Pub Date : 2019-07-26DOI: 10.3126/SAARCTB.V17I1.25028
Avinash Kumar, P. Das
Introduction: Pott’s spine is a destructive form of tuberculosis and accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal Tuberculosis is most often missed due to inadequate sample and lack of clinical history. Most of the Extrapulmonary tuberculosis (EPTB) can be diagnosed by Ziehl Nelson stain (ZN) only, when clinically suspected samples are adequate and optimally stained. We are reporting four case series of spinal tuberculosis diagnosed by ZN stain and confirmed by Bactec MGIT Culture. Material & Methods: These four clinically suspected spinal biopsis were received for ZN stain and MTB culture by MGIT. Results: All the four spinal biopsies were found positive by ZN stain as well as by BacTec MGIT.All the four cases were HIV negative. ESR and CRP of all four cases were raised. Discussion & Conclusion: Spinal tuberculosis can be easily diagnosed by ZN stain in resource constraint lab. Despite its common occurrence and the high frequency of long-term morbidity, there are no straight forward guidelines for the diagnosis and treatment of spinal tuberculosis. Early diagnosis and prompt treatment is necessary to prevent permanent neurological disability and to minimize spinal deformity.
{"title":"Case Series of Pott’s Spine Diagnosed by ZN Stain and BacTec MGIT in a Tertiary Care Hospital","authors":"Avinash Kumar, P. Das","doi":"10.3126/SAARCTB.V17I1.25028","DOIUrl":"https://doi.org/10.3126/SAARCTB.V17I1.25028","url":null,"abstract":"Introduction: Pott’s spine is a destructive form of tuberculosis and accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal Tuberculosis is most often missed due to inadequate sample and lack of clinical history. Most of the Extrapulmonary tuberculosis (EPTB) can be diagnosed by Ziehl Nelson stain (ZN) only, when clinically suspected samples are adequate and optimally stained. We are reporting four case series of spinal tuberculosis diagnosed by ZN stain and confirmed by Bactec MGIT Culture. \u0000Material & Methods: These four clinically suspected spinal biopsis were received for ZN stain and MTB culture by MGIT. \u0000Results: All the four spinal biopsies were found positive by ZN stain as well as by BacTec MGIT.All the four cases were HIV negative. ESR and CRP of all four cases were raised. \u0000Discussion & Conclusion: Spinal tuberculosis can be easily diagnosed by ZN stain in resource constraint lab. Despite its common occurrence and the high frequency of long-term morbidity, there are no straight forward guidelines for the diagnosis and treatment of spinal tuberculosis. Early diagnosis and prompt treatment is necessary to prevent permanent neurological disability and to minimize spinal deformity.","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124826687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-26DOI: 10.3126/SAARCTB.V17I1.25019
T. Mahmood, Pankaj Dwivedi, A. Shukla, A. Jain, A. Verma
Introduction: Drug-resistant TB is a persistent threat, with 490 000 million cases of multidrug-resistant TB emerging in 2016.The countries with the largest numbers of MDR/RR-TB cases were China, India and the Russian Federation. Given the prolonged nature of MDR-TB, one might expect higher rates of chronic disability among cured patients with MDR-TB. To explore these questions, we conducted an observational study focusing on: clinical, bacteriological, biochemical and various health parameter status of successfully treated MDR-TB patients. Methods: Subjects enrolled in study as per inclusion and exclusion criteria were assessed by recording of demographic data and were subjected to a predetermined set of questions for determining the history of previous anti tubercular treatment and exposure to various type of risk factor for development of MDR TB. Physical parameters of health were determined and recorded. Results: Total of 84 patients were enrolled in our study (57-males, 27 females).69 subjects (46-males, 23-Females) were found apparently healthy. 25 subjects migrated outside.6 patients (male-6, Female-2) died.7 patients were diagnosed as XDR-TB (5-Males,2-Females).34 subjects (18- males, 16-females) (44.73%) were very under weight. Total 13 (Males-12, Females-1) out of 76 subjects (17.10%) were under weight. Mid arm circumference (MAC) of 35 out of 76(21- males, 18-females) subjects (46.05%) was below 5th percentile. Majority of subjects showed moderate & severe obstruction in PEFR. Conclusion: This study shows that the community based standardized treatment regimen is effective as only one of the patients was bacteriologically positive on follow up. However, significant numbers of treated MDR-TB patients suffer from clinical, nutritional and functional post-treatment adverse events leading to some morbidity.
