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PubMed2004

Tuberculosis treatment default at the communicable diseases unit of Effia-Nkwanta Regional Hospital: a 2-year experience.

SETTING: Effia-Nkwanta Regional Hospital, located at Sekondi-Takoradi, the capital and third largest city of the Western Region of Ghana. OBJECTIVE: To examine factors associated with treatment default among tuberculosis (TB) patients registered for treatment in 2000-2001. DESIGN: Retrospective review of institutional records of TB patients. METHOD: The database for registered TB patients was sorted out into the six treatment outcomes. Five outcomes were combined into one variable named 'non-defaulters' and were compared with defaulters. Statistical significance was taken as P < 0.05. RESULTS: The defaulter rate for all categories of patients was 13.9%. Default from treatment was significantly associated with male sex, smear positivity and living in communities far from the treatment centre. Patients in the 25-44 year age group and those put on the retreatment regimen have higher defaulter rates, but these were not statistically significant when compared to non-defaulters. The mean defaulting moment was 3.4 months. The overall probability of a patient remaining on treatment 5 months after starting was 3.6%. CONCLUSION: Treatment centres should be sited near the patients to improve access. Further studies are needed to identify the barriers for patients in completing their treatment.

Adolescent↗

PubMed1978

[What is the use of an occupational physician?].

In four occidental countries, an analysis of available statistics shows a decrease of industrial accidents, occupational diseases and tuberculosis during the last decades. However this decrease is correlated neither with the number of occupational physicians, nor with the spread of statutory annual medical examinations. Efficient prevention depends mainly on measures taken by the employers and employees themselves. If the medical examination in itself doesn't protect the worker, tasks of the occupational physician should be reassessed: a) to identify health hazards in industry by clinical and epidemiological surveys, b) to advise on safety at work, c) to control the effectiveness of the measures taken by medical examination and/or biological tests of workers exposed to well defined hazards. Occupational health could be developped in Switzerland, with limited cost, but sharing the tasks between the occupational physicians already working in the large industries and new occupational State-physicians in cantons or regions.

Humans↗

PubMed1989

Pre-morbid height and weight as risk factors for development of central nervous system neoplasms.

Information on pre-morbid height and weight from a national screening of tuberculosis between 1963 and 1975 was linked with the registrations in the population-based Norwegian Cancer Registry. For each case with a primary central nervous system (CNS) neoplasm, 10 matched controls were taken from the non-cases. Analyses were done by a Cox regression model for the total group of CNS neoplasms and the various histological groups. In the case of the total group, height emerged as a significant risk factor for both sexes. Within each sex, a similar trend was found for each histological group although statistical significance was retained only for glioblastoma among males and for other types of glioma (astrocytoma, oligodendroglioma, mixed glioma and ependymoma) for females. A significant negative association was revealed between Quetelet's index (weight/height squared) and 'other gliomas' in females. No association with body mass, as expressed by Quetelet's index, was found for patients with meningioma.

Adolescent↗

PubMed2005

Evolution of tuberculosis control and prospects for reducing tuberculosis incidence, prevalence, and deaths globally.

