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Title: Oral contraceptives and neoplasms other than breast and female genital tract.
Author: La Vecchia C; Bosetti C
Source: European Journal of Cancer Prevention. 2009 Jul 15;
Abstract: We reviewed epidemiological data on oral contraceptive (OC) use and colorectal, liver, lung and other nonfemale neoplasms. The data for colorectal cancer are suggestive of a favourable effect of OC, in the absence, however, of any duration-risk relation. Current, but not past, OC use is associated with excess risk of benign liver tumours, and a modest excess risk of liver cancer. The association with liver cancer was smaller for recent, low-dose OC. There was no evidence of an association between OC use and lung, digestive tract neoplasms other than colorectum, cutaneous malignant melanoma, thyroid cancer and any of the other neoplasms investigated.
Language: English
Keywords:
ITALY | RESEARCH REPORT | EPIDEMIOLOGY | WOMEN | CANCER | LIVER NEOPLASMS | THYROID EFFECTS | ORAL CONTRACEPTIVES | PULMONARY EFFECTS | NEOPLASMS | Developed Countries | Europe, Southern | Europe | Public Health | Health | Demographic Factors | Population | Diseases | Endocrine Effects | Endocrine System | Physiology | Biology | Contraceptive Methods | Contraception | Family Planning
Document Number: 342122

Title: In vitro fertilization in two patients with Kartagener's syndrome and infertility.
Author: Abu-Musa A; Nassar A; Usta I
Source: Gynecologic and Obstetric Investigation. 2008 Jan;65(1):29-31.
Abstract: Women with Kartagener's syndrome (KS) are at a risk for infertility because of the dyskinetic ciliary activity in the fallopian tubes. In vitro fertilization - embryo transfer (IVF-ET) is considered the treatment of choice for patients with tubal factor infertility. In the literature only 2 patients with KS were treated with IVF-ET, with only one pregnancy achieved. We report 2 patients with KS and infertility treated successfully with IVF-ET. (author's)
Language: English
Keywords:
LEBANON | RESEARCH REPORT | WOMEN | PULMONARY EFFECTS | COMPLICATIONS | RISK FACTORS | INFERTILITY | IN VITRO | FERTILIZATION | PREGNANCY OUTCOMES | Middle East | Developing Countries | Demographic Factors | Population | Physiology | Biology | Diseases | Reproduction | Clinical Research | Research Methodology | Pregnancy
Document Number: 323122

Title: Comparison of the two-dimensional and multiplanar methods and establishment of a new constant for the measurement of fetal lung volume.
Author: Araujo Junior E; Nardozza LM; Pires RC; Guimaraes Filho HA; Moron AF
Source: Journal of Maternal-Fetal and Neonatal Medicine. 2008 Jan;21(1):81-88.
Abstract: The objectives were to compare the two-dimensional (2D) and multiplanar methods in the measurement of lung volume in normal fetuses, to obtain a new constant to be incorporated into the 2D equation, and to apply the new equation in fetuses with pulmonary hypoplasia (PH) confirmed postnatally. A cross-sectional study was performed on 51 pregnant women at between 20 and 35 weeks of gestation. The ellipsoid formula (x x y x z x 0.52) was used to calculate lung volume by the 2D method. A sequence of multiple planes with 2.0-mm intervals was used with the multiplanar method. In order to compare the techniques, the intra-class correlation coefficient (ICC) and the Student's t-test (p) were used. First-order linear regressions were used to establish a new constant, with three-dimensional (3D) lung volume as dependent variable and gestational age and 2D volume as independent variables. In order to validate it, the new equation was applied to 11 fetuses with confirmed lethal PH. The mean volumes obtained by the 2D method were overestimated when compared to the multiplanar method (right lung: 23.87 vs. 18.26 mL, respectively, p < 0.001 and left lung: 16.18 vs. 14.33 mL, respectively, p = 0.008). Using a first-order polynomial regression, new constants were obtained for the right lung (0.152) and for the left lung (0.167). When compared to the traditional formula, the new equation presented higher sensitivity (18.1%) in predicting lethal PH. The recalculated 2D equation can be a promising alternative to 3D ultrasonography in the prediction of PH. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | MEASUREMENT | COMPARATIVE STUDIES | FETUS | PULMONARY EFFECTS | OBSTETRICS | EXAMINATIONS AND DIAGNOSES | ULTRASONICS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Studies | Pregnancy | Reproduction | Physiology | Biology | Medicine | Health Services | Delivery of Health Care | Health | Medical Procedures
Document Number: 323406

Title: Clinical application of a rapid lung-orientated immunoassay in individuals with possible tuberculosis.
Author: Breen RA; Barry SM; Smith CJ; Shorten RJ; Dilworth JP
Source: Thorax. 2008 Jan;63(1):67-71.
Abstract: BACKGROUND: Immunological ex vivo assays to diagnose tuberculosis (TB) have great potential but have largely been blood-based and poorly evaluated in active TB. Lung sampling enables combined microbiological and immunological testing and uses higher frequency antigen-specific responses than in blood. METHODS: A prospective evaluation was undertaken of a flow cytometric assay measuring the percentage of interferon-gamma synthetic CD4+ lymphocytes following stimulation with purified protein derivative of Mycobacterium tuberculosis (PPD) in bronchoalveolar lavage fluid from 250 sputum smear-negative individuals with possible TB. A positive assay was defined as >1.5%. RESULTS: Of those who underwent lavage and were diagnosed with active TB, 95% (106/111) had a positive immunoassay (95% CI 89% to 98%). In 139 individuals deemed not to have active TB, 105 (76%) were immunoassay negative (95% CI 68% to 82%). Of the remaining 24% (34 cases) with a positive immunoassay, a substantial proportion had evidence of untreated TB; in two of these active TB was subsequently diagnosed. Assay performance was unaffected by HIV status, disease site or BCG vaccination. In culture-positive pulmonary cases, response to PPD was more sensitive than nucleic acid amplification testing (94% vs 73%). The use of early secretory antigen target-6 (ESAT-6) responses in 71 subjects was no better than PPD, and 19% of those with culture-confirmed TB and a positive PPD immunoassay had no detectable response to ESAT-6. CONCLUSIONS: These findings suggest that lung-orientated immunological investigation is a potentially powerful tool in diagnosing individuals with sputum smear-negative active TB, regardless of HIV serostatus.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | CLIENTS | TUBERCULOSIS | EXAMINATIONS AND DIAGNOSES | PULMONARY EFFECTS | Developed Countries | Europe, Western | Europe | Research Methodology | Studies | Program Activities | Programs | Organization and Administration | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology
Document Number: 325764

