Extensively drug-resistant tuberculosis (XDR-TB) is a rare, highly drug-resistant form of TB caused by bacteria resistant to the most effective anti-TB drugs. XDR-TB develops when individuals with multidrug-resistant TB (MDR-TB) do not complete or improperly take their medication regimen. Diagnosis requires culturing the bacteria and testing drug susceptibility, which can take 6-16 weeks. Treatment involves extensive chemotherapy with second-line drugs for up to two years, which are more toxic and expensive than standard TB treatment. XDR-TB has a high mortality rate due to limited treatment options.
Background- Multidrug-resistant tuberculosis (MDR-TB) is caused by strain of Mycobacterium tuberculosis, it is transmitted through air droplets from infected person and Close contacts of MDR-TB patients have a high potential to developing TB. This study aims to determine the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. Material and Methods- The cases were recruited from the King George’s Medical University, Lucknow, India. In this cross-sectional study, Close contacts of MDR-TB patients were screened for tuberculosis. clinical, radiological and bacteriological experiments were performed to find out the evidence of TB/MDR-TB. Results- The cases were enrolled Between December 2015 to December 2016, a total of 100 index MDR-TB patients were recruited which initiated on MDR-TB treatment. A total of 428 contacts who could be studied, 11 (2.57%) were diagnosed with MDR-TB and 4 (0.93%) had TB. The most frequent symptoms observed in patients were cough, chest pain and fever. Conclusions- Tracing symptomatic contacts of MDR-TB cases could be a high yield strategy for early detection and treatment of MDR-TB cases to contribute to reduced morbidity, mortality and to cut the chain of transmission of infection in the community. The approach should be bringing about for wider implementation and dissemination. Key-words- TB, MDR-TB, Symptomatic, Household, Transmission
ABSTRACT
Background: With the advances in medical care, invasive fungal
infections possess a significant health problem especially in
immunocompromised patients. These infections have varied aetiological
agents which are commonly found in soil, water, plant debris and organic
substrates. Aim: The overview of different fungal aetiological agents,
newer and rapid diagnostic modalities and overall treatment and
prevention options available is presented in this article. Methods:
Literature search was performed in PubMed by using MeSH terms
‘mycoses’ and ‘immunocompromised host’. Only relevant review articles
published within the last five years were considered. Google Scholar
search engine was also used. Results: Common invasive fungi include
Candida spp., Cryptococcus spp., Aspergillus spp., Trichosporon spp.,
Rhodotorula spp., Fusarium spp., Mucormycotina, Pheohyphomycosis
spp., Pneumocystis jirovecii, Scedosporium spp., and endemic mycoses
such as Penicillium, Histoplasma and Blastomyces. A high degree of
suspicion is required for early diagnosis and optimal management of these
infections. Conclusion: Early and rapid diagnosis of causative fungal
agents is required so that appropriate treatment can be initiated. Adequate
preventive measures must be applied in an immunocompromised host that
can prevent development of drug resistant super-infections.
Background- Multidrug-resistant tuberculosis (MDR-TB) is caused by strain of Mycobacterium tuberculosis, it is transmitted through air droplets from infected person and Close contacts of MDR-TB patients have a high potential to developing TB. This study aims to determine the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. Material and Methods- The cases were recruited from the King George’s Medical University, Lucknow, India. In this cross-sectional study, Close contacts of MDR-TB patients were screened for tuberculosis. clinical, radiological and bacteriological experiments were performed to find out the evidence of TB/MDR-TB. Results- The cases were enrolled Between December 2015 to December 2016, a total of 100 index MDR-TB patients were recruited which initiated on MDR-TB treatment. A total of 428 contacts who could be studied, 11 (2.57%) were diagnosed with MDR-TB and 4 (0.93%) had TB. The most frequent symptoms observed in patients were cough, chest pain and fever. Conclusions- Tracing symptomatic contacts of MDR-TB cases could be a high yield strategy for early detection and treatment of MDR-TB cases to contribute to reduced morbidity, mortality and to cut the chain of transmission of infection in the community. The approach should be bringing about for wider implementation and dissemination. Key-words- TB, MDR-TB, Symptomatic, Household, Transmission
ABSTRACT
Background: With the advances in medical care, invasive fungal
infections possess a significant health problem especially in
immunocompromised patients. These infections have varied aetiological
agents which are commonly found in soil, water, plant debris and organic
substrates. Aim: The overview of different fungal aetiological agents,
newer and rapid diagnostic modalities and overall treatment and
prevention options available is presented in this article. Methods:
Literature search was performed in PubMed by using MeSH terms
‘mycoses’ and ‘immunocompromised host’. Only relevant review articles
published within the last five years were considered. Google Scholar
search engine was also used. Results: Common invasive fungi include
Candida spp., Cryptococcus spp., Aspergillus spp., Trichosporon spp.,
Rhodotorula spp., Fusarium spp., Mucormycotina, Pheohyphomycosis
spp., Pneumocystis jirovecii, Scedosporium spp., and endemic mycoses
such as Penicillium, Histoplasma and Blastomyces. A high degree of
suspicion is required for early diagnosis and optimal management of these
infections. Conclusion: Early and rapid diagnosis of causative fungal
agents is required so that appropriate treatment can be initiated. Adequate
preventive measures must be applied in an immunocompromised host that
can prevent development of drug resistant super-infections.
