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Background Timika scoring system is a radiographic grading tool, widely employed for grading the severity of tuberculosis (TB). We evaluated the predictive accuracy of this tool for adverse treatment outcomes among TB patients in Indian setting. Methods We undertook a longitudinal analysis of cohort data under the RePORT-India consortium. Cohort having participants with active pulmonary TB were included. CXRs were independently scored by chest physicians. Timika scoring system had a total score of 140. The predictive nature of the tool was assessed using the ROC analysis. Results Around 364 laboratory confirmed TB patients were enrolled. The mean (SD) of overall Timika score was 62.3 (24.9). Sputum conversion was achieved among 218/260 (83.8%) patients available at end of intensive phase. AUC for Timika score was 0.53 (95% CI: 0.43–0.63) and for percent lung affected, was 0.56 (95% CI: 0.46–0.65). Unfavorable treatment outcome was observed among 67/287 (23.3%) at the end of continuation phase. AUC for percent lung affected was 0.62 (95% CI: 0.54–0.70) and for Timika score was 0.59 (95% CI: 0.51–0.67). Conclusion Both Timika scoring system and percent lung affected had poor predictive accuracy, highlighting the inability of a single CXR scoring system to predict the treatment outcome in Indian setting.

In pulmonary tuberculosis (PTB), the sputum conversion rate at 2 months is frequently used to evaluate treatment outcomes and effectiveness of a TB control programme.The study aimed to estimate the rate of delayed sputum conversion and explore its predicting factors at the end of the intensive phase among smear-positive PTB (PTB +ve) patients.A 3-year retrospective study was conducted in the government hospital in Pulau Pinang from 2016 to 2018. During the study, a standardized, data collection form was used to collect data from the patient record. Patients aged over 18 years were recruited. Multivariable logistic regression analysis was used to identify significant independent variables associated with delayed sputum conversion.A total 1128 of PTB patients were recorded visiting the TB clinic, 736 (65.2%) were diagnosed as PTB +ve; of these, 606 (82.3%) PTB +ve had a record of sputum conversion at the end of the intensive phase. Age ≥ 50 years, blue-collar jobs, smoking, heavy bacillary load, relapsed and treatment interrupted were significantly (P0.05) associated with delayed sputum conversion. Delayed sputum conversion rate at the end of the intensive phase was 30.5%.The rate of sputum smear conversion in the intensive phase of treatment was independently associated with high sputum smear grading at diagnosis, relapsed and treatment interrupted categories, old age and blue-collar occupations.تحديد عوامل الخطر المرتبطة بتأخر تحول البلغم في نهاية المرحلة المكثفة من العلاج بين مرضى السل.زهرة بهاتي، عامر حياتي خان، سيد أزهار سيد سليمان، مديحة لغاري، عرفان علي بن حيدر علي.يستخدم معدل تحول البلغم بعد شهرين عادة مع مرض السل الرئوي، لتقييم مخرجات العلاج وفعالية برنامج مكافحة السل الرئوي.هدفت هذه الدراسة إلى تقدير معدل تأخر تحول البلغم، وتحديد عوامل التنبؤ بحدوثه في نهاية المرحلة المكثفة من العلاج بين مرضى السل الرئوي الإيجابي اللُّطَاخة.أُجريت دراسة استعادية لمدة 3 سنوات في المستشفى الحكومي بولاية بولاو بينانج، في الفترة من عام 2016 إلى عام 2018. وخلال الدراسة، استُخدِم نموذج موحد لجمع البيانات من سجل المرضى. وتم استقطاب مرضى تزيد أعمارهم عن 18 عامًا. واستُخدِم تحليل الانحدار اللوجستي المتعدد المتغيرات لتحديد المتغيرات المستقلة المهمة المرتبطة بتأخر تحول البلغم.سُجِّلت زيارة 1128 من مرضى السل الرئوي لعيادة السل، وشُخِّصت إصابة 736 مريضًا (65.2٪) بالسل الرئوي الإيجابي اللُّطَاخة، ومنهم 606 مريضا (82.3٪) كان لديهم سجل بتحول البلغم في نهاية المرحلة المكثفة من العلاج. وكانت عوامل بلوغ 50 عامًا أو أكثر من العمر، والوظائف العمالية، والتدخين، والحمل العَصَوِيّ الثقيل، والانتكاس، وانقطاع العلاج مرتبطة بصورة كبيرة بتأخر تحول البلغم (الاحتمالية0.05). وبلغ معدل تحول البلغم المتأخر في نهاية المرحلة المكثفة 30.6٪.ارتبط معدل تحول لُّطَاخة البلغم في المرحلة المكثفة من العلاج ارتباطًا مستقلاً بارتفاع تصنيف لُّطَاخة البلغم عند التشخيص، والفئات التي تعرضت للانتكاس وانقطاع العلاج، والشيخوخة، والمهن العمالية.Détermination des facteurs de risque associés à une conversion tardive des expectorations à la fin de la phase intensive du traitement chez les patients atteints de tuberculose.Dans le domaine de la tuberculose pulmonaire (TBP), le taux de conversion des expectorations à deux mois est fréquemment utilisé pour évaluer les résultats du traitement et l'efficacité d'un programme de lutte contre la tuberculose.La présente étude visait à estimer le taux de conversion tardive des expectorations et à explorer ses facteurs prédictifs à la fin de la phase intensive du traitement chez les patients atteints de TBP à frottis positif.Une étude rétrospective sur trois ans a été menée dans l'hôpital public de Pulau Pinang de 2016 à 2018. Au cours de l'étude, un formulaire de collecte de données standardisé a été utilisé pour recueillir les données à partir des dossiers des patients. Des patients âgés de plus de 18 ans ont été recrutés. Une analyse de régression logistique multivariable a été utilisée pour identifier les variables indépendantes significatives associées à la conversion tardive des expectorations.Au total, 1128 patients atteints de TBP ont été enregistrés lors de leur consultation à la clinique de la tuberculose, 736 (65,2 %) ont été diagnostiqués comme des patients atteints de TBP à frottis positif ; parmi eux, 606 patients (82,3 %) avaient une conversion des expectorations à la fin de la phase intensive du traitement. Les facteurs suivants étaient significativement associés (p0,05) à la conversion tardive des expectorations : âge supérieur à 50 ans, emploi d'ouvrier, tabagisme, charge bacillaire élevée, rechute et interruption du traitement. Le taux de conversion tardive des expectorations à la fin de la phase intensive du traitement était de 30,6 %.Le taux de conversion des frottis d'expectoration dans la phase intensive du traitement était indépendamment associé à un classement élevé des frottis d'expectoration pendant le diagnostic, aux catégories d'interruption et de rechute du traitement, à l'âge avancé et aux professions ouvrières.

