of the study. However, when including an additional control for changes in unmeasured variables overtime, the absolute mortality rate decreased by 5.4%. Conclusions This study found that anticoagulation was the most significant treatment for the reduction of COVID-related mortality. Anticoagulation Only was the sole treatment category associated with a significant decrease in mortality for both intensive care and non-intensive care patients. Treatment combinations that additionally included corticosteroids and/or remdesivir were also associated with decreased mortality, though only in the non-intensive care stratum. Further, we found that factors other than measured changes in demographics, clinical characteristics or pharmacological interventions accounted for an additional decrease in the COVID-19-related mortality rate over time.

Real World Data (RWD) Treatment Patterns and Sequencing of Patients with Multiple Myeloma (MM)

Introduction: Despite advances in treatment, MM remains an incurable disease. RWD are key to improving our understanding of treatment patterns for patients with MM. This study examined the proportion of patients with MM (1) treated with an immunomodulatory drug (IMiD), a proteasome inhibitor (PI), an anti-CD38 monoclonal antibody (aCD38), or Other in first line (1L) through fourth line or greater (4L+) by calendar year; and (2) who had a change in treatment regimen at line change. Subgroup analyses were performed by cytogenetic risk status (high vs. standard), stem cell transplant (SCT) eligibility (eligible vs. ineligible), and practice type (community vs. academic). Methods: The Flatiron Health Database was used, comprising de-identified EHR-derived data for patients treated in the Flatiron Health network. Patients were excluded if they had no record of a 1L treatment recognized as an induction regimen based on NCCN guidelines, a 1L regimen that contained an active therapy for another cancer type, 1L initiated &gt;60 days after MM diagnosis, and &lt;3 consecutive months of data. Treatments were classified into 15 mutually exclusive categories (inclusive of steroids): Chemotherapy, IMiD, IMiD+chemo, PI, PI+chemo, IMiD+PI, IMiD+PI+chemo, aCD38, aCD38+chemo, aCD38+IMiD, aCD38+IMiD+chemo, aCD38+PI, aCD38+PI+chemo, aCD38+IMiD+PI, and Other. Treatment use and sequencing patterns were assessed using proportions. Results: 5890 adult patients diagnosed with MM between 1/1/2011 and 12/31/19 were included. 45% of patients were female, 60% were white, and the median age was 69 (IQR = 61-76). Nearly 90% of the cohort were from community practices. Across years and lines, the most common treatment categories were IMiD, PI, and IMiD+PI. After 2015, IMiD+ PI was the dominant category in 1-3L and IMiD was the dominant category in 4L+. After 2015 and across lines, the most common aCD38 containing treatment was aCD38+IMiD. After 2015, aCD38 treatments were used in 2-4% of 1L patients regardless of subgroup. Between 2015 and 2019, the use of aCD38 treatments in 2L increased from 1% to 20% in all, standard risk, SCT eligible, and community patients, 2% to 15% in SCT ineligible, and 10% to 20% academic patients. Between 2015 to 2019, the use of aCD38 treatments in 3L increased from 10% to &gt;30% in all, standard risk and SCT eligible patients, 10% to 20% in academic patients, and 2% to 20% in community and SCT ineligible patients. Over 40% of 4L+ patients were treated with aCD38 treatments by 2019 regardless of subgroup. As shown in Figure 1, of the patients receiving an IMiD, PI, or IMiD+PI in 1-3L in 2015-2019, 10-25% stayed with the same treatment category (though likely switched drugs within the class), whereas 25-50% switched to a different treatment category, in the next line. These proportions generally hold regardless of subgroup. Of the patients receiving an aCD38 regimen in 1-2L in 2015-2019, 10-20% stayed with the same treatment category, 5-40% switched to a different treatment category, and 5-25% stayed with an aCD38 regimen but switched to a different combination in the next line. Of 3L patients receiving an aCD38 regimen, under 15% stayed with the same treatment category, 5-40% switched to a different treatment category, and 1-40% stayed with an aCD38 regimen but switched to a different combination in 4L. Conclusions: Our findings suggest that across lines, IMiD, PI, and IMiD+PI are the most common treatment categories but that aCD38 treatments are increasingly used in recent years and in later lines. For the major treatment categories (IMiD, PI, IMiD+PI), &lt;25% patients will remain with the same treatment category, whereas 25-50% will switch to another treatment category, in the next line. For aCD38 treatments, 20% or less will remain with the same treatment category, whereas 5-40% will switch, in the next line. Disclosures Gershon: Genentech, Inc./ F. Hoffmann-La Roche: Current Employment, Current equity holder in publicly-traded company. Liu:Genesis Research receives consulting fees from Genentech, Inc. a member of the F. Hoffmann-La Roche Group: Consultancy; Genesis Research: Current Employment. James:Genentech, Inc./ F. Hoffmann-La Roche: Current Employment, Current equity holder in publicly-traded company. Williamson:Amgen: Current equity holder in publicly-traded company; F. Hoffmann-La Roche: Current Employment, Current equity holder in publicly-traded company. Hong:Genentech, Inc.: Current Employment; F. Hoffmann-La Roche: Current equity holder in publicly-traded company. Sarsour:F. Hoffmann-La Roche: Current equity holder in publicly-traded company; Genentech, Inc.: Current Employment.

