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Biomedical subjects

M Zierski

Publications and source records attributed to M Zierski.

At least 19 recordsLinked to original sources
PubMed1989

[Survey of the initial treatment of pulmonary tuberculosis in West Germany. A study by the German Central Committee for the Prevention of Tuberculosis].

1405 adult patients were selected for assessment who had been newly notified in the years 1986/87 with confirmed diagnosis of active progressive pulmonary tuberculosis who required treatment. Of these, 83.5% excreted tubercle bacilli in the sputum; radiographic lung cavities were confirmed in 53.6%, and 859 (61.1%) had a concomitant disease. 1173 patients (94.2%) were hospitalized for initial treatment and only 232 (5.8%) received outpatient treatment. The median duration of the hospital stay was 12 weeks. Isoniazid and rifampicin were prescribed in 96% and 93% patients, respectively, mostly all the time, ethambutol in 75% initially and in 50% throughout, streptomycin in 50% initially. Three or four drug regimens including pyrazinamide in the initial phase were employed in 76% of the patients. Premature discontinuation of therapy for different reasons was noted in 135 patients (9.5%). Of these, treatment was discontinued in 59 (4.2%) due to death; 37 (2.6%) patients died due to tuberculosis. Adverse reactions were observed in 193 patients (13.7%); 0.3% of the patients discontinued chemotherapy because of toxicity. The duration of chemotherapy was between 9 and 12 months in the majority of patients; 30%, however, were treated for more than 12 months. The chemotherapy of 6-months duration was performed only in about 10% of treated patients. Among the patients who completed the treatment, this proved effective in 98%. Although the majority received initially the rational chemotherapy with a three or four drugs regimen, it is concluded that the inpatient stay and the outpatient duration of chemotherapy in the routine clinical practice is too long, therapy control is insufficient.

Adolescent↗
PubMed1986

Short-course tuberculosis chemotherapy studies conducted in Poland during the past decade.

During the past decade, six short-course (6-month) chemotherapy regimens were studied in which drugs were given daily and intermittently. Four regimens containing isoniazid, rifampin, and ethambutol caused little toxicity but yielded relapse rates (8-21%) which were unacceptably high. The safety of giving rifampin (450 or 600 mg) twice weekly was confirmed, however, and there was evidence that daily therapy during the 4-month continuation phase was no more effective than twice weekly isoniazid and rifampin. Once weekly therapy during the continuation phase was clearly inadequate. The use of four drugs (isoniazid, rifampin, pyrazinamide, and streptomycin) given daily during the initial 2 months of therapy followed by 4 months of twice weekly isoniazid and rifampin resulted in a nearly 100% cure rate. However, this regimen was not well tolerated by patients. Deleting streptomycin improved the tolerability of the regimen but appears to have slightly increased the frequency of treatment failure and relapse. A suggested model for choosing treatment regimens is presented.

Adolescent↗
PubMed1985

Heterozygosity in the Pi-system as a pathogenetic cofactor in chronic obstructive pulmonary disease (COPD).

A population (n = 526), consisting of employees with COPD, was compared with 2 control populations for the prevalence of Pi-phenotypes. In the patient group, the proportions of ZZ, SZ and MZ were significantly elevated. Among the patient population a prospective study was carried out to evaluate the role of alpha 1-antitrypsin deficiency as a cofactor in COPD. Severity of disease was estimated by standard pulmonary function tests, X-ray signs for emphysema and clinical assessment. Patients with ZZ, SZ and MZ were significantly worse than their MM partners. An influence of MS cannot be rejected. Phenotyping of all patients with COPD is advocated. Screening can also be by determining the ratio of alpha 1-antitrypsin and acid alpha 1-glycoprotein concentrations, which allowed detection of all ZZ, SZ, MZ and about 60% of the MS patients.

Adult↗
PubMed1982

Successful intermittent treatment of smear-positive pulmonary tuberculosis in six months: a cooperative study in Poland.