Title: Diagnosis of pulmonary tuberculosis in young children.
Author: Coulter JB
Source: Annals of Tropical Paediatrics. 2008 Mar;28(10):3-12.
Abstract: The Stop TB Strategy encompasses promotion and support for childhood TB including diagnosis. The diagnosis of TB in low-income countries needs to be improved using existing technology. All hospitals involved in managing children with TB should have a regular stock of tuberculin. A chest radiograph (CXR) is an integral part of the diagnosis of pulmonary TB and hospitals should be able to take satisfactory CXRs of young children. If there is a reliable laboratory service, bacterial confirmation should be undertaken in selected cases. The laboratory should be able to deal satisfactorily with paediatric specimens. Gastric aspiration is the method of choice to obtain sputum from young children and generally produces higher yields than other methods, and, with good technique, results in outpatients may not be much lower than in inpatients. Nasopharyngeal aspiration is a simple alternative method requiring limited equipment. Sputum induction requires a special room, capital and recurrent equipment and a dedicated nurse. Laryngeal swabs are suitable for older outpatients unable to produce adequate sputum. Each hospital should have a clinician trained in the diagnosis and management of childhood TB, including the interpretation of CXRs and skill in fine-needle aspiration. Radiologists and clinicians should use a simple, clear, internationally accepted classification of paediatric CXRs. The clinician(s) in charge of TB services should oversee all inpatients with TB and be at the forefront in running the TB clinic. A TB nurse specialist(s) should be part of the team. There is now a will to improve the diagnosis and management of childhood TB but bringing it to fruition requires efforts by the local TB service, paediatricians, radiology departments and laboratory services. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | CHILD | PULMONARY EFFECTS | TUBERCULOSIS | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | PREVENTION AND CONTROL | TESTING | LABORATORY PROCEDURES | TREATMENT | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Physiology | Biology | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Research Methodology | Laboratory Examinations and Diagnoses
Document Number: 325070

Peer Reviewed

Title: Clinical profile of pleural empyema and associated factors with prolonged hospitalization in paediatric tertiary centre in Angola, Luanda.
Author: de Britto MC; Silvestre SM; Duarte MD; Bezerra PG
Source: Tropical Doctor. 2008 Apr;38(2):118-120.
Abstract: In a case series of 152 children aged from 2 to 132 months will pleural emphema from a paediatric tertiary hospital in Luanda, Angola between September 2004 and March 2005, the authors found a high prevalence of anaemia and malnutrition. The most prevalent bacteria in pleural fluid were: D pneumoniae, Haemophyllus and S aureus. The median for hospital stay was 25 days. The lethality was 7.8% and was not statistically associated with malnutrition, although this variable was associated, in multivariate analysis, with prolonged hospitalization time.
Language: English
Keywords:
ANGOLA | SUMMARY REPORT | INCIDENCE | CHILD | ANEMIA | MALNUTRITION | PNEUMONIA | PULMONARY EFFECTS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Diseases | Nutrition Disorders | Physiology | Biology
Document Number: 308929

Title: Outcome of multi-drug resistant tuberculosis cases treated by individualized regimens at a tertiary level clinic.
Author: Dhingra VK; Rajpal S; Mittal A; Hanif M
Source: Indian Journal of Tuberculosis. 2008 Jan;55(1):15-21.
Abstract: The aim was to determine the clinical, radiological and drug resistance profile as well as the factors associated with treatment outcome of Multi-Drug Resistant Tuberculosis (MDR-TB). All newly diagnosed patients with pulmonary MDR-TB from August 2002 to December 2004 enrolled at New Delhi Tuberculosis Centre, were included in the study. They were followed up clinically, radiologically and bacteriologically by sputum smear, culture and Drug Susceptibility Testing (DST) at regular intervals. According to their DST pattern and previous history of Anti-Tubercular Treatment (ATT), individualized treatment regimens were tailored for each patient. Out of total 27 bacteriologically proven cases of MDR-TB included in this study, 19 were males (mean age and weight 38.5 years and 52.6 kgs, respectively) and eight females (mean age and weight 34.3 years and 40.7 kgs, respectively). A majority (18) were residents of Delhi and the rest hailed from different parts of North India. All of them had a history of previous treatment ranging from six to 34 months. Cavity on chest X-rays was seen in 81%, while 44% showed extensive involvement. The patients received at least four "second line drugs" during their treatment with a mean of 6.2 anti-tubercular drugs during their intensive phase. Of the 27 patients, 13 were cured, 10 defaulted, one died, one is still on treatment and two were referred for surgery. Radiological improvement was observed in two third of cases and chest X-ray of two patients showed a complete resolution. Six predictors were identified for successful outcome of MDR-TB. They include weight gain at six months, culture conversion, radiological improvement during treatment, disease with M. tuberculosis strains exhibiting resistance to less than or up to three anti-tubercular drugs, use of less than or up to three second line drugs in treatment and no change of regimen during treatment. Default from treatment was observed to be a major challenge in the treatment of MDR-TB due to long duration and expense of ATT. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | CLINICAL RESEARCH | CLIENTS | TUBERCULOSIS | TREATMENT | TERTIARY SECTOR | PULMONARY EFFECTS | DRUGS | Developing Countries | Asia, Southern | Asia | Research Methodology | Program Activities | Programs | Organization and Administration | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Macroeconomic Factors | Economic Factors | Physiology | Biology
Document Number: 326642

Title: Opportunistic infection among HIV seropositive cases in Manipal Teaching Hospital, Pokhara, Nepal.
Author: Dhungel BA; Dhungel KU; Easow JM; Singh YI
Source: Kathmandu University Medical Journal. 2008 Jul-Sep;6(3):335-339.
Abstract: Background: Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) claimed more than 22 million deaths in the past two decades. About 10,000-15,000 Nepalese are expected to die of AIDS related deaths every year in the absence of effective treatment and care. Major cause of mortality and morbidity in HIV infected people is opportunistic infection (OI). Type of pathogen(s) responsible for OI varies from region to region. Objective: This study attempts to find out OI among HIV seropositive patients visiting MTH, Pokhara. Results: Tuberculosis (30%) was found to be most common OI followed by candidiasis (14%). Pulmonary tuberculosis (21.14%) was more common than extra pulmonary tuberculosis (8.92%). Oral candidiasis (8.92%) was more common than oesophageal candidiasis (5.35%). Conclusion: The study findings indicate that immediate and strong action needs to be taken and guidelines and strategies to tackle the HIV AIDS problems are required and should be equally implemented to achieve a decline in the rate of prevalence of HIV.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | HIV INFECTIONS | COMPLICATIONS | HUMAN GEOGRAPHY | TUBERCULOSIS | PULMONARY EFFECTS | ORAL EFFECTS | CANDIDIASIS | Developing Countries | Asia, Southern | Asia | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Geography | Social Sciences | Science | Sociocultural Factors | Infections | Physiology | Biology | Bacterial and Fungal Diseases
Document Number: 328185

