2019年《ATS/CDC/ERS/IDSA临床实践指南:耐药结核病治疗》解读及与我国《耐药结核病化学治疗指南(2019年)》对比

作者介绍了《ATS/CDC/ERS/IDSA临床实践指南:耐药结核病治疗》的要点,包括耐药结核病治疗的药品、方案制定及疗程、异烟肼单耐药结核病的治疗、耐多药结核病接触者的治疗等;并与我国《耐药结核病化学治疗指南(2019年)》进行了对比,对于不同之处提出了自己的意见。     

国内《耐药结核病化学治疗指南(2019年)》与相关共识的特色及要点分析

作者针对国内《耐药结核病化学治疗指南(2019年)》(简称“《指南(2019)》”)与《中国耐多药结核病和利福平耐药结核病治疗专家共识(2019年版)》的异同进行具体分析,并与WHO相关指南进行比对,从药物的分组、抗结核治疗的实施路径、《指南(2019)》的特色与国内耐药结核病治疗研究的发展方向等方面进行阐述,为临床一线医师对指南的理解提供思路。     

世界卫生组织《结核病整合指南模块4：耐药结核病治疗2022年更新版》解读

世界卫生组织于2022年12月15日发布了《结核病整合指南模块4:耐药结核病治疗2022年更新版》。笔者介绍了更新版指南内容的要点，包括耐药结核病的治疗(重点是一个新的短程方案)、管理、患者关怀，以及治疗监测等方面的推荐意见，并就该指南在中国临床实践的可行性和未来研究方向提出了思考和讨论。     

耐药结核病处理指南简介

耐药结核病处理指南简介汪谋岳耐药结核病（ＤＲ－ＴＢ）是困扰结核病控制工作的一大难题。为了使全球对ＤＲ－ＴＢ的定义、预防、治疗等方面有个比较统一的认识，ＷＨＯ于１９９７年组织Ｃｒｏｆｔｏｎ等有关专家拟定了《耐药结核病处理指南》（《Ｇｕｉｄｅｌｉｎｅｆｏ...     

《WHO耐药结核病治疗指南(2016更新版)》药物分类要点

2015年11月,世界卫生组织(WHO)召集了多学科的结核耐药结核病专家,对耐药结核病的治疗策略进行了更新,并推出《WHO耐药结核病治疗指南(2016更新版)》,该指南对传统利福平耐药结核病(RR-TB)与耐多药结核病(MDR-TB)个体化方案中的抗结核药物进行重新分组和分类,即将药物分为A、B、C、D4组,其中A、B、C组为核心二线抗结核药物,D组为非核心附加药物,具体内容如下。     

修订版耐药结核病规划管理指南对中国耐药结核病防治工作的启示

耐药结核病是重大的公共卫生问题,也是社会问题.估计全球每年新发耐多药结核病(MDR-TB)患者50万例[1],我国每年新发MDR-TB患者约12万例[2].2006年,世界卫生组织(WHO)出版了"耐药结核病规划管理指南"(简称06版指南)[3],该指南对于推动全球耐药结核病的防治工作发挥了积极作用.近年来出现了广泛耐药结核病(XDR-TB)[4],其高病死率、低治愈率的特点引起人们的更多忧虑,同时,由于耐药结核病管理经验的不断积累和新的诊断、治疗及管理技术的应用,原有的06版指南已经难以满足目前的工作需要.     

耐药结核病化学治疗指南(2009)

耐药结核病,尤其耐多药结核病,是当今结核病防治工作中遇到的重大挑战。为了使耐药结核的化学治疗工作规范化,中国防痨协会于2002年编写发行了《耐多药结核病化学治疗的意见(试行)》。随着对耐药结核病认识的不断深入和耐药结核病化学治疗工作的进展,需要对其内容进行修改、扩展和完善。为此,中国防痨协会邀请肖和平、屠德华、朱莉贞、王黎霞、王文杰、端木宏瑾、成诗明、陈明亭、马玙、万利亚、周伯年、李仁忠和蒋建英等13位专家编写了《耐药结核病化学治疗指南(2009)》,为耐药结核病的治疗提供指导。希望防痨界各位同仁在实践中不断总结经验,使其更为完善。     

重视循证医学研究 在结核病国际指南中发出“中国声音”

<正>最近,2019版《WHO耐药结核病治疗指南》(简称"《2019指南》")正式发布~([1]),与前几版的耐药指南相比,《2019指南》几乎颠覆了既往指南中选取有效药物的策略,在国内广泛使用的二线药物如卷曲霉素、丙硫异烟胺等药物已完全被排斥于核心药物之外。虽然《2019指南》推荐的首选方案在结核病高负担国家的可操作性并不强,引起了包括中国在内的许多国家的专家的热议,但是纵观《2019指南》的制订过程,从制订小组的建立、文献的搜集,以及证据的分级等,都体现了严谨的科学态度和充足的依据。中国作为利福平耐药结核病疫情高发的国     

