Treatment Outcomes of Isoniazid-Resistant (Rifampicin Susceptible) Tuberculosis Patients in Uzbekistan, 2017–2018

Tuberculosis patients “resistant to isoniazid and susceptible to rifampicin (Hr-TB)” remain neglected, despite a high burden and poor outcomes. The World Health Organization (WHO) recommends a 6 month regimen consisting of levofloxacin, rifampicin, ethambutol, and pyrazinamide (LRZE) to treat Hr-TB. In contrast, Uzbekistan uses a 9 month regimen (LRZE plus a second-line injectable in the first 3 months). We aimed to assess the treatment outcomes of this novel regimen among Hr-TB patients treated in two regions of Uzbekistan (Fergana and Bukhara) in 2017–2018. We conducted a cohort study involving secondary analysis of routine surveillance data. Of 132 Hr-TB patients, 105 (80%) were successfully treated. Death was the predominant unsuccessful outcome (13, 10%) followed by “treatment failure” (10, 8%) and “lost to follow-up” (4, 2%). High treatment success is an indicator of the potential effectiveness of the novel regimen and adds to the limited global evidence on this issue. However, the sample size was small and there was no comparison group. Since the study was conducted in two regions of Uzbekistan only, the findings have limited generalizability. We recommend future research using an adequate sample size and an appropriate study design (randomized controlled trial or prospective cohort with a control group receiving the WHO-recommended regimen).

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The effect of empirical and laboratory-confirmed tuberculosis on treatment outcomes

Scientific Reports ◽

10.1038/s41598-021-94153-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Osman Abdullahi ◽

Ngari Moses ◽

Deche Sanga ◽

Willetts Annie

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Clinical Signs ◽

World Health ◽

Routine Practice ◽

Public And Private ◽

Systematic Screening ◽

Tb Treatment ◽

Resource Limited ◽

Health Organization

AbstractThe World Health Organization (WHO) criteria for diagnosing and treating Tuberculosis (TB) includes clinical signs, therefore not requiring bacteriological laboratory confirmation. In resource-limited settings, including Kenya, this empirical TB treatment is routine practice however limited data exist on patient clinical outcomes when comparing the method of diagnosis. We evaluated TB treatment outcomes comparing clinically diagnosed and bacteriologically confirmed TB, 6 months after starting treatment of TB in a rural county in Kenya. Our analysis compared patients with a clinical versus a bacteriologically confirmed TB diagnosis. In this retrospective analysis, we included all adults (≥ 18 years) starting treatment of TB and followed up for 6 months, within the County TB surveillance database from 2012 to 2018. Patients included from both public and private facilities. The TB treatment outcomes assessed included treatment success, treatment failure, death, defaulted and transferred out. We used survival regression models to assess effect of type of diagnosis on TB treatment outcome defining time at risk from date of starting treatment to experiencing one of the treatment outcomes or completing 6-months of treatment. A total of 12,856 patients; median age 37 [IQR 28 − 50] years were included. 7639 (59%) were male while 11,339 (88%) were pulmonary TB cases. Overall, 11,633 (90%) were given first-line TB treatment and 3791 (29%) were HIV infected. 6472 (50%) of the patients were clinically diagnosed of whom 4521/6472 (70%) had a negative sputum/GeneXpert test. During the study 5565 person-years (PYs) observed, treatment success was 82% and 83% amongst clinically and bacteriologically diagnosed patients (P = 0.05). There were no significant differences in defaulting (P = 0.70) or transfer out (P = 0.19) between clinically and bacteriologically diagnosed patients. Mortality was significantly higher among clinically diagnosed patients: 639 (9.9%) deaths compared to 285 (4.5%) amongst the bacteriologically diagnosed patients; aHR 5.16 (95%CI 2.17 − 12.3) P < 0.001. Our study suggests survival during empirical TB treatment is significantly lower compared to patients with laboratory evidence, irrespective of HIV status and age. To improve TB treatment outcomes amongst clinically diagnosed patients, we recommend systematic screening for comorbidities, prompt diagnosis and management of other infections.

