Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Cme tb 1

2,062 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Cme tb 1

  1. 1. TB (PART 1) 04/18/11
  2. 2. HISTORICALLY: <ul><li>Challenge of Tuberculosis </li></ul><ul><li>Through the Ages </li></ul><ul><li>IUATLD </li></ul><ul><li>1st Asia-Pacific Region </li></ul><ul><li>Conference </li></ul><ul><li>Kuala Lumpur </li></ul><ul><li>August 2, 2007 </li></ul><ul><li>Contents </li></ul><ul><li>􀂄 Tuberculosis through the ages </li></ul><ul><li>􀂄 Evolution of WHO policies for TB control </li></ul><ul><li>􀂄 From DOTS to the New Stop TB Strategy </li></ul><ul><li>• Phthisis </li></ul><ul><li>• Wasting </li></ul><ul><li>• Scrofula </li></ul><ul><li>• Pott’sdisease </li></ul><ul><li>• Lupus vulgaris </li></ul><ul><li>• Consumption </li></ul><ul><li>• The Captain of the Men of Death </li></ul><ul><li>• The White Plague </li></ul><ul><li>Tuberculosis: What’s in a Name ? </li></ul><ul><li>The disease was named </li></ul><ul><li>Tuberculosis in 1839 </li></ul><ul><li>by J. L. Schönlein </li></ul><ul><li>Tuberculosis: </li></ul><ul><li>An Ancient Killer </li></ul><ul><li>􀂄 Tubercular decay in skull and spinal </li></ul><ul><li>bones found in 4000 year old </li></ul><ul><li>Egyptian mummies </li></ul><ul><li>􀂄 Hippocrates around 400 BC: </li></ul><ul><li>“ Phthisis is the most common </li></ul><ul><li>disease of humans and it is </li></ul><ul><li>nearly always fatal” </li></ul><ul><li>Tuberculosis as Killer </li></ul><ul><li>in Arts </li></ul><ul><li>􀂄 Violetta in Verdi’s opera La </li></ul><ul><li>Traviata (1853) dies of TB </li></ul><ul><li>􀂄 Edvar Munch’s painting “Sick </li></ul><ul><li>Child” (1885) depicts his </li></ul><ul><li>sister dying of tuberculosis </li></ul>04/18/11
  3. 3. 04/18/11
  4. 4. 04/18/11
  5. 5. 04/18/11
  6. 6. 04/18/11
  7. 7. MDG 6 <ul><li>Target 6C </li></ul><ul><li>To Halt And To Reverse The Incidence </li></ul><ul><li>Of TB </li></ul>04/18/11
  8. 8. SITUATION IN PERAK <ul><li>Kadar kejadian TB negeri Perak 2009 </li></ul><ul><ul><li>52.19 per 100,000 penduduk </li></ul></ul><ul><li>Kadar kematian TB negeri Perak 2009 </li></ul><ul><ul><li>2.09 per 100,000 penduduk </li></ul></ul><ul><li>Target Kebangsaan untuk Kadar kematian, < 3 per 100,000 </li></ul>04/18/11
  9. 9. By 2005, to detect at least 70% of new sputum smear positive TB cases Case Detection Rate Smear +ve detection has not reached 70% in 5 districts in Perak. All health facilities have been asked to screen all patients with cough more than 1 week and work towards a target of 3% AFB screening in all new outpatients.
  10. 10. Case Detection Rate (CDR) Target 58.3 % ( Jan - Okt 2010 ) 48/100,000
  11. 11. Cure Rate Target 85 % ( Jan - Jun 2009 )
  12. 12. TB Mortality Perak – (Jan- Okt 2010) Bil District Total TB Death Non TB Death Deaths Audited Deaths NOT Audited 1 Kerian 2 0 2 2 0 2 LMS 41 4 13 17 24 3 Hulu Perak 5 4 0 4 1 4 K Kangsar 7 2 1 3 4 5 Pk Tengah 7 3 4 7 0 6 Btg Padang 8 3 0 3 5 7 Hilir Perak 10 3 7 10 0 8 Manjung 20 10 10 20 0 9 Kinta 36 15 21 36 0 Total 136 44 58 102 34
  13. 13. <ul><li>Mengurangkan kes TB baru sehingga 50% dari jumlah kes tahun 2000 (1014 kes) sebelum tahun 2015. Jumlah Kes pada tahun 2010 adalah sebanyak 1389 kes </li></ul><ul><li>Mengurangkan 50% kematian disebabkan TB dari Jumlah kematian pada tahun 2000 iaitu 149. Jumlah kematian TB pada tahun 2010 adalah sebanyak 151 kes </li></ul>
  14. 14. Objektif Khusus <ul><li>Meningkatkan pengesanan Kes TB Berkahak Positif dari 72% ke 80% melalui saringan aktif & pasif. </li></ul><ul><li>Pengesanan kes TB diperingkat awal iaitu mengurangkan bilangan kes baru dengan keputusan “X-Ray Sangat Teruk” dari 8% ke 5% pada 2015 </li></ul><ul><li>Meningkatkan hasil rawatan dari 76% kepada 85% melalui pengendalian rawatan secara DOTS untuk semua pesakit TB dan mengurangkan kes keciciran tidak melebihi 2.5% </li></ul>