Hintergrund In der Entstauungsphase der Komplexen Physikalischen Entstauungstherapie des Lymphodems (KPE Phase I) werden verschiedene Untermaterialien eingesetzt, um die Anlage der Kurzzugbinden zu stabilisieren und die Haut zu schutzen. Eine neuartige Form der Unterpolsterung bieten mit Baumwolle umnahte Schaumstoffbandagen. Deren Therapieeffekte sind jedoch bislang nicht untersucht. Material und Methoden Prospektive, randomisierte Nichtunterlegenheitsstudie an Proband/innen mit sekundarem Armlymphodem. Die Kontrollgruppe erhielt eine KPE Phase I mit Standardtherapie (Unterpolsterung aus Schlauchverband und Wattebinde), die Interventionsgruppe erhielt die KPE Phase I mit Schaumstoffbandagen (SC). Primarer Endpunkt war das optoelektronisch gemessene Volumen. Zudem wurde die Umfangsreduktion ermittelt und die Patientenperspektive erfragt. Ergebnisse n=30 Proband/innen konnten analysiert werden. SC zeigten einen signifikant groseren Effekt in der Volumenreduktion (p=0,026; 95% Kl [−207,9;+7,4]). Bei apriori definiertem Aquivalenzbereich von±50 ml sind SC der Referenztherapie nicht unterlegen. Die Patienten bewerteten die Abnahme des Spannungsgefuhls sowie den Tragekomfort bei SC signifikant besser (p=0,026 sowie p=0,003). Schlussfolgerung Schaumstoffbandagen sind Standardpolstermaterial nicht unterlegen. Sie konnen in der Entstauungsphase von Lymphodemen als alternatives Unterpolsterungsmaterial eingesetzt werden. Die Daten liefern Hinweise darauf, dass sie die Reduktion des Odemvolumens im Vergleich mit bislang verwendeten Untermaterialien verbessern konnen und das Spannungsgefuhl durch sie deutlicher reduziert werden kann. Background In the intensive phase of complex decongestive therapy for lymphedema (CDT Phase I), different padding materials are used underneath short-stretch bandages to avoid skin lesions and slipping. Foam bandages with vertical foam channels offer a novel form of sub-compression under-padding. Their therapeutic effects have not yet been investigated. Material and methods Prospective, randomized non-inferiority trial in subjects with CDT phase I for treatment of secondary arm lymphedema. The control group received usual care consisting of sub-compression application of stockinettes and cotton-wool bandages, while the intervention group received sub-compression foam bandages (SC). Volume effects were compared between the groups. Circumference reduction effects and the patient's perspective were surveyed as secondary outcomes. Results n=30 subjects could be analyzed. SC showed a significantly greater effect in volume reduction (p=0.026; 95% cl [−207.9;+7.4]). According to the apriori defined equivalence interval of±50 ml SC are non-inferior to reference therapy. Patients using SC reported a significantly greater decrease in their feeling of tension as well as significantly greater wearing comfort (p=0.026 and p=0.003). Conclusions SC are non-inferior to standard padding material. They can be used as an alternative underpadding material in the intensive phase of complex decongestive therapy of lymphedema. The data suggest that they could improve the reduction of volume compared to conventional padding materials and further reduce a patients’ feeling of tension.

Background Tuberculosis (TB) is an ancient disease and remains to be a public health problem all over the world. Noncompliance of treatment among TB patients affect the control of disease, leading to increased burden of the disease, mortality, drug resistant and relapse. Assessing the factors associated with noncompliance of TB treatment will be useful to reduce the noncompliance and burden. Objectives To assess the factors associated with noncompliance of treatment among TB patients in intensive phase at Kalutara District, Sri Lanka. Methods A descriptive cross-sectional study was conducted among the new TB patients registered at District Chest Clinic (DCC), Kalutara for a period of six months. A questionnaire was administered for total study population registered during the data collection period. The relevant data were abstracted from registers and records maintaining at the DCC. Results Data were collected from 252 patients [males = 160 (63.5%) and females = 92 (36.5%)]. The percentage of noncompliance was 18.3% (n = 46) among newly diagnosed TB patients. Only 13.5% (n = 34) of TB patients visited Directly Observed Treatment, short-course (DOTS) provider daily. Majority (61.9%, n = 156) of DOTS providers did not observe for drug intake. The factors significantly associated with noncompliance for TB treatment were (1) not observing the drug intake by DOTS providers, (2) side effects of the drugs, (3) educational level, (4) living environment and (5) absent of a care giver. Conclusions Noncompliance of treatment is still a common problem among TB patients. Special emphasis should be made on TB patients based on the factors associated with the noncompliance of the treatment. DOTS providers should adhere to DOTS policy.

Introduction: Tuberculosis is a highly prevalent chronic infectious disease. TB exerts various hematologic effects & hematological abnormalities. Anti-Tuberculosis treatment has its own spectrum of effects on TB patients. This study aimed to study & compare various hematological parameters in newly diagnosed TB patients before ATT & to evaluate after the intensive phase ATT in same patient. Materials and Methods: A total of 40 newly diagnosed cases of TB were randomly selected. Under aseptic precautions, 2.5 ml of blood collected from patients in EDTA vacutainers & the following hematological parameters were analysed – HB%, TLC, DC, PC, MCV, MCHC, PCV and ESR. The same patients were put on 2 months of intensive phase of ATT. After completion of ATT, the hematological parameters of each patient were analysed. PreATT and after ATT the parameters were compared and analyzed with suitable statistics. Results: There was significant post treatment improvements in Hb%(Pre ATT-10g/dl & post ATT 11.8g/dl), RBC count (Pre ATT-4.8 millions/cumm & Post ATT-4.85 millions/cumm), PCV (Pre ATT-38% & Post ATT-40%), Total leucocyte count (Pre ATT-10,295cells/cumm & post ATT- 9,500 cells /cumm), Neutrophils (Pre-ATT-73% & post ATT-63%) and Lymphocytes (PRE-ATT - 20% & post ATT-30%) and ESR (PreATT 79mm/hr & post ATT 54mm/hr). The present study showed that, there was a significant statistical difference in HB%, TLC, DC, Platelets & ESR values. Conclusion: Hematological parameters can be a guide to assess the improvement of TB patients after ATT which indirectly speaks about the improvement in patients. Keywords: TB, ATT.