10.
Title: Manifestations of pulmonary tuberculosis in the elderly: a prospective observational study from north India.
Author: Gupta D; Singh N; Kumar R; Jindal SK
Source: Indian Journal of Chest Diseases and Allied Sciences. 2008 Jul-Sep;50(3):263-7.
Abstract: BACKGROUND: There is scarcity of published literature on manifestations of pulmonary tuberculosis (PTB) among elderly patients in India. The aim of the present study was to compare the clinical, radiological and laboratory manifestations of PTB among young and elderly patients. METHODS: This prospective study involved 100 human immunodeficiency virus (HIV) negative patients with PTB. The demographic, clinical, radiological and laboratory manifestations were compared between young (n=50; under 60 years of age) and elderly (n=50; aged 60 years and above) with PTB. RESULTS: Elderly patients, in comparison to younger patients, tended to be heavier smokers and had more co-morbidities (40% vs 8%; p < 0.05). They presented more frequently with constitutional symptoms (except fever) and less frequently with respiratory symptoms. The mean duration of symptoms and rate of sputum smear-positivity for acid-fast bacilli was similar in both groups. Both the groups were similar with respect to physical examination and chest radiograph findings. Median values of erythrocyte sedimentation rate and total leukocyte count were significantly higher and lower respectively in the elderly patients. CONCLUSIONS: The presentation of PTB in elderly patients differs from that of younger patients by the predominance of constitutional rather than respiratory symptoms. A high index of suspicion is required to make a timely diagnosis of tuberculosis in the elderly.
Language: English
Keywords:
INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | OLDER ADULTS | TUBERCULOSIS | PULMONARY EFFECTS | RESPIRATORY INFECTIONS | EXAMINATIONS AND DIAGNOSES | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Adults | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 328408

11.

Title: Lymphangioleiomyomatosis: a review.
Author: Hohman DW; Noghrehkar D; Ratnayake S
Source: European Journal of Internal Medicine. 2008 Jul;19(5):319-24.
Abstract: Lymphangioleiomyomatosis (LAM) is a rare disease, of unknown etiology, affecting women almost exclusively. Microscopically, LAM consists of a diffuse proliferation of smooth muscle cells. LAM can occur without evidence of other disease (sporadic LAM) or in conjunction with tuberous sclerosis complex (TSC). TSC is an autosomal dominant tumor suppressor gene syndrome characterized by seizures, mental retardation, and tumors in the brain, heart, skin, and kidney. LAM commonly presents with progressive breathlessness or with recurrent pneumothorax, chylothorax, or sudden abdominal hemorrhage. Computed tomography (CT) scans show numerous thin-walled cysts throughout the lungs, abdominal angiomyolipomas, and lymphangioleiomyomas. No effective treatment currently exists for this progressive disorder. The prevalence of lymphangioleiomyomatosis is probably underestimated based on its clinical latency and the absence of specific laboratory tests. With the utilization of international LAM data registries the "classical" picture of the disorder appears to be evolving as a larger number of patients are evaluated. An increased awareness of LAM and its common clinical presentation may advance the development of new therapeutic strategies and reduce the number of mistakenly diagnosed patients.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | WOMEN | DISEASES | PULMONARY EFFECTS | NEEDS | SCREENING | Developed Countries | North America | Americas | Demographic Factors | Population | Physiology | Biology | Economic Factors | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 328353

12.

Title: Changing global epidemiology of pulmonary manifestations of HIV/AIDS.
Author: Hull MW; Phillips P; Montaner JS
Source: Chest. 2008 Dec;134(6):1287-98.
Abstract: Tremendous advances have occurred in the care of patients with HIV/AIDS resulting from the advent of highly active antiretroviral therapy (HAART). This has led to differences in the presentations of HIV-related pulmonary disease. Infections such as bacterial pneumonias, particularly Streptococcus pneumoniae, remain commonplace, while opportunistic agents such as Pneumocystis jirovecii remain a concern in patients without adequate access to optimal medical care. The tuberculosis epidemic, once thought to be slowing, has been re-energized by the spread of HIV, particularly in sub-Saharan Africa. Unusual inflammatory responses due to a phenomenon of immune reconstitution, are now recognized as a consequence of HAART, with a reported incidence of IRIS in this setting ranges from 7 to 45% in retrospective reviews. Noninfectious pulmonary conditions such as chronic obstructive lung disease and pulmonary malignancies are gaining prominence as patients are accessing antiretroviral care and enjoying significantly extended survival.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | EPIDEMIOLOGY | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | HIV INFECTIONS | PULMONARY EFFECTS | ANTIRETROVIRAL THERAPY | AIDS | Africa | Developing Countries | Public Health | Health | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Infections | Physiology | Biology | HIV
Document Number: 329767

13.

Title: Local immunodiagnosis of pulmonary tuberculosis by enzyme-linked immunospot.
Author: Jafari C; Ernst M; Strassburg A; Greinert U; Kalsdorf B
Source: European Respiratory Journal. 2008 Feb;31(2):261-265.
Abstract: Lymphocytes are crucial in the immune defence against Mycobacterium tuberculosis (MTB) infection. The aim of the present study was to ascertain whether or not MTB-specific lymphocytes are selectively compartmentalised in the lungs of patients with minimal active pulmonary tuberculosis (PTB). Patients with smear-negative MTB-culture-confirmed PTB were prospectively recruited. Differential cell counts, immunophenotyping with monoclonal antibodies directed against the cell surface markers CD4, CD8, CD4CD45RA, CD4CD45R0, CD38, human leukocyte antigen DR, CD19, CD3, CD57 and CD16 and MTB-specific enzyme-linked immunospot assays of peripheral blood mononuclear cells and bronchoalveolar lavage (BAL) mononuclear cells with 6-kDa early secretory antigenic target and culture filtrate protein 10 were performed. Among 12 patients with culture-confirmed smear-negative PTB, no differences were found in the distribution of total CD4 or CD8 T-cells in peripheral blood or BAL fluid (BALF). Activated human leukocyte antigen-DR-positive cells, as well as memory CD4CD45R0-positive T-cells, were expanded among cells of the BALF. Compared with a group of control patients with alternative pulmonary pathologies, there was no significant difference in lymphocyte subpopulations. However, 6-kDa early secretory antigenic target- and culture filtrate protein 10-specific lymphocytes were more concentrated, with a median BALF:peripheral blood ratio of 9.9 and 8.9, respectively, in patients with PTB. Mycobacterium tuberculosis-specific T-cells are highly selectively compartmentalised at the site of infection in active pulmonary tuberculosis.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | CLINICAL RESEARCH | PROSPECTIVE STUDIES | CLIENTS | TUBERCULOSIS | EXAMINATIONS AND DIAGNOSES | IMMUNE SYSTEM | PULMONARY EFFECTS | Europe, Central | Europe | Developed Countries | Research Methodology | Studies | Program Activities | Programs | Organization and Administration | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology
Document Number: 325762