CONTEXT: The United Nations Millennium Development Goals (MDGs) are stimulating more rigorous evaluations of the impact of DOTS (the WHO-recommended approach to tuberculosis control based on 5 essential elements) and other possible strategies for tuberculosis (TB) control. OBJECTIVE: To evaluate the prospects for detecting 70% of new sputum smear-positive cases and successfully treating 85% of these by the end of 2005, for reducing TB incidence, and for halving TB prevalence and deaths globally between 1990 and 2015, as specified by the MDGs. DATA SOURCES: TB case notifications (1980-2003) from DOTS and non-DOTS programs and cohort treatment outcomes (1994-2002) reported annually to the World Health Organization (WHO) by up to 200 countries, TB death registrations, and prevalence surveys of infection and disease. STUDY SELECTION: Case notification series that reflect trends in incidence, treatment outcomes from DOTS cohorts, death statistics from countries with WHO-validated vital registration systems, and national prevalence surveys of infection and disease. DATA EXTRACTION: Case reports, treatment outcomes, prevalence surveys, and death registrations from WHO's global TB database covering 1990-2003 to estimate TB incidence, prevalence, and death rates through 2015 for 9 epidemiologically different world regions. DATA SYNTHESIS: TB incidence increased globally in 2003, but incidence, prevalence, and death rates were approximately stable or decreased in 7 of 9 regions. The exceptions were regions of Africa with low (<4% in adults 15-49 years) and high rates (> or =4%) of HIV infection. The global detection rate of new smear-positive cases by DOTS programs increased from 11% in 1995 to 45% in 2003 (with the lowest case-detection rates in Eastern Europe and the highest rates in the Western Pacific) and could reach 60% by 2005. More than 17 million patients were treated in DOTS programs between 1994 and 2003, with overall treatment success rates more than 80% since 1998. In 2003, overall reported treatment success was 82%, with much variation among regions. The highest rates were reported in the Western Pacific region (89%) and lowest rates in African countries with high and low HIV infection rates (71% and 74%, respectively), in established market economies (77%), and in Eastern Europe (75%). To halve the prevalence rate by 2015, TB control programs must reach global targets for detection (70%) and treatment success (85%) and also reduce the incidence rate by at least 2% annually. To halve the death rate, incidence must decrease more steeply, by at least 5% to 6% annually. CONCLUSION: Reduction of TB incidence, prevalence, and deaths by 2015 could be achieved in most of the world, but the challenge will be greatest in Africa and Eastern Europe.

Africa↗

PubMed2001

The impact of AIDS, immigration and housing overcrowding on tuberculosis deaths in São Paulo, Brazil, 1994-1998.

The objective of this paper was to describe the distribution of tuberculosis (TB) mortality by area in the municipality of São Paulo, Brazil, from 1994 to 1998, and to evaluate its statistical association with several population characteristics. We surveyed TB deaths grouped by residential area, at the district level, and we calculated the rates for these areas standardized by gender and age groups. We applied simultaneous autoregressive--SAR regression analysis (autocorrelated errors model) in order to fit a "stepwise" model correlating TB deaths with the variables of interest. Significant associations were found between TB mortality rates and AIDS mortality rates, overcrowding at the household level, social development (expressed by a socioeconomic index), and rates of foreign immigration and immigration from other Brazilian States. Regression analysis allowed us to estimate the frequency of TB deaths virtually attributable to co-infection with HIV at 22.37% (95% confidence interval: 12.15-41.17%). TB death rates and utilization of public health services were not statistically associated, suggesting a reduced effectiveness of programs directed at control of the disease. The correlation between TB death rates and deprivation, measured by the socioeconomic index, indicates higher mortality in underprivileged areas. The significance of the association between housing overcrowding and TB deaths, in contrast to the absence of association with district-level overcrowding, indicates that prolonged contact is needed for disease transmission. Although the influx of foreigners and national migrants to the city diminished after the 1980s, immigration rates have been significantly correlated with TB mortality, suggesting greater vulnerability of these population segments to the disease.

AIDS-Related Opportunistic Infections↗

PubMed2002

Vitamin A levels and immunity in humans.

In animal studies, vitamin A deficiency induces a shift from type 2 (humoral) to type 1 (cellular) cytokines; there are no similar data for humans. Control of human immunodeficiency virus (HIV) and Mycobacterium tuberculosis infections requires type 1 cytokine (cellular) immunity. These infections and vitamin A deficiency are highly prevalent in Africa. We therefore examined the interactions among serum vitamin A levels, immune parameters, HIV infection status, Mycobacterium bovis BCG vaccine scarring (as an indicator of a type 1 cytokine profile), and clinical findings for 70 hospitalized children in Malawi, Africa. Directly conjugated monoclonal antibodies and flow cytometry were used to assess cell-specific cytokine production by peripheral blood monocytes and lymphocyte subpopulations. The statistical techniques employed included nonparametric statistics and logistic regression analyses. Thirty percent of the participants had severe vitamin A deficiency (<10 microg/dl), 34% had moderate deficiency (10 to <20 microg/dl), and 36% had normal levels (> or = 20 microg/dl). Vitamin A levels were lower for HIV-positive than for HIV-negative children (median, 10 and 17 microg/dl, respectively). Vitamin A-deficient children (<20 microg/dl) were more likely than non-vitamin A-deficient children to have higher proportions of natural killer (NK) cells (median, 8.3 and 5.2%, respectively) and lower ratios of interleukin-10-producing monocytes to tumor necrosis factor alpha-producing monocytes after induction (median, 1.0 and 2.3, respectively). Vitamin A-deficient children were also more likely than non-vitamin A-deficient children to exhibit respiratory symptoms (47% versus 12%) and visible BCG vaccine scars (83% versus 48%), which are indicative of a type 1 response to vaccination. Vitamin A status did not vary with gender, age, incidence of malaria parasitemia, blood culture positivity, or rates of mortality (6% of vitamin A-deficient children died versus 20% of non-vitamin A-deficient children). Lower vitamin A levels were associated with a relative type 1 cytokine dominance and proportionately more NK cells, both of which may be somewhat beneficial to persons who are exposed to HIV, M. tuberculosis, or other type 1 pathogens.