The cessation of bacterial excretion is the main condition for the effective treatment of multiresistant tuberculosis (MRTB). Surgical procedures for treating tuberculosis patients significantly increase the effectiveness of treatment for such patients. The selection of new selection criteria for surgical treatment of MRI is relevant, as it will increase the effectiveness of MRI treatment, which remains insufficient.Objective — to predicting the effectiveness of treatment for MRI of the lungs by developing a mathematical model to predict treatment outcomes.Materials and methods. 84 patients with MRI of the lungs: group 1 (n = 56) — with signs of effective TB treatment at the end of the intensive phase; group 2 (n = 28) — patients with signs of ineffective treatment. We used the multivariate discriminant analysis method using the statistical environment Statistica 13.Results and discussion. During the discriminant analysis, the parameters of the clinical blood analysis (monocytes, stab leukocytes, erythrocytes) were selected, which were associated with high (r > 0.5) statistically significant correlations with the levels of MMP-9, TIMP-1, oxyproline and its fractions and aldosterone in the formation of the prognosis. The mathematical model allows, in the form of comparing the results of solving two linear equations and comparing their results, to predict the outcome of treatment: 1 — effective treatment, 2 — ineffective treatment. Conсlusions. Early prediction of treatment effectiveness is promising, as it allows the use of the developed mathematical model as an additional criterion for the selection of patients for whom surgical treatment is recommended, in order to increase the effectiveness of treatment., Прекращение бактериовыделения — главное условие эффективного лечения мультирезистентного туберкулеза (МРТБ). Хирургические методики лечения больных туберкулезом значительно повышают эффективность лечения таких пациентов. Выделение новых критериев отбора для хирургического лечения МРТБ актуально, так как позволит повысить эффективность лечения МРТБ, которая остается недостаточной.Цель работы — прогнозирование эффективности лечения МРТБ легких путем разработки математической модели для прогнозирования результатов лечения.Материалы и методы. 84 больных МРТБ легких разбили на 2 группы: группа 1 (n = 56) — с признаками эффективного лечения туберкулеза в конце интенсивной фазы; группа 2 (n = 28) — пациенты с признаками неэффективного лечения. Использовали метод многомерного дискриминантного анализа с использованием статистического среды STATISTICA 13. Результаты и обуждение. В ходе проведенного дискриминантного анализа были отобраны показатели клинического анализа крови (моноциты, палочкоядерные лейкоциты, эритроциты), которые были связаны высокими (r > 0,5) статистически значимыми корреляционными связями с уровнями ММП-9, ТИМП-1, оксипролина и его фракций и альдостерона при формировании прогноза. Математическая модель позволяет в виде сравнения результатов решения двух линейных уравнений и сопоставления их результатов прогнозировать исход лечения: 1 — эффективное лечения, 2 — неэффективное лечение. Выводы. Раннее прогнозирование эффективности лечения является перспективным, так как позволяет использовать разработанную математическую модель в качестве дополнительного критерия отбора пациентов, которым рекомендовано хирургическое лечение, с целью повышения эффективности лечения., Припинення бактеріовиділення — головна умова ефективного лікування мультирезистентного туберкульозу (МРТБ). Хірургічні методики лікування хворих на туберкульоз значно підвищують ефективність лікування таких пацієнтів. Виділення нових критеріїв відбору для хірургічного лікування МРТБ актуальне, оскільки дасть змогу підвищити ефективність лікування МРТБ, яка залишається недостатньою.Мета роботи — спрогнозувати ефективність лікування МРТБ легень через розроблення математичної моделі для прогнозування результатів лікування.Матеріали та методи. Було залучено 84 хворих на МРТБ легень, яких розподілили на 2 гру­пи: група 1 (n = 56) — пацієнти з ознаками ефективного лікування туберкульозу в кінці інтенсивної фази; група 2 (n = 28) — пацієнти з ознаками неефективного лікування. Використано метод багатовимірного дискримінантного аналізу з використанням статистичного середовища STATISTICA 13.Результати та обговорення. Під час проведеного дискримінантного аналізу було відібрано показники клінічного аналізу крові (моноцити, паличкоядерні лейкоцити, еритроцити), які були пов’язані високими (r > 0,5) статистично значущими кореляційними зв’язками з рівнями ММП-9, ТІМП-1, оксипроліну та його фракцій і альдостерону під час формування прогнозу. Математична модель дає змогу у вигляді порівняння результатів вирішення двох лінійних рівнянь і зіставлення їхніх результатів спрогнозувати результат лікування: 1 — ефективне лікування, 2 — неефективне лікування. Висновки. Розроблена математична модель дає змогу оцінити результати лікування хворих на мультирезистентний туберкульоз на ранніх стадіях лікування, виходячи зі значень показників еритроцитів, паличкоядерних лейкоцитів та моноцитів, виявити його неефективність та рекомендувати таким пацієнтам застосовувати комбіноване лікування з хірургічними втручаннями для підвищення ефективності лікування.

The objective of the study: to analyze treatment outcomes in patients with pulmonary destructive MDR tuberculosis who completed the intensive phase of treatment and had healed or persisting cavities.Subjects and methods. Treatment outcomes were retrospectively analyzed in 191 patients suffering from destructive pulmonary MDR tuberculosis who underwent the intensive phase of chemotherapy in in-patient settings in 2009-2012 and 2013-2015 (treated by different regime ns); in each of those cohorts, groups were formed depending on persistence/healing of destruction (cavities) during the intensive phase of chemotherapy: (CV-) ‒ the destruction healed, (CV+) – the destruction persisted.Results. In 24 months, treatment was found to be effective only in 19/68 (27.9%) in the (CV+) group versus 31/40 (77.5%) in the (CV-) group, p Conclusion. Considering the above, when assessing treatment in the intensive phase of chemotherapy in destructive pulmonary tuberculosis patients, it is necessary to take into account the rate of cavity healing but not being limited to sputum conversion. Patients with persisting cavities should not be transferred to the continuation phase, the surgery or collapse treatment should be considered for such patients.

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. The incidence of tuberculosis in Indonesia is high because the success rate of tuberculosis treatment has decreased which causes the chain of transmission continues to occur. The main government programs to decrese the incidence and increasing the success treatment with the Directly Observed Treatment (DOTS) program. One important indicator of the DOTS program to assessing the success of tuberculosis treatment is the conversion of positive AFB sputum to negative at the end of the intensive phase of treatment. AFB sputum conversion to negative at the end of the intensive phase of treatment is influenced by several internal factors such as level of education and income, gender, adherence, patient's nutritional status, and comorbidities. Then external factors can also influence the AFB sputum conversion in anti-tuberculosis treatment such as environmental conditions, smear positivity, drug taking supervisors (PMO), and availability of drugs in health facilities.

Background Following initiation of MDR-TB treatment, patients have a choice to receive follow up DOT supervision at either the central initiating facility or at a peripheral facility. Objectives We describe the adherence patterns of MDR-TB patients undergoing DOT supervision at the two health facility categories during intensive phase of treatment. Methods We used a retrospective cohort of patients initiated on MDR TB treatment at Mulago National Referral Hospital between 2014 and 2016. We extracted data from the National Tuberculosis and Leprosy Program records and analysed these using STATA V14. Result Majority (84.01%) of the patients received their DOT supervision from the peripheral facilities. Males made up 62.1% of patients, and 91.2% had had their household contacts screened for MDR-TB. 26.5% of the patients on peripheral DOT supervision had good adherence to treatment protocol compared to 0% among patients on central initiating health facility DOT supervision. Among the patients with good adherence, 24.1% had contacts screened for MDR-TB as compared to 3.6% with poor adherence. Conclusion More patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settingsMore patients preferred MDR-TB DOT supervision at peripheral facilities, which had better adherence to the treatment protocol compared to the central initiating facility. Younger people and those with household contacts screened had better adherence to the treatment protocol, highlighting areas for targeted interventional programs for MDR-TB in resource limited settings.

Tuberkulosis adalah penyakit infeksi yang disebabkan oleh bakteri tahan asam atau Mycobacterium Tuberkulosis. Di Puskesmas Pekauman Kota Banjarmasin, tercatat 101 pasien pada tahun 2017. Dan terdapat 27 kasus TB baru sejak bulan Januari 2018 sampai Juni 2018. Dua puluh diantaranya yang dapat dijadikan sampel pada penelitian ini. Penelitian ini bertujuan untuk Mengetahui gambaran kepatuhan minum obat pada penderita Tuberkulosis Pasien di Puskesmas Pekauman Kota Banjarmasin. Penelitian ini menggunakan metode deskriptif observasional nonanalitik, dengan desain penelitian observational studi. Jenis data primer dikumpulkan menggunakan metode wawancara dengan kuesioner terstruktur dan data sekunder dari puskesmas berupa data rekam medis pasien dengan menggunakan pendekatan cross sectional dengan pengambilan data secara kualitatif atau data yang bukan berbentuk angka. Berdasarkan hasil penelitian yang dilakukan didapatkan hasil gambaran kepatuhan pasien dalam minum obat pada fase intensif, fase lanjutan serta pemeriksaan dahak sebesar 100% dinyatakan patuh.

This paper reviews our institutional experience in the management of rhino-facial entomophthoromycosis, a rare subcutaneous fungal infection. We adopt a fixed two-phase protocol comprising an initial ‘intensive phase’ (two-drug regimen) followed by an ‘eradication phase’ (monotherapy). We present five patients treated between May 2013 and May 2020 in our institution who were subjected to the mentioned protocol. All five patients received six months of supersaturated potassium iodide solution and itraconazole, followed by four months of monotherapy with only supersaturated potassium iodide solution. All patients responded well to the treatment and were disease-free on follow-up of a minimum two years post-treatment. We recommend this procedure for all typical cases of entomophthoromycosis and suggest avoiding surgical intervention which may disseminate the fungus and delay response to treatment.