Tuberculosis- International Perspectives on Epidemiology, diagnosis and ControlsRanjini Manuel
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
About one-quarter of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease.
People infected with TB bacteria have a 5–15% lifetime risk of falling ill with TB. Persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill.
More than 5.7 million new cases of TB (all forms, both pulmonary and extra-pulmonary) were reported to the World Health Organization (WHO) in 2013; 95% of cases were reported from developing countries
Latest figures from 20151 indicate an estimated 10.4 million people had TB, and 1.8 million people died (1.4 million HIV negative and 400 000 HIV positive).
Of further concern is that 480 000 cases of multidrug-resistant (MDR) TBa and a further 100 000 that were estimated to be rifampicin-resistant (RR) TB have occurred in the same period.
Define tuberculosis
Explain the risk factors and causes of tuberculosis
Describe the pathophysiology of tuberculosis.
Identify the types of tuberculosis.
Enumerate clinical features of tuberculosis
Describe the diagnostic evaluations for tuberculosis
Explain the medical management for tuberculosis
Explain the nursing management for tuberculosis
Enlist the complications of tuberculosis
Describe the prevention of tuberculosis
this presentation is based on national health program in india in relation to tuberculosis and malaria as these are mostly occuring disease in india so national program are organised to irradicate the spread of vector borne disease by various methods like controlling the vector (mosquitos) from spreading
role of community pharmacist in educating and monitoring of patients for infection and counselling and educating them regarding the control of malaria and tb.
Tuberculosis- International Perspectives on Epidemiology, diagnosis and ControlsRanjini Manuel
Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
About one-quarter of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease.
People infected with TB bacteria have a 5–15% lifetime risk of falling ill with TB. Persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a higher risk of falling ill.
More than 5.7 million new cases of TB (all forms, both pulmonary and extra-pulmonary) were reported to the World Health Organization (WHO) in 2013; 95% of cases were reported from developing countries
Latest figures from 20151 indicate an estimated 10.4 million people had TB, and 1.8 million people died (1.4 million HIV negative and 400 000 HIV positive).
Of further concern is that 480 000 cases of multidrug-resistant (MDR) TBa and a further 100 000 that were estimated to be rifampicin-resistant (RR) TB have occurred in the same period.
Define tuberculosis
Explain the risk factors and causes of tuberculosis
Describe the pathophysiology of tuberculosis.
Identify the types of tuberculosis.
Enumerate clinical features of tuberculosis
Describe the diagnostic evaluations for tuberculosis
Explain the medical management for tuberculosis
Explain the nursing management for tuberculosis
Enlist the complications of tuberculosis
Describe the prevention of tuberculosis
this presentation is based on national health program in india in relation to tuberculosis and malaria as these are mostly occuring disease in india so national program are organised to irradicate the spread of vector borne disease by various methods like controlling the vector (mosquitos) from spreading
role of community pharmacist in educating and monitoring of patients for infection and counselling and educating them regarding the control of malaria and tb.
The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB drugs.
The 2 reasons why multidrug resistance continues to emerge and spread are mismanagement of TB treatment and person-to-person transmission. Most people with TB are cured by a strictly followed, 6-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs (such as use of single drugs, poor quality medicines or bad storage conditions), and premature treatment interruption can cause drug resistance, which can then be transmitted, especially in crowded settings such as prisons and hospitals.
In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and expensive, recommended medicines are not always available, and patients experience many adverse effects from the drugs. In some cases even more severe drug-resistant TB may develop. Extensively drug-resistant TB, XDR-TB, is a form of multidrug-resistant TB with additional resistance to more anti-TB drugs that therefore responds to even fewer available medicines. It has been reported in 117 countries worldwide.