《耐药结核病化学治疗指南》修订工作研讨会在京召开

由中国防痨协会组织的《耐药结核病化学治疗指南》(简称《指南》)修订工作研讨会于2013年7月1日在北京潇湘大厦召开。中国防痨协会理事长王撷秀教授、中国防痨协会副理事长兼秘书长万利亚教授、中国防痨杂志副主编肖和平教授、中国防痨协会名誉理事长端木宏谨教授、中国防痨杂志前任主编屠德华教授、中国CDC结核病预防控制中心主任王黎霞教授、中国CDC结核病预防控制中心副主任成诗明教授、北京市结核病胸部肿瘤研究所马玙教授和初乃惠教授、中国CDC结核病预防控制中心耐药结核病项目办主任李仁忠教授、中国防痨协会朱桂林教授及中国防痨协会临床专业委员会副主任委员唐神结教授等参加了会议。     

世界卫生组织耐药结核病治疗整合指南(2020年版)解读

1993年结核病被世界卫生组织宣布为"全球公共卫生紧急事件"。在复杂和严峻的大背景下,世界卫生组织发布了耐药结核病治疗整合指南(2020年版),相信有助于加速推动终止结核病策略的进程,扭转当前耐药结核病防治的被动局面。本文分别从异烟肼耐药结核病、含贝达喹啉全口服短程方案治疗耐多药结核病(MDR-TB)和利福平耐药结核病(RR-TB)、长程方案治疗MDR/RR-TB、贝达喹啉-普托马尼(PA-824)-利奈唑胺新方案、治疗反应监测、人类免疫缺陷病毒阳性耐药结核病患者的抗逆转录病毒治疗、外科治疗及耐药患者的关怀和支持等方面进行解读,供读者借鉴。     

《中国学校结核病防控指南(2020 年版) 》重点问题解读与思考

学生是我国结核病防治工作的重点人群,学校结核病防控是校内传染病防控工作的重点、难点和热点。 为加强新形势下的学校结核病控制工作,国家卫生健康委、教育部制定下发了《中国学校结核病防控指南( 2020 年版)》。 本文针对该指南中学校结核病防控策略和措施、入学健康体检结核病筛查、学校结核病预警响应、接触者筛查和处置以及学生患者诊疗质量控制和管理等一些重点问题进行了解读和思考,为日常学校结核病防控工作提供参考。     

Tuberculosis burden in India and its control from 1990 to 2019: Evidence from global burden of disease study 2019

BackgroundTuberculosis is still a major public health problem in India. This study aims to assess trends in the burden of tuberculosis from 1990 to 2019 for tracking success of tuberculosis control programme in India.MethodsIn this study, the 2019 global burden of disease study data were used to measure the incidence, prevalence, mortality, and disability-adjusted life years lost (DALY)rates of Tuberculosis during 1990–2019 for India and its states. Age and gender-specific rates were also analyzed for India. All rates were age-standardized and 95% uncertainty intervals (UIs) were computed.ResultOverall incidence, prevalence, death and DALY of TB decreased in India from 1990 to 2019. Tuberculosis morbidity and mortality was higher in males as compared to females. Incidence of TB was low in children up to 14 years of age. Prevalence of TB was higher in females as compared to males till 29 years of age, whereas higher prevalence was reported in males as compared to females in adults aged 30 years and more. Death rate of TB was low in children and young adults up to 29 years of age.ConclusionThis study shows that overall incidence, prevalence, death and DALY of tuberculosis decreased from 1990 to 2019 in India. The burden of TB was higher among males as compared to females during study period. TB affects all the age groups but deaths were higher in older age groups.     

Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update)

Diabetic foot disease results in a major global burden for patients and the health care system. The International Working Group on the Diabetic Foot (IWGDF) has been producing evidence‐based guidelines on the prevention and management of diabetic foot disease since 1999. In 2019, all IWGDF Guidelines have been updated based on systematic reviews of the literature and formulation of recommendations by multidisciplinary experts from all over the world. In this document, the IWGDF Practical Guidelines, we describe the basic principles of prevention, classification, and treatment of diabetic foot disease, based on the six IWGDF Guideline chapters. We also describe the organizational levels to successfully prevent and treat diabetic foot disease according to these principles and provide addenda to assist with foot screening. The information in these practical guidelines is aimed at the global community of health care professionals who are involved in the care of persons with diabetes. Many studies around the world support our belief that implementing these prevention and management principles is associated with a decrease in the frequency of diabetes‐related lower extremity amputations. We hope that these updated practical guidelines continue to serve as reference document to aid health care providers in reducing the global burden of diabetic foot disease.     