The article presents the review of publications devoted to personalized tuberculosis chemotherapy in children and adolescents with consideration of the specific course of the disease with the relevance to age. It is possible to reduce the duration of chemotherapy and the number of anti-tuberculosis drugs within the regimen. At the same time, the major criteria include results of microbiological tests of diagnostic specimens of the patient’s and/or index case and drug susceptibility tests in full both by express and traditional microbiological methods, microbiological and radiological monitoring, primarily in the intensive phase of chemotherapy. Generally, this personalized approach can assure high treatment efficacy.

The objective of the study : to assess the efficacy of patient-oriented chemotherapy of local tuberculous lesions in children exposed to multiple/extensive drug resistant tuberculosis (MDR/XDR TB) based on the results of the immediate and postponed follow-up, and to define the criteria of chemotherapy efficacy in such cases. Subjects and methods : 39 children (3-12 years old) with tuberculosis of chest lymph nodes or focal pulmonary tuberculosis. Patients were randomly divided into two groups treated with different chemotherapy regimens: Group 1 (20 persons) – 5 drugs for the intensive phase / 4 drugs for the continuation phase; Group 2 (19 patients) – 4 drugs for the intensive phase / 3 drugs for the continuation phase. The regimen consisted of the drugs, to which the index case was susceptible. Chemotherapy efficacy was assessed based on the immediate (the ones observed during chemotherapy) and postponed follow-up results (in 1 and 2 years upon treatment completion). The duration of the intensive phase and total duration of treatment were the same in both groups: Group 1 – 3.5 ± 0.5 and 10.5 ± 0.5 months respectively; Group 2 – 3.1 ± 0.6 and 10.0 ± 0.6 months respectively. Results . The efficacy of patient-oriented chemotherapy was confirmed in both groups by results of immediate follow-up and absence of relapses in 1 and 2 years upon chemotherapy completion. Conclusions . The supposed chemotherapy regimens can be used in children with local tuberculous lesions exposed to MDR/XDR tuberculosis as an alternative to standard regimens.

Children had better treatment outcomes and lower mortality rates than adults., Extensively drug-resistant tuberculosis (XDR TB) has extremely poor treatment outcomes in adults. Limited data are available for children. We report on clinical manifestations, treatment, and outcomes for 37 children (

Background In resource-limited settings, sputum smear conversion is used to document treatment response. Many People living with HIV (PLHIV) are smear-negative at baseline. The Xpert MTB/RIF test can indirectly measure bacterial load through cycle threshold (ct) values. This study aimed to determine if baseline Xpert MTB/RIF could predict time to culture negativity in PLHIV with newly diagnosed TB. Methods A subset of 138 PLHIV from the ‘SOUTH’ study on outcomes related to TB and antiretroviral drug concentrations were included. Bacterial load was estimated by Mycobacterium Growth Indicator Tubes (MGIT) culture time-to-positivity (TTP) and Lowenstein Jensen (LJ) colony counts. Changes in TTP and colony counts were analyzed with Poisson Generalised Estimating Equations (GEE) and multilevel ordered logistic regression models, respectively, while time to culture negativity analysed with Cox proportional hazard models. ROC curves were used to explore the accuracy of the ct value in predicting culture negativity. Results A total of 81 patients (58.7%) were males, median age 34 (IQR 29 ̶ 40) years, median CD4 cell count of 180 (IQR 68 ̶ 345) cells/μL and 77.5% were ART naive. The median baseline ct value was 25.1 (IQR 21.0 ̶ 30.1). A unit Increase in the ct value was associated with a 5% (IRR = 1.05 95% CI 1.04 ̶ 1.06) and 3% (IRR = 1.03 95% CI 1.03 ̶ 1.04) increase in TTP at week 2 and 4 respectively. With LJ culture, a patient’s colony grade was reduced by 0.86 times (0R = 0.86 95% CI 0.74 ̶ 0.97) at week 2 and 0.84 times (OR = 0.84 95% CI 0.79 ̶ 0.95 P = 0.002) at week 4 for every unit increase in the baseline ct value. There was a 3% higher likelihood of earlier conversion to negativity for every unit increase in the ct value. A ct cut point ≥28 best predicted culture negativity at week 4 with a sensitivity of 91. 7% & specificity 53.7% while a cut point ≥23 best predicted culture negativity at week 8. Conclusion Baseline Xpert MTB/RIF ct values predict sputum conversion in PLHIV on anti-TB treatment. Surrogate biomarkers for sputum conversion in PLHIV are still a research priority.

Background: Moxifloxacin (MFX, M) is currently a second-line antituberculosis drug as initial therapy of pulmonary tuberculosis and one of the main anti-TB drugs in drug-resistant TB, which can kill both intracellular and extracellular Mycobacterium tuberculosis. We started a trial to study the efficacy and safety of the substitution of pyrazinamide and ethambutol with moxifloxacin during the intensive phase of treatment of newly diagnosed susceptive pulmonary tuberculosis. Methods/design: This is a prospective, open, randomized, parallel-controlled, single-center clinical study. The study consists of three phases: a screening period, a treatment period of 6 (or 7) months, and a follow-up period of 1 year. Patients selected for the study will be allocated to the trial group or the control group randomly. The control group will be given six months of a standard regimen(2HRZE/4HR). The trial group will be given a total of six months of treatment with substitution of pyrazinamide and ethambutol with moxifloxacin during the intensive phase(2HRM/4HR). The primary outcome is the rate of adverse outcomes within one year of completion of therapy. The Secondary outcomes include the rate of treatment success at the 2nd, 3rd, 5th and 6th months, the rate of sputum Mtb(Mycobacterium tuberculosis) negative conversion at the 2nd, 3rd, 5th and 6th months, the time of sputum Mtb negative conversion at the 2nd, 3rd, 5th and 6th months, and the number of patients with adverse events within one year of completion of therapy. Comparisons will be performed using two-sided tests with a statistical significance level of 5%.Discussion: This trial will reveal the effectiveness and safety of 2months of use of moxifloxacin instead of pyrazinamide and ethambutol during the intensive phase of treatment for newly diagnosed susceptive pulmonary tuberculosis. If the new regimen including isoniazid, rifampicin and moxifloxacin during the intensive phase of treatment (2HRM/4HR) is no less effective and safe than the standard regimen(2HRZE/4HR), it could be a new alternative treatment for newly diagnosed susceptive pulmonary tuberculosis in the future. Trial registration: ClinicalTrials.gov, NCT04187469. Registered on 5 December 2019.

Tuberculous meningitis (TBM) results in considerable morbidity and mortality, especially in developing countries such as South Africa. Treatment regimens have been extrapolated from treatment for pulmonary tuberculosis, and the intensive-phase duration of 2 months may be inadequate for treatment of patients with TBM. We highlight this situation with a case report of a patient with TBM whose illness progressed after institution of the maintenance phase of treatment. We propose that the intensive-phase treatment of TBM be revisited with regard to duration of treatment, choice of drugs during continuation-phase therapy, or both.

BACKGROUND Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients. METHODS We conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6 months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dysglycemia as well as sputum conversion. RESULTS A significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs 67%, P-value .05). After controlling for age group and adjusting for other covariates, patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months, respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times increased odds and 89% less likely for sputum conversion, respectively. CONCLUSION A significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.

Compliance with treatment guidelines is essential to achieve successful outcomes in tuberculosis patients. Thus, we assessed if multidrug-resistant tuberculosis treatment practices from 2012–2018 in Uzbekistan were compliant with national guidelines in terms of regimens prescribed, weight-based drug dosages used, and documentation of treatment changes (such as prolongation of intensive phase, change of drugs, and their reasons) in the treatment card and Consilium form. A total of 1481 patients were included. Of them, only 25% received standardized regimens as per guidelines and the remaining received individualized regimens. There was an increasing trend in using standardized regimens from 2% in 2012 to 44% in 2018. Compliance to recommended weight-based drug dosages was observed in 85% of the patients during the intensive phase and 84% in the continuation phase—ranged 71–91% over the years. Prolongation of the intensive phase was done in 42% of patients. The treatment was changed in 44% of patients during the intensive phase and 34% of patients during the continuation phase. The documentation of treatment changes was suboptimal (42–75%) during the initial years (2012–2014), however, it improved significantly during later years (86–100%). Future research should explore reasons for non-compliance so that the quality of patient care can be improved.