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Tianwang Buxin Granules Influence the Intestinal Flora in Perimenopausal Insomnia

BioMed Research International ◽

10.1155/2021/9979511 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Xiqian Yang ◽

Hesong Xiao ◽

Yi Zeng ◽

Liangliang Huang ◽

Ke Ji ◽

...

Keyword(s):

Clinical Trial ◽

Controlled Trial ◽

Intestinal Flora ◽

World Health ◽

Control Group ◽

Metagenomic Sequencing ◽

Clinical Trial Registry ◽

Clinical Trial Registration ◽

Faecalibacterium Prausnitzii ◽

Health Organization

Study Objectives. To study the relationship between perimenopausal insomnia (PI) and intestinal flora and the potential mechanism of Tianwang Buxin granules (TWBXG) in exerting its clinical efficacy. Methods. The subjects included 13 PI patients from the Hubei Provincial Hospital of TCM, Hubei University of TCM, and Wuhan Traditional Chinese Medicine Hospital, and the corresponding noninsomniac spouses of the patients were selected as controls. TWBXG was continuously administered for 4 weeks. The feces of PI patients and their noninsomniac spouses before and after treatment with TWBXG were collected. The intestinal flora composition of each group was detected by metagenomic sequencing, and the efficacy of TWBXG was evaluated by the PSQI scale. Results. Compared with the control group, the model group showed an increase in the abundance of Roseburia faecis, Ruminococcus, Prevotella copri, Fusicatenibacter saccharivorans, and Blautia obeum, while those of Bacteroides, fecal Bacteroidetes, and Faecalibacterium prausnitzii were decreased. Compared with pretreatment, the PSQI score was significantly reduced ( P < 0.05 ), the abundance of Bacteroides, fecal Bacteroidetes, and Faecalibacterium prausnitzii increased, and that of Roseburia faecis, Ruminococcus, Prevotella copri, Fusicatenibacter saccharivorans, and Blautia obeum decreased after treatment. However, there was still a certain gap in the abundance of related flora in the treatment group compared with the control. Conclusion. PI is associated with disturbances in the intestinal flora and is mainly related to the disorders of Roseburia faecis, Ruminococcus, Prevotella copri, Fusicatenibacter saccharivorans, Blautia obeum, Bacteroides, fecal Bacteroidetes, and Faecalibacterium prausnitzii. TWBXG can effectively treat PI, and its effect may be achieved by regulating the disordered intestinal flora. Clinical Trials. The study was registered in the Chinese clinical trial registry and approved by the World Health Organization clinical trial registration platform (Effects of the modified Tianwang Buxin granule and modified Tianwang Buxin decoction pieces on insomnia: a randomized, controlled trial, ChiCTR-IPR-17011549).

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565. Tocilizumab Use in COVID-19: Act(emra) to Inhibit Intubation and Decompensation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.759 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S347-S348

Author(s):

Debra M Willner ◽

Victoria Bengualid ◽

Ilanit Zada ◽

Judith Berger ◽

Nigam Patel

Keyword(s):

