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Biomedical subjects

P Mihăilescu

Publications and source records attributed to P Mihăilescu.

At least 19 recordsLinked to original sources
PubMedDate not supplied

[The exclusively outpatient treatment of pulmonary tuberculosis under the conditions in Romania].

In order to demonstrate the possibility of an exclusively outpatient treatment of pulmonary tuberculosis in the present conditions in our country, a study was performed on 140 cases in Bucharest. The admission criteria were as follows: sputum negative patients (M-C-); paubacillary cases, sputum positive only in culture (M-C+); Tb pleuritis; patients refusing hospitalization, regardless their bacteriological status, and sputum positive cases also at smear examination (M+C+), if they had no household contacts under 20 years of age or with a good social economic standard of life. The patients were given the intensive chemotherapy regimen HSRZ 2/7 for 6 months, that was prolonged to 9 months in specified cases. A number of 31 patients were non-bacillary (M-C-) out of which 14 cases with pleuritis; 70 were paucibacillary (M-C+), and 39 were smear positive (M+C+). Out of 109 patients which were bacteriologically confirmed, sputum reversion in culture was obtained in 71.6% of cases at 2 months and in 89.0% at 3 months. At treatment end, sputum negativation was not obtained in a single patient (0.9%). Case follow-up for 6-41 months after treatment end led to the registration of 8 therapeutical failures and bacteriological relapses (5.7%). Five cases recovered through re-treatment, 1 patient (0.7%) died through tuberculosis, and 2 (1.4%) became chronic case. Periodical control of the 95 contact children in the respective households revealed a single conversion of the tuberculin reaction and no Tb case after treatment start in index cases, which proves the epidemiological reliability of the method.

Adolescent↗
PubMedDate not supplied

[The association of tuberculosis with HIV/AIDS infection in children in Romania].

The great number of AIDS cases in children in Romania, together with the high annual risk of Tb infection, created the premises for the occurrence of a relatively great number of disease cases through HIV infection/AIDS + tuberculosis, particularly in the age-group "0-5 years". Serum positive HIV children were considered as AIDS cases when tuberculosis was also associated. Twelve cases in which the infections were concomitant, transmitted through injections, constituted an exception to the point. The 12 children serum positive for HIV showed a primary musculo-cutaneous complex on their thighs, at the very place of injections. A proportion of 50% of them showed a favourable evolution under anti-Tb treatment. Most children developed primary tuberculosis aerogenically acquired, associated with AIDS. A proportion of 59.5% of them evoluted towards severe disseminated forms (milliaria, meningitis), with many deaths, and 37.8% only showed a favorable evolution under anti-tuberculosis treatment. HIV infection in children took place predominantly between 1987-1989. Tuberculosis was associated 1-2 years later, when the switching from bacillary infection into active tuberculosis was facilitated by the progressive immunodepression which is specific for AIDS. The tuberculin test with 2 IU-PPD was positive in less advanced AIDS cases but faded in children in the final stage of the syndrome or in those with severe forms of tuberculosis. Tuberculosis finding out in children with HIV infection/AIDS is however possible; therefore, skin test reaction is compulsory in all children in this category. In children with a tuberculosis cured through specific treatment in their histories, the association of HIV infection reaching AIDS stage can lead to a Tb relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Model of eradication of tuberculosis in children in an area with high epidemiological potential].

In the territory of the Drajna TB dispensary, in the Prahova County, a series of complex measures have been experimented in the course of the second trimester of 1972, intending to prevent and to eliminate tuberculosis in children. Of the 31,731 children aged between 1 and 14 years, 29,496 have been tested with 2 units of PPD-IC65 (93 percent). A proportion of 12,6 percent of those tested presented reactions of more than 10 mm in diameter and 22,779 were vaccinated with BCG (Pasteur-Paris strain). The radiological pulmonary control of the reactors allowed for the detection of 24 cases of tuberculosis all of them new and asymptomatic. The efficiency of the detection was of 0,8 new cases per 1,000 tuberculin tested children or of 0,4 new cases per 100 of reactors that had been x-ray examined. This prophylactic action was repeated in 1973 in 2,219 children aged between 1 and 2-1/2 years that had been ommited in the preceding year and 4 new cases of tuberculosis were detected. In the medical districts in which there was a high prevalence of the children infection total radiophotographic case finding of the adult population was carried out. The result was a doubling of the TB incidence in children in 1972 followed by a 5-fold reduction of the indicators in 1973. The severe forms and death through tuberculosis in children have disappeared. The risk to develop the disease in BCG vaccinated children was reduced to 4,4 0/0000 per year. It is estimated that a generalization over the whole of the county of these prophylactic measures, as applied in the Drajna territory, under the form of a mass campaign, will allow for an improvement of the epidemiometric indicators in children in a relatively short time.

Adolescent↗
PubMedDate not supplied

[Comparative results of total detections and detection in a group of patients with high risk for tuberculosis in an urban environment].