BCG Vaccine↗

PubMedDate not supplied

A gender comparison of health status among users of crack cocaine.

This study examines a population of inner-city crack cocaine users in Miami, Florida. Many study participants were also injection drug users; others were the sexual partners of injection drug users. In general, the self-reported health status of the study population was good, but men perceived their health in a more positive light than did women. HIV-seronegative men were most likely to report excellent or good health, and seropositive women reported the greatest incidence of poor health, regardless of the amount of crack use. Serostatus was statistically significant for women but not for men. Pneumonia was reported more frequently by women, while hepatitis and tuberculosis were reported more frequently by men. There was a significant gender difference in reported endocarditis among light users of crack, with more women that men reporting a history of endocarditis. Among sexually transmitted diseases, men reported more gonorrhea and women reported more syphilis. These gender differences were statistically significant only for heavy users of crack. A gender difference was evident in the HIV seropositivity rates, with 25.7% of men and 32.2% of women testing positive for antibodies to HIV. While this difference held true when frequency of crack use was controlled, the difference was not statistically significant. Women were significantly more likely than men to trade sex for drugs and/or money. Women who were heavy crack users traded most often and would be expected to be at correspondingly increased risk for HIV infection or transmission.

Adolescent↗

PubMed1999

[Multilevel automatic monitoring system for epidemiological tuberculous process in the north-western region, project and implementation].

The paper proposes a variant how to solve the problem of complex automation of the work of antituberculous service by using the concept of building up a multilevel automatic informational and analytical system of antituberculous service at the regional level developed at the regional level. The programme product "statistical phthisiologist AMP" for the lower level of the area (urban) antituberculous dispensary which has been developed within this project is given.

Communicable Disease Control↗

PubMed1991

[Studies about the therapy of tuberculosis in East Germany (former GDR)].

On the basis of a questionnaire the therapy of 2285 patients with tuberculosis was evaluated for the years 1987-1989. The data of the GDR National Tuberculosis Register (9827 patients) were used for statistical comparison. 85% of the patients had a pulmonary tuberculosis, 947 patients (41% of all) excreted tubercle bacilli in the sputum. The average duration of treatment was 31.8 weeks, 94.7% of the patients were hospitalised for treatment for an average time of 12.4 weeks, the following outpatient treatment was 19.4 weeks in average. The initial phase (daily-treatment) in all cases of tuberculosis was 8.6 weeks, the follow-up phase was 23.2 weeks (all data are averages). The intermittent outpatient drug administration was made in 95% of cases under nurse control in outpatient departments. The initial treatment was started in 92.1% with 3 or 4 drugs (H/R/Z/S or E). Isoniacid and rifampicin were prescribed in 89.7% and pyrazinamide was used as a 4th drug. In the follow-up phase the combination isoniacid and rifampicin was employed intermittent in 75.7%. The delaytime for the evaluated cases was 38.8 days in average. The result of study shows, in most cases the patients were treated according to the recommendation of therapy. The clinical stay of patients is too long.

Adolescent↗

PubMedDate not supplied

Results of a 29-state survey of tuberculosis in nursing homes and correctional facilities.