Treatment Failure ◽

Sample Size ◽

Treatment Outcomes ◽

Inflammatory Markers ◽

Treatment Success ◽

Small Sample ◽

Control Group ◽

Respiratory Status ◽

Baseline Characteristics ◽

Overall Mortality

Abstract Background Tocilizumab is an IL-6 receptor inhibitor that has been utilized for the prevention and treatment of the cytokine storm inflammatory reaction in COVID-19. The objectives of this analysis were to evaluate clinical outcomes of tocilizumab treatment in relation to respiratory status improvements and to analyze the association between initial inflammatory markers and treatment outcomes. Methods IRB approved retrospective chart review of adult patients with confirmed COVID-19 treated with tocilizumab from March- May 2020. Data collection focused on relevant past medical history, hematologic and inflammatory markers before and after tocilizumab administration, concomitant COVID-19 treatments, and disease outcomes such as mortality and discharge. Assessed baseline characteristics and treatment outcomes in patients who received tocilizumab prior to intubation versus after intubation, and evaluated for any significant markers of treatment success and failure. Results 84 patients were evaluated. Baseline characteristics did not vary between intubated and not intubated patients (Figure 1). Overall mortality in patients who received an IL-6 inhibitor was 43%. Mortality in patients who received IL-6 inhibitor when intubated (63%) compared to patients who were not intubated (26%) was significantly higher (p = 0.005). Patients with BMI’s of 30 or above and patients with diabetes had a higher rate of treatment failure (p < 0.05) (Figure 2). Patients with IL-6 levels of 1000 or above had higher rates of treatment failure (p = 0.0001); however, given the small sample size larger studies are required for further analysis (Figure 3). Baseline Characteristics by Respiratory Status Pre-Tocilizumab Administration Subgroup Analysis Outcome by Baseline IL-6 Levels Conclusion Overall mortality in our patients was 43%; however, our sample size was small and the study did not have a control group to fully assess treatment success or failure. Comorbidities such as diabetes and obesity, and elevated IL-6 levels were associated with significantly higher rates of treatment failure. Randomized control trials are needed to determine the true benefit of tocilizumab in COVID-19. Disclosures All Authors: No reported disclosures

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Tuberculosis Notification Trends and Treatment Outcomes in Penitentiary and Civilian Health Care Sectors in the WHO European Region

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18189566 ◽

2021 ◽

Vol 18 (18) ◽

pp. 9566

Author(s):

Andrei Dadu ◽

Ana Ciobanu ◽

Araksya Hovhannesyan ◽

Natavan Alikhanova ◽

Oleksandr Korotych ◽

...

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

World Health ◽

European Region ◽

Correctional Institutions ◽

Success Rates ◽

Relative Risks ◽

Average Annual Change ◽

Health Organization ◽

Substantial Decline

Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to ending TB in the World Health Organization (WHO) European Region. Objectives and design: a comparative analysis of TB notification rates during 2014–2018 and of treatment outcomes in the civilian and penitentiary sectors in the WHO European Region, with an assessment of risks of developing TB among people experience incarceration. Results: in the WHO European Region, incident TB rates in inmates were 4–24 times higher than in the civilian population. In 12 eastern Europe and central Asia (EECA) countries, inmates compared to civilians had higher relative risks of developing TB (RR = 25) than in the rest of the region (RR = 11), with the highest rates reported in inmates in Azerbaijan, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, and Ukraine. The average annual change in TB notification rates between 2014 and 2018 was −7.0% in the civilian sector and −10.9% in the penitentiary sector. A total of 15 countries achieved treatment success rates of over 85% for new penitentiary sector TB patients, the target for the WHO European Region. In 10 countries, there were no significant differences in treatment outcomes between civilian and penitentiary sectors. Conclusion: 42 out of 53 (79%) WHO European Region countries reported TB data for the selected time periods. Most countries in the region achieved a substantial decline in TB burden in prisons, which indicates the effectiveness of recent interventions in correctional institutions. Nevertheless, people who experience incarceration remain an at-risk population for acquiring infection, developing active disease and unfavourable treatment outcomes. Therefore, TB prevention and care practices in inmates need to be improved.

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Effectiveness and cost-effectiveness of brief Mindfulness-Based Cognitive Therapy for the improvement of productivity in the workplace: Study protocol for a randomized controlled trial (Preprint)

10.2196/preprints.36012 ◽

2021 ◽

Author(s):

Mitsuhiro Sado ◽

Masashi Yamada ◽

Akira Ninomiya ◽

Maki Nagaoka ◽

Naho Goto ◽

...