  15. 15. Objektif Khusus <ul><li>Meningkatkan pengetahuan Pengamal Perubatan berkaitan penyakit TB melalui “Pendidikan Kesihatan Berterusan” dan mengadakan Kursus Sehari untuk TB setiap bulan bagi setiap daerah </li></ul><ul><li>Meningkatkan kesedaran masyarakat mengenai penyakit TB melalui Pendidikan Kesihatan dan kerjasama dengan agensi-agensi bukan kerajaan. </li></ul>
  16. 16. 04/18/11
  17. 17. Case Study 1 <ul><li>11year old school boy </li></ul><ul><li>Admitted to Hosp.A on 20/6/2008 </li></ul><ul><li>Presented with 4 months history of </li></ul><ul><ul><li>On off fever especially at night with chill and rigors </li></ul></ul><ul><ul><li>Productive cough </li></ul></ul><ul><ul><li>LOA ,LOW , Lethargic, malaise </li></ul></ul><ul><li>Hist Of Present Illness: </li></ul><ul><ul><li>17.02.08 - fever, URTI </li></ul></ul><ul><ul><li>18.02.08 - URTI with sputum </li></ul></ul><ul><ul><li>18.03.08 - right sided chest pain, syr. Bena given </li></ul></ul><ul><ul><li>26.03.08 - cough with greenish sputum, syr bena and ampicillin given </li></ul></ul><ul><ul><li>21.04.08 - cough, fever, vomiting. Syr phenergen, amoxicillin </li></ul></ul><ul><ul><li>19.06.08 - X-ray ordered, sputum AFB, **** TCA 1 WEEK </li></ul></ul>
  18. 18. Case Study 1 <ul><li>Multiple clinics and OPD visits with same complaints, mostly treated as URTI </li></ul><ul><li>CXR:showed </li></ul><ul><ul><li>Multiple cavities and consolidations at right and left upper lobes, and right middle lobe. </li></ul></ul><ul><ul><li>Fibrotic changes at the left upper lobe. </li></ul></ul><ul><ul><li>Pleural Effusion-right lung. </li></ul></ul><ul><ul><li>Sputum AFB: >50/3L for 3/7 </li></ul></ul>Diagnosis : Advance PTB
  19. 19. <ul><li>Contact defaulted 2 nd screening. </li></ul><ul><li>Was contacted and advised to come, but still did not turn up. </li></ul><ul><li>Visited a GP in February with complain of cough, and was referred to a private hospital for X-ray. </li></ul><ul><li>X-ray: shows consolidation at Rt.upper lobe with fibrosis. Cavitating lesion seen at the rt. upper lobe. </li></ul><ul><li>Pulmonary TB </li></ul>Contact Tracing Is Very Important CASE STUDY 2
  20. 20. Be Aware Of TB And Think Of TB
  21. 21. 04/18/11
  22. 22. 04/18/11
  23. 24. <ul><li>Inhomogenous opacities with cavitation seen in both upper zones, more on the right side. </li></ul><ul><li>Impression: Active pulmonary tuberculosis </li></ul><ul><li>(MODERATELY ADVANCED) </li></ul>
  24. 26. <ul><li>Inhomogenous opacities seen at the left mid zone. There is a cavitating lesion within the opacities </li></ul><ul><li>Impression: Active Pulmonary </li></ul><ul><li>Tuberculosis </li></ul><ul><li>(MILD) </li></ul>
  25. 28. 22 & 23 <ul><li>There are multiple diffuse tiny nodular opacities 1-2 mm throughout both lung fields </li></ul><ul><li>Impression: Miliary Tuberculosis </li></ul><ul><li>(FAR ADVANCED) </li></ul>
  26. 29. 04/18/11
  27. 30. 04/18/11
  28. 31. 04/18/11 RECOMMENDATIONS <ul><li>Active case detection : </li></ul><ul><li>Sputum AFB for symptomatic patients in </li></ul><ul><li>OPD ~ spot speciment & 2 nd sp </li></ul><ul><li>~ target 3% of all new outpt </li></ul><ul><li>attendance </li></ul><ul><li>CXR ~ To use CXR findings as one of the key </li></ul><ul><li>performance indicators </li></ul><ul><li>To increase index of suspicion on outpatients with Cough > 5 days </li></ul>
  29. 32. 04/18/11
  30. 33. 04/18/11
  31. 34. 04/18/11 Risk of progression of TB infection to disease <ul><li>Life-time risk of 10% in </li></ul><ul><li>immunocompetent adults; 5% risk in first </li></ul><ul><li>2 years after infection </li></ul><ul><li>Risk especially high in early childhood </li></ul><ul><li>Risk increased in certain medical </li></ul><ul><li>conditions </li></ul>
  32. 35. 04/18/11
  33. 36. 04/18/11
  34. 37. 04/18/11
  35. 38. 04/18/11

×