Drug resistance can be detected using special laboratory tests which test the bacteria for sensitivity to the drugs or detect resistance patterns. These tests can be molecular in type (such as Xpert MTB/RIF) or else culture-based. Molecular techniques can provide results within hours and have been successfully implemented even in low resource settings.
New WHO recommendations aim to speed up detection and improve treatment outcomes for MDR-TB through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen. At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.
Solutions to control drug-resistant TB are to:
cure the TB patient the first time around
provide access to diagnosis
ensure adequate infection control in facilities where patients are treated
ensure the appropriate use of recommended second-line drugs.
In 2015, an estimated 480 000 people worldwide developed MDR-TB, and an additional 100 000 people with rifampicin-resistant TB were also newly eligible for MDR-TB treatment. India, China, and the Russian Federation accounted for 45% of the 580 000 cases. It is estimated that about 9.5% of these cases were XDR-TB.
MDR in Mycobacterium species by Parth AgarwalParth Agarwal
Introduction to MDR and MDR-TB. Types of MDR, History and Diagnostic methods, Antibiotics used and their Mechanism, Mechanism of resistance towards Antibiotics by the bacteria and Future Technologies
India is the highest TB burden country in the world & accounts for nearly 1/5th (20 per cent) of global burden of tuberculosis, 2/3rd of cases in SEAR. Every year approximately 1.8 million persons develop tuberculosis, of which about 0.8 million are new smear positive highly'- infectious cases.Annual risk of becoming infected with TB is 1.5 % and once infected there is 10 % life-time risk of developing TB disease
CARLO MARIA ROSA CROCEStatus is online
CARLO MARIA ROSA CROCE
-Quantum physics is the physical theory that describes the behavior of matter,
111 articles
Antonin is a founder of the VII photo agency.
No alt text provided for this image
Antonin is a founder of the VII photo agency which is an international photo agency which is owned and controlled by only the members. It was launched at the Visa pour l'image Festival France in the town of Perpignan in September 2001. This was one of his own great achievements but eventually, he was suspended from the VII Photo Agency after sexual harassment allegations were made upon him despite he continued to deny those.
More on his personal life, he was born in 1947 in a town called Litomerice in Czechoslovakia and eventually pursued his studies in photography in Netherlands where he got his BFA in Photography at the Gerrit Rietveld Academie in Amsterdam.
Antonin Kratochvil specializes mostly in documenting the world's hot topic or showing how a refugee life is by depicting those realities in his pictures. He would provide his own personal experience towards those events together with those affected in it in order to provide a true aspect of the reality we are all living in but decide to ignore it sometimes.
" He took pictures in the Mongolia's street children for the magazine published by the Museum of Natural History to a portrait session with David Bowie for Detour, from covering the war in Iraq for Fortune Magazine to shooting Deborah Harry for a national advertising campaign for the American Civil Liberties Union, Kratochvil's ability to see through and into his subjects and show immutable truth has made his pictures not facsimiles but uncensored visions." - From Antonin's website.
During his years of being a professional photographer, he had a widespread of publications examining various topics and interests as from the description above taken from Antonin's website. This sum up a lot of his jobs and only shows that he is versatile to a lot of topics of interests and also he is keen to try new ways to target his audience. We can see from one side that he is willing to raise awareness upon topics that we often ignore or forget in our busy society. However, he also merges into the world of celebrities and fame by depicting portraits of those icons of the industry while at the same time giving his art more value in terms of audience. This can be seen as a strategy for himself in order to raise awareness for his other art as people will still keep up with his work either through celebrities or through his pictures about real world issues.
Some of his pictures can be shown as below:
Picture credits: Antonin Kratochvil
This is a portrait of David Bowie taken in New York in 1997 by Kratochvil.
Picture credits: Antonin Kratochvil
A picture at the Prague gallery is one of his art work of taking pictures in the moment.
In 2002, we won the World Press Photo Awards in the cat
Human reproduction planning is the practice of intentionally controlling the rate of growth of a human population. Historically, human population planning has been implemented with the goal of increasing the rate of human population growth. However, in the period from the 1950s to the 1980s, concerns about global population growth and its effects on poverty, environmental degradation and political stability led to efforts to reduce human population growth rates. More recently, some countries, such as China, Iran, and Spain, have begun efforts to increase their birth rates once again. While population planning can involve measures that improve people's lives by giving them greater control of their reproduction, a few programs, most notably the Chinese government's "one-child policy and two-child policy", have resorted to coercive measures.
George Soros, Barack Obama and Hillary Clinton orchestrated a coup in the Vatican to overthrow the conservative Pope Benedict and replace him with radical leftist Pope Francis, according to a group of Catholic leaders citing evidence from various sources including WikiLeaks emails.