{"title":"An Observational Study of Follow Up of MDR Tuberculosis Patients after Successful Completion of Category 4 Treatment under RNTCP (PMDT) in Allahabad District","authors":"T. Mahmood, Pankaj Dwivedi, A. Shukla, A. Jain, A. Verma","doi":"10.3126/SAARCTB.V17I1.25019","DOIUrl":"https://doi.org/10.3126/SAARCTB.V17I1.25019","url":null,"abstract":"Introduction: Drug-resistant TB is a persistent threat, with 490 000 million cases of multidrug-resistant TB emerging in 2016.The countries with the largest numbers of MDR/RR-TB cases were China, India and the Russian Federation. Given the prolonged nature of MDR-TB, one might expect higher rates of chronic disability among cured patients with MDR-TB. To explore these questions, we conducted an observational study focusing on: clinical, bacteriological, biochemical and various health parameter status of successfully treated MDR-TB patients. \u0000Methods: Subjects enrolled in study as per inclusion and exclusion criteria were assessed by recording of demographic data and were subjected to a predetermined set of questions for determining the history of previous anti tubercular treatment and exposure to various type of risk factor for development of MDR TB. Physical parameters of health were determined and recorded. \u0000Results: Total of 84 patients were enrolled in our study (57-males, 27 females).69 subjects (46-males, 23-Females) were found apparently healthy. 25 subjects migrated outside.6 patients (male-6, Female-2) died.7 patients were diagnosed as XDR-TB (5-Males,2-Females).34 subjects (18- males, 16-females) (44.73%) were very under weight. Total 13 (Males-12, Females-1) out of 76 subjects (17.10%) were under weight. Mid arm circumference (MAC) of 35 out of 76(21- males, 18-females) subjects (46.05%) was below 5th percentile. Majority of subjects showed moderate & severe obstruction in PEFR. \u0000Conclusion: This study shows that the community based standardized treatment regimen is effective as only one of the patients was bacteriologically positive on follow up. However, significant numbers of treated MDR-TB patients suffer from clinical, nutritional and functional post-treatment adverse events leading to some morbidity.","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"150 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115562912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-26DOI: 10.3126/SAARCTB.V17I1.25027
T. Dorji
Introduction: Multidrug resistant tuberculosis (MDR-TB) is defined as a case of tuberculosis resistant to rifampicin and isoniazid which are the first line anti tuberculosis drugs. Globally emergences of MDR-TB possess a challenge to TB control. In Bhutan, the proportion of MDR-TB is high at par with the global level. This study will explore the predictors of MDR-TB and the trend at Samtse General Hospital which has high burden of tuberculosis. Methods: This was a retrospective cross sectional study. The data was extracted from TB treatment cards maintained at TB unit of Samtse General Hospital TB from January 2012 to June 2018. Results: The study showed the prevalence of drug resistant to at least one drug at 21% and MDR-TB prevalence at 16%. The patients with previous treatments (AOR: 4.59; 95% CI .03-.18) and patients under the age of 30 years (AOR: 2.7; 95% CI 1.01- 7.42) were significantly associated with MDR-TB. Conclusion: This study shows high prevalence of MDR-TB in Samtse. Better strategies and concrete actions need to be developed to combat the increase of MDR-TB.