14.
Title: The considerable, often neglected, impact of pulmonary tuberculosis on the prevalence of COPD [letter]
Author: Jung KH; Kim SJ; Shin C; Kim JH
Source: American Journal of Respiratory and Critical Care Medicine. 2008 Aug 15;178(4):431; author reply 432-3.
Abstract: In the executive summary of the 2006 update of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines (1), the authors state that it is difficult to differentiate between chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis (TB) in some subjects due to similar respiratory symptoms and chronic airflow limitation, and they suggest that a possible diagnosis of pulmonary TB should be considered in developing countries where these two diseases are common. Such comments focusing only on overlapping respiratory symptoms are adequate, but not enough for the clinician in TB endemic areas. Treated pulmonary TB is a significant cause of obstructive airway disease, with an inverse relationship between FEV1 and the extent of the disease on the original chest radiograph (2). Moreover, this relationship is valid even with minimal involvement without cavitations on chest radiograph at presentation. Chronic bronchitis, or bronchiolitis, and emphysema often occur as complications of pulmonary TB. Additional exposure to cigarette smoke and other environmental risk factors leads to an increase in such occurrences. This was emphasized in the GOLD Workshop summary published in 2001 (3). Interestingly, the degree of obstructive airway changes in subjects treated for TB increases with age, the number of cigarettes smoked, and the extent of the initial TB disease (4). In a study performed by our group (5), the impact of pulmonary TB on the prevalence of COPD was assessed. Even minimal scar change on chest radiograph without destroyed lung was associated with chronic airflow limitation. This was true in all subjects, regardless of previous treatment history for TB. The prevalence of COPD increased from 3.7 to 5.0% by including participants with radiographically minimal previous TB lesions or past history of TB treatment. This substantially significant increase might act as a confounding factor and contribute to the prevalence of COPD in pulmonary TB endemic areas. The diagnosis of COPD recommended by GOLD is still based on the degree of airflow limitation assessed by spirometry. With respect to the epidemiology of COPD in pulmonary TB endemic areas, further studies, with careful consideration of subjects with minimal scar change on chest radiograph and/or previous history of pulmonary TB treatment, are required to assess the impact of pulmonary TB on the prevalence of COPD. Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript. (full-text)
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | TARGET POPULATION | PREVALENCE | TUBERCULOSIS | CHRONIC DISEASES | PULMONARY EFFECTS | SIGNS AND SYMPTOMS | EXAMINATIONS AND DIAGNOSES | COMPLICATIONS | Research Methodology | Program Design | Programs | Organization and Administration | Measurement | Infections | Diseases | Physiology | Biology | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 328451

15.

Title: Mycobacterial infections in human immuno-deficiency virus seropostive patients: Role of non-tuberculous mycobacteria.
Author: Khatter S; Singh UB; Arora J; Rana T; Seth P
Source: Indian Journal of Tuberculosis. 2008 Jan;55(1):28-33.
Abstract: There is high prevalence of tuberculosis in patients with HIV infection; hence the role of non-tuberculous mycobacteria (NTM) in HIV patients has always been undermined. NTM may be responsible for clinical disease in a substantial number of immuno-compromised HIV sero-positive individuals even in a country endemic for Mycobacterium tuberculosis (M. tuberculosis). The study was designed to look for the contribution of NTM to morbidity in HIV seropositive patients. In a prospective study of ninety-four HIV seropositive individuals presenting with pulmonary or extra-pulmonary symptoms suggestive of mycobacterial infection, appropriate samples were collected and processed. Detailed clinical history was utilized to differentiate colonization or contamination by NTM from true lung disease. Fourteen samples grew mycobacterial species, 8(57.2%) being NTM. The distribution of NTM was - 3 M. avium complex, 2 M. fortuitum, 2 M. vaccae, 1 M. phlei. 6 isolates were M. tuberculosis. NTM may be responsible for asignificant proportion of mycobacterial infections in HIV seropositive individuals. Despite the high endemicity of tuberculosis in developing countries like India, the presence of NTM should be ruled out; especially in immuno-compromised HIV seropositive individuals before instituting anti-tubercular therapy empirically. In addition, non-response of NTM to ATT may be wrongly attributed to multi-drug resistant tuberculosis. (author's)
Language: English
Keywords:
INDIA | RESEARCH REPORT | PROSPECTIVE STUDIES | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | SIGNS AND SYMPTOMS | PULMONARY EFFECTS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Measurement | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Infections | Physiology | Biology
Document Number: 326644

16.

Peer Reviewed

Title: Extrapulmonary tuberculosis, human immunodeficiency virus, and foreign birth in North Carolina, 1993 - 2006.
Author: Kipp AM; Stout JE; Hamilton CD; Van Rie A
Source: BMC Public Health. 2008 Apr 4;8:107.
Abstract: The proportion of extrapulmonary tuberculosis (EPTB) reported in the United States has been gradually increasing. HIV infection and foreign birth are increasingly associated with tuberculosis and understanding their effect on the clinical presentation of tuberculosis is important. Case-control study of 6,124 persons with tuberculosis reported to the North Carolina Division of Public health from January 1, 1993 to December 31, 2006. Multivariate logistic regression was used to obtain adjusted odds ratios measuring the associations of foreign birth region and US born race/ethnicity, by HIV status, with EPTB. Among all patients with tuberculosis, 1,366 (22.3%) had EPTB, 563 (9.2%) were HIV co-infected, and 1,299 (21.2%) were foreign born. Among HIV negative patients, EPTB was associated with being foreign born (adjusted ORs 1.36 to 5.09, depending on region of birth) and with being US born, Black/African American (OR 1.84; 95% CI 1.42, 2.39). Among HIV infected patients, EPTB was associated with being US born, Black/African American (OR 2.60; 95% CI 1.83, 3.71) and with foreign birth in the Americas (OR 5.12; 95% CI 2.84, 9.23). Foreign born tuberculosis cases were more likely to have EPTB than US born tuberculosis cases, even in the absence of HIV infection. Increasing proportions of foreign born and HIV-attributable tuberculosis cases in the United States will likely result in a sustained burden of EPTB. Further research is needed to explore why the occurrence and type of EPTB differs by region of birth and whether host genetic and/or bacterial variation can explain these differences in EPTB. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | NORTH CAROLINA | RESEARCH REPORT | CASE STUDIES | MULTIVARIATE ANALYSIS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | FOREIGNERS | BLACKS | TUBERCULOSIS | PULMONARY EFFECTS | Developed Countries | North America | Americas | Studies | Research Methodology | Data Analysis | Program Activities | Programs | Organization and Administration | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Nationality | Population Characteristics | Demographic Factors | Population | Ethnic Groups | Cultural Background | Infections | Physiology | Biology
Document Number: 325912

17.