A VERY IMPORTANT PREMISE
GEORGE SOROS
Soros has long planned to buy Italy after having economically, culturally and artistically reduced-and-downgraded it.
George Soros, Barack Obama and Hillary Clinton orchestrated a coup in the Vatican to overthrow the conservative Pope Benedict and replace him with radical leftist Pope Francis, according to a group of Catholic leaders citing evidence from various sources including WikiLeaks emails.
A VERY IMPORTANT PREMISE
GEORGE SOROS
Soros has long planned to buy Italy after having economically, culturally and artistically reduced-and-downgraded it.
-CENTRAL AMERICA-
>IN THE PERIOD BETWEEN 2002-2003, I WORKED (...) FOR A YEAR AND A HALF IN CENTRAL AMERICA (MEXICO-CUBA-GUATEMALA-BELIZE-HONDURAS-NICARAGUA-EL SALVADOR-COSTA RICA-PANAMA) ALSO AND ESPECIALLY WITH THE CONTACTS BY ANTONIN KRATOCHVIL.
> IN THAT PERIOD , I RECEIVED A VERY GOOD JOB OFFER FROM THE UNITED STATES GOVERNMENT-.
>AS AN ANALYST-STRATEGIC-OPERATIONAL ON THE TERRITORY, IN THE FIELD ,”IN DA ZONE” I "FOUND" FULLY PREPARED IN A NATURAL WAY.
-AFTERWARDS I WANTED/HAD TO "ABANDON THE TEAM" TO GO TO END ***-"THE NYC DANCE KABALLAH QUANTUM PROJECT"***
-I MUST SAY IT WAS A GREAT EXPERIENCE, "MADE" WITH HIGHLY TRAINED PROFESSIONALS, WITH VERY SPECIAL TALENTS AND SKILLS THEY HAVE TAUGHT ME.
MOTH812
C.M.R.
No alt text provided for this image
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Extensivelydrug 191130082813
1. Extensively drug-resistant
tuberculosis
From Wikipedia,the free encyclopedia
Jump to navigationJump to search
Description ofExtensively Drug-Resistant Tuberculosis.
Extensively drug-resistant tuberculosis (XDR-TB) is a form
of tuberculosis caused by bacteria that are resistant to some of the most
effective anti-TB drugs. XDR-TBstrains have arisen after the mismanagement of
individuals with multidrug-resistant TB (MDR-TB).
Almost one in four people in the world is infected with TB bacteria.[1]
Only when
the bacteria become active do people become ill with TB. Bacteria become active
as a result of anything that can reduce the person’s immunity, such as HIV,
advancing age, or some medical conditions. TB can usually be treated with a
course of four standard, or first-line, anti-TB drugs (i.e., isoniazid, rifampin and
any fluoroquinolone). If these drugs are misused or mismanaged, multidrug-
resistant TB (MDR-TB) can develop. MDR-TB takes longer to treat with second-
line drugs (i.e., amikacin, kanamycin, or capreomycin), which are more expensive
and have more side-effects. XDR-TBcan develop when these second-line drugs
are also misused or mismanaged and therefore also become ineffective.
XDR-TB raises concerns of a future TB epidemic with restricted treatment
options, and jeopardizes the major gains made in TB controland progress on
reducing TB deaths among people living with HIV/AIDS. It is therefore vital that
TB control be managed properly and new tools developed to prevent, treat and
diagnose the disease.
The true scale of XDR-TB is unknown as many countries lack the necessary
equipment and capacity to accurately diagnose it. It is estimated however that there
are around 40,000 cases per year. As of June 2008, 49 countries had confirmed
cases of XDR-TB.[2]
As of 2017, that number had risen to more than 100.[3]
Contents
1Symptoms
2Transmission
3Diagnosis
4Prevention
5Treatment
6BCG vaccine
7Enforced quarantine
8Epidemiology
9XDR-TB and HIV/AIDS
10History
o 10.1South African epidemic
11See also
12References
13External links
Symptoms[edit]
2. Symptoms of XDR-TB are no different from ordinary or drug-susceptible TB: a
cough with thick, cloudy mucus (or sputum), sometimes with blood, for more than
two weeks; fever, chills, and night sweats; fatigue and muscle weakness; weight
loss; and in some cases shortness of breath and chest pain. A person with these
symptoms does not necessarily have XDR-TB, but they should see a physician for
diagnosis and a treatment plan. TB patients whose symptoms do not improve after
a few weeks of treatment for TB and are taking treatment should inform their
clinician or nurse.[4]
Transmission[edit]
Like other forms of TB, XDR-TB is spread through the air. When a person with
infectious TB coughs, sneezes, talks or spits, they propel TB germs, known
as bacilli, into the air. XDR-TB cannot be spread by kissing, sharing food or drinks
and by shaking someone’s hand. The bacterium has the ability to stay in the air for
several hours.[5]
A person needs only to inhale a small number of these to be
infected. People infected with TB bacilli will not necessarily become sick with the
disease. The immune system "walls off" the TB bacilli which, protected by a thick
waxy coat, can lie dormant for years.