In the territory of 5 anti-TBC dispensaries in the area of Bucharest 2 circumscriptions have been selected at random in which radiophotographic detection was to be carried out integrally and 2 other circumscriptions were selected for the investigation of groups at high risk of developing tuberculosis. All the new cases of active pulmonary tuberculosis that have been recorded, through all the methods in these 20 circumscriptions in 1973 were analized retrospectively and the reasons appeared that had determined their existence was mentioned or was ommitted on the occasion of previous investigations. These reasons were correlated with the data concerning the method for detection that had been employed, according to the indications of the tuberculosis dispensaries. In view of the evaluation of the degree of real covering of the population in integral rf investigations, the team of the Institute of Phtysiology investigated representative lots of population from each dispensary and checked the catagraphy of the population in the field, house-by-house. It was noted that 20--21% of the subjects that had been programmed for the integral rf examination (according to catagraphic criteria) were absent when the checking in the field, that should have been programmed, were not included in the catagraphy. On the basis of this study the methodology for radiophotographic detection for groups with risk of developing tuberculosis was established.

Humans↗
PubMedDate not supplied

[The risk of tuberculosis in students of professional schools].

In four technical schools in a Burcharest district, the first grade scholars were tested at the beginning of the term with 2 units PPD; those with a reaction of 0--9 mm received BCG vaccine. After 6 months, in the 3rd term, they were controlled by MMR examination which was repeated in the second year. The incidence of tuberculosis detected by X-ray and clinically was of 298.8 per 100 000 in the frist year and 283.6 per 100000 in the second year. In all disease cases but one the intradermoreation and greater than or equal to 15 mm which may thus be considered the risk group (a risk of 9.5 per thousand); there were no cases among the children revaccinated with BCG. In conclusion it is recommended to apply in adolescent communities tuberculin testing and BCG revaccination of the non-infected children 0--9 mm) in their first term and periodical X-ray control of the risk group, i.e. those with a reaction of 15 mm or more.

Adolescent↗
PubMedDate not supplied

[The risk of tuberculosis infection and disease among children in contact with tuberculous foci].

Three groups of children aged 0-14 years, in the 4-th district of Bucharest, have been followed up during 1988-89, as follows: a retrospective group--331 contact children in new tb foci registered in 1986-87; a prospective group--213 contact children in newly registered foci in 1988 and a group of 49 contact children in chronic foci. The children have been controlled clinically and X-ray and tuberculin tested on case-finding of the index-case and 3, 6 and 12 months thereafter; those from the retrospective group even after 2-3 years. The non-infected children were BCG vaccinated; in those infected chemoprophylaxis was administrated. The most dangerous infection sources for children were the tb bacilli eliminators on microscopy. The tuberculin conversions were noted during the first 3-6 months after contact; the children from chronic foci can converse even after 1-3 years. The active tuberculosis in children were noted on the initial check-up and were missing during the follow-up period, even in chronic foci. These observations could be accounted to the prophylactic measures applied in contact children, corroborated with intensive treatment of infection sources. Since most of disease cases in children were under 2-3 years of age, we consider necessary to continue the BCG vaccination at birth.

Adolescent↗
PubMedDate not supplied

[Reducing the risk of tuberculosis in children vaccinated with BCG].

In 1973, of 1774192 children aged 18 months to 6 years, 82,2% had to be revaccinated with BCG, 10.7% presented tuberculin reactions larger than 10 mm and 7.1% were absentees. In 1974 a number of 485 children belonging to the respective age group contracted tuberculosis. Analysis of these cases showed that the risk of tuberculosis was of 10.9 per 100,000 revaccinated subjects and of 74.6 per 10,000 absentees. BCG vaccination not only lowered the risk of the disease but also reduced the risk of a severe evolution and death.

BCG Vaccine↗
PubMedDate not supplied

[The risk of grave evolution of tuberculosis in young children (under 2 years of age)].

Between 1971 and 1972, 22% of all children under two years with tuberculosis presented with severe forms of the disease (meningitis, miliaria, caseous forms). In the period 1974-1975, although the number of cases in the group was reduced by half, the severe forms still represented 20,4% of the total. The risk of severe evolution of tuberculosis decreases rapidly, from 55--66% in the first months of life. to 14,2--15,5% at 1--2 years. The risk of death in children aged between 0 and 2 years with tuberculosis (all forms) was of 26,6--58,3% between 0 and 5 months but only 4,5--9,3% in the second year of life. The risk of death in young children with severe forms of tuberculosis was as high as 70--76,7% in those under the age of 6 months. The source of infection was identified in 72,4--76,4% of the severe cases. At the onset of the disease only 57,1% of the sources were known, while 42,9% were discovered later, by epidemiologic investigations. An analysis of cause for a severe evolution of tuberculosis in young children led to the conclusion that BCG vaccination should be performed systematically at birth, and that tuberculin skin test be carried out in all hospitalized children, regardless the diagnosis. They also recommend the use of anamnestic data concerning the possible existence of tuberculosis cases in the families of patients, performing of radiologic controls in young mothers etc. In the case of infants that come into a close contact at a very early age with parents, or other relatives suffering with tuberculosis, chemoprophylaxis with two associated tuberculostatics is indicated.

Age Factors↗