Title: [Lung disease and HIV infection in children at the Charles de Gaulle university pediatric hospital center in Ouagadougou (Burkina Faso)] Pneumopathies et infection VIH chez l'enfant au centre hospitalier universitaire
Author: Koueta F; Ye D; Dao L; Zoungrana-Kabore A; Ouedraogo SA
Source: Sante. 2008 Jan-Mar;18(1):15-8.
Abstract: To compare the clinical and radiological aspects of lung diseases in HIV-positive and HIV-negative children, we conducted a retrospective case control study covering a 3-year period from January 2003 through December 2005 at Charles de Gaulle University Pediatric Hospital Center in Ouagadougou. HIV-positive patients hospitalised for lung disease were matched to HIV-negative patients controls, hospitalised for the same symptoms, by age and date of hospitalisation. The study included 186 patients (93 HIV-positive and 93 HIV-negative) and collected data on age, sex, clinical signs, radiological signs and short-term course. Of the 93 HIV-positive children suspected to have been contaminated by mother-to-child transmission, 92 had HIV1 and 1 had a double infection of HIV1 and 2. The mean age in both groups was 48 months. Clinically severe lung disease (44%) was more common in HIV-positive children. Radiology showed that interstitial syndrome was significantly more common in HIV-positive children (p=0001) with a sensitivity of 71% and a specificity of 60%. The case-fatality rate was 4.2% among HIV-positive children. This study allows us to remind paediatricians of the importance of lung disease in HIV-infected children. Moreover, the vertical transmission responsible for disease in all our patients shows the need to accelerate the scaling up of the program for prevention of mother-to-child HIV transmission in our country.
Language: French
Keywords:
BURKINA FASO | RESEARCH REPORT | COMPARATIVE STUDIES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | PULMONARY EFFECTS | HIV INFECTIONS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Physiology | Biology | Disease Transmission Control | Prevention and Control
Document Number: 329312

18.
Title: Managing tuberculosis and HIV in sub-Sahara Africa.
Author: Lalloo UG; Pillay S
Source: Current HIV / AIDS Reports. 2008 Aug;5(3):132-9.
Abstract: Tuberculosis (TB) and HIV represent a deadly duo in sub-Sahara Africa, a region most affected by both diseases. The HIV epidemic has aggravated already strained and frequently poorly performing TB control programs. These programs face numerous challenges, and novel, regionally appropriate solutions need to be developed. In the context of TB, some challenges include the rapid diagnosis of active TB in the face of paucibacillary lung disease and atypical presentations with HIV/AIDS, lack of clinical expertise, poor contact tracing, limited laboratory facilities, delayed recognition of drug-resistant TB, increased workload of health care workers, erratic drug supplies, inadequate isolation facilities, and environmental and personal protection in drug-resistant cases. Similar problems exist in the context of HIV but are aggravated by the need for complex antiretroviral drug regimens and lifelong treatment. Treating both conditions invites drug interactions and toxic effects that are common to both HIV and TB treatment and the vexing question of when to introduce antiretroviral treatment in subjects with active TB. Combining HIV and TB care has the potential to bring additional infrastructural and human resources to the respective programs, with synergistic benefits.
Language: English
Keywords:
AFRICA, SUB SAHARAN | CRITIQUE | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | HIV INFECTIONS | COMPLICATIONS | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | PULMONARY EFFECTS | DRUG RESISTANCE | ANTIRETROVIRAL THERAPY | DRUG INTERACTIONS | TOXICITY | INTEGRATED PROGRAMS | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Treatment | HIV | Drugs | Programs | Organization and Administration
Document Number: 328423

19.

Title: RDRio Mycobacterium tuberculosis infection is associated with a higher frequency of cavitary pulmonary disease.
Author: Lazzarini LC; Spindola SM; Bang H; Gibson AL; Weisenberg S
Source: Journal of Clinical Microbiology. 2008 Jul;46(7):2175-83.
Abstract: Molecular genotyping has shown Mycobacterium tuberculosis lineages to be geographically restricted and associated with distinct ethnic populations. Whether tuberculosis (TB) caused by some M. tuberculosis lineages can present with a differential clinical spectrum is controversial because of very limited clinical data. We recently reported on the discovery of RD(Rio) M. tuberculosis, a Latin American-Mediterranean sublineage that is the predominant cause of TB in Rio de Janeiro, Brazil. To investigate the clinical attributes of TB caused by RD(Rio) strains, we studied a cohort of TB cases from Belo Horizonte, Brazil, in which clinical information recorded on a standardized questionnaire was collected at the time of microbiological testing. These patients were referred for culture and drug susceptibility testing because of the clinical suspicion of "complicated" TB, as demonstrated by high rates of multidrug resistance (12%) and cavitary TB (80%). We performed spoligotyping and RD(Rio) genotyping on the M. tuberculosis strains and analyzed the clinical data from these patients. RD(Rio) M. tuberculosis accounted for 37% of the total TB burden. Multivariate analysis found a significant association between TB caused by RD(Rio) strains and pulmonary cavitation and residence in Belo Horizonte. Since cavitary TB is associated with higher sputum bacillary load, our findings support the hypothesis that RD(Rio) M. tuberculosis is associated with a more "severe" disease as a strategy to increase transmission. Future studies are needed to confirm these observations and to better define the contribution of RD(Rio) M. tuberculosis to the global TB epidemic.
Language: English
Keywords:
BRAZIL | LATIN AMERICA | RESEARCH REPORT | COHORT ANALYSIS | QUESTIONNAIRES | RESPONDENTS | ETHNIC GROUPS | POPULATION GENETICS | TUBERCULOSIS | PULMONARY EFFECTS | Developing Countries | South America, Eastern | South America | Americas | Research Methodology | Surveys | Sampling Studies | Studies | Cultural Background | Population Characteristics | Demographic Factors | Population | Genetics | Biology | Infections | Diseases | Physiology
Document Number: 328465

20.

Peer Reviewed

Title: Risk factors for neonatal mortality due to birth asphyxia in southern Nepal: A prospective, community-based cohort study.
Author: Lee AC; Mullany LC; Tielsch JM; Katz J; Khatry SK
Source: Pediatrics. 2008 May;121(5):e1381-e1390.
Abstract: Our goal was to identify antepartum, intrapartum, and infant risk factors for birth asphyxia mortality in a rural, low-resource, population-based cohort in southern Nepal. Data were collected prospectively during a cluster-randomized, community-based trial evaluating the impact of newborn skin and umbilical cord cleansing on neonatal mortality and morbidity in Sarlahi, Nepal. A total of 23 662 newborn infants were enrolled between September 2002 and January 2006. Multivariable regression modeling was performed to determine adjusted relative risk estimates of birth asphyxia mortality for antepartum, intrapartum, and infant risk factors. Birth asphyxia deaths (9.7/1000.0 live births) accounted for 30% of neonatal mortality. Antepartum risk factors for birth asphyxia mortality included low paternal education, Madeshi ethnicity, and primiparity. Facility delivery; maternal fever; maternal swelling of the face, hands, or feet; and multiple births were significant intrapartum risk factors for birth asphyxia mortality. Premature infants (less than 37 weeks) were at higher risk, and the combination of maternal fever and prematurity resulted in a 7-fold elevation in risk for birth asphyxia mortality compared to term infants of afebrile mothers. Maternal infections, prematurity, and multiple births are important risk factors for birth asphyxia mortality in the low-resource, community-based setting. Low socioeconomic status is highly associated with birth asphyxia, and the mechanisms leading to mortality need to be elucidated. The interaction between maternal infections and prematurity may be an important target for future community-based interventions to reduce the global impact of birth asphyxia on neonatal mortality. (author's)
Language: English
Keywords:
NEPAL | RESEARCH REPORT | PROSPECTIVE STUDIES | COHORT ANALYSIS | INFANT | RISK FACTORS | NEONATAL MORTALITY | OXYGEN | PULMONARY EFFECTS | PREGNANCY COMPLICATIONS | PREMATURE BIRTH | SOCIOECONOMIC STATUS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Biology | Infant Mortality | Mortality | Population Dynamics | Inorganic Chemicals | Ingredients and Chemicals | Physiology | Diseases | Pregnancy Outcomes | Pregnancy | Reproduction | Socioeconomic Factors | Economic Factors
Document Number: 326575

21.