Keyword(s):

Cost Effectiveness ◽

Cognitive Therapy ◽

Work Performance ◽

Controlled Trial ◽

Self Report ◽

World Health ◽

Control Group ◽

Work Related ◽

Health Organization ◽

The Impact

BACKGROUND Numerous studies have demonstrated the effectiveness of Mindfulness Based Programs’ (MBPs) among both clinical and non-clinical populations. These data document positive impacts in the workplace, including reducing perceived stress and burnout and increasing wellbeing. However, the effectiveness for productivity, which is of most interest to managers and administrators, is still unclear. In addition, MBPs in the workplace tend to be modified by reducing the number of the program sessions or delivering content online to improve accessibility. To date, however, the impact on productivity of MBPs in the workplace that feature these modifications has not been investigated. OBJECTIVE The study aimed to investigate the effectiveness and cost-effectiveness of the online-delivered brief Mindfulness Based Cognitive Therapy (bMBCT) for improving productivity and other work related outcomes. METHODS We conduct a four-week RCT with a six-month follow-up. Employees are included in the study if they 1) are between the ages of 20-65 and 2) work longer than 30 hours weekly. Employees were randomly allocated to either the bMBCT group or wait-list control group. The primary outcome of the study is the mean difference of productivity measured by World Health Organization Health and Work Performance Questionnaire (WHO-HPQ) between the groups at 4, 16, 28 weeks. Secondary outcomes include several clinical outcomes and health economics evaluation. RESULTS Recruitment began in August 2021. 104 participants have been enrolled in the study as of October 2021. The intervention is ongoing and scheduled to be completed in December 2023. Data collection will be completed by March 2024. CONCLUSIONS The novelty of the study is that 1) it will investigate the bMBCTs’ effectiveness on productivity, which is still unclear, 2) samples are recruited from three companies in different industries, etc. The limitations of the study are 1) all measures assessed are self-report format, 2) we lack an active control group. This study has the potential to provide new data on the relationship between MBPs and occupational health and productivity. CLINICALTRIAL UMIN Clinical Trials Registry: UMIN000044721

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Psychoeducation Group on Improving Quality of Life of Mild Cognitive Impaired Elderly

Research on Social Work Practice ◽

10.1177/1049731517732420 ◽

2017 ◽

Vol 29 (3) ◽

pp. 303-310 ◽

Cited By ~ 1

Author(s):

Daniel Kim-wan Young ◽

Petrus Yat-nam Ng ◽

Daphne Cheng

Keyword(s):

Quality Of Life ◽

Treatment Group ◽

Controlled Trial ◽

T Test ◽

World Health ◽

Control Group ◽

World Health Organization Quality ◽

Life Measure ◽

Health Organization

Purpose: This research study aims to evaluate the effectiveness of a psychoeducation group, which is founded on an Eastern approach to health care, in improving the quality of life of Chinese people with mild cognitive impairment (PwMCI). Method: In a randomized controlled trial (RCT), 40 Chinese PwMCI were randomly assigned to either a 10-session psychoeducation group or the control group. Results: A paired sample t test indicated that the treatment group ( n = 18) showed significant improvement in their World Health Organization Quality of Life Measure (WHOQOL) score, while the control group ( n = 22) did not. Moreover, an independent t test showed that the treatment group was more effective than the control group to improve their WHOQOL score. A reduction in the depressive symptoms was related to the improvement in WHOQOL score. Conclusions: This RCT provides evidence to support the feasibility and effectiveness of psychoeducation groups for improving the overall quality of life of PwMCI.

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Comprehensive Stroke Education Program (CSEP) on Knowledge and Quality of Life among Patients with Stroke and Burden among Caregivers

Nursing and Health Care ◽

10.33805/2573-3877.142 ◽

2019 ◽

pp. 71-80

Author(s):

Baminidevi Nagarajan

Keyword(s):

