health information
Thrice weekly tuberculosis treatment category 1 and 11 patients of pulmonary tuberculosis Sub Directly Observed Therapy (DOTS)
three times per week for TB treatment in one category and 11 patients of pulmonary tuberculosis SUB Directly Observed Therapy (DOTS) in rural areas of Sindh, Pakistan.
Author:
DR: Ghulam Rasool BHURGRI
DR: Shamim-ur-Rehman
DR: Muhammad Momina TAKI
strong> DR: Shah Murad MASTOEE .
Dr. Raj Kumar Chohan.
DR: DAHR Ghulam Mustafa.
DR: Faisal Khan.
DR : Atif Sheikh.
SUMMARY:
OBJECTIVE:
The purpose of this study was three times weekly anti-tuberculosis treatment (ATT) for classes 1 and 11 patients of pulmonary tuberculosis directly observed therapy rate in order to save costs and time required for ATT.
Location and date:
This study was conducted in the TB clinic, conducted Muhammad Medical College Hospital Mirpurkhas, Sindh, Pakistan , July 2005-June 2007
Patients and methods:
outstanding results>:
After eight months in Category1 on 70 patients, 67 patients (96% ) were cured, 3 patients (4%) were smear positive at the start of ATT remained sputum positive. In the category 11 of the 60 patients, 53 patients (88%) were cured, 7 patients (12%) remained smear positive. Throughout the cure rate for both categories 1 and 11 was 92%.
CONCLUSION:
Three times a week ATT is as effective as daily administration of ATT. It needs to be given under strict DOTS strategy. It saves 65-7 -% of drug cost and time compared to the daily diet. words
words: Anti-tuberculosis treatment ATT
Directly Observed Therapy Short Course DOTS.
Address for correspondence:
(2) Dr: Ghulam Rasool Bhurgari
Assistant Professor
Department of Pharmacology and Therapeutics
Muhammad Medical College
Mirpurkhas, Pakistan
0333 2871918.
0345-3702876
drgr72@gmail.com E-mail / strong>
INTRODUCTION:
Almost a third of the world population or two billion people are infected with Mycobacterium tuberculosis and risk of the disease to develop. More than eight million people develop tuberculosis die (TB) and force every year, around one million people (2). This problem is even worse in Pakistan. There are no reliable data on the incidence and deaths caused by tuberculosis. It seems to rise every year. Although tuberculosis affects all classes of people, it is more common in poor countries, particularly in the productive age of 22-55 years, a large financial burden and hardship to their families.
DOTS (Directly Observed Therapy Short Course) was introduced in 1993 by the World Health Organization (WHO) declared TB a EMERGNCY GLOBAL recognition of the growing significance as a public health problem. (1)
component of case management, which ensures that the patients comply to treatment DOT.DOT means that health care workers or other designated person watches the patient swallow each dose of the drug against tuberculosis. DOT offers a detailed account of the quantity of drugs the patient has really taken out. DOT should be considered for all patients, because doctors often inexact match in predicting which patients with drug therapies on their own. DOT has been shown to be effective if the systems are sometimes used. DOT can significantly reduce the incidence of developing drug resistance and treatment failure or relapse after treatment. The treatment of drug-TB cons can be given if they are directly observable times. With the intermittent regimen repair of the total number of meetings with the health of workers, making these systems more viable. (3)
intermittent ATT, three times a week is as effective as daily therapy.Isoniazid rifampicin, pyrazinamide and streptomycin are effective when administered three times a week if administered daily. This result should not be surprising, since Mycobacterium tuberculosis double 18-24 hours, compared to 12-20 minutes for most bacteria (4).
DOTS has been used successfully in many countries of the UN. We conducted this study in points, the results of three days per week schedules to see better results at lower cost.
PATIENTS AND METHODS :
criteria for patient enrollment in the study:
1
. Patients, the World Health Organisation (WHO) diagnostic criteria for category 1 (patients who completed never been in treatment for tuberculosis) and category 11 (reprocessing, relapse, treatment failure, smear positive ATT took over a month and not reimbursed) pulmonary tuberculosis (WHO) programmed for the treatment of tuberculosis in 2003 National.
2
. Patients and their families has promised to come regularly three times a week for eight months.
130 patients were enrolled in first grade category11.Out study.70 patients and 60 patients of 70 patients in category 1, 40 patients (57%) were smear positive and 30 patients (43%) were smear negative.
Category 11 of 60 patients, 10 patients (17%) were previously used for 8 months, were treated six of these patients had smear positive.50 treatment broke after more than a month . In the category 11 of 36 patients (60%) had positive sputum ridges and 24 patients (40%) swabs were negative.
Among the 130 patients in total there were 70 men (54%) and 60 women (46%). Their ages ranged from 16 to 65 80% of patients were 20-55 years.
MANAGEMENT:
1 COUNCILLING:
A. The patient and his family have the TB disease has been informed of its distribution, course and treatment. Regular treatment for 8 months to heal the patient. improper treatment or discontinuation of treatment for eight months, will reduce TB resistant to the treatment and prognosis.
Food as advised, “all that exists to eat. Diet increases every day, some patients receive drugs to stimulate the appetite. Some patients need short courses of corticosteroids.
C. The focus has been on regular visits are not missed and to treatment. Patients and phone numbers of family and address were recorded.