Peer Reviewed

Title: Verbal autopsy methods to ascertain birth asphyxia deaths in a community-based setting in southern Nepal.
Author: Lee AC; Mullany LC; Tielsch JM; Katz J; Khatry SK
Source: Pediatrics. 2008 May;121(5):e1372-e1380.
Abstract: The goals of this study were to (1) develop an approach to ascertain birth asphyxia deaths by using verbal autopsy data from a community-based setting in Nepal, and (2) explore variations in birth asphyxia mortality fractions by using different birth asphyxia case definitions and hierarchical classifications. Data were prospectively collected during a cluster-randomized, community-based trial of health interventions on neonatal mortality in Sarlahi, Nepal from 2002 to 2006. To assign cause of death, 4 computer-assigned, symptom-based asphyxia case definitions; Nepali physician classification; and our independent review of verbal autopsy open narratives were used. Various hierarchical classification approaches to assign cause of death were also explored. Birth asphyxia specific mortality ranged from 26% to 54%, depending on the computer case definition used. There was poor agreement between computer and physician classification of birth asphyxia. By comparing computer results, physician results, and our independent ascertainment of cause of death, we identified 246 cases of birth asphyxia (32% of neonatal deaths). Allowing for greater than 1 cause of death, 30% and 42% of asphyxia cases also met criteria for prematurity and serious infection, respectively. When a hierarchy was used to assign a single cause of death, the birth asphyxia proportionate mortality was reduced to 12% when identification of deaths because of congenital anomalies, prematurity, and serious infections preceded birth asphyxia. The use of various verbal autopsy definitions and hierarchical approaches to assign cause of death may substantially affect estimates of birth asphyxia-specific mortality and analyses of risk factors. Verbal autopsy methods need to be standardized and validated to generate accurate global estimates to direct policy and resource allocation in low-middle-income countries. (author's)
Language: English
Keywords:
NEPAL | RESEARCH REPORT | PROSPECTIVE STUDIES | CLINICAL TRIALS | INFANT | NEONATAL MORTALITY | RISK FACTORS | OXYGEN | PULMONARY EFFECTS | CAUSES OF DEATH | CONGENITAL ABNORMALITIES | SOCIOECONOMIC FACTORS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Clinical Research | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Biology | Inorganic Chemicals | Ingredients and Chemicals | Physiology | Neonatal Diseases and Abnormalities | Diseases | Economic Factors
Document Number: 326574

22.

Title: Transcatheter arterial embolization for massive hemoptysis in patients with coal workers' pneumoconiosis: An 11-year experience.
Author: Lee SH; Hahn ST; Choi BG
Source: Acta Radiologica. 2008 Feb;49(1):26-31.
Abstract: BACKGROUND: Transcatheter arterial embolization (TAE) is a safe and well-established treatment option to control hemoptysis, but there are few studies focused on treating hemoptysis accompanying coal workers' pneumoconiosis (CWP). PURPOSE: To evaluate the immediate and long-term efficacy of TAE for control of massive hemoptysis in patients with CWP, and to clarify the factors which influence the frequency of rebleeding. MATERIAL AND METHODS: This study included 34 CWP patients with massive hemoptysis who were treated with 47 TAE sessions over the last 11 years. Immediate (within 1 month) and long-term outcomes (mean 37 months, range 1 month-11 years) were evaluated retrospectively. The relationships between the frequency of rebleeding and the type of CWP, angiographic findings, and presence of tuberculosis were evaluated. RESULTS: The immediate success rate was 91.2% (31/34). In 23 patients (68%), hemoptysis did not recur on long-term follow-up. In eight patients who received repeated proceduresfor recurrent hemoptysis, bleeding was discovered in the non-bronchial systemic artery (n = 13) or bronchial artery (n = 7). The frequency of recurrent hemoptysis was higher in cases with complicated pneumoconiosis (n = 7) than in cases of the simple type (n = 1; P = 0.029). There was no statistical difference between rebleeding and angiographic findings or the presence of tuberculosis. CONCLUSION: TAE is an effective treatment modality for controlling massive hemoptysis in patients with CWP. However, many non-bronchial systemic collaterals contribute to recurrent hemoptysis. Furthermore, there is a high probability of rebleeding in patients with the complicated type of CWP, and extra care must be taken in the embolization procedure.
Language: English
Keywords:
REPUBLIC OF KOREA | RESEARCH REPORT | CLINICAL RESEARCH | LONGITUDINAL STUDIES | MINE WORKERS | PULMONARY EMBOLISM | TUBERCULOSIS | COMPLICATIONS | RESPIRATORY INSUFFICIENCY | SURGERY | BLEEDING | PULMONARY EFFECTS | Asia, Eastern | Asia | Developed Countries | Research Methodology | Studies | Labor Force | Human Resources | Economic Factors | Embolism | Vascular Diseases | Diseases | Infections | Physiology | Biology | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms
Document Number: 325745

23.
Title: [Child tuberculosis at the teaching hospital of Brazzaville from 1995 to 2003] La tuberculose chez l'enfant au CHU de Brazzaville de 1995 a 2003.
Author: M'Pemba Loufoua-Lemay AB; Youndouka JM; Pambou B; Nzingoula S
Source: Bulletin de la Societe de Pathologie Exotique. 2008 Oct;101(4):303-7.
Abstract: In the paediatric service of the teaching hospital of Brazzaville, 582 files of children hospitalized were studied from January 1995 to December 2003. To determine tuberculosis frequency among sickle cell children and estimate the clinical and paraclinical aspects, a case-control study of tubercular patients with HIV negative serology was carried out by comparing at the same time a cohort of 75 sickle cell patients versus 125 patients without sickle cell disease. The results of these studies are as follows. The main assessment is the high frequency of tuberculosis. In 1995 the tuberculosis rate reaches 8%, in 2003 it was up to 13.6%, and 20.6% in 2000 due to the serious consequences of the recurrent wars between 1993 and 1999. Another cause of that high frequency is the rate of HIV/aids patients with a frequency of 2.5% of hospitalization ranging from 1.6 to 3.2%, among them 35% of the tubercular patients were seropositive. The tuberculosis prevalence was 7.4% among sickle cell patients versus 14.2% among control patients. Infection was more often identified in control patients (51.2%) than in sickle cell patients (24%). 68% of the parents were really poor and 18.5% of the children were evicted from their home by war. The pulmonary localizations were prevailing in groups of patients with sickle cell disease as well as in group of control patients. Pleuritis was observed in 8% of the patients with sickle cell disease versus 16.8% for control patients (P = 0.02). No patient with sickle cell disease had a miliary. Anergia to tuberculin test was reported in 35.8% sickle cell patients versus 10.4% for the control patients (P = 0.001). Tuberculosis prevalence is higher among control patients than in sickle cell patients. The high proportion of clinical and paraclinical data of tuberculosis did not significantly differ from the two groups. Evolution was good for 98% of the patients, 1.4% of them died; 74% of deceased patients were affected by HIV/aids.
Language: French
Keywords:
AFRICA, WESTERN | RESEARCH REPORT | CASE STUDIES | PREVALENCE | CHILDREN | TUBERCULOSIS | PULMONARY EFFECTS | DISEASES | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Measurement | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Physiology | Biology
Document Number: 329488

