结核病研究和治疗

背景。Children are highly susceptible toMycobacterium tuberculosis感染，大约70生活在肺结核阳性患者同一家庭的孩子％将被感染。然而，肺阳肺结核是一种常见的现象，推荐的接触筛查和异烟肼预防性治疗开始的实现是非常低的。因此，本研究旨在评估接触筛选实践和五岁以下儿童在巴赫达尔，埃塞俄比亚西北部肺结核阳性患者中儿童的异烟肼预防性治疗的开始。方法。一种设施的基于截面研究从3月1日进行到30，2016年共267肺结核阳性患者纳入本研究。以鉴定接触筛选和异烟肼预防性治疗开始的独立预测因子，我们进行多变量logistic回归分析使用SPSS版本20的95％CI在值<0.05。Results。总共有230（90.2％），肺结核阳性患者与他们的五岁以下儿童接触单。一百九（64.8％）儿童进行了筛选。从这些筛选，11（7.4％）发生肺结核病，并开始抗结核治疗。四十四（31.9％）的孩子开始异烟肼预防性治疗。参与者的性别，到位的服务交付，以接触，艾滋病病毒感染状况的关系，以及态度的PTB +病例的接触筛选显著预测（ ）。参与者的知识,态度啊f participants, and relationship of the child with participant were significant predictors of isoniazid preventive therapy initiation ( ）。Conclusion。Contact screening practice and isoniazid preventive therapy initiation of children under the age of 5 in Bahir Dar zone were very low. Intimate family contact with pulmonary tuberculosis-positive patients, place of service delivery, and attitude towards screening are the key factors of contact screening. Participant’s knowledge, attitude of participants, and relationship of the child with participant are the key factors of isoniazid preventive therapy initiation. Therefore, household contact screening and isoniazid preventive therapy initiation should be paid attention to reduce transmission.

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背景。有人类免疫缺陷病毒（HIV）和结核病（TB）感染感染之间复杂的相互作用的结果在他们的患病率，发病率和死亡率的协同增加。在加纳，结核病例32％，估计到了人类免疫缺陷病毒合并感染可以和获得性免疫缺陷综合症（艾滋病病毒/艾滋病）病毒，随着沃尔特地区混合感染人数最多的。本研究评估在加纳南部Tongu区结核病和艾滋病防治合作活动之间的联系程度。方法。The study employed both qualitative and quantitative methods to assess the coverage of activities to reduce the burden of TB in people living with HIV and the coverage of activities to reduce the burden of HIV in TB patients and explored the barriers to collaborative activities from the providers’ perspective.结果。The study showed that 344 (94.8%) HIV-positive clients were screened for TB, of which 10 (8.5%) were bacteriologically confirmed. Among those positive for TB, 6 (60%) received cotrimoxazole preventive therapy (CPT) and antiretroviral therapy. Sixty-seven (93.1%) TB patients were screened for HIV. Of these, 28 (38.9%) were retropositive, among whom 14 (50%) received anti-TB treatment. However, there were no records of isoniazid preventive therapy (IPT) for these patients. Inadequately trained personnel leading to work overload, manual record-keeping, lack of staff motivation, and absence of “enablers” packages for patients were identified as barriers to TB/HIV collaboration.结论。总体而言，在研究设置结核病和艾滋病防治合作活动之间的适度联动。尽管如此，也存在一些障碍，对成功实现从供应商的角度来看，合作的过程中，减少因此我们建议采取措施，确保有效，高效，并通过解决这些障碍的持续集成的TB / HIV活动。

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背景。在印度的结核病诊断和治疗服务在全国各地的计划范围内提供免费的。有在医疗保健利用而产生不同的成本，并进行这项研究，以评估这些费用。方法。纵向研究的达文盖雷，Belagavi，和班加罗尔，卡纳塔克邦三个城市结核单元（TU）的患者中进行的。训练有素的数据收集管理的验证的问卷，并记录由以中位数印度国家卢比（INR）表示，患者发生的每月费用。该分析采用SPSS 23.0版完成。一个的<0.05的值作为统计学显著。Results。间214名患者中，大约37％，42％，和21％分别属于达文盖雷，Belagavi，和班加罗尔，。跨越三个课时发生的中位值总前和postdiagnostic成本是3800和4000 INR，分别。直接非医疗费用是住宿（800 INR的平均成本）和非结核药物直接医疗费用（2000 INR的平均成本）更高。然而，最大的直接医疗和非医疗费用在postdiagnostic期分别归属于住院（1200 INR）和住宿费用（700 INR）。发生的中位数间接成本为300 INR整体，且最大总间接成本在postdiagnostic期40000 INR。约有三分之一面临收入损失和面临应对成本19.6％的患者。患者花了大约他们对结核病治疗收入的6.7％（0.97％-52.3％）。约12.3％的患者面临灾难性支出。平均成本为那些寻求私人医疗机构（12100 INR在公私与6800 INR之间显著较高; ）during the prediagnostic period. Prediagnostic and diagnostic out-of-pocket expenditures (OPE) were significantly higher across all the three centres ( ）。Conclusion。结核病患者出现下编程设置不适当的开支。通过八分之一的患者遇到的成本是由自然灾难。