2 Substance Abuse Treatment: All patients received treatment three days a week as part of the DOTS strategy. The drugs were just drugs and different doses were administered based on calculated weight of the patients by the WHO guidelines for the treatment of tuberculosis in 2003 for three days a week schedule recommended. given
strong> In a class in the early stages Rifamicin months, isoniazid, pyrazinamide and ethambutol were and were given during the continuation phase of six months Rifampcin, isoniazid and ethambutol.
received in the category of 11 patients during the initial period of two months Rifamicin, isoniazid, pyrazinamide, ethambutol and streptomycin. arrested early in the third month of streptomycin and four other drugs was continued. During the continuation of ionized phase of five months, rifampicin, ethambutol and continue
.
third During each visit:
a. The patient was followed immediately after their arrival by the greetings and asked about his health, family and work.
b. The temperature and the weight recorded. The patients do not gain weight were encouraged to grow food. Some have drugs that stimulate the appetite and get a little that corticosteroids.
v. A glass of water and medicine from
d. Any given co existing disease was treated.
e. When leaving the patient was reminded about the upcoming visit. If he can not come and medicine have been placed with a family member to give to patients under his supervision. The patient was the feeling that we care about him and want him to become better.
PROGRESS: X-ray of the chest, ESR, Hb soutum smear and AFB were at 2 months, 5 months and end of treatment, repeated eight months.
Results:
After the completion of eight months of ATT, have taken the following criteria in order to heal.
statistics
type a category
patients
categry two TB patients
seventy patients a cat
Patient
cat sixty two
three patients not missed
seven patients two cat
N
br />
60
70
60
3
br />
missing />
2
12
2
12
69
65
average
1.0000
2.0000
3.0000
4.0000
5.0000
6.0000
Std error / P>
0.00000
0.00000
0.00000
0.00000
0.00000
0.00000
1.0000
2.0000
3.0000
4 0000
5.0000
6.0000
0.00000
0.00000 br /> 0.00000
0.00000
0.00000 frequency table kind a category patients / p>
Cumulative percent / p> br /> Valid
Catone 70
97.2
100.0 missing
2 2.8
Total
72 categry two patients
Valid
catTwo
60 br /> 83.3
100.0
100.0
12 Total
72
100, 0 three patients not
Valid Percent / p>
valid / p> trees
3
4.2
100.0
100.0
69
95.8
Total 72 br /> 100.0 seven patients missed two cat
svn
9.7
100.0
100.0
Total / p>
72
100.0 frequencies VARIABLES =
Catone Senty catTwo sixty SVN tree / ORDER = analysis.
hours
0.00000
/>
percentage
100.0
100.0
7
<65 / p>
90.3
/ PieChart FREQ
chart
user
/ strong>
1 Smear negative for AFB on three occasions.
2 Opacities on chest X-rays had been approved, or healed by fibrosis and calcification.
3
. had gained weight.
. ESR fell to normal limits.
5 Hb increased.
6th Symptoms of the patients was free and did his thing.
Class 1 67 (96%) of 70 patients cured.3 patients (4%) positive sputum at the start of ATT had remained smear positive. In the category 11 of 53 patients (88%) were 60 cured.7 (12%) were sputum positive, as they were in early ATT. While all cure rate in both categories 1 and 11 was 92%.
DISCUSSION:
The general objective for the successful treatment of new smear is 85% or more (5). Successful treatment with DOTS is close to national 82% to 85% global target. (6) We have cure rates of 96% for class 1, class 88% in 11 patients with pulmonary tuberculosis and the overall cure rate in both categories 1 and 11 92% was achieved.
The result better than the global target for national programs by the WHO. Perhaps because our total number of patients was small, and few multi-resistant (MDR) were enrolled.
We believe that our high rate of recovery is due to the fact that during this trip, we do not leave a patient misses even a single dose of the medication. Council Ling at each visit was useful. We had to scare the patient if he is still missing a single dose of the medication, it will not be cured. He died coughing blood and helps no medicine.
patients were told that the success of inpatient treatment also of interest when they catch the illness of the patient.Diet also plays an important role:
at each visit the patient was weighed and advised to increase their daily food intake. Some very anorexic patients received steroids and antidepressants.
Dot give not only drugs under the supervision of the Peon. The doctor and his team win the confidence of treatment, the patient, patient care, sympathy, concern and courtesy, while the patient is not on his ATT complete without interruption. This increases the cure rate and reduce the development of MDR.CONCLUSION:
three days per week for an ATT group and 11 patients Pulmonary benign part of a strategy and strict DOTS strategy is effective and less costly than the half of my heart monitored diet.
If the entire plan to use drugs for eight months are 3 days per week compared to the daily diet for 8 months, a gain 65-70% of the cost and time.
This means that the amount allocated by the government for the fight against tuberculosis, up to three times more patients can be treated. This also means that only 40% sincere and dedicated staff can do better than now to be done.
Key Message:
a) All patients in Group 1 and 11 of pulmonary tuberculosis can be treated successfully with three days one week ATT plan under DOTS.
b) three days per week ATT saves 65-70% of the money and time,
c) can improve DOTS, if the results used with sincerity and devotion.
References:
a guideline for national TB control programs on the management of TB, World Health Day 2003
2 Dye C et al. The global burden of tuberculosis: estimated incidence, morbidity and prevelent on the country. JAMA 1999, 282 (7) :677-678
traffic Core 3 on the 4th Edition TB 200 SU Department of Health and of Human Services.
4 North RJ, Izzo AA, Mycobactrium virulence J.EXP.Med 1993:177 (6) from 1723 to 1733rd
5 A framework of the DOTS strategy for effective TB control WHO/CDS/TB/2002.297.Geneva: World Health Organization Global TB Programme, 2002.six global TB control, planning financing.WHOreport, 2005.> WHO/HTM/TB/2005.49.Geneva (Switzerland), World Health Org
Anorexia Treatment