简介:耐多药结核病(MDR-TB)被定义为对一线抗结核药物利福平和异烟肼耐药的结核病病例。全球出现的耐多药结核病对结核病控制构成挑战。在不丹，耐多药结核病的比例与全球水平相当。本研究旨在探讨结核病高负担的Samtse总医院耐多药结核病的预测因素和趋势。方法:回顾性横断面研究。数据提取自2012年1月至2018年6月Samtse总医院结核病部门保存的结核病治疗卡。结果:该研究显示，对至少一种药物的耐药患病率为21%，耐多药结核病患病率为16%。既往治疗患者(AOR: 4.59;95% CI: 0.03 - 0.18)和30岁以下患者(AOR: 2.7;95% CI 1.01- 7.42)与耐多药结核病显著相关。结论:本研究显示Samtse地区耐多药结核病高发。需要制定更好的战略和具体行动，以应对耐多药结核病的增加。
{"title":"Epidemiology of Drug Resistant Tuberculosis in Samtse General Hospital, Bhutan: A Retrospective Study","authors":"T. Dorji","doi":"10.3126/SAARCTB.V17I1.25027","DOIUrl":"https://doi.org/10.3126/SAARCTB.V17I1.25027","url":null,"abstract":"Introduction: Multidrug resistant tuberculosis (MDR-TB) is defined as a case of tuberculosis resistant to rifampicin and isoniazid which are the first line anti tuberculosis drugs. Globally emergences of MDR-TB possess a challenge to TB control. In Bhutan, the proportion of MDR-TB is high at par with the global level. This study will explore the predictors of MDR-TB and the trend at Samtse General Hospital which has high burden of tuberculosis. \u0000Methods: This was a retrospective cross sectional study. The data was extracted from TB treatment cards maintained at TB unit of Samtse General Hospital TB from January 2012 to June 2018. \u0000Results: The study showed the prevalence of drug resistant to at least one drug at 21% and MDR-TB prevalence at 16%. The patients with previous treatments (AOR: 4.59; 95% CI .03-.18) and patients under the age of 30 years (AOR: 2.7; 95% CI 1.01- 7.42) were significantly associated with MDR-TB. \u0000Conclusion: This study shows high prevalence of MDR-TB in Samtse. Better strategies and concrete actions need to be developed to combat the increase of MDR-TB.","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129067753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-26DOI: 10.3126/SAARCTB.V17I1.25024
B. Subba, N. Rimal, B. Shrestha
Introduction: TB is considered one of the opportunistic infection among PLHIV. The increasing burden of HIV/TB co-infection among key population cause problem to maintain adherence to ART and DOTS services. The emergence of MDR-TB is one of the greatest challenge to control and management of both diseases. However, having knowledge and information of both diseases are important role to access the available HIV/TB services. Methods: A cross-sectional survey was conducted among key population who had HIV/TB co-infection in two-epidemic zone of Nepal. A pretested semi-structured questionnaire was used to collect data. ANOVA test was done to analyze the collected data by using SPSS version 20.0. Results: A total of 343 HIV/TB co-infected individuals were enrolled to the study. Most of participants were from ART and DOTS clients. Therefore, the study found that there was significance difference found between knowledge about TB (F=4.400, p= 0.005), causative agent of TB (F=3.160, p=0.025), risk of TB illness among PLHIV (F=8.491, p=0.001) and among key affected population. Moreover, there was significance difference found between access to OI treatment (F=5.113, p=0.002) and access to viral load (F=4.642, p=0.003) among key study population. In gender perspective, there was no significance difference to use and access to available HIV/TB services. Conclusion: The general knowledge on HIV/TB co-infection was significant association with key population. The knowledge on HIV/TB and access to NGOs’ help can significant effect to access the available HIV and TB services.