The spread of TB bacteria depends on factors such as the number and
concentration of infectious people in any one place together with the presence of
people with a higher risk of being infected (such as those with HIV/AIDS). The
risk of becoming infected increases with the longer the time that a previously
uninfected person spends in the same room as the infectious case. The risk of
spread increases where there is a high concentration of TB bacteria, such as can
occur in closed environments like overcrowded houses, hospitals or prisons. The
risk will be further increased if ventilation is poor. The risk of spread will be
reduced and eventually eliminated if infectious patients receive proper treatment.
Diagnosis[edit]
Successful diagnosis of XDR-TB depends on the patient’s access to quality health-
care services. If TBbacteria are found in the sputum, the diagnosis of TB can be
made in a day or two, but this finding will not be able to distinguish between drug-
susceptible and drug-resistant TB. To evaluate drug susceptibility, the bacteria
need to be cultivated and tested in a suitable laboratory. Final diagnosis in this way
for TB, and especially for XDR-TB, may take from 6 to 16 weeks.[4]
To reduce the
time needed for diagnosis, new tools for rapid TB diagnosis are urgently needed.
The original method used to test for MDR-TB and XDR-TB was the Drug
Susceptibility Testing (DST). DST is capable of determining how well four
primary antitubercular drugs inhibit the growth of Mycobacterium Tuberculosis.
The four primary antitubercular drugs are Isoniazid, Rifampin, Ethambutol and
Pyrazinamide.[6]
Drug Susceptibility testing is done by making a Lowenstein-
Jensen medium plate and spreading the bacteria on the plate.[7]
Disks containing
one of the four primary drugs are added to the plate. After weeks of allowing the
bacteria to grow the plate is checked for clear areas around the disk. If there is a
clear area, the drug has killed the bacteria and most likely the bacteria are not
resistant to that drug.
As Mycobacterium tuberculosis evolved new strains of resistant bacteria were
being found such as XDR-TB. The problem was that primary DST was not
suitable for testing bacteria strains that were extensively drug resistant. This
problem was starting to be fixed when drug susceptibility tests started including
not just the four primary drugs, but secondary drugs. This secondary test is known
as Bactec MGIT 960 System.[8]
Although Bactec MGIT 960 System was accurate
it was still slow at determining the level of resistance.[8]
3. Diagnosis of MDR and XDR-TB in children is challenging. With an increasing
number of cases being reported worldwide there is a great need for better
diagnostic tools available for pediatric patients.[9]
In recent years drug resistant tuberculosis testing has shown a lot of progress.
Some studies have found an in-house assay that could rapidly detect resistance to
drugs involved in the definition of XDR-TB directly from smear-positive
specimens. The assay is called Reverse Line Blot Hybridization Assay also known
as RLBH.[10]
The study showed that the results of RLBH were as accurate as other
drug susceptibility tests, but at the same time didn`t take weeks to get results.
RLBH testing only took 3 days to determine how resistant the strain of bacteria
was.[10]
The current research has shown progress in the testing of drug resistance. A recent
study found that a research technique known as direct nitrate reductase assay (D-
NRA) showed efficient accuracy for the rapid and simultaneous detection of
resistance to isoniazid (INH), rifampicin (RIF), kanamycin (KAN) and ofloxacin
(OFL). D-NRA results were obtained in 16.9 days,[11]
comparably less than other
drug susceptibility testing. At the same time the study mentioned how D-NRA is a
low-cost technology, easy to set up in clinical laboratories and suitable to be used
for DST of M. tuberculosis in all smear-positive samples.[11]
Prevention[edit]
Countries aim to prevent XDR-TB by ensuring that the work of their national TB
control programmes, and of all practitioners working with people with TB, is
carried out according to the International Standards for TB Care.[12]
These
emphasize providing proper diagnosis and treatment to all TB patients, including
those with drug-resistant TB; assuring regular, timely supplies of all anti-TB
drugs; proper management of anti-TB drugs and providing support to patients to
maximize adherence to prescribed regimens; caring for XDR-TB cases in a centre
with proper ventilation, and minimizing contact with other patients, particularly
those with HIV, especially in the early stages before treatment has had a chance to
reduce the infectiousness. Also an effective disease controlinfrastructure is
necessary for the prevention of XDR tuberculosis. Increased funding for research,
and strengthened laboratory facilities are much required. Immediate detection
through drug susceptibility testing's are vital, when trying to stop the spread of
XDR tuberculosis.