The last several years have seen an emergence of literature documenting the utility of combination antimicrobial therapy, particularly in the salvage of refractory methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Recent clinical data are shaping conundrums of which regimens may be more beneficial, which can be potentially harmful, and which subset of patients stand to benefit from more aggressive treatment regimens than called for by current standards. In addition, the incorporation of combination therapy for MRSA bacteremia should be accompanied by the reminder that antimicrobial therapy does not need to be uniform for the entire duration, with an early intensive phase in high inoculum infections (eg, with combination therapy), followed by a consolidation phase (ie, monotherapy). This review and perspective consolidates the recent data on this subject and directs future goals in filling the knowledge gaps to methodically move forward towards improving patient outcomes.

Background: Post delivery is decisive period for post-partum women who had undergone episiotomywhich is a throbbing and disquiet procedure during this time. So the aim of the study is to appraise the effectof infrared light fomentation therapy on episiotomy wound pain relief among postpartum women.Aim: To asses the level of episiotomy wound pain among postpartum mothers before and after infraredfomentation.Methodology:1. The study participants will be selected among postpartum mothers having normal vaginal delivery withepisiotomy within 2 hours.2. Accordingly 30 postpartum Women will be randomly selected and allocated into matched groups.3. Written consent will be obtained from recruited Postpartum mothers.4. Intensive Phase:a. Twice a day until the fourth day morning infrared lamp and normal episiotomy wound care (twospoons betadine in 4 glasses of water).b. Best and worst levels of pain will be measured using 10 pain scale from 0(none) – 10(severe).5. Technique of procedure: Infrared light will be placed 45cm away from the perineum and heat emittedwith 220V will be used for 10-15 minutes then pain will be assessed.6. Appraising phase: The results will be compared for the 4 following days follow up of infraredfomentation therapy in postpartum mothers with episiotomy.Results: The study show that the intensity of pain decreased with the infrared light fomentation on episiotomyhad good results and pain relief is seen at the end of 4th day of follow up.Conclusion: Post-partum women who apply infrared lamp therapy on episiotomy display faster pain reliefthan those who do not.

Tuberculosis (TB) is the leading cause of mortality as a single infectious agent globally with increasing numbers of case notification in developing countries. This study seeks to investigate the clinical and socio-demographic factors of time to TB treatment interruption among Tuberculosis patients in Kiambu County, 2016–2019. We retrospectively analyzed data for all treatment outcomes patients obtained from TB tracing form linked with the Tuberculosis Information Basic Unit (TIBU) of patients in Kiambu County health facilities using time to treatment interruption as the main outcome. Categorical variables were presented using frequency and percentages. Kaplan-Meir curve was used to analyze probabilities of time to treatment interruptions between intensive and continuation phases. Log-rank test statistics was used to compare the equality of the curves. Cox proportion model was used to determine determinants of treatment interruption. A total of 292 participants were included in this study. Males were 68%, with majority (35%) of the participants were aged 24–35 years; 5.8% were aged 0–14 years and 5.1% aged above 55 years. The overall treatment success rate was 66.8% (cured, 34.6%; completed 32.2%), 60.3% were on intensive phase of treatment. Lack of knowledge and relocation were the major reasons of treatment interruptions. Patients on intensive phase were 1.58 times likely to interrupt treatment compared to those on continuation phase (aHR: 1.581; 95%CI: 1.232–2.031). There is need to develop TB interventions that target men and middle aged population in order to reduce treatment interruption and increase the treatment success rates in the County and Country.

Background: Breast cancer-related lymphedema (BCRL) is a potentially debilitating complication of breast cancer and its treatment. The aim of this study was to determine the efficacy of manual lymp...

Background India's National Tuberculosis Elimination Programme (NTEP) provides free diagnosis and treatment services but does not monitor TB-related costs. This study aimed to estimate the direct and indirect costs borne by adult patients with newly diagnosed TB. Methods A longitudinal study in Ballabgarh block, Haryana (North India) was conducted. A total of 110 patients were interviewed and data regarding costs were collected at three points of time (after diagnosis, at the end of intensive phase and at the end of the treatment) using a semistructured questionnaire. The total direct (out-of-pocket expenses) and indirect (income lost) costs before and during treatment were calculated for patients who completed the treatment. Results We enrolled 110 patients with drug-sensitive TB; 6 patients could not complete the treatment. The TB-related median total cost was US$150 (IQR 65–335). The median prediagnosis and postdiagnosis costs were US$42 (IQR 19–313) and US$63 (IQR 10.2–190), respectively. The median direct and indirect costs were US$75 (IQR 36–148) and US$16 (IQR 0–197), respectively. A catastrophic cost was experienced by 18% (95% CI 12 to 27%) of households. Conclusion Despite free diagnosis and treatment services, there is a substantial TB-related cost for TB care under the NTEP. Accelerated efforts are needed to achieve the target of zero catastrophic cost.

Aim: to study of changes in serum uric acid levels in patients with newly diagnosed MDR pulmonary tuberculosis (TB) before and during treatment with pyrazinamide. Materials and Methods: we studied the level of uric acid (UA) in sera of 134 patients (78 men and 56 women). The study was carried before and after 1,2,3,4,5,6,7 and 8 months of treatment (intensive phase). Results: It was found that the level of UA before the treatment increased and significantly higher than normal values in 28,2% men and in 37,5% women. After 1 month of chemotherapy in these patients the level of UA continues to grow and significantly exceeds the initial values. Starting from the 2nd month of treatment, the concentration of UA decreases. Primary cases of an increase in UA levels in patients with initially normal values were observed every month the entire period of treatment, both in men and women. Moreover, in men, hyperuremia was more often observed during the first 2 months of treatment (23,2% and 10,7%). Starting from the 3rd month, the number of patients with a primary increase in UA levels at different periods of treatment ranged from 3,6 to 7,1%. In women, hyperuricemia was also more often observed in the first 2 months of treatment (22,8% and 20,0%). From the 3rd to 5th months of chemotherapy, new cases of an increase in the level of UA were observed in 5,7% of patients. Starting from the 6th month of treatment, an increase in the number of such patients was again observed. In 37,5% of men and in 8,6% of women, before and during the treatment, the level of UA was normal. Conclusion: Uric acid levels must be determined before and within 8 months of treating patients with newly diagnosed MDR TB.