24.
Title: [Pulmonary tuberculosis in infants in Brazzaville, Congo. A review of 117 cases] Tuberculose pulmonaire du nourrisson a Brazzaville (congo). A propos de 117 cas.
Author: Mabiala-Babela JR; M'Pemba Loufoua AB; Mouko A; Senga P
Source: Medecine Tropicale. 2008 Apr;68(2):167-72.
Abstract: Little information is available on pulmonary tuberculosis in infants in sub-Saharan Africa. This retrospective study was conducted in infants ranging in age from 1 to 23 months admitted to the Paediatric Departments of the University Hospital Centre in Brazzaville, Congo for pulmonary tuberculosis between January 1, 1999 and July 1, 2004. Tuberculosis was diagnosed on the basis of epidemiological, clinical, radiological, and follow-up data. All children over 12 months old underwent HIV testing. In case of positive test results, children between the ages of 12 and 18 months were retested after the age of 18 months. Of a total of 803 children admitted for tuberculosis during the study period, 117 (14.6%) were under the age of 24 months (53% males). Mean age was 17.5 months. The BCG test was mentioned in 75.2% of cases. Determination of the contagion in 50.4% of cases indicated that transmission was intrafamilial in 69.3% of cases. The mean delay for hospitalization was 2.6 months (range, 21 days to 16 months). Eighty-one patients (69.2%) presented severe malnutrition. Intrathoracic forms accounted for most cases with bronchopneumopathy (72.6%) and mediastinal adenopathy (40.2%). The incidence of bronchopneumonopathy and isolated forms was significantly higher in children over one year old than in children under one year old: 78.3% versus 21.7 % (p<0.01) and 62.8% versus 37.2% (p<0.001) respectively. A total of 35 children (43.8%) over the age of 12 months presented HIV infection. In comparison with HIV-negative children, HIV-positive children were more likely to present malnutrition and presented a statistically higher incidence of mediastinal adenopathy and multifocal forms. All associated extrathoracic lesions (21.4% of cases) occurred in HIV-positive children. Outcome was favourable in all HIV-negative children while 7 HIV-positive children (20%) died during treatment. Pulmonary tuberculosis in infants in Brazzaville is characterized by frequent association with HIV infection and prognosis is more severe in case of HIV co-infection.
Language: French
Keywords:
AFRICA, SUB SAHARAN | DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | CHILDREN | TUBERCULOSIS | PULMONARY EFFECTS | HIV TESTING | MALNUTRITION | HIV INFECTIONS | SIGNS AND SYMPTOMS | TREATMENT | Africa | Developing Countries | Africa, Central | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Physiology | Biology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Nutrition Disorders | Viral Diseases
Document Number: 328914

25.

Peer Reviewed

Title: The effect of diagnostic delays on the drop-out rate and the total delay to diagnosis of tuberculosis.
Author: Millen SJ; Uys PW; Hargrove J; van Helden PD; Williams BG
Source: PLoS One. 2008 Apr;3(4):e1933.
Abstract: Numerous patient and healthcare system-related delays contribute to the overall delay experienced by patients from onset of TB symptoms to diagnosis and treatment. Such delays are critical as infected individuals remain untreated in the community, providing more opportunities for transmission of the disease and adversely affecting the epidemic. We present an analysis of the factors that contribute to the overall delay in TB diagnosis and treatment, in a resource-poor setting. Impact on the distribution of diagnostic delay times was assessed for various factors, the sensitivity of the diagnostic method being found to be the most significant. A linear relationship was found between the sensitivity of the test and the predicted mean delay time, with an increase in test sensitivity resulting in a reduced mean delay time and a reduction in the drop-out rate. The results show that in a developing country a number of delay factors, particularly the low sensitivity of the initial sputum smear microscopy test, potentially increase total diagnostic delay times experienced by TB patients significantly. The results reinforce the urgent need for novel diagnostic methods, both for smear positive and negative TB, that are highly sensitive, accessible and point of care, in order to reduce mean delay times. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | CLIENTS | DROPOUTS | EXAMINATIONS AND DIAGNOSES | PULMONARY EFFECTS | TUBERCULOSIS | TESTING | TREATMENT | SIGNS AND SYMPTOMS | PROGRAM ACCESSIBILITY | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Infections | Diseases | Measurement | Research Methodology | Program Evaluation
Document Number: 325989

26.

Title: Performance of an interferon-gamma release assay for diagnosing latent tuberculosis infection in children.
Author: Okada K; Mao TE; Mori T; Miura T; Sugiyama T
Source: Epidemiology and Infection. 2008 Sep;136(9):1179-87.
Abstract: Newly developed interferon-gamma release assays have become commercially available to detect tuberculosis (TB) infection in adults. However, little is known about their performance in children. We compared test results between the QuantiFERON-TB Gold test (QFT) and tuberculin skin test (TST) in young children living with pulmonary TB patients in Cambodia. Of 195 children tested with both QFT and TST, the TST-positive rate of 24% was significantly higher than the QFT-positive rate of 17%. The agreement between the test results was considerable (kappa-coefficient 0.63). Positive rates increased from 6% to 32% for QFT and from 15% to 43% for TST, according to the sputum smear grades of the index cases. The presence of Bacille Calmette-Guerin (BCG) scars did not significantly affect the results of TST or QFT in a logistic regression analysis. In conclusion, QFT can be a substitute for TST in detecting latent TB infection in childhood contacts aged Language: English
Keywords:
CAMBODIA | RESEARCH REPORT | CHILDREN | TUBERCULOSIS | PULMONARY EFFECTS | TESTING | SCREENING | FALSE POSITIVE REACTIONS | Developing Countries | Asia, Southeastern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infections | Diseases | Physiology | Biology | Measurement | Research Methodology | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Error Sources
Document Number: 328445

27.