{"title":"Access of Key Population to Available HIV and TB Services in Nepal: A Cross Section Study","authors":"B. Subba, N. Rimal, B. Shrestha","doi":"10.3126/SAARCTB.V17I1.25024","DOIUrl":"https://doi.org/10.3126/SAARCTB.V17I1.25024","url":null,"abstract":"Introduction: TB is considered one of the opportunistic infection among PLHIV. The increasing burden of HIV/TB co-infection among key population cause problem to maintain adherence to ART and DOTS services. The emergence of MDR-TB is one of the greatest challenge to control and management of both diseases. However, having knowledge and information of both diseases are important role to access the available HIV/TB services. \u0000Methods: A cross-sectional survey was conducted among key population who had HIV/TB co-infection in two-epidemic zone of Nepal. A pretested semi-structured questionnaire was used to collect data. ANOVA test was done to analyze the collected data by using SPSS version 20.0. \u0000Results: A total of 343 HIV/TB co-infected individuals were enrolled to the study. Most of participants were from ART and DOTS clients. Therefore, the study found that there was significance difference found between knowledge about TB (F=4.400, p= 0.005), causative agent of TB (F=3.160, p=0.025), risk of TB illness among PLHIV (F=8.491, p=0.001) and among key affected population. Moreover, there was significance difference found between access to OI treatment (F=5.113, p=0.002) and access to viral load (F=4.642, p=0.003) among key study population. In gender perspective, there was no significance difference to use and access to available HIV/TB services. \u0000Conclusion: The general knowledge on HIV/TB co-infection was significant association with key population. The knowledge on HIV/TB and access to NGOs’ help can significant effect to access the available HIV and TB services.","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123756122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.3126/SAARCTB.V16I2.23342
P. Sharma, S. Duggal, S. Gupta, R. Gur, S. Kaushik, T. Bharara
Introduction: Stenotrophomonas maltophilia (S. maltophilia) is multidrug resistant (MDR) organism usually associated with hospital acquired infections. Here we report a rare case of community acquired S. maltophilia empyema in a human immunodeficiency virus (HIV) positive patient. Case Report: A 54 year old male presented with cough, breathlessness and chest pain for one month. On investigation, radiological picture was suggestive of massive right empyema. Pleural fluid culture grew S. maltophilia repeatedly which was treated with cotrimoxazole and levofloxacin based on antibiogram. Following improvement patient was discharged on anti-retro viral and anti-tubercular treatment. Conclusion: Community acquired invasive S. maltophilia infections should be kept as differential diagnosis in immunocompromised patients. Being MDR, appropriate microbiological identification and susceptibility play an important role in treatment and outcome of these patients.