Treatment[edit]
The principles of treatment for MDR-TB and for XDR-TB are the same.
Treatment requires extensive chemotherapy for up to two years. Second-line drugs
are more toxic than the standard anti-TB regimen and can cause a range of serious
side-effects including hepatitis, depression, hallucinations,
and deafness.[13]
Patients are often hospitalized for long periods, in isolation. In
addition, second-line drugs are extremely expensive compared with the cost of
drugs for standard TB treatment.
XDR-TB is associated with a much higher mortality rate than MDR-TB, because
of a reduced number of effective treatment options.[14]
Despite early fears that this
strain of TB was untreatable, recent studies have shown that XDR-TB can be
treated through the use of aggressive regimens. A study in the Tomsk oblast of
Russia, reported that 14 out of 29 (48.3%) patients with XDR-TB successfully
completed treatment.[15]
Nix-TB regimen, a combination pretomanid, bedaquiline,
and linezolid,[16]
has shown promise in early clinical trials.[17]
Successful outcomes depend on a number of factors including the extent of the
drug resistance, the severity of the disease and whether the patient’s immune
system is compromised. It also depends on access to laboratories that can provide
early and accurate diagnosis so that effective treatment is provided as soon as
4. possible. Effective treatment requires that all six classes of second-line drugs be
available to clinicians who have special expertise in treating such cases.[9]
BCG vaccine[edit]
The BCG vaccine prevents severe forms of TB in children, such as TB meningitis.
It would be expected that BCG would have the same effect in preventing severe
forms of TB in children, even if they were exposed to XDR-TB. The vaccine has
shown to be less effective at preventing the most common strains of TB and in
blocking TB in adults.[18]
The effect of BCG against XDR-TB would therefore
likely be very limited. New vaccines are urgently needed, and WHO and members
of the Stop TB Partnership are actively working on new vaccines.
Enforced quarantine[edit]
Carriers who refuse to wear a mask in public have been indefinitely involuntarily
committed to regular jails, and cut off from contacting the world.[19][20]
Some have
run away from the USA, complaining of abuse.[21]
Epidemiology[edit]
Studies have found that men have a higher risk of getting XDR-TB than
women.[22]
One study showed that the male to female ratio was more than
threefold, with statistical relevance (P<0.05)[23]
Studies done on the effect of age
and XDR-TB have revealed that individuals who are 65 and up are less likely to
get XDR-TB.[24]
A study in Japan found that XDR-TB patients are more likely to
be younger.[25]
XDR-TB and HIV/AIDS[edit]
This section needs more medical references for verification or relies too
heavily on primary sources. Please review the contents of the section
and add the appropriate references if you can. Unsourced or poorly sourced
material may be challenged and removed. (May 2017)
TB is one of the most common infections in people living with HIV/AIDS.[26]
In
places where XDR-TB is most common, people living with HIV are at greater risk
of becoming infected with XDR-TB, compared with people without HIV, because
of their weakened immunity. If there are a lot of HIV-infected people in these
places, then there will be a strong link between XDR-TB and HIV. Fortunately, in
most of the places with high rates of HIV, XDR-TB is not yet widespread. For this
reason, the majority of people with HIV who develop TB will have drug-
susceptible or ordinary TB, and can be treated with standard first-line anti-TB
drugs. For those with HIV infection, treatment with antiretroviral drugs will likely
reduce the risk of becoming infected with XDR-TB, just as it does with ordinary
TB.
A research study titled "TB Prevalence Survey and Evaluation of Access to TB
Care in HIV-Infected and Uninfected TB Patients in Asembo and Gem, Western
Kenya", says that HIV/AIDS is fueling large increases in TB incidence in Africa,
and a large proportion of cases are not diagnosed.