A survey of the 15,379 cases of tuberculosis reported to the Centers for Disease Control and Prevention by 29 State health departments in 1984 and 1985 revealed that 7.7 percent of the victims older than age 64 were living in a nursing home at the time of diagnosis and 1.8 percent between the ages of 15 and 64 were living in a correctional institution at the time of diagnosis. Incidence rates of tuberculosis for residents of nursing homes and for inmates of Federal and State prisons and local jails were estimated using denominators derived from institutional population counts provided by the National Center for Health Statistics and by the Department of Justice, Bureau of Justice Statistics, and Bureau of Prisons. The aggregate tuberculosis incidence rate for nursing home residents in the 29 States was 1.8 times higher than the rate seen in elderly persons who were living in the community (95 percent confidence interval on the relative risk 1.64, 2.02). The aggregate tuberculosis incidence rate for inmates in correctional facilities was 3.9 times higher than the rate for persons of a similar age who were not incarcerated (95 percent confidence interval on the relative risk 3.35, 4.49). Strengths and limitations of the design and implications of the first survey of tuberculosis incidence, in a large number of States, among residents of nursing homes and correctional facilities are discussed.

Adolescent↗

PubMed2005

Is malaria a predisposing factor for third molar pericoronitis in the tropics?

BACKGROUND: Malaria is an important disease in the tropics, and its role as a predisposing factor or co morbidity has been investigated in many diseases including HIV infection and tuberculosis. There are very few studies, which have investigated its role in oral and dental diseases. Our study aimed to demonstrate the possible role of malaria in predisposing to pericoronitis, an infection affecting impacted third molars predominantly. PATIENTS AND METHODS: Thirty-eight patients presenting with pericoronitis were tested for malaria parasites and results compared with that obtained from controls that were equally susceptible to pericoronitis but did not have the infection. RESULTS: 19.7% of the study group compared to 6.6% of control group had malaria parasite in their blood. This difference was statistically significant, P=0.018 (Fisher's exact). The odds ratio was 4.3 (95% CI=1.2-17.0). CONCLUSIONS: Malaria appears to be a predisposing factor to pericoronitis in this study. There is a need for further studies on the possible role of malaria in oral and dental diseases.

Adult↗

PubMed2005

Factors affecting delays in tuberculosis diagnosis in rural China: a case study in four counties in Shandong Province.

Improving case detection is an urgent and serious challenge for tuberculosis (TB) control in China. We investigated the extent to which TB patients delayed seeking TB care and health services delayed reaching a diagnosis, and socio-economic factors associated with the delays. Standard questionnaires were administered to 190 new smear-positive TB patients who had completed treatment at TB dispensaries in four counties of Shandong Province in 2001. Multivariate analysis using Cox Regression showed that old age, lack of education and distance from home to a township health centre were significantly associated with delay in seeking care from service providers. In examining the delay between first contact with a service provider and diagnosis, we found that women experienced longer delays than men, and that the higher the level of facility patients first visited, the less time was needed to achieve a diagnosis. These two factors were statistically significant in multivariate Cox Regression analysis. We concluded that the elderly, the less educated, women, and those living far from health facilities face the longest delays in reaching TB services and achieving diagnosis.

Adult↗

PubMed2002

[Smoking: the main cause of high mortality rate among Russian population].

Mortality rates in Russia are very high as compared to those in other developed countries, particularly among men. A series of hypotheses associating heavy drinking and social and economic stresses of the transition period with drastic increases in mortality rates in Russia in the mid-1990s have been generated. However, the hypotheses are under analytical study on an individual level. A case control study was carried out to investigate the association of mortality due to smoking, alcoholic consumption, and a variety of socioeconomic indices. A total of 13,079 individuals who died in 1990-1999 were identified during a populational survey of 90,147 families in four Russian cities: Barnaul, Tomsk, Tyumen, and Vladivostok. Data on lifestyle habits, such as smoking, alcohol consumption, and some socioeconomic characteristics of the deceased were obtained from questionnaire surveys with proxy respondents (wives, husbands, etc.). Proportional mortality analyses were carried out. Controls were selected from those who died from non-smoking-related causes. A statistically significant association was established between smoking and the risk of death due to cancers of the lung, mouth, pharynx, larynx, esophagus, stomach, and urinary bladder. There was also a dose-response relationship of the numbers of cigarettes smoked to the risk of cancers at these sites. Smokers were found to be at a statistically significantly increased risk for coronary heart disease and stroke. There was a close and statistically significant association between smoking and chronic obstructive lung diseases, respiratory tuberculosis, and other respiratory infections. There was also a close dose-response relationship of the number of cigarettes consumed per day to the risk of respiratory tuberculosis and obstructive lung disease.