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Oxidative stress is a common feature of tuberculosis (TB), and persons with reduced antioxidants are at more risk of TB. TB patients with relatively severe oxidative stress had also more advanced disease as measured by the Karnofsky performance index. Since adverse effects from anti-TB drugs are also mediated by free radicals, TB patients are prone to side effects, such as hearing loss. In previous articles, researchers appealed for clinical trials aiming at evaluating N-acetyl cysteine (NAC) in attenuating the dreaded hearing loss during multidrug-resistant TB (MDR-TB) treatment. However, before embarking on such trials, considerations of NAC’s overall impact on TB treatment are crucial. Unfortunately, such a comprehensive report on NAC is missing in the literature and this manuscript reviews the broader effect of NAC on TB treatment. This paper discusses NAC’s effect on mycobacterial clearance, hearing loss, drug-induced liver injury, and its interaction with anti-TB drugs. Based on the evidence accrued to date, NAC appears to have various beneficial effects on TB treatment. However, despite the favorable interaction between NAC and first-line anti-TB drugs, the interaction between the antioxidant and some of the second-line anti-TB drugs needs further investigations.

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背景。实体器官移植（SOT）受者和病人开始长期透析的国家里，结核病的发病率较低之间的活动性结核病的风险还不是很清楚。方法。患者移植wi > 18岁th a solid organ or initiated chronic dialysis at Copenhagen University Hospital in the period 2004-2017 were followed from date of transplantation or initiation of dialysis. Data on demographics and outcomes were obtained from nationwide registries.Results。我们包括1989和SOT收件人和1305例慢性开始透析，谁分别跟随共计9,785和4,196人年（PY）。只有少数患者已被筛选之前，SOT潜伏性结核或透析的开始。的发生率（IRS）的中/高结核病流行区的患者中/ 100000 PY TB的358（95％CI 115-1,110）和1266（95％CI 681-2354），用于SOT和透析患者，分别，而国税局丹麦裔的患者中11例（95％CI 2-81）和31（95％CI 4-218）。Conclusion。TB来自中/高TB流行国家免疫抑制的移民中的发病率非常高，而结核病的低流行国家的病人中的风险是最小的。

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背景。结核病是由感染性空中疾病Mycobacterium tuberculosis。它仍然是一个重大的公共卫生问题，影响所有年龄组。曝光的风险是比一般人群的家庭成员接触高。目的。这项研究的目的是评估的流行和在中区Haramaya，奥罗莫地区，埃塞俄比亚东部二至三月，2019涂片阳性肺结核的成人家居接触结核病的相关因素。方法。以社区为基础进行了横断面研究设计。共有454名研究参与者采用系统抽样方法，从治疗七月2017年到2018年使用预测试和结构式问卷收集资料，十二月初治涂阳肺结核患者的所有成年的家庭接触者选择;和实验室检查是采用荧光显微镜涂片处理。采用Logistic回归分析，以确定在被宣布感染肺结核和统计学显著关联有关的因素 -值<0.05。结果。The overall prevalence of pulmonary tuberculosis among adult household contacts was 7.8% (95% CI: 5.8–10.0). The risk factors for tuberculosis infection among household contacts were eating meals less than three times per day (AOR = 4.31; 95% CI: 1.61, 11.55), drinking raw milk (AOR = 4.12; 95% CI: 1.43, 11.90), having family history of tuberculosis with more than one index case (AOR = 2.7; 95% CI: 1.02, 6.92), living in poor ventilated houses (AOR = 4.02; 95% CI: 1.38, 11.76), and living in inadequate size of living room (AOR = 3.4; 95% CI: 1.30, 8.86).结论。在这项研究中，结核病中涂片阳性肺结核的成年家庭接触者的患病率较高。进餐少于每天三次，喝生牛奶，居住在通风差的房屋，房间大小不足被确认为促成因素。因此，我们建议可以潜在地更好的接触者追踪和治疗策略与适当的健康教育一起减少肺结核的传播。

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