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Biomedical subjects

A Kochi

Publications and source records attributed to A Kochi.

At least 19 recordsLinked to original sources
PubMed2000

Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in 6 countries.

CONTEXT: No large-scale study has investigated the impact of multidrug-resistant tuberculosis (TB) on the outcome of standard short-course chemotherapy under routine countrywide TB control program conditions in the World Health Organization's (WHO) directly observed treatment short-course strategy for TB control. OBJECTIVE: To assess the results of treatment with first-line drugs for patients enrolled in the WHO and the International Union Against Tuberculosis and Lung Disease's global project on drug-resistance surveillance. DESIGN AND SETTING: Retrospective cohort study of patients with TB in the Dominican Republic, Hong Kong Special Administrative Region (People's Republic of China), Italy, Ivanovo Oblast (Russian Federation), the Republic of Korea, and Peru. PATIENTS: New and retreatment TB cases who received short-course chemotherapy with isoniazid, rifampicin, pyrazinamide, and either ethambutol or streptomycin between 1994 and 1996. MAIN OUTCOME MEASURE: Treatment response according to WHO treatment outcome categories (cured; died; completed, defaulted, or failed treatment; or transferred). RESULTS: Of the 6402 culture-positive TB cases evaluated, 5526 (86%) were new cases and 876 (14%) were retreatment cases. A total of 1148 (20.8%) new cases and 390 (44.5%) retreatment cases were drug resistant, including 184 and 169 cases of multidrug-resistant TB, respectively. Of the new cases 4585 (83%) were treated successfully, 138 (2%) died, and 151 (3%) experienced short-course chemotherapy failure. Overall, treatment failure (relative risk [RR], 15.4; 95% confidence interval [CI], 10.6-22.4; P<.001) and mortality (RR, 3.73; 95% CI, 2.13-6.53; P<.001) were higher among new multidrug-resistant TB cases than among new susceptible cases. Even in settings using 100% direct observation, cases with multidrug resistance had a significantly higher failure rate than those who were susceptible (9/94 [10%] vs 8/1410 [0.7%]; RR, 16.9; 95% CI, 6.6-42.7; P<.001). Treatment failure was also higher among patients with any rifampicin resistance (n=115) other than multidrug resistance (RR, 5.48; 95% CI, 3.04-9.87; P<.001), any isoniazid resistance (n=457) other than multidrug resistance (RR, 3. 06; 95% CI, 1.85-5.05; P<.001), and among patients with TB resistant to rifampicin only (n=76) (RR, 5.47; 95% CI, 2.68-11.2; P<.001). Of the retreatment cases, 497 (57%) were treated successfully, 51 (6%) died, and 124 (14%) failed short-course chemotherapy treatment. Failure rates among retreatment cases were higher in those with multidrug-resistant TB, with any isoniazid resistance other than multidrug resistance, and in cases with TB resistant to isoniazid only. CONCLUSIONS: These data suggest that standard short-course chemotherapy, based on first-line drugs, is an inadequate treatment for some patients with drug-resistant TB. Although the directly observed treatment short-course strategy is the basis of good TB control, the strategy should be modified in some settings to identify drug-resistant cases sooner, and to make use of second-line drugs in appropriate treatment regimens. JAMA. 2000;283:2537-2545

Antitubercular Agents↗
PubMed1999

[Arterial oxygenation during one lung ventilation in obese patients].

To test the hypothesis that arterial oxygenation during one lung ventilation (OLV) is impaired more in obese patients than in non-obese control patients, we performed consecutive measurements of arterial oxygen tension (PaO2) during OLV in 48 patients scheduled for pulmonary lobectomy. Minimum value of PaO2 during OLV was significantly less in 16 obese patients [body mass index (BMI) > 25] compared to 32 control patients (BMI < 25). Moreover, PaO2 value of left lung ventilation was significantly less than the value of right lung ventilation in obese patients while the difference was not statistically significant in the control group.

Aged↗
PubMed1997

Assessment of worldwide tuberculosis control. WHO Global Surveillance and Monitoring Project.