Adult↗

PubMed1991

[Infusion dynamic uretero-scintigraphy in the evaluation of the functional status of the ureter and pelvis].

A proposed new method of infusion dynamic ureteroscintigraphy was used for investigation of 51 controls and 27 patients with unilateral tuberculous ureterohydronephrosis. Values of the contractility of different parts of the ureters and pelvis were obtained. The statistic law of distribution of these values is logarithmically normal. A high sensitivity of the method in the assessment of ureteral and pelvic function was shown.

Humans↗

PubMed1991

[The metabolic index of nocturnal hypoxia in patients after lung resection and thoracoplasty].

The authors measured urinary uric acid (UA) and creatinine (CR), serum lactate, and CoQ10 prior to retiring at night and on awakening in the morning in 127 patients (PG) after lung resection and thoracoplasty which were done more than 20 years age for treatment of tuberculosis and in 20 controls (NC). delta UA:CR, delta lactate, and delta CoQ10 were calculated respectively as the overnight changes in urinary UA:CR and in serum lactate and CoQ10. delta UA:CR increased in PG (4.0 +/- 43.6%), whereas it decreased in NC (-22.3 +/- 17.7%) (mean +/- SD) (p less than 0.05). Nocturnal hypoxemia suggested from positive balance of delta UA:CR was seen in 37% of PG, but in only 10% of NC. delta UA:CR showed no relationship with delta lactate and delta CoQ10 and also did not correlate with the nadir of arterial oxygen saturation. PG were divided into PG with a positive balance of delta UA:CR (PG-P) and with a negative balance of delta UA:CR (PG-N). The %VC and PaO2 in the PG-P group were lower and PaCO2 was higher than in PG-N, although the difference did not achieve statistical significance.

Aged↗

PubMed2000

The results of anterior radical debridement and anterior instrumentation in Pott's disease and comparison with other surgical techniques.

Classic procedure in the treatment of vertebral tuberculosis is drainage of the abscess, curettage of the devitalized vertebra and application of antituberculous chemotherapy regimen. Posterior instrumentation results are encouraging in the prevention or treatment of late kyphosis; however, a second stage operation is needed. Recently, posterolateral or transpedicular drainage without anterior drainage or posterior instrumentation following anterior drainage in the same session is preferred to avoid kyphotic deformity. Seventy-six patients with spinal tuberculosis were operated in the 1st Department of Orthopaedics and Traumatology, Ankara Social Security Hospital, between January 1987 and January 1997. There were four children in our series. Average follow-up period was 36.1 +/- 14.5 months and the average age at the time of operation was 40.8 +/- 15.2 years. This study reports the surgical results of 45 patients with Pott's disease who had anterior radical debridement with anterior fusion and anterior instrumentation [14 patients with Z-plate and 31 patients with Cotrel-Dubousset-Hopf (CDH system)]. The results are compared with those of 8 patients who had posterolateral drainage and posterior fusion, 12 patients who had only anterior drainage and anterior strut grafting and, 11 patients who had posterior instrumentation following anterior radical debridement in the same session in terms of fusion rates, correction of kyphotic deformity, recurrence rate and clinical results. All patients had one year consecutive triple drug therapy. Preoperative 23.2 degrees +/- 12.5 degrees local kyphosis angle was lowered to 6.1 degrees +/- 6.9 degrees with a correction rate of 77.4 +/- 22.3%. When the other three groups which had been instrumented were compared, the correction rates in the local kyphosis angle values were not statistically different and the variation in loss of correction at the last follow-up was also statistically insignificant. The sagittal contour of the involved vertebra's region did not change in the uninstrumented group, while it did so in instrumented groups which had normal range values postoperatively. Overall, 27 patients had neurologic deficits preoperatively. Twenty of these (74.1%) had complete, and 5 (18.5%) had partial recovery with a combined 92.6% neurologic improvement. All the patients had a solid fusion mass at the last controls. Reactivation was not seen. Additionally, contrary to the common belief, anterior instrumentation which anterior autologous strut grafting following anterior radical debridement can be a good treatment option with low complication rate, high correction rate in acute local kyphosis, and high fusion rate.