Japan Society of Hepatology Guidelines for the Management of Hepatitis B Virus Infection: 2019 update

The Drafting Committee for Hepatitis Management Guidelines established by the Japan Society of Hepatology published the first version of the Guidelines for the Management of Hepatitis B in 2013 (first English version in 2014), and has since been publishing updates to the Guidelines as new drugs become available, with the latest original Japanese version being Version 3.1. Herein, the Drafting Committee publishes the second English version that contains all the changes made since the first English version of the guidelines was published in 2014. This 2019 version covers: (i) the nucleos(t)ide analogs, tenofovir disoproxil fumarate and tenofovir alafenamide; (ii) updates to treatment recommendations and management of drug‐resistant hepatitis B virus that reflect the new availability of these drugs; and (iii) new information about hepatitis B virus reactivation with each update. This latest update also contains information about treatment goals, indications for treatment and cessation of nucleos(t)ide analog therapy, most of which were covered by the first version.     

丙型肝炎防治指南(2019年版)

目的 为了规范和更新丙型肝炎的预防、诊断和抗病毒治疗,实现世界卫生组织提出的“2030年消除病毒性肝炎作为公共卫生威胁”目标,中华医学会肝病学分会和感染病学分会于2019年组织国内有关专家,以国内外丙型肝炎病毒感染的基础和临床研究进展为依据,结合现阶段我国的实际情况,更新形成了《丙型肝炎防治指南(2019年版)》,为丙型肝炎的预防、诊断和治疗提供重要依据。     

South Carolina Guidelines for Diabetes Care 2013

BackgroundThere is a huge economic burden of diabetes in South Carolina.MethodsThe South Carolina Guidelines for Diabetes Care were based on the 2013 Standards of Medical Care from the American Diabetes Association.ResultsFrom a review of the Diabetes Quality Indicators in South Carolina 2007, Medicare claims data show: 65% of South Carolinians with diabetes insured by Medicare received 2 A1C test per year, 54% received an eye examination and 78% received a lipid panel. Only 42% of these individuals with diabetes had all 3 tests in the same year. In addition, only 50% of individuals with diabetes in South Carolina attended a diabetes self-management class. To improve the statistics and outcomes, the Diabetes Advisory Council provided the evidence-based South Carolina Guidelines for Diabetes Care. They are based on the 2013 Standards of Medical Care from the American Diabetes Association. These guidelines have been promoted at the continuing education programs sponsored by the Diabetes Initiative of South Carolina and the South Carolina Division of Diabetes Prevention and Control and distributed in the community sites by the Racial and Ethnic Approaches to Community Health coalition.ConclusionsThe South Carolina Guidelines for Diabetes will provide evidence-based therapy and monitoring to minimize complications from diabetes and promote a higher quality of life for those with diabetes.     

新型冠状病毒肺炎患者4S呼吸康复指引

2019新型冠状病毒(2019-nCoV)感染的肺炎具有高度传染性,本文结合4S(simple,safe,satisfy,save)呼吸康复内容和2019新型冠状病毒肺炎的诊治标准,对2019-nCoV所致的肺炎患者提供可行的呼吸康复指引.     

Tuberculosis verrucosa cutis (TBVC)--foot with miliary tuberculosis

Tuberculosis Verrucosa Cutis (TBVC) or warty tuberculosis is a variant of cutaneous tuberculosis in patients with good cell mediated immunity (CMI) to Mycobacterium Tuberculosis, while Miliary Tuberculosis is associated with very poor CMI. Two widely different clinical presentations in the same patient are very rare and being reported.     

Major Global Coronary Artery Calcium Guidelines

This review summarizes the framework behind global guidelines of coronary artery calcium (CAC) in atherosclerotic cardiovascular disease risk assessment, for applications in both the clinical setting and preventive therapy. By comparing similarities and differences in recommendations, this review identifies most notable common features for the application of CAC presented by different cardiovascular societies across the world. Guidelines included from North America are as follows: 1) the 2019 American College of Cardiology/American Heart Association Guideline on the Primary Prevention of Cardiovascular Disease; and 2) the 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for Prevention of Adult Cardiovascular Disease. The authors also included European guidelines: 1) the 2019 European Society for Cardiology/European Atherosclerosis Society Guidelines for the Management of Dyslipidemias; and 2) the 2016 National Institute for Health and Care Excellence Clinical Guidelines. In this comparison, the authors also discuss: 1) the Cardiac Society of Australia and New Zealand Guidelines on CAC; 2) the Chinese Society of Cardiology Guidelines; and 3) the Japanese Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases. Last, they include statements made by specialty societies including the National Lipid Association, Society of Cardiovascular Computed Tomography, and U.S. Preventive Services Task Force. Utilizing an in-depth review of clinical evidence, these guidelines emphasize the importance of CAC in the primary and secondary prevention of atherosclerotic cardiovascular disease. International guidelines all empower a dynamic clinician-patient relationship and advocate for individualized discussions regarding disease management and pharmacotherapy treatment. Some differences in precise coronary artery calcium score intervals, risk cut points, treatment thresholds, and stratifiers of specific patient subgroups do exist. However, international guidelines employ more similarities than differences from both a clinical and functional perspective. Understanding the parallels among international coronary artery calcium guidelines is essential for clinicians to correctly adjudicate personalized statin and aspirin therapy and further medical management.