History[edit]
XDR-TB is defined as TB that has developed resistance to at
least rifampicin and isoniazid (resistance to these first line anti-TB drugs
defines Multi-drug-resistant tuberculosis, or MDR-TB), as well as to any member
of the quinolone family and at least one of the following second-line anti-TB
injectable drugs: kanamycin, capreomycin, or amikacin.[27]
This definition of XDR-
5. TB was agreed by the WHO Global Task Force on XDR-TB in October
2006.[28]
The earlier definition of XDR-TB as MDR-TB that is also resistant to
three or more of the six classes of second-line drugs,[14]
is no longer used, but may
be referred to in older publications.[29]
South African epidemic[edit]
XDR-TB was first widely publicised following the report of an outbreak in South
Africa in 2006. 53 patients in a rural hospital in Tugela Ferry were found to have
XDR-TB of whom 52 died.[30]
The median survival from sputum specimen
collection to death was only 16 days and that the majority of patients had never
previously received treatment for tuberculosis suggesting that they had been newly
infected by XDR-TB strains, and that resistance did not develop during
treatment.[30]
This was the first epidemic for which the acronym XDR-TB was
used, and although TB strains that fulfill the current definition have been identified
retrospectively,[31][32]
this was the largest group of linked cases ever found. Since
the initial report in September 2006, cases have now been reported in most
provinces in South Africa. As of 16 March 2007, there were 314 cases reported,
with 215 deaths.[33]
It is clear that the spread of this strain of TB is closely
associated with a high prevalence of HIV and poor infection control; in other
countries where XDR-TB strains have arisen, drug resistance has arisen from
mismanagement of cases or poor patient compliance with drug treatment instead of
being transmitted from person to person.[34]
It is now clear that the problem has
been around for much longer than health department officials have suggested, and
is far more extensive.[35]
See also[edit]
Multi-drug-resistant tuberculosis (MDR-TB)
Totally drug-resistant tuberculosis (TDR-TB)
Tuberculosis
Tuberculosis treatment
References[edit]
1. Jump up^ Houben &Dodd (2016). “The Global Burden ofLatent Tuberculosis
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3. Jump up^ Berman,Jessica."ExtensivelyDrug-Resistant TB on the Rise in South
Africa".VOA.Retrieved 2017-01-30.
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Centers forDisease Controland Prevention,18Jan.2013. Web.28 Jan.2014.
<https://www.cdc.gov/tb/publications/factsh
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"Drug-susceptibility TestingIn TB: Current Status And Future Prospects."Expert
Review of Respiratory Medicine 3.5:497-510.
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Susceptibility Testing(DST).N.p., n.d.Jan.2014.
<http://health.mo.gov/lab/dst.php>
8. ^ Jump up to:a b Rodrigues,C.et al. (2008)"Drug susceptibility testing of
Mycobacteriumtuberculosis against second-line drugs usingthe Bactec MGIT
960 System." Int J Tuberc Lung Dis.12.12:1449-1455.
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(2015)."Extensivelydrug-resistanttuberculosis in a youngchild after travelto
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3099(15)00356-4.PMC 4843989.PMID26607130.
6. 10. ^ Jump up to:a b Kanchan,A.et al. ( 2011) "Rapid Diagnosis ofExtensively
Drug-Resistant Tuberculosis byUse ofa Reverse Line Blot Hybridization
Assay."J Clin Microbiol49.7: 2546-2551.
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Martin.(2014). "Predictive value ofdirect nitrate reductase assayand its clinical
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13. Jump up^ Jason Beaubien (June 4,2013). "Moldova Grapples With WhetherTo
Isolate TB Patients".SpecialSeries:Tuberculosis Returns With A Deadly
Twist.NPR.Retrieved January29,2015.
14. ^ Jump up to:a b Center for Disease Control(2006)."Emergence
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Worldwide,2000–2004".MMWR Weekly. 55 (11):301&ndash,305.
15. Jump up^ Keshavjee,S;Gelmanova,I; Farmer,P; Mishustin,S;Strelis,A;
Andreev,Y;Pasechnikov,A;Atwood,S;et al.(2008)."Treatmentofextensively
drug-resistant tuberculosis in Tomsk,Russia:a retrospective cohort study". The
Lancet.372 (9647):1403.doi:10.1016/S0140-6736(08)61204-0.
16. Jump up^ "Nix-TB".TB Alliance.
17. Jump up^ Cohen,Jon (2017)."Simpler,safer treatment hailed as 'breakthrough'
againstdrug-resistantTB".Science.doi:10.1126/science.aal0769.
18. Jump up^ "CDC | TB | Fact sheets | Extensively Drug-ResistantTuberculosis
(XDR TB)".www.cdc.gov.Retrieved2017-01-30.
19. Jump up^ "Man Isolated withDeadly Tuberculosis Strain".NPR.
20. Jump up^ "Drug-proofTB strain poses ethicalbind-Health -Infectious
diseases _ NBC News.htm".