“Stopping the itch”: mass drug administration for scabies outbreak control covered for over nine million people in Ethiopia

Introduction: In 2018, the Ethiopian Ministry of Health embarked on a Mass Drug Administration (MDA) campaign that involved over 9 million people in Ethiopia – the largest scabies MDA campaign ever conducted on a global level. We describe its implementation and report on a) numbers screened and identified with scabies, b) treatment category and drug type and c) human resources used, duration, and cost of the campaign. Methodology: The MDA campaign was conducted according to national guidelines and activities including: planning and organization, engagement of local leaders, community mobilisation and advocacy, awareness-raising among health workers, field implementation, and monitoring and evaluation. The campaign was conducted between July and August 2018. Results: The MDA campaign was implemented by about 15,000 people, mostly from the community, over an average of 6 days and reached 9, 057, 427 people. A total of 875,890 (9.7%) scabies cases were detected and 995,471 (11.0%) contacts received treatment. (Contact-to-case ratio = 1.3). Scabies prevalence varied, the highest prevalence was seen in Central Gondar (39.2%), South Gondar (16.7%) and North Gondar (15.0%), these neighbouring zones contributing more than two third of all scabies cases in the region. Of 1,738,304 (93%) who received treatment, 94% received ivermectin, the rest topical permethrin and sulfur. The average coverage capacity of an MDA campaign staff member was 84 people per day. The total cost was 11,696,333 United States Dollars (USD). Cost per 100,000 population = 129,135 USD. Conclusions: This experience of rapid-large scale implementation would be useful to scale up similar interventions and “stop the itch” in other regions of Ethiopia.

Treatment outcomes of patients with tuberculosis in war affected region of Khyber Pakhtunkhwa, Pakistan

Background: Globally, tuberculosis (TB) remains the leading cause of death from a single infectious disease. TB treatment outcome is an indicator for the effectiveness of a national TB control program. This study aimed to assess treatment outcomes of TB patients and its determinants in Batkhela, Khyber Pakhtunkhwa, Pakistan. Methods: A retrospective cohort study was designed using all TB patients who were enrolled at District Head Quarter (DHQ) Hospital Batkhela, Pakistan, from January 2011 to December 2014. A binary logistic regression models were used to identify factors associated with successful TB treatment outcomes defined as the sum of cure and completed treatment. Results: A total of 515 TB patients were registered, of which 237 (46%) were males and 278 (53.98%) females. Of all patients, 234 (45.44%) were cured and 210 (40.77%) completed treatment. The overall treatment success rate was 444 (86.21%). Age 0-20 years (adjusted odds ratio, AOR= 3.47; 95% confidence interval, CI)= 1.54-7.81; P= 0.003), smear-positive pulmonary TB (AOR)= 3.58; 95% CI= 1.89-6.78; P= <0.001), treatment category (AOR= 4.71; 95% CI= 1.17-18.97; P= 0.029), and year of enrollment 2012 (AOR= 6.26; 95% CI= 2.52-15.59; P= <0.001) were significantly associated with successful treatment outcome. Conclusions: The overall treatment success rate is satisfactory but still need to be improved to achieve the international targeted treatment outcome. Type of TB, age, treatment category, and year of enrollment were significantly associated with successful treatment outcomes.

MS Disease and Providing a Biologic Perspective and Reducing the Symptoms of the Disease with the Help of Stem Cells

Introduction: MS is one of the most common inflammatory diseases of the central nervous system, with the destruction of nerves. One of the symptoms of MS disorder is dystonia, fatigue, spasticity, disturbances, lack of sensation in the organs, cognitive impairment, weakness, tremor, pain, bladder and bowel dysfunction. Method: The search was carried out in the Pubmed/Medline database. 63 The study was designed to investigate patients with MS and therapeutic samples that were materially similar to the current research, and are included in this article. Findings: Therapeutic injection methods in MS have responded, but patients are still in trouble. Studies have shown that the use of stem cells for treating patients with MS has been fruitful and can be used to treat MS. Discussion: As it has been said, the most important treatment challenges in this way is to reduce treatment, and moreover, that anti-MS drugs in advanced forms are limited. Hence, the production of new, improved medicines for the complete treatment of MS is essential. Stem cells play a veryw important role in the repair process, and the complications of these cells are low in patients and provide an acceptable response. Reliably, the focus on new immunology methods with more biological properties has a greater impact on the treatment category. They will have patients.

Treatment outcomes of patients with tuberculosis in war affected region of Khyber Paktunkhwa, Pakistan

Background: Globally, tuberculosis (TB) remains the leading cause of death from a single infectious disease. TB treatment outcome is an indicator for the effectiveness of a national TB control program. This study aimed to assess treatment outcomes of TB patients and its determinants in Batkhela, Khyber Pakhtunkhwa, Pakistan. Methods: A retrospective cohort study was designed using all TB patients who were enrolled at District Head Quarter (DHQ) Hospital Batkhela, Pakistan, from January 2011 to December 2014. A multivariable logistic regression models were used to identify factors associated with successful TB treatment outcomes defined as the sum of cure and completed treatment. Results: A total of 515 TB patients were registered, of which 237 (46%) were males and 278 (53.98%) females. Of all patients, 234 (45.44%) were cured and 210 (40.77%) completed treatment. The overall treatment success rate was 444 (86.21%). Age 0-20 years (adjusted odds ratio, AOR= 3.47; 95% confidence interval, CI)= 1.54-7.81; P= 0.003), smear-positive pulmonary TB (AOR)= 3.58; 95% CI= 1.89-6.78; P= <0.001), treatment category (AOR= 4.71; 95% CI= 1.17-18.97; P= 0.029), and year of enrollment 2012 (AOR= 6.26; 95% CI= 2.52-15.59; P= <0.001) were significantly associated with successful treatment outcome. Conclusions: The overall treatment success rate is satisfactory but still need to be improved to achieve the international targeted treatment outcome. Type of TB, age, treatment category, and year of enrollment were significantly associated with successful treatment outcomes.