{"title":"Community acquired Stenotrophomonas maltophilia causing empyema in an adult with HIV","authors":"P. Sharma, S. Duggal, S. Gupta, R. Gur, S. Kaushik, T. Bharara","doi":"10.3126/SAARCTB.V16I2.23342","DOIUrl":"https://doi.org/10.3126/SAARCTB.V16I2.23342","url":null,"abstract":"Introduction: Stenotrophomonas maltophilia (S. maltophilia) is multidrug resistant (MDR) organism usually associated with hospital acquired infections. Here we report a rare case of community acquired S. maltophilia empyema in a human immunodeficiency virus (HIV) positive patient. \u0000Case Report: A 54 year old male presented with cough, breathlessness and chest pain for one month. On investigation, radiological picture was suggestive of massive right empyema. Pleural fluid culture grew S. maltophilia repeatedly which was treated with cotrimoxazole and levofloxacin based on antibiogram. Following improvement patient was discharged on anti-retro viral and anti-tubercular treatment. \u0000Conclusion: Community acquired invasive S. maltophilia infections should be kept as differential diagnosis in immunocompromised patients. Being MDR, appropriate microbiological identification and susceptibility play an important role in treatment and outcome of these patients.","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128113416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.3126/SAARCTB.V16I2.23341
J. Kumar, C. Cheekavolu, V. Ashalatha, P. Leela, H. Daginawala
Introduction: Tuberculosis (TB) is a major health problem in India, so early diagnosis and treatment of Mycobacterium tuberculosis (M.tb.) infection can prevent deaths from this pathogen. The secretion of proteins by M.tb. is important in diagnostic purposes for generation of therapeutic drugs and vaccines candidates for TB. The objective of this study was to identify the protein expression (biomarkers) in TB and Tuberculosis meningitis (TBM) using proteomic approach. Methods: In this study, using Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDSPAGE), we analyzed the secretory proteins of M.tb. in serum, cerebrospinal fluid (CSF) samples. The identified proteins were determined by Total Lab- 100 Quantity One densitometry software. Results: Our study showed that protein bands expressed in CSF samples reveals the presence of 72kD, 70kD, 44kD, 40kD & 16kD predominantly in TBM patients compared to healthy individuals. The electrophoretogram identified 97kD, 72kD, 44kD, 38kD, 29kD & 16kD predominant proteins in serum samples of TB patients. Conclusion: The detection of secretory proteins in serum and CSF samples of M.tb. in TB and TBM patients gives reliable and early diagnosis of TB and TBM. The secretory proteins can be useful as immunodiagnostic and vaccine targets which can serve as important biomarkers
{"title":"Proteomic profile of pulmonary and extra pulmonary TB samples","authors":"J. Kumar, C. Cheekavolu, V. Ashalatha, P. Leela, H. Daginawala","doi":"10.3126/SAARCTB.V16I2.23341","DOIUrl":"https://doi.org/10.3126/SAARCTB.V16I2.23341","url":null,"abstract":"Introduction: Tuberculosis (TB) is a major health problem in India, so early diagnosis and treatment of Mycobacterium tuberculosis (M.tb.) infection can prevent deaths from this pathogen. The secretion of proteins by M.tb. is important in diagnostic purposes for generation of therapeutic drugs and vaccines candidates for TB. The objective of this study was to identify the protein expression (biomarkers) in TB and Tuberculosis meningitis (TBM) using proteomic approach. \u0000Methods: In this study, using Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDSPAGE), we analyzed the secretory proteins of M.tb. in serum, cerebrospinal fluid (CSF) samples. The identified proteins were determined by Total Lab- 100 Quantity One densitometry software. \u0000Results: Our study showed that protein bands expressed in CSF samples reveals the presence of 72kD, 70kD, 44kD, 40kD & 16kD predominantly in TBM patients compared to healthy individuals. The electrophoretogram identified 97kD, 72kD, 44kD, 38kD, 29kD & 16kD predominant proteins in serum samples of TB patients. \u0000Conclusion: The detection of secretory proteins in serum and CSF samples of M.tb. in TB and TBM patients gives reliable and early diagnosis of TB and TBM. The secretory proteins can be useful as immunodiagnostic and vaccine targets which can serve as important biomarkers","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129144887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.3126/SAARCTB.V16I2.23337
S. Shrestha, N. P. Shah, K. K. Jha, R. Pant, Lok Raj Joshi, R. P. Bichha, K. Karki