21. Jump up^ "TB Patient Flees U.S."Abuse"For Russia".
22. Jump up^ ( Flor de Lima, B, and M Tavares."Riskfactors forextensively drug-
resistanttuberculosis:a review." The Clinical Respiratory Journal8.1 (2013): 11-
23.)
23. Jump up^ ( Velayati AA,MasjediMR,Farnia P, TabarsiP,Ghanavi J, Ziazarifi
AH, HoffnerSE. Emergence of newforms of totally drug-resistant tuberculosis
bacilli: superextensively drug-resistant tuberculosis ortotally drug-resistant
strains in Iran.Chest.2009;136(2): 420–425.
24. Jump up^ (Shah NS, Pratt R, Armstrong L,Robison V, Castro K, Cegielski JP.
Extensively drug-resistant tuberculosis in the United States,1993–2007. JAMA.
2008;300(18): 2153–2160.)
25. Jump up^ (Murase Y, Maeda S,Yamada H, Ohkado A,Chikamatsu K, Mizuno
K, Kato S, MitaraiS. Clonalexpansion ofmultidrug-resistantand extensively
drug-resistant tuberculosis,Japan.Emerg Infect Dis.2010;16(6): 948–954.)
26. Jump up^ Alexander,PaulE;De, Prithwish(2017-01-30)."Theemergenceof
extensively drug-resistant tuberculosis (TB):TB/HIV coinfection,multidrug-
resistant TB and the resulting public health threat fromextensively drug-resistant
TB, globally and in Canada".The CanadianJournal ofInfectious Diseases&
Medical Microbiology. 18 (5):289–291.ISSN 1712-
9532.PMC 2533560.PMID18923728.
27. Jump up^ World Health Organisation (2006). Press release:"WHOGlobalTask
Force outlines measures to combat XDR-TBworldwide" [3]
28. Jump up^ "Report ofthe Meetingofthe WHO Global Task Force on XDR-
TB" (PDF). 2006.
29. Jump up^ Centers for Disease ControlandPrevention(2006)."Notice to
Readers:RevisedDefinitionofExtensively Drug-Resistant Tuberculosis".JAMA:
the Journalofthe AmericanMedical Association.American Medical
Association.296 (23):2792.doi:10.1001/jama.296.23.2792-a.Retrieved2009-
05-30.
30. ^ Jump up to:a b Gandhi,NR;Moll,A;Sturm,AW; Pawinski,Robert;Govender,
Thiloshini;Lalloo,Umesh;Zeller,Kimberly;Andrews,Jason;Friedland,Gerald
(2006)."Extensivelydrug-resistanttuberculosis as a cause ofdeath in patients
co-infectedwithtuberculosis and HIV in a rural area ofSouthAfrica". The
Lancet.368 (9547):1575–80.doi:10.1016/S0140-6736(06)69573-
1. PMID 17084757.
7. 31. Jump up^ Shah NS, Wright A,DrobniewskiF, et al..(2005). "Extreme drug
resistance in tuberculosis (XDR-TB): globalsurvey ofsupranationalreference
laboratories for_Mycobacteriumtuberculosis_with resistance to second-line
drugs".Int J Tuberc Lung Dis 9(Suppl 1): S77.
32. Jump up^ Centers;Control,Diseases (2006)."Emergence ofMycobacterium
tuberculosis withextensive resistance to second-line drugs-worldwide,2000-
2004".MorbMortal Wkly Rep. 55:301–5.
33. Jump up^ Angela Quintal."314XDR-TB cases reported in SA".Cape Times.
Retrieved on 2007-04-04.
34. Jump up^ Migliori,GB;Ortmann,J;Girardi,E."et al". (2007)."Extensively
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35. Jump up^ Sidley,P.(2006). "South Africaacts to curbspreadoflethalstrain of
TB".Br Med J. 333(7573):825.doi:10.1136/bmj.333.7573.825-
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External links[edit]
World Health Organization Stop TB Department
Stop TB Partnership
The Global Plan to Stop TB
Advocacy to Control TB Internationally - ACTION
International Standards of TB Care
Video: Drug-Resistant TB in Russia July 24, 2007, Woodrow Wilson
Center event featuring Salmaan Keshavjee and Murray Feshbach
XDRTB.org: Spread the Story. Stop the Disease. (photo documentary of
XDR-TB by James Nachtwey)
TB Drug Resistance Mutation Database
British Red Cross helps combat TB
Drug Resistant TB, a Nagging Challenge
The Strange, Isolated Life of a Tuberculosis Patient in the 21st Century
Population Services International
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