Aim: to study the states of leukocytes by detecting of stages of leukocytes apoptosis (SLA) in patients with pulmonary tuberculosis (PPTB) with different efficacy of intensive phase of treatment (IPT). Materials/methods: 30 patients with PPTB were divided into groups: 1 gr. included 12 PPTB with possitive result (after 60 doses of IPT conversion of bacterial excretion and positive dynamics according to clinical and radiological studies were determined); 2 gr. - 18 PPTB with negative result (after 60-90-120 doses of IPT persistant bacterial excretion and stable or negative dynamics werer detected); 3 gr. - 12 healthy donors. The study was performed by flow cytometry on a flow cytometer FACS Calibur. Assessment of SLA was performed by adding markers CD45+, AnnexinV FITC detection KIT I, 7AAD. Results: Comparison of SLA in groups of PPTB does not show significant (p>0.05) differences in each of the analyzes states of leukocytes, with significant (p

Backgoround: TNF-? plays a role in the occurrence of anorexia and weight loss in pulmonary tubercolusis (TB) patients. Evaluation of treatment response can be done with clinical, microbiological and radiological evaluation. In patients without cough, Body Mass Index (BMI) and TNF-? levels can be used to evaluate clinical treatment response. Objectives: The aim of the study is to measure the Acid Resistant Bacteria (ARB) sputum positivity decrease, TNF-? levels and increased BMI after 2 weeks and 4 weeks intensive treatment of pulmonary TB patients with new case of ARB positive. Methods: The sample size was 14 people with ARB positive pulmonary TB cases, consisting of 9 men and 5 women. It was done sputup smear, BMI and TNF-? examination before treatment, at week 2 and week 4 of intensive phase treatment Result: At the end of the second week, TNF-? levels decreased significantly compared to baseline TNF-? levels with p = 0.015. There was a non significant increase of BMI at the end of the second and fourth week with p = 0.309 and p = 0.270 respectively. The decrease in ARB sputum smear positivity at the end of the second week compared to the fourth week was not statistically significant with p = 0.157. There was a strong correlation between TNF-? and IMT levels before treatment with negative correlation, r = -0.702 and p = 0.005. Conclusion: Levels of TNF-? at the end of the second week decreased significantly compared to baseline TNF-? levels. There was a strong correlation between TNF-? levels and BMI prior to treatment.

Introduction:Conventionally, a combination of four separate drugs (ethambutol, isoniazid, rifampicin, and pyrazinamide [EHRZ]) is the first-line pharmacotherapy for pulmonary tuberculosis (TB). In recent years, fixed-dose combination (FDC) formulation, where a single tablet contains the active ingredients of four aforementioned drugs, is gaining popularity due to its ease of administration. Objective:To compare the real-world effectiveness of EHRZ and FDC treatment groups on a cohort registry by investigating the sputum conversion rate and treatment outcomes of both groups. Methods:A total of 11,489 patients' data were extracted from the Sabah TB registry between January 2012 and June 2016, including EHRZ (n= 4188) and FDC (n= 7301) patients. Then, 1:1 propensity score matching was adopted to reduce the baseline bias. Caliper matching was conducted with maximum tolerance score set at 0.001. Confounders included in the propensity score matching were gender, nationality, diabetes, HIV status, smoking status, and chest X-ray status. Successful matching provided 4188 matched pairs (n= 8376) for final analysis. Results:In this matched cohort of 4188 pairs, the 2-month sputum conversion rate of FDC group was significantly higher than the EHRZ group (96.3% vs. 94.3%;P< 0.001) whereas 6-month sputum conversion of both groups showed no significant difference. Treatment outcomes such as noncompliance rate, failure rate, and success rate have no significant difference (P> 0.05) in both the treatment groups. There was an incidental finding of reduced death rate among FDC group compared to the EHRZ group (0.2% vs. 0.5%;P= 0.034). Conclusion:The FDC formulation has better sputum conversion rate at 2 months compared to conventional EHRZ regime as separate-drug formulation. It was also observed that FDC has a slight protective effect against all-cause death among TB patients. This protective effect of FDC, however, still needs to be proven further.

Background: A report on the usefulness of the instruction of lay carers in multilayer short-stretch compression bandaging within the initial intensive phase physical treatment of mixed-etiology chr...

Setting: Ten selected microscopy centres in Sagaing Region, Myanmar, functioning under an external quality assurance system with no reported major errors. Objective: To assess the pattern of serial sputum results (NN, both smear-negative; NP, first smear-negative and second smear-positive; PN, first smear-positive and second smear-negative; and PP, both smear-positive) among follow-up sputum microscopy examinations of tuberculosis (TB) patients (end of intensive phase, mid-continuation phase and end of treatment) conducted from 1 November 2017 to 15 April 2018. Design: Cross-sectional study using secondary data (laboratory registers). Results: Of 2001 examinations, 94 (4.7%) were smear-positive: 66 PP (3.3%), 12 PN (0.6%) and 16 NP (0.8%); 75% of NP results were scanty. The proportion of NP results was 0.8% (95%CI 0.5-1.3), i.e., 125 smears (95%CI 77-200) were required to detect one additional smear-positive result in the second sample. Of the 16 NP results (15 patients), 14 were tested using Xpert® MTB/RIF and none had rifampicin resistance. During the continuation phase of treatment, 13 became smear-negative, one remained smear-positive and one had unknown follow-up smear status. Conclusion: The benefit of the second sputum sample for monitoring anti-tuberculosis treatment was negligible. Given the favourable resource implications (reduced laboratory workload and costs), we recommend changing the policy from two sputum smears to one during follow-up sputum examinations of TB patients.

Background Melioidosis is an infection caused by a facultative intracellular Gram-negative bacterium, Burkholderia pseudomallei. It can present as septicemia, localized infection with/without septicemia, asymptomatic infections, ulcers, pneumonia, visceral abscesses, neurological infection, musculoskeletal infections and can involve any organ. Case presentation A 56 year old Sri Lankan diabetic female presented with fever, chills and rigors for 2 weeks. She also had malaise and loss of appetite, but no other features. On examination, she was febrile (temperature was 101.4 0 F) and rest of the examination was unremarkable. Her blood culture was positive for Burkholderia pseudomallei and she was started on IV antibiotics, on day 3. During her 2nd week of hospital stay, she developed right sided low back pain with buttock pain, right hip joint pain and restricted hip joint movements suggestive of right sacroiliitis. CE CT and MRI scans confirmed the diagnosis of right iliopsoas abscesses and right sacroiliitis. Incision and drainage was performed and a pigtail catheter was left in place for continuous drainage of abscesses. Her intensive phase was initiated with IV ceftazidime 2 g every 6 h for 12 days, then changed over to IV meropenem 2 g every 8 h together with oral co-trimoxazole. 2 weeks later, oral co-trimoxazole was replaced by oral doxycycline for another 6 weeks (due to transient pancytopaenia). She made a complete and uneventful recovery with oral co-trimoxazole for another 6 months, in her eradication phase. We report this case to show the importance in early diagnosis of melioidosis, and to consider it in the differential diagnosis of multiple abscesses and to emphasize the importance in suspecting melioidosis as a causative agent in infective sacroiliitis. Discussion Melioidosis can have 2 major presentations; acute infection (symptoms lasting less than 2 months) and chronic infection (symptoms lasting more than 2 months). Musculoskeletal melioidosis is a well-recognized manifestation of the disease, which can manifest as soft tissue abscesses, septic arthritis, spondylitis, sacroiliitis and osteomyelitis. Management of melioidosis consists of 2 phases. The intensive phase and the eradication phase. These are aimed at the importance of rapidly treating the septicemia, the need of eradication of the persistent disease and the prevention of recurrent infections or relapses. The intensive phase consists of minimum 10–14 days of IV antibiotics: IV ceftazidime or IV carbapenem (meropenem/ imipenem). Eradication phase should be followed by 3–6 months of oral co-trimoxazole alone or in combination with oral doxycycline/ oral amoxiciliin-clavulanic acid.