Introduction: GeneXpert MTB/Rif assay is an automated, cartridge-based nucleic acid amplification test that can accurately detect both tuberculosis and Rifampicin resistance. Since its introduction, there has been a steady uptake of this technology by the National Tuberculosis Program of Nepal. Nevertheless, a large number of drug-resistant TB cases remains undiagnosed. This study aims to examine the challenges in diagnosis of drug-resistant tuberculosis by the GeneXpert MTB/Rif assay in Nepal and explore the possible solutions. Methods: This was a cross-sectional study consisting of two parts – a quantitative part assessing the individual details and a qualitative part assessing the challenges on the diagnosis of drug-resistant TB by GeneXpert MTB/Rif assay. Data were collected from the GeneXpert operators, clinicians and program managers from 16 centers across the country and analyzed by IBM SPSS for Windows v23 and QDA Miner 4 Lite. Descriptive statistics were used to summarize the sociodemographic and other characteristics of the study participants using mean, standard deviation and proportions as appropriate. Results: A total of 48 technical manpower participated in the study. The mean age was 39.95 years and a majority of them (77.3%) were male. The major challenges identified were inadequate training, frequent power failure, difficulty in maintaining appropriate steady temperature, module failure which is often not replaced in time, issues with calibration and timely availability of cartridges as well as appropriate ways to store the new cartridges and safe disposal of the used cartridges. Conclusion: A number of challenges limit the optimal utilization of GeneXpert MTB/Rif assay warranting action.
GeneXpert MTB/Rif检测是一种自动化的、基于药筒的核酸扩增检测，可以准确检测结核病和利福平耐药性。自从引进这项技术以来，尼泊尔国家结核病规划一直在稳步采用这项技术。然而，大量耐药结核病病例仍未得到诊断。本研究旨在检查尼泊尔使用GeneXpert MTB/Rif测定法诊断耐药结核病所面临的挑战，并探索可能的解决方案。方法:这是一项横断面研究，由两部分组成——定量部分评估个体细节，定性部分评估通过GeneXpert MTB/Rif检测诊断耐药结核病的挑战。从全国16个中心的GeneXpert操作员、临床医生和项目经理那里收集数据，并通过IBM SPSS for Windows v23和QDA Miner 4 Lite进行分析。描述性统计用于总结研究参与者的社会人口学和其他特征，使用平均值，标准差和适当的比例。结果:共有48名技术人力参与了研究。平均年龄39.95岁，男性居多(77.3%)。确定的主要挑战是培训不足、经常停电、难以保持适当的稳定温度、模块故障往往不能及时更换、校准和及时提供墨盒的问题以及存储新墨盒的适当方法和安全处置使用过的墨盒的问题。结论:一些挑战限制了GeneXpert MTB/Rif检测的最佳利用，需要采取行动。
{"title":"Challenges in the diagnosis of drug-resistant tuberculosis by GeneXpert MTB/Rif in Nepal","authors":"S. Shrestha, N. P. Shah, K. K. Jha, R. Pant, Lok Raj Joshi, R. P. Bichha, K. Karki","doi":"10.3126/SAARCTB.V16I2.23337","DOIUrl":"https://doi.org/10.3126/SAARCTB.V16I2.23337","url":null,"abstract":"Introduction: GeneXpert MTB/Rif assay is an automated, cartridge-based nucleic acid amplification test that can accurately detect both tuberculosis and Rifampicin resistance. Since its introduction, there has been a steady uptake of this technology by the National Tuberculosis Program of Nepal. Nevertheless, a large number of drug-resistant TB cases remains undiagnosed. This study aims to examine the challenges in diagnosis of drug-resistant tuberculosis by the GeneXpert MTB/Rif assay in Nepal and explore the possible solutions. \u0000Methods: This was a cross-sectional study consisting of two parts – a quantitative part assessing the individual details and a qualitative part assessing the challenges on the diagnosis of drug-resistant TB by GeneXpert MTB/Rif assay. Data were collected from the GeneXpert operators, clinicians and program managers from 16 centers across the country and analyzed by IBM SPSS for Windows v23 and QDA Miner 4 Lite. Descriptive statistics were used to summarize the sociodemographic and other characteristics of the study participants using mean, standard deviation and proportions as appropriate. \u0000Results: A total of 48 technical manpower participated in the study. The mean age was 39.95 years and a majority of them (77.3%) were male. The major challenges identified were inadequate training, frequent power failure, difficulty in maintaining appropriate steady temperature, module failure which is often not replaced in time, issues with calibration and timely availability of cartridges as well as appropriate ways to store the new cartridges and safe disposal of the used cartridges. \u0000Conclusion: A number of challenges limit the optimal utilization of GeneXpert MTB/Rif assay warranting action.","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114713403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.3126/saarctb.v16i2.23338
N. Adhikari, R. Bhattarai, R. Basnet, L. Joshi
Introduction: Globally there were an estimated 10.6 million new tuberculosis patients and 1.7 million deaths from TB in 2016. There is an evidence of tuberculosis transmission at health care settings where health care workers and patients come in contact with people having tuberculosis. This study aims to explore infection control measures at health facilities in terms of administrative, environmental and personal protective measures needed for infection control. Methods: This is a cross-sectional study carried out at 79 health facilities across the country. The study continued for three months starting from January 2018 to March 2018. Trained enumerators from health sciences background collected the information using semi-structured questionnaire. Written consent was obtained prior interview. Results: All the selected health facilities participated in the study. Around 44% of health facilities have infection prevention plan, but very few of them have budgeted for tuberculosis infection control activities. Less than one third of health facilities (24 out of 79 HFs) have provision to separate presumptive tuberculosis patients, however, only 50% (12 HFs) have turned such provision into action. Only 15 HFs (38%) out of 40 HFs having N95 or FPP2 mask for health workers. Around half of the HFs (44%, 35 out of 79) was found to have cross ventilation. Conclusion: Tuberculosis infection plan needs to be developed and implemented by all the health facilities to strengthen administrative, managerial, and environmental and person protective measures of inaction control to minimize the risk of TB transmission at health facilities.