BACKGROUND: Because worldwide tuberculosis (TB) control had never been assessed, WHO set up a surveillance and monitoring project in 1995. The objectives were to assess the performance of national TB programmes; to assess the extent of implementation of the WHO strategy of TB control; and to attempt a comparison between regions that had adopted the WHO strategy and those that had not. METHODS: In June, 1996, we sent data-collection forms requesting information on national TB programmes' control policies, 1995 case notifications, and 1994 treatment results to 216 countries, areas, and territories. We assessed the performance of national TB programmes by comparing case notifications with estimated incidence and by outcome of treatment in cohorts of patients. We also investigated worldwide treatment success and case detection among sputum-smear-positive patients. FINDINGS: 180 (83%) of the 216 countries, areas, and territories surveyed replied to WHO (98% of the worldwide population). In 1995, the WHO control strategy had been implemented in 75 countries, and in 39 of these implementation was countrywide. UP to 23% of the worldwide population lived in regions where the strategy was available. In 1995, 3 297 688 cases of TB (all types) were reported, of which 1161411 (35%) were sputum-smear positive. 54% of all reported cases in countries that used the WHO strategy were sputum-smear positive, compared with 30% in other countries. The worldwide case-detection rate of new sputum-smear-positive cases was 35%. 92% of cases registered for treatment in 1994 in regions that used WHO strategy were assessed for outcome and 76% were treated successfully, compared with 54% and 42%, respectively, in regions that had not implemented the WHO strategy. Among cases reported worldwide in 1994, the documented treatment-success rate was 43%. INTERPRETATION: National TB programmes that have adopted the WHO TB control strategy achieve higher cure rates, but their impact on TB is modest on a worldwide scale. Wider continuous coverage with the WHO strategy is needed for effective worldwide TB control.

Communicable Disease Control↗
PubMed1997

Tuberculosis control--is DOTS the health breakthrough of the 1990s?

The resurgence of tuberculosis in recent years has made an effective control strategy indispensable. The strategy exists and is called DOTS--Directly Observed Treatment, Short-course. It has proved its effectiveness and now needs to be used worldwide on a much larger scale.

Adult↗
PubMed1995

Global epidemiology of tuberculosis. Morbidity and mortality of a worldwide epidemic.

This article describes the global epidemiology of tuberculosis and reviews recent estimates of tuberculosis incidence and mortality in the world. The highest prevalence of tuberculosis infection and estimated annual risk of tuberculosis infection are in sub-Saharan Africa and Southeast Asia. Overall, almost 3.8 million cases of tuberculosis were reported in the world in 1990, of which 49% were in Southeast Asia. From the period 1984 through 1986 to the period 1989 through 1991, notification rates increased in all World Health Organization regions, except the American and the European regions. In 1990, there were an estimated 7.5 million cases of tuberculosis and 2.5 million deaths worldwide. The human immunodeficiency virus epidemic is causing increases in the number of tuberculosis cases, particularly in Africa, although increases are also expected in Southeast Asia. In many industrialized countries, tuberculosis has recently failed to decline, and in eastern Europe and the former Soviet Union, cases and deaths are increasing. Drug resistance is a serious problem, especially in the United States. If worldwide control of tuberculosis does not improve, 90 million new cases and 30 million deaths are expected in the decade 1990 through 1999.

Data Collection↗
PubMed1995

Low-dose halothane produces airway dilatation but does not alter parenchymal mechanics in the normal canine lung.

The purpose of this study was to examine whether halothane reduces the contractile tone of the normal lung and to distinguish the effects of halothane on airways from those on lung tissue. We also tested whether a mathematical model was capable of quantitatively describing the mechanical changes in the lung produced by halothane. We measured lung impedence (ZL(omega) a complex function of real (lung resistance) and imaginary (reactance) parts) at low frequencies in dogs using a forced volume oscillation technique before and during 1 MAC halothane anaesthesia. Halothane produced small changes in ZL(omega). The lung resistance tended to decrease during halothane anaesthesia whereas the lung reactance did not show change. Using an alveolar capsule technique to separate the airways from the lung tissue components, these lung mechanical changes were induced mainly by alterations in lung tissue and not in the airways. Our mathematical model featured a single airway leading to an alveolar region surrounded by a viscoelastic lung tissue. In the model analysis, estimates of airway resistance and inertance decreased by the administration of halothane. In contrast, estimates of lung tissue elastance and resistance did not change during halothane anaesthesia. These modeling results were consistent with those obtained by direct alveolar pressure measurements. Our results suggest that a low concentration of halothane dilates the airways but does not alter the parenchymal mechanics in the normal lung, and that the model provides a quantitative tool to assess lung mechanics precisely, if respiratory signals are measured only at the true airway opening.