Objective: To compare a fixed-dose combination (FDC) of Rifampicin 450 mg, Isoniazid 300 mg, Pyrazinamide 1500 mg and Ethambutol 800 mg (usual care group) and regimen of Rifampicin 200 mg, Isoniazid 300 mg and piperine 10 mg along with Pyrazinamide 1500 mg and Ethambutol 800 mg (intervention care group). Methods: A randomized, prospective, parallel group study was conducted on newly diagnosed tuberculosis patients. The drugs were given during intensive and continuous phase of treatment to newly diagnosed sputum positive pulmonary tuberculosis. All the patients were subjected to sputum examination, biochemical investigations followed by adverse drug event (ADE) monitoring. Results: A total of 63 patients completed the study. No significant difference was observed in baseline characteristics of patients between the study groups. At the end of the continuous phase, both the groups showed zero bacteria detection. However, in the intervention group, the rate of sputum conversion was much faster than the usual care group. The rate of increase in SGOT and SGPT was much higher in the usual care group (p

The objective of the study: to define indications for discontinuation of a drug causing adverse reactions during chemotherapy in tuberculosis patients. The frequency, severity, and outcomes of adverse reactions with anti-tuberculosis drugs discontinued and not were analyzed in 435 new tuberculosis patients. The severity of AE was assessed using modified criteria of NCI CTCAE version 4.0 and DMID. In 69.2% of patients (95% CI 64.7-73.3%) AE resulted in the discontinuation of at least one drug and it was associated with the significant increase of the intensive phase duration. Severe AE (severity grades 3-4) were observed in 54.3% of patients (95% CI 49.6-58.9%). In 17.0% of cases, the discontinuation of drugs could have been avoided, in 20.9% the drug had to be discontinued due to the risk of complications and irreversible damage of organs as per the signs of grade 2 of severity. The continued in-take of anti-tuberculosis drugs in case of AE of severity grade 3-4 was associated with negative changes in 20 out of 62 cases (32.2%). Indications for discontinuation of anti-tuberculosis drugs in the intensive phase of treatment include grades 3-4 of severity, the risk of irreversible damage of an organ and life-threatening conditions. Discontinuation of the drug can be discussed in case of some moderate adverse events should all available conservative measures fail.

Lymphedema of the arm and/or hand is a well-established complication of breast cancer therapy. The objective of the study was to determine the interest of auto-adjustable MOBIDERMThis is a subgroup analysis of MARILYN Study, conducted on 40 patients after completion of intensive DLT. Patients were randomized in Night-user group (fitted with MOBIDERM Autofit device) or No night-user group (no night compression). For subgroups analysis, patients were defined as high responders (HR) if their lymphedema volume reduction during DLT was ≥35% or as low responders (LR) if it was below 35%.In HR subgroups (n = 16), the mean lymphedema volume variation between Day 0 and 30 was 28.4 mL in the night-user group versus 181.4 mL in the no night-user group. When adjusted to the loss of volume during DLT, 89% of the DLT benefit is maintained in HR night-user versus 54% in no night-user group. Between LR (24 patients), this mean volume variation was by 65.1 mL versus 54.9 mL in night-user and no night-user groups respectively between Day 0 and 30.Wearing MOBIDERM Autofit, on top of the day time hosiery, appears a promising way to control the early rebound effect during the maintenance phase especially in DLT-HR.

In order to evaluate the frequency and risk factors of adverse reactions, the monitoring results of clinical and laboratory tests of 435 new cases of respiratory tuberculosis being on the intensive phase of chemotherapy have been analyzed. 95.2% of patients had adverse reactions (95% CI 92.7-96.9); 48.7% demonstrated severe adverse reactions and in 72.7% treatment regimen had to be changed. Regarding the profile of adverse reactions, hepatotoxic ones prevailed (59.3%), they were followed by allergic reactions (53.6%), gastrointestinal reactions (35.6%) and hyperuricemia (61.6%). Certain risk factors have been identified for each of the above types of adverse reactions, making it possible to predict and prevent them prior to the start of chemotherapy.

Background: Pulmonary Tuberculosis (PTB) is a contagious, airborne infection that develops when M. tuberculosis infect the lungs. PTB is totally curable infection. However, an early diagnosis and antibiotic treatment is needed to get the desired outcomes. Despite availability of treatment, stigmatization and negative emotions resulting from the illness could hamper the psychological well-being of patients which may eventually result in poor compliance, work absenteeism thus effecting economic productivity and prosperity. Methods: This was a cross-sectional study conducted over a period of one year. A total of 231 category II DOTS patients were recruited for the study. Quality of Life (QOL) was assessed after 3 months of the intensive phase. For QOL WHO based QOLBREF was used. Results: In the present study patients scored lowest in the psychological domain (7.82 ± 1.86) followed by physical (8.21 ± 1.98). Conclusion: HRQOL is significantly reduced in patients with PTB.

Acid fast bacilli (AFB) sputum microscopy is used to diagnose tuberculosis (TB) and to evaluate the effectiveness of anti-tuberculosis drugs in TB eradication program. The AFB sputum microscopy should be performed before treatment, two months after intensive phase and four months after advance phase treatment. The aim of this study was to evaluate the sputum conversion rate of AFB in pulmonary TB patients who received category I of antituberculosis (anti-TB) drugs. Evaluation of sputum conversion was perfomed before initation of anti TB drugs and at the end of the intensive phase. This cohort prospective study was done from February to May, 2018. Nine pulmonary TB patients fulfilled the criteria during the study. This AFB sputum microscopy was evaluated by using Ziehl Neelsen and read by means of International Union Against Tuberculosis and Lung Disease (IUATLD) scale. Nine sputum smear positive were followed for two months. After two months (end of the intensive phase), the smear conversion rate was 100%. All patients received standard dose of anti-TB drugs in fix dose combination (FDC). It can be concluded that the sputum conversion of AFP in pulmonary TB patients who received category I of anti-TB was success at the second month of intensive phase.

Purpose There have been few reports on height disturbance in childhood acute lymphoblastic leukemia (ALL) patients treated without cranial radiation therapy (CRT). Our study aimed to clarify the critical period of growth in pediatric patients who were treated by the Japan Childhood Leukemia Study (JACLS) ALL-02 protocol, which involved short-term intensive treatment without CRT. Patients and methods A retrospective, cohort study was conducted for prepubertal children with B-precursor ALL who were diagnosed from July 2002 to November 2011 and treated by the JACLS ALL-02 protocol at Oita University Hospital. The heights were chronologically measured at pretreatment, after the intensive phase (INT), at the end of treatment (END), and at 1 to 5 year(s) posttreatment (POST 1 to 5). Results Nine boys and 4 girls were enrolled. Z score of the height was reduced at INT and END. Delta Z scores of the height and Z score of height velocity were reduced from pretreatment to INT, and they demonstrated an early recovery during maintenance treatment in INT to END. Conclusions Early recovery of delta Z scores of the height and Z score of height velocity was observed during the INT to END period. The shortened intensive phase without CRT may result in an adequate height in prepubertal ALL patients.

BACKGROUND: Indonesia is in the second rank for the most TB (Tuberculosis) cases in the world after India. It is estimated that there are 1 million cases per year in Indonesia. AIM: To find out the influence of Vitamin A supplementation in the medication of pulmonary TB on the acceleration of sputum conversion time at an intensive phase in the Working Area of Puskesmas in Medan Kota Subdistrict METHODS: This research was Quasi Experiment method. With two groups. The samples were 30 newly diagnosed pulmonary TB patients consisting of of15 patients in the treatment group and 15 patients in the control group. The statistical data were analysed with t independent test, significance 95% (p < 0.05) RESULTS: The treatment group discovered that they were mostly 18-27 years old 40.0%, male 73.3%, mostly university students 26.7%, had BTA conversion in the second week 80.0%; and the sputum conversion time was 2.4 weeks in average. The results of the research on the control group demonstrated that they were mostly 18-27 years old 33.3%, male 80.0%, mostly university students and entrepreneurs 20.0%, had BTA conversion in the second week 80%; and the sputum conversion time was 4.1 weeks in average. Vitamin A supplementation in the medication of pulmonary TB patients had some influence on the acceleration of sputum conversion at the intensive phase (p ≤ 0.001). CONCLUSION: We concluded that Vitamin A in the medication of pulmonary TB patients had some influence on the acceleration of sputum conversion at the intensive phase in the Medan Kota.