{"title":"Tuberculosis infection control measures at health facilities providing tuberculosis services in Nepal","authors":"N. Adhikari, R. Bhattarai, R. Basnet, L. Joshi","doi":"10.3126/saarctb.v16i2.23338","DOIUrl":"https://doi.org/10.3126/saarctb.v16i2.23338","url":null,"abstract":"Introduction: Globally there were an estimated 10.6 million new tuberculosis patients and 1.7 million deaths from TB in 2016. There is an evidence of tuberculosis transmission at health care settings where health care workers and patients come in contact with people having tuberculosis. This study aims to explore infection control measures at health facilities in terms of administrative, environmental and personal protective measures needed for infection control. \u0000Methods: This is a cross-sectional study carried out at 79 health facilities across the country. The study continued for three months starting from January 2018 to March 2018. Trained enumerators from health sciences background collected the information using semi-structured questionnaire. Written consent was obtained prior interview. \u0000Results: All the selected health facilities participated in the study. Around 44% of health facilities have infection prevention plan, but very few of them have budgeted for tuberculosis infection control activities. Less than one third of health facilities (24 out of 79 HFs) have provision to separate presumptive tuberculosis patients, however, only 50% (12 HFs) have turned such provision into action. Only 15 HFs (38%) out of 40 HFs having N95 or FPP2 mask for health workers. Around half of the HFs (44%, 35 out of 79) was found to have cross ventilation. \u0000Conclusion: Tuberculosis infection plan needs to be developed and implemented by all the health facilities to strengthen administrative, managerial, and environmental and person protective measures of inaction control to minimize the risk of TB transmission at health facilities.","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120863732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2018-12-31DOI: 10.3126/SAARCTB.V16I2.23336
D. Yadav, D. Yadav, R. Yadav
Introduction: Multidrug-resistant tuberculosis is an intense and feared problem, difficult to control and has shown a trend of increase worldwide. MDR-TB poses a therapeutic and infection control challenge with significantly higher rates of morbidity and mortality. Hence, this study was conducted with objective to assess prevalence of multidrug resistance and its risk factors among Tuberculosis patients in Kaski district. Methods: The main component of the study comprised institutional based cross sectional study design which was conducted in directly observed treatment short course (DOTS) centers in Kaski district. The study period was from July 2016 to December 2016. The sample size for the study was 175 participants. Data collection was done through interview with used interview schedule, and review of patient treatment cards. Data were entered in Epidata software and analyzed by using SPSS 20 version software. Results: The prevalence of multidrug resistance in Kaski district was 5.7 per cent. Variables such as TB history in past, TB treatment in past, and cured in past are found statistically significant (p<0.005). People with prior history of TB were shown to be 19 times more likely to get MDR TB than those with no prior history (OR=19.056, CI: 4.522-80.294). People with complete TB treatment in past were 0.2 times less likely to get MDR TB than those with incomplete TB treatment in past (OR=0.182, CI: 0.075-0.441). Conclusion: Present of previous TB infection and prior treatment outcome (to be defaulted or failed in treatment) were also identified as the risk factors for developing MDR TB. Proper surveillance system is to be established in terms of complete treatment to all TB patients that leads the prevention from MDRTB and prevent potent expensive costs from medical care for MDRTB patients.
{"title":"Prevalence of multi-drug resistance and its risk factors among tuberculosis patients in Kaski, Nepal","authors":"D. Yadav, D. Yadav, R. Yadav","doi":"10.3126/SAARCTB.V16I2.23336","DOIUrl":"https://doi.org/10.3126/SAARCTB.V16I2.23336","url":null,"abstract":"Introduction: Multidrug-resistant tuberculosis is an intense and feared problem, difficult to control and has shown a trend of increase worldwide. MDR-TB poses a therapeutic and infection control challenge with significantly higher rates of morbidity and mortality. Hence, this study was conducted with objective to assess prevalence of multidrug resistance and its risk factors among Tuberculosis patients in Kaski district. \u0000Methods: The main component of the study comprised institutional based cross sectional study design which was conducted in directly observed treatment short course (DOTS) centers in Kaski district. The study period was from July 2016 to December 2016. The sample size for the study was 175 participants. Data collection was done through interview with used interview schedule, and review of patient treatment cards. Data were entered in Epidata software and analyzed by using SPSS 20 version software. \u0000Results: The prevalence of multidrug resistance in Kaski district was 5.7 per cent. Variables such as TB history in past, TB treatment in past, and cured in past are found statistically significant (p<0.005). People with prior history of TB were shown to be 19 times more likely to get MDR TB than those with no prior history (OR=19.056, CI: 4.522-80.294). People with complete TB treatment in past were 0.2 times less likely to get MDR TB than those with incomplete TB treatment in past (OR=0.182, CI: 0.075-0.441). \u0000Conclusion: Present of previous TB infection and prior treatment outcome (to be defaulted or failed in treatment) were also identified as the risk factors for developing MDR TB. Proper surveillance system is to be established in terms of complete treatment to all TB patients that leads the prevention from MDRTB and prevent potent expensive costs from medical care for MDRTB patients.","PeriodicalId":175434,"journal":{"name":"SAARC Journal of Tuberculosis, Lung Diseases and HIV/AIDS","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133716591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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