Adolescent↗

PubMed2003

Tuberculosis and pregnancy.

OBJECTIVES: There are many myths surrounding pregnancy and tuberculosis (TB), and outcome of treatment. This prospective study was conducted at the Department of Obstetrics and Gynecology, SCB Medical College, Cuttack, India, and at the authors' private clinics from 1986 to 2001 to determine the outcome of pregnancy if TB is treated properly. METHODS: A total of 111 pregnant women diagnosed as having pulmonary and glandular TB were included in the study. They were matched for age, parity, and socioeconomic status with 51 pregnant women without TB (first control group), and 51 women with pulmonary TB but without pregnancy (second control group). The usual pregnancy management was given to the women in the study group, along with a short course of chemotherapy: either ethambutol, INH, or rifampicin and pyrazinamide for 2 months followed by INH and rifampicin for 4 months; or ethambutol, INH, and rifampicin for 2 months followed by INH and rifampicin for 7 months. Statistical analysis was done using a chi(2)-test. RESULTS: There were no statistical differences in duration of gestation, preterm labor, and other complications of pregnancy, labor, and puerperium between the pregnancy groups. There were no congenital anomalies in the babies born to the groups. Pregnancy had no effect on the course of TB as regards sputum conversion, stabilization of the disease, and non-relapse even after 2-5 years of follow-up and a further delivery in a few cases. CONCLUSIONS: If proper and adequate chemotherapy is given to pregnant women with TB, they are not a higher risk than non-pregnant women with TB. Neither the disease nor chemotherapy is threatening to mother or newborn. However, today the ominous combination of human immunodeficiency virus, TB, and pregnancy poses a new challenge.

Adult↗

PubMed2005

Differential respirable dust related lung function effects between current and former South African coal miners.

Dust-related dose-response decrements in lung function among coal miners have been reported in several studies, with varying magnitudes across populations. Few studies have compared differences between current and former coal miners. No studies on dose response relationships with lung function have been conducted in South African coal mines, one of the top three producers of coal internationally. The objectives of this study were (1) to describe the relationship between respirable dust exposure and lung function among current and former South African coal miners and to determine whether differential dust related effects were present between these employment categories; (2) to examine dust related dose response relationships, controlling for potential confounding by smoking and a history of tuberculosis (TB). Six hundred and eighty-four current and 188 ex-miners from three bituminous coal mines in Mpumalanga Province were studied. Interviews assessing work histories, smoking profiles and other risk factors were conducted. Work histories were also obtained from company records. Standardised spirometry was performed by trained technicians. Cumulative respirable dust exposure (CDE) estimates were constructed from company-collected sampling and measurements conducted by the researchers. Regression models examined the associations of CDE with per cent predicted FEV(1) and FVC, controlling for smoking, past history of TB and employment status. A statistically significant decline in FEV(1) of 1.1 and 2.2 ml/mg-year/m(3) was found in representative 40-year-old, 1.7-m tall current and former miners, respectively. Significant differences were found between the highest and medium exposure categories. Ex-miners had a lower mean per cent predicted lung function than current miners for each cumulative exposure category, suggesting a "healthy worker" effect. Past history of TB contributed to 21 and 14% declines in per cent predicted FEV(1) and FVC, respectively. Thus, in this cohort, a dose-related decline in lung function was associated with respirable dust exposure, with a magnitude of effect similar to that seen in other studies and important differences between current and former employees. A "healthy worker" effect may have attenuated the magnitude of this relationship. TB was a significant contributor to lung function loss.

Adult↗