Background: India’s national tuberculosis (TB) programme recommends that among patients with diabetes mellitus and TB, fasting blood glucose (FBG) be recorded at baseline, the end of intensive phase and the end of continuation phase of TB treatment. We conducted this operational research in select districts of Tamil Nadu, India, in 2016 to determine the availability of blood glucose records and glycemic control status during TB treatment. Methods: This was a descriptive study involving secondary programme data. Glycemic control during TB treatment was ‘optimal’ if both baseline and end of intensive phase FBG (during TB treatment) were Results: Of 438 patients, FBG at baseline, the end of intensive phase and the end of continuation phase were each available in Conclusion: Among patients with diabetes and tuberculosis, recording of FBG during tuberculosis treatment requires urgent attention.

Actuality: There is lack of criteria to determine chemotherapy duration for children and adolescents with MDR/XDR TB. Aim: To develop new approaches to determine chemotherapy duration for children and adolescents with MDR/XDR TB; assess their effectiveness. Material and Methods: A cohort prospective study of 2017-18 included 18 patients aged 13-18 with MDR/XDR TB. Sputum examinations: three times at admission, monthly, DST, BACTEC MGIT-960. Dynamic computed tomography of the chest. The criteria for 12-month chemotherapy (6-month intensive phase with 5 drugs, 6-month continuation phase with 3 drugs): sputum conversion within 3 mo., cavity closure within 6 mo.. The criteria for chemotherapy of more than 12 mo.: sputum positivity for more than 3 mo., cavities – for more than 6 mo; surgery. Three-year follow-up after treatment completion. Results: MDR TB – 11, XDR TB – 8. Chemotherapy duration: 12 mo.– 9, more than year – 9. Shortened chemotherapy regimens: sputum conversion after 1 mo. – 8, 2 mo. – 1. Cavity closure: after 2 mo.– 3, 4 mo. – 2, 6 mo. – 4. Out of 9 cases on long-term chemotherapy sputum conversion was observed: after 1 mo. – 5, 3 mo. 2, 6 mo. – 1. Cavity closure: after 3 mo.– 1,6 m. – 1, 9 mo. – 2, without dynamics – 5. All 9 underwent surgery. The indications for surgery were: tuberculomas with decay – 8, fibrotic cavities –1. None developed relapse one year after treatment. Conclusions: We originally developed new scientifically justified criteria to determine chemotherapy duration for children and adolescents with MDR/XDR TB. Effectiveness of shortened chemotherapy regimens using fewer drugs was proved by absence of relapses.

Background Multi-drug resistant Tuberculosis (MDR-TB) is a strain of Mycobacterium tuberculosis that is resistant to at least Rifampicin and Isoniazid drugs. The treatment success rate for MDR-TB cases is lower than for drug susceptible TB. Globally only 55% of MDR-TB patients were successfully treated. Monitoring the early treatment outcome and better understanding of the specific reasons for early unfavorable and unknown treatment outcome is crucial for preventing the emergence of further drug-resistant tuberculosis. However, this information is scarce in Ethiopia. Therefore, this study aimed to determine the intensive phase treatment outcome and contributing factors among patients treated for MDR-TB in Ethiopia. Methods A 6 year retrospective cohort record review was conducted in fourteen TICs all over the country. The records of 751 MDR-TB patients were randomly selected using simple random sampling technique. Data were collected using a pre-tested and structured checklist. Multivariable multinomial logistic regression was undertaken to identify the contributing factors. Results At the end of the intensive phase, 17.3% of MDR-TB patients had an unfavorable treatment outcome, while 16.8% had an unknown outcome with the remaining having a favorable outcome. The median duration of the intensive phase was 9.0 months (IQR 8.04–10.54). Having an unfavorable intensive phase treatment outcome was found significantly more common among older age [ARRR = 1.047, 95% CI (1.024, 1.072)] and those with a history of hypokalemia [ARRR = 0.512, 95% CI (0.280, 0.939)]. Having an unknown intensive phase treatment outcome was found to be more common among those treated under the ambulatory care [ARRR = 3.2, 95% CI (1.6, 6.2)], rural dwellers [ARRR = 0.370, 95% CI (0.199, 0.66)], those without a treatment supporter [ARRR = 0.022, 95% CI (0.002, 0.231)], and those with resistance to a limited number of drugs. Conclusion We observed a higher rate of unfavorable and unknown treatment outcome in this study. To improve favorable treatment outcome more emphasis should be given to conducting all scheduled laboratory monitoring tests, assignment of treatment supporters for each patient and ensuring complete recording and reporting which could be enhanced by quarterly cohort review. Older aged and rural patients need special attention. Furthermore, the sample referral network should be strengthened.

Dheda K, Barry CE 3rd, Maartens G. Tuberculosis. Lancet 2016; 387: 1211–26—In panel 2, the section “Isoniazid mono-resistant tuberculosis” should have read “Treat for 6 months with rifampicin, pyrazinamide, and ethambutol, or for 9 months with rifampicin, ethambutol, and pyrazinamide in the 2 month intensive phase and rifampicin and ethambutol in the continuation phase”. This correction has been made to the online version as of Oct 5, 2015, and the printed Seminar is correct. Published Online October 5, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)00399-2

The adoption of electric vehicles are an environmental friendly initiative and a cost-effective opportunity because the number of these vehicles in the globe would be over 35 million by 2022. However, planning the routes of electric vehicles for timely delivery of goods, involves to take into account the limited energy which may lead the drivers to detour from the initial plan for recharging the batteries. In this work, the studied vehicles are modular. It means that they consist of an innovative system with one cabin for the driver and one or more modules for the goods. The research problem arising when planning the routes of such vehicles is recent. It is a particular routing problem (VRP) where the objective is the minimization of all the costs with some adding constraints linked with the recharges and the nature of the vehicles which are composed of modules. Therefore, the best current methods capable of addressing efficiently the VRP have been investigated. In this work, we propose to hybridize the population based evolutionary schema with two possible local search procedures. An intensive phase of experiments is operated to compare the approaches and show the usefulness of using the electric modules for freight delivery.

Background Lymphedema is a common complication of breast cancer or its treatment. The gold standard treatment for lymphedema is complete decongestive therapy. There are few studies about the predictive factors for the effectiveness of complete decongestive therapy. Aim To evaluate the results of the intensive phase of complete decongestive therapy, and to determine the predictive factors for the response to treatment in patients with breast cancer-related lymphedema. Methods and results Fifty-seven patients with breast cancer-related lymphedema (mean age: 56.2 ± 11.2 years) who underwent complete decongestive therapy between 2014 and 2016 were evaluated retrospectively. Extremity volume was calculated using circumferential measurements and the truncated cone formula technique. Response to treatment was evaluated using the percentage reduction of excess volume formula, which was obtained by calculating the extremity volume before and after treatment. The median percentage reduction of excess volume was 27.7% (IQR,13.6-50.3). The history of skin infection was related to lower percentage reduction of excess volume (P = 0.001). Although percentage reduction of excess volume was positively correlated with education level (r = 0.286, P = 0.031), percentage reduction of excess volume was negatively correlated with lymphedema duration (r = -0.361, P = 0.006), postoperative duration (r = -0.314, P = 0.018), percentage of excess volume (r = -0.398, P = 0.002), and number of complete decongestive therapy sessions (r = -0.436, P = 0.001). Univariate and multivariate analyses showed that the independent variables for percentage reduction of excess volume were percentage of excess volume (P = 0.009) and education level (P = 0.021). Conclusion Complete decongestive therapy is an effective method in patients with breast cancer related-lymphedema. The most important predictive factors for the efficacy of treatment were found as percentage of excess volume and education level. Patients with breast cancer should be followed up regularly and receive complete decongestive therapy in the early stage of lymphedema.