Quality Of Life ◽

Controlled Trial ◽

World Health ◽

Control Group ◽

Study Group ◽

Level Of Knowledge ◽

The Mean ◽

Health Organization ◽

And Control

Stroke is a global health problem. Rehabilitation is a major part of patient care. The statistics on Cerebrovascular Accident (CVA) quoted by world health organization projects that nearly 15 million people suffer from stroke worldwide each year. Of these, 5 million die and another 5 million are permanently disabled. High blood pressure contributes to more than 12.7 million strokes worldwide. Study objectives were to determine the effectiveness of CSEP on knowledge and Quality of Life (QoL) among patients with stroke and to evaluate the effectiveness of CSEP on knowledge and burden among caregivers. This study was conducted at Sri Ramachandra Medical Centre (SRMC), Chennai-600 116. It is a 1675 bedded multi-specialty hospital. The pretest was conducted in neurology wards and the posttest was conducted at neurology OPD. Permission obtained from ethical committee. Randomized controlled trial research method was adopted. Sample size was 170 dyads (patient+caregiver) in those 85 dyads in each group were recruited by lottery method. Following pretest, CSEP was implemented to the study group dyads. Posttests were taken on 30th day, 90th day and 180th day at neurology OPD for both the groups. Comparison of mean scores of knowledge on stroke between the study and control group showed the level of knowledge found to be high among study group patients at p<0.001. The mean scores of ADL in the study group was statistically significant at p<0.05 level. The mean scores of Physical Component Summary (PCS) and Mental Component Summary (MCS) showed statistically significant at p<0.05. Overall mean scores of Stroke Specific Quality of Life (SSQOL) in the study group were found to be significant at p<0.01. Study group caregiver’s knowledge on stroke was statistically significant at p<0.01. The burden mean scores were higher among control group than the study group caregiver.

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Treatment outcomes of Gene Xpert positive tuberculosis patients in KwaMashu Community Health Centre, KwaZulu-Natal, South Africa: A retrospective review

Southern African Journal of Infectious Diseases ◽

10.4102/sajid.v36i1.217 ◽

2021 ◽

Vol 36 (1) ◽

Author(s):

Sarusha Pillay ◽

Nombulelo P. Magula

Keyword(s):

Treatment Outcomes ◽

Treatment Success ◽

Multiple Logistic Regression Analysis ◽

Health Centre ◽

World Health ◽

Unsuccessful Treatment ◽

Kwazulu Natal ◽

Sputum Conversion ◽

Health Organization ◽

Lost To Follow Up

Background: We sought to investigate the relationship between tuberculosis (TB) treatment outcomes and its predictors in the KwaMashu region in KwaZulu-Natal (KZN). This area is currently a hotbed for TB and human immunodeficiency virus (HIV) co-infection.Method: A retrospective study design was adopted to characterise adult patients diagnosed with Gene Expert (GXP) positive pulmonary TB from 01 January 2016 to 31 December 2017. Tuberculosis treatment outcomes were assessed after two months and five months according to the standard World Health Organization (WHO) criteria. Multiple logistic regression analysis was used to calculate the odds ratio (OR) of the possible determinants associated with unsuccessful treatment outcomes.Results: Amongst the 596 patients diagnosed, 57.4% (95% confidence interval [CI]: 53.3–61.4; 342 of 596) had successful treatment outcomes. Of these reported cases, 88.89% (85.1–92.0; 304 of 342) were cured. For the unsuccessful treatment outcomes, 52.4% (46.0–58.6; 133 of 254) patients were lost to follow-up, 20.9% (16.0–26.4; 53 of 254) failed treatment, 1.2% (0.2–3.4; 3 of 254) died and 25.6% (20.3–31.4; 65 of 254) of the patients could not be accounted for. Patients with unknown HIV status were more likely to have unsuccessful treatment outcomes (adjusted OR [aOR] = 4.94 [1.83–13.36]). Patients who had sputum conversion at 2 months (aOR = 1.94 [1.27–2.96]) were significantly more likely to exhibit unsuccessful treatment outcomes.Conclusion: Treatment success rate was 57.4% which was below the target set by the WHO. This underscores the urgent need to strengthen treatment adherence strategies to improve outcomes, especially in high HIV burden settings.