One hundred nineteen patients 15 to 70 yr of age, all with smear-positive, previously untreated, pulmonary tuberculosis, were treated with a 6-month regimen containing isoniazid and rifampin, supplemented during the initial 2 months with streptomycin and pyrazinamide. The 4 drugs were administered daily in the hospital during the initial 2 months, followed by isoniazid and rifampin administered twice weekly on an outpatient basis during the next 4 months. Adverse reactions to the drugs were seen in 19 patients, but only 6 had toxic reactions requiring withdrawal of drugs for 7 days or more. Three of the toxic reactions were attributed to streptomycin, 2 to rifampin, 1 to isoniazid, and none to pyrazinamide. Eighty-five (71%) of the 119 eligible patients completed treatment. After the first 2 months of therapy, 91% of these patients had negative sputum cultures, and all of them had negative cultures by the end of the third month of treatment. No relapses have occurred among the 84 patients observed for 18 months after therapy was completed.

Adolescent↗
PubMed1981

Short-course (6-month) cooperative tuberculosis study in Poland: results 30 months after completion of treatment.

This final report compared the efficacy of four 6-month chemotherapy regimens 30 months after the completion of treatment. All patients received isoniazid, rifampin, and ethambutol daily in hospital for the first 8 wk of treatment. One group continued to receive these 3 drugs daily as outpatients for an additional 18 wk; a second group received the same drugs twice-weekly, and a third group received the 3 drugs once-weekly during the 18-wk "continuation phase." A fourth group of patients received 2 drugs, isoniazid and rifampin, twice-weekly during the continuation phase. Drug toxicity was not a major problem; drugs were permanently discontinued in only 1% of the patients. All 4 regimens were highly effective in achieving sputum negativity. However, the relapse rate was found to be relatively high for all regimens (range, 8 to 22%).

Adolescent↗
PubMed1980

Side-effects of drug regimens used in short-course chemotherapy for pulmonary tuberculosis. A controlled clinical study.

An analysis is presented of the side effects which occurred in 530 patients treated with 6 months chemotherapy for newly detected pulmonary tuberculosis. Five treatment regimens were used. The initial phase of treatment consisted of daily isoniazid, rifampicin and ethambutol (HRE) or isoniazid, rifampicin, streptomycin and pyrazinamide (HRSZ) given for 2 months. The second phase of treatment consisted of isoniazid and rifampicin given twice weekly (H2R2) or isoniazid, rifampicin and ethambutol given daily (4HRE) or intermittently (H1R1E1 or H2R2E2) for 4 months. Side effects were detected in 66 (12.4%) patients. Hepatotoxic reactions occurred in 48 (9%) patients, mainly of amild and transient nature and the majority were attributable to isoniazid. The 'flu like' syndrome occurred in only 2 patients both during the daily phase of treatment, and it was not encountered in patients taking rifampicin intermittently (dose 600 mg). Inclusion of pyrazinamide in the initial phase of 1 regimen did not result in an increase of frequency of side effects. In 56% of patients on pyrazinamide the serum uric acid concentration was elevated but there was no arthralgia. Drug toxicity leading to alteration or withdrawal of treatment occurred in only 10 (1.8%) patients. This study shows that with these 6 month regimens the overall risk of drug toxicity was low, and less than that associated with more conventional treatment regimens.

Adolescent↗
PubMed1980

Short-course (6 month) cooperative tuberculosis study in Poland: results 18 months after completion of treatment.

This study compared the efficacy and toxicity of 4 drug regimens containing rifampin, isoniazid, and ethambutol administered both daily and intermittently for a total duration of 6 months (26 wk). There were 411 patients with newly diagnosed, previously untreated, pulmonary tuberculosis admitted to the study. All patients received isoniazid, rifampin, and ethambutol daily in a hospital for the first 8 wk of treatment. One group continued to receive these 3 drugs daily as outpatients for an additional 18 wk; a second group received the same drugs twice weekly, and a third group received the 3 drugs once weekly during the 18-wk "continuation phase." A fourth group of patients received 2 drugs, isoniazid and rifampin, twice weekly during the continuation phase. Drug toxicity was not a major problem; drugs were permanently discontinued in only 1% of the patients. All 4 regimens were highly effective in achieving sputum negativity. By the fifty month, 100% of the patients had become culture negative. However, the relapse rate was found to be relatively high for all regimens (range, 7 to 20%). Patients with extensive disease, large cavities, heavy growth on pretreatment cultures, slow sputum conversion, persistent cavities, heavy use of alcohol, and concomitant diseases were more likely to relapse. In order to achieve relapse rates acceptable in developed countries, regimens containing rifampin and isoniazid must either be given for longer than 6 months or strengthened by the addition of supplemental drugs during the initial phase.

Adolescent↗