Airway Resistance↗
PubMed1995

[High tissue concentration of 5-FU reduced local recurrence after administration of tegafur suppositories].

Forty-two patients with head and neck cancer were treated with tegafur suppository for 7 days preoperatively and clinical value of this treatment was assessed. In a group which indicated tumor tissue concentrations of 5-FU were more than 0.5 micrograms/g, local recurrence decreased in the period of postoperative observation for 42 months. A survival rate of this group was better than others. From these results, preoperative tegafur suppository treatment seemed to have a role in expectation of improvement of local control in head and neck cancer therapy.

Chemotherapy, Adjuvant↗
PubMed1994

Drug-resistant tuberculosis: laboratory issues. World Health Organization recommendations.

There is a suggestion that drug resistance rates decreased in developing countries over the period 1962-85, while recent data suggest that resistance may be increasing. The initial decrease in resistance appears to be associated with well-functioning National Tuberculosis Control Programmes (NTP), while the recently observed increase may be due either to understaffed, resource-poor programmes or to the effect of the HIV epidemic, or to both. It is possible that the HIV epidemic may overwhelm the NTP, resulting in decreased programme efficiency and ultimately increased drug resistance. Resistance surveillance appears to be a good measure of programme efficiency. For research purposes, primary drug resistance surveys should be done on a sample of relevant patients which includes and distinguishes between HIV-positive and HIV-negative patients. At this time, there is not enough information to warrant a recommendation regarding HIV testing of TB patients for surveillance purposes. In order for resistance surveys to be relevant from the public health perspective, one must know the proportion of patients presenting for treatment having previously received treatment. The meaningful denominator for drug resistance surveys from the programme evaluation perspective should be the number of patients presenting for treatment. For initial drug resistance surveys the measurement should be the number of people never having received prior TB treatment with resistant bacilli, divided by the number of new patients presenting for treatment. For acquired resistance, one should look at all patients who begin treatment with susceptible bacilli who become resistant 6 months later.

Antitubercular Agents↗
PubMed1994

Tuberculosis trends in eastern Europe and the former USSR.

The aim of this paper is to assess trends in tuberculosis morbidity and mortality in the countries of Eastern Europe and the former USSR. Data on morbidity and mortality were obtained from reports of the Ministries of Health, a 1992 WHO questionnaire, national tuberculosis associations, and other sources. The quality of surveillance of tuberculosis cases differs widely between countries. Ranging from 19 to 80 per 100,000 population in 1990-1992, tuberculosis notification rates of most Eastern European and former USSR countries are higher than those of Western European countries. The lowest tuberculosis notification rate is reported in the Czech Republic, while the highest are reported in Romania and Kazakhstan. While in Albania, Croatia and Slovenia notification rates have continued to decline, in the remaining countries of Eastern Europe the declining trend has recently stopped. Nevertheless, countries such as the Czech Republic, Hungary, Poland and the Slovak Republic have experienced a distinct rate decrease when the 3-year average rate around 1985 is compared to that around 1990, despite the very recent levelling-off or increase. In Romania, the previous decline in notification rate ended in 1985 and in the period 1986-1992 an average 5.4% annual increase was observed. In this country, two-thirds of all cases still occur among young adults. Among the Baltic countries of the former USSR, the declining trend continues in Estonia, whereas in Latvia and Lithuania notification rates decreased less markedly from 1985 to 1990 than in the first half of the 1980s. Among the other European countries of the former USSR, Russia and Ukraine had a slow decline in the first half of the 1980s and a more pronounced one from 1985 to 1990. During the latter period of time, in Belarus and Moldova the decrease has been steeper. In the Caucasian countries of the former USSR, where underreporting and low case-finding are recognized, case rates have stabilized in Armenia, while in Azerbaijan and Georgia there was a decrease from 1985 to 1990. Among the Asian countries of the former USSR, Kazakhastan and Tajikistan reported a lower decline in case rates from 1985 to 1990 than from 1980 to 1985. Kyrgyzstan, Turkmenistan, and Uzbekistan reported increases in notification rates from 1985 to 1990: in Turkmenistan an average 5.5% annual increase in rate was observed between 1987 and 1991. Tuberculosis mortality is steadily increasing in Romania, Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, and Turkmenistan, while no decline is seen in most of the other countries of Eastern Europe and the former USSR.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