Title: Validity of the CA125 level in the differential diagnosis of pulmonary tuberculosis.
Author: Ozsahin SL; Turgut B; Nur N; Dogan OT; Erselcan T
Source: Japanese Journal of Infectious Diseases. 2008 Jan;61(1):68-69.
Abstract: The aim of the current study was to determine the possible crucial role of cancer antigen 125 (CA125) in the diagnosis of pulmonary tuberculosis (PTB). The CA125 levels of study and control groups were statistically compared. In a total of 146 patients that were included in the current study, 30 had active PTB, 37 inactive PTB, 28 community-acquired pneumonia (CAP), 25 pleural or pulmonary malignancies, and 13 patients exacerbation of chronic obstructive pulmonary disease. The mean CA125 levels in PTB, inactive PTB, CAP, and pleural-pulmonary malignancies were 118.46 +/- 248.41, 40.80 +/- 50.95, 47.76 +/- 60.76, and 57.77 +/- 65.59, respectively. For active-inactive discrimination of PTB, with a cut-off level of >35 U/ml, the sensitivity, specificity, positive predictive value, and negative predictive value of CA125 were 63, 59, 56, and 67%, respectively. Increased CA125 levels were detected in active PTB in the current results. The current results also show that high level CA125 should be reconsidered in the prediagnosis and/or discrimination of active and inactive PTB patients.
Language: English
Keywords:
TURKEY | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | TARGET POPULATION | LABORATORY EXAMINATIONS AND DIAGNOSES | VALIDITY | CANCER | ANTIGENS | PULMONARY EFFECTS | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Program Design | Programs | Organization and Administration | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Neoplasms | Diseases | Immunologic Factors | Immunity | Immune System | Physiology | Biology
Document Number: 325797

28.

Title: Therapeutic hypothermia for birth asphyxia in low-resource settings: A pilot randomised controlled trial [letter]
Author: Robertson N; Nakakeeto M; Hagmann C; Cowan FM; Acolet D
Source: Lancet. 2008 Sep 6-12;372(9641):801-803.
Abstract: This letter describes a study done at Mulago Hospital, Kampala, Uganda aimed at determining the feasibility of whole-body cooling by use of simple methods in a low-resource setting. The study, performed after written informed parental consent, randomly assigned standard care plus therapeutic hypothermia or standard care alone on infants within 3 hours of birth. Data suggests that therapeutic hypothermia with whole-body cooling, screening, informed consent, and randomisation are feasible and inexpensive in a special-care baby unit in a low-resource setting. Rigorous randomised trials to determine the safety and efficacy of therapeutic hypothermia in this context are urgently needed so that any benefi ts of this novel therapy can reach areas of the world that might need it most. (excerpt)
Language: English
Keywords:
UGANDA | INFANT | NEONATAL MORTALITY | RESPIRATORY INSUFFICIENCY | PULMONARY EFFECTS | BODY TEMPERATURE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Mortality | Mortality | Population Dynamics | Physiology | Biology
Document Number: 328176

29.

Peer Reviewed

Title: Could clinical audit improve the diagnosis of pulmonary tuberculosis in Cuba, Peru and Bolivia?
Author: Siddiqi K; Volz A; Armas L; Otero L; Ugaz R
Source: Tropical Medicine and International Health. 2008 Apr;13(4):566-578.
Abstract: The objectives were to assess the effectiveness of clinical audit in improving the quality of diagnostic care provided to patients suspected of tuberculosis; and to understand the contextual factors which impede or facilitate its success. Twenty-six health centres in Cuba, Peru and Bolivia were recruited. Clinical audit was introduced to improve the diagnostic care for patients attending with suspected TB. Standards were based on the WHO and TB programme guidelines relating to the appropriate use of microscopy, culture and radiological investigations. At least two audit cycles were completed over 2 years. Improvement was determined by comparing the performance between two six-month periods pre- and post-intervention. Qualitative methods were used to ascertain facilitating and limiting contextual factors influencing change among healthcare professionals' clinical behaviour after the introduction of clinical audit. We found a significant improvement in 11 of 13 criteria in Cuba, in 2 of 6 criteria in Bolivia and in 2 of 5 criteria in Peru. Twelve out of 24 of the audit criteria in all three countries reached the agreed standards. Barriers to quality improvement included conflicting objectives for clinicians and TB programmes, poor coordination within the health system and patients' attitudes towards illness. Clinical audit may drive improvements in the quality of clinical care in resource-poor settings. It is likely to be more effective if integrated within and supported by the local TB programmes. We recommend developing and evaluating an integrated model of quality improvement including clinical audit. (author's)
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | CLIENTS | PULMONARY EFFECTS | TUBERCULOSIS | EXAMINATIONS AND DIAGNOSES | PERFORMANCE IMPROVEMENT | ATTITUDES | QUALITY OF HEALTH CARE | Program Activities | Programs | Organization and Administration | Physiology | Biology | Infections | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Management | Psychological Factors | Behavior | Health Services Evaluation | Program Evaluation
Document Number: 325998

30.

Peer Reviewed

Title: Comparison of pulmonary and extrapulmonary tuberculosis in Nepal- a hospital-based retrospective study.
Author: Sreeramareddy CT; Panduru KV; Verma SC; Joshi HS; Bates MN
Source: BMC Infectious Diseases. 2008 Jan 24;8:8.
Abstract: BACKGROUND: Studies from developed countries have reported on host-related risk factors for extra-pulmonary tuberculosis (EPTB). However, similar studies from high-burden countries like Nepal are lacking. Therefore, we carried out this study to compare demographic, life-style and clinical characteristics between EPTB and PTB patients. METHODS: A retrospective analysis was carried out on 474 Tuberculosis (TB) patients diagnosed in a tertiary care hospital in western Nepal. Characteristics of demography, life-style and clinical features were obtained from medical case records. Risk factors for being an EPTB patient relative to a PTB patient were identified using logistic regression analysis. RESULTS: The age distribution of the TB patients had a bimodal distribution. The male to female ratio for PTB was 2.29. EPTB was more common at younger ages (< 25 years) and in females. Common sites for EPTB were lymph nodes (42.6%) and peritoneum and/or intestines (14.8%). By logistic regression analysis, age less than 25 years (OR 2.11 95% CI 1.12-3.68) and female gender (OR 1.69, 95% CI 1.12-2.56) were associated with EPTB. Smoking, use of immunosuppressive drugs/steroids, diabetes and past history of TB were more likely to be associated with PTB. CONCLUSION: Results suggest that younger age and female gender may be independent risk factors for EPTB in a high-burden country like Nepal. TB control programmes may target young and female populations for EPTB case-finding. Further studies are necessary in other high-burden countries to confirm our findings.
Language: English
Keywords:
NEPAL | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | TUBERCULOSIS | PULMONARY EFFECTS | RISK FACTORS | DEMOGRAPHIC FACTORS | Developing Countries | Asia, Southern | Asia | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Infections | Diseases | Physiology | Biology | Population
Document Number: 325756


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