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Effectiveness of the World Health Organization Safe Childbirth Checklist (WHO-SCC) in preventing poor childbirth outcomes: a study protocol for a matched-pair cluster randomized control trial

BMC Public Health ◽

10.1186/s12889-021-11673-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tieba Millogo ◽

Kadidiatou Raïssa Kourouma ◽

Aïssatou Diallo ◽

Marie Laurette Agbre-Yace ◽

Mamadou Diouldé Baldé ◽

...

Keyword(s):

Low Cost ◽

Controlled Trial ◽

Healthcare Providers ◽

World Health ◽

Matched Pair ◽

Control Group ◽

Safe Childbirth Checklist ◽

Cluster Randomized ◽

Health Organization ◽

Safe Childbirth

Abstract Background Women delivering in health facilities in sub-Saharan Africa and their newborns do not always receive proven interventions needed to prevent and/or adequately manage severe complications. The gaps in quality of care are increasingly pointed out as major contributing factor to the high and slow declining perinatal mortality rates. The World Health Organization Safe Childbirth Checklist (WHO-SCC), as a quality improvement strategy, targets low cost and easy to perform interventions and suits well with the context of limited resource settings. In this matched-pair cluster randomized controlled trial, we assess the effectiveness of the WHO-SCC in improving healthcare providers’ adherence to best practices and ultimately improving childbirth outcomes. Methods This is a multi-country study. In each country we will carry out a matched-pair cluster randomized controlled trial whereby four pairs of regional hospitals will be randomized on a 1:1 basis to either the intervention or control group. A context specific WHO-SCC will be implemented in the intervention facilities along with trainings of healthcare providers on best childbirth practices and ongoing supportive supervisions. The standard of care will prevail in the control group. The primary outcome is a summary composite metric that combine the following poor childbirth outcomes: stillbirths, maternal deaths, early neonatal deaths, severe postpartum hemorrhage, maternal infections, early neonatal infections, prolonged obstructed labor, severe pre-eclampsia, uterine rupture in the health facility, eclampsia and maternal near miss. The occurrence of these outcomes will be ascertained in a sample of 2530 childbirth events in each country using data extraction. A secondary outcome of interest is the adherence of healthcare providers to evidence best practices. This will be measured through direct observations of a sample of 620 childbirth events in each country. Discussion Our study has the potential to provide strong evidence on the effectiveness of the WHO-SCC, a low cost and easy to implement intervention that can be easily scaled up if found effective. Trial registration The trial was registered in the Pan-African Clinical Trials Registry on 21st January 2020 under the following number: PACTR202001484669907. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9662

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Goal Attainment and Treatment Compliance in a Cognitive-Behavioral Telephone Intervention for Family Caregivers of Persons with Dementia

GeroPsych ◽

10.1024/1662-9647/a000043 ◽

2011 ◽

Vol 24 (3) ◽

pp. 115-125 ◽

Cited By ~ 18

Author(s):

Gabriele Wilz ◽

Denise Schinköthe ◽

Renate Soellner

Keyword(s):

Family Caregivers ◽

Mentally Ill ◽

Goal Attainment ◽

Outcome Measurement ◽

Controlled Trial ◽

Treatment Success ◽

Treatment Compliance ◽

Control Group ◽

Telephone Intervention ◽

Effective Interventions

Introduction: The evaluation of effective interventions is still needed to prevent family caregivers of persons with dementia from becoming physically or mentally ill. However, in most existing intervention studies, primary outcomes are not well matched to the treatment goals. Method: A randomized controlled trial (N = 229) was conducted to compare a treatment group (CBT), a treated control group, and an untreated control group. In theses analyses we focused on the primary outcome measurement (GAS) as a perceived treatment success as well as treatment compliance and participants’ evaluation. Results: Results showed that 30.1% achieved complete goal attainment, 39.8% partial goal attainment, and 24.1% declared no change (overachievement 2.4%; deterioration 3.6%). Discussion: The intervention can be considered to have been successful.

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