A comparative analysis of the epidemic characteristics of tuberculosis in elderly and non-elderly in Jing’an District,Shanghai from 2014 to 2019

目的 通过分析上海市静安区老年(≥60岁)与非老年(<60岁)肺结核患者的流行特征,为老年结核病的防治提供参考依据。方法 从《中国疾病预防控制信息系统》的子系统《结核病管理信息系统》导出静安区2014年4月1日至2019年3月31日登记为首次管理、病种为“肺结核”的患者病案信息、诊疗情况、0月序时的实验室及影像学检查、治疗效果及转归等。再将患者病案信息按照年龄≥60岁(≥60岁组)和<60岁(<60岁组)分别整理统计,对比分析两组肺结核患者的特征。结果 2014年4月1日至2019年3月31日,全人群共登记肺结核患者1563例,其中≥60岁组患者555例(35.51%),5年来构成比由27.62%(95/344)上升至41.30%(114/276),呈上升趋势(χ²=7.501,P=0.006)。≥60岁组患者中,本市户籍[95.86%(532/555)]、男性[74.59%(414/555)]明显高于<60岁组患者[分别为61.71%(622/1008)、68.35%(689/1008)](χ²=2.160、6.713;P=0.000、0.010)。静安区≥60岁组与<60岁组肺结核患者的主要来源均以因症就诊[分别为67.21%(373/555)和69.35%(699/1008)]及转诊[30.27%(168/555)和28.37%(286/1008)]等被动发现方式为主。≥60岁组患者在并发其他疾病[26.13%(145/555)]、病原学检测阳性[46.67%(259/555)]、复治[14.59%(81/555)]、0月序痰涂片阳性[41.62%(231/555)]和胸部X线摄影(简称“胸片”)检查异常[99.10%(550/555)]等方面均高于<60岁组[分别为14.19%(143/1008)、35.32%(356/1008)、9.23%(93/1008)、25.69%(259/1008)、96.73%(975/1008)](χ²值分别为33.946、19.318、10.427、42.189、8.496;P值分别为0.000、0.000、0.001、0.000、0.004)。≥60岁组患者在2个月末痰涂片阴转率[73.59%(170/231)]、治愈或完成疗程率[80.18%(445/555)]等方面均低于<60岁组[分别为85.33%(221/259)、92.86%(936/1008)](χ²值分别为10.430、57.199;P值分别为0.001、0.000)。结论 静安区全人群登记肺结核患者逐年下降,而老年登记肺结核患者占比高且逐年上升,应重点关注本市户籍、男性、并发基础疾病的老年人群,并结合该类人群的痰菌检测及胸片检查阳性率高、治疗效果差等特点积极开展主动筛查和规范治疗。     

Misdiagnosis of tuberculosis and the clinical relevance of non—tuberculous mycobacteria in Zambia

ObjectiveTo determine the accuracy of TB diagnosis of TB in Zambia in the era of increasing HIV prevalence.MethodsSputum of the clinically diagnosed TB cases was additionally subjected to liquid culture and molecular identification. This study distinguished between TB cases confirmed by positive Mycobacterium tuberculosis (M. tuberculosis) cultures and mycobacterial disease caused by non-tuberculous mycobacteria (NTM).ResultsOnly 49% of the 173 presumptively diagnosed TB cases was M. tuberculosis cultured, while in 13% (22) cases, a combination of M. tuberculosis and NTM was found. In 18% of the patients only NTM were cultured. In 28%, no mycobacteria was cultivable. HIV positive status was correlated with the isolation of NTM (P <0.05).ConclusionsThe diagnosis of tuberculosis based on symptoms, sputum smear and/or chest X-ray leads to significant numbers of false-positive TB cases in Zambia, most likely due to the increased prevalence of HIV. The role of NTM in tuberculosis-like disease also seems relevant to the false diagnosis of TB in Zambia.     

Where is Malaysia in the midst of the Asian epidemic of diabetes mellitus?

Population studies all over the world have clearly showed that the prevalence of Type 2 diabetes mellitus (DM) is escalating at phenomenal scale and very likely we are heading towards epidemic proportions. In 1985, the estimated population of diabetic individuals in the world was 30 million but by 1995 this figure soared to 135 million. Based on current trends, epidemiologists predict that the population of diabetic individuals will swell up to a staggering 300 million by the year 2025. Almost half of that will be in the Asia Oceania region alone. Dr Hilary King of WHO pointed out that there will be a projected rise of about 42% in developed countries whereas the developing countries will see an escalation to the magnitude of 170% (H. King, R.E. Aubert, W.H. Herman, Global burden of diabetes, 1995-2025: prevalence, numerical estimates and projections, Diabetes Care 21 (1998) 1414-1431; WHO Health Report 1997, WHO Switzerland). There will be a 3-fold rise of the disease in Asia and much of these will be seen in China (40 million) and India (55 million) by virtue of the massive population of these countries. Nevertheless, the other rapidly developing Asian nations like Singapore, Malaysia, Thailand and those making up Indochina will experience the surge. At the same time the prevalence and incidence of diabetes complications will also increase. Based on recent WHO prediction (WHO Newsletter, The global burden of diabetes 1995-2025. World Diabetes 3 (1997) 5-6), it is estimated that by the year 2000 the following figures will be seen:Diabetes complications are major causes of premature death all over the world and most of these are avoidable. DCCT and UKPDS are landmark studies showing strong evidence that major complications can be drastically reduced by maintaining to near normoglycaemic control.     

Differentiation of Crohn’s disease from intestinal tuberculosis in India in 2010

Differentiating intestinal tuberculosis from Crohn’s disease (CD) is an important clinical challenge of considerable therapeutic significance. The problem is of greatest magnitude in countries where tuberculosis continues to be highly prevalent, and where the incidence of CD is increasing. The final clinical diagnosis is based on a combination of the clinical history with endoscopic studies, culture and polymerase chain reaction for Mycobacterium tuberculosis, biopsy pathology, radiological investigations a...     

Is the BCG test of diagnostic value in tuberculosis?

Setting: In developing countries including Turkey, tuberculosis is still a major problem. Rapid diagnosis and early medical intervention are the two most important considerations in preventing the spread of the disease.Objective: This study was carried out to determine the diagnostic value of BCG test in childhood tuberculosis and compare it with tuberculin test in this regard.Design: 50 patients and 20 healthy children without any evidence of previous BCG vaccination and aged 80 days-15 years were simultaneously tested with purified protein derivative (PPD) and BCG vaccine.Results: In pulmonary tuberculosis BCG test was positive in 100% of cases and the PPD test in 44.5%. Similarly, BCG test was positive in 100% of miliary tuberculosis and tuberculous meningitis cases but PPD test was negative in all of them. Out of 22 patients with malnutrition 18 (82%) had positive BCG test and 4 had positive PPD test. BCG test showed uniformly high positivity in all grades of malnutrition.Conclusion: BCG is more reliable and sensitive than the tuberculin test in the diagnosis of tuberculosis. It is still valuable in the diagnosis of tuberculosis especially in developing countries where the disease is still a major public health problem and where sophisticated methods such as rapid culture with BACTEC and demonstration of bacilli with DNA probes are not widely available.     

What is the significance of the HPV epidemic?

Human papillomavirus (HPV) is the most common sexually transmitted infection. The incidence of this infection has been on the rise in recent times. It is estimated that approximately 6 million new HPV infections are acquired each year in the United States alone, and prevalence data suggest that as many as 24 million American adults--that is, 1 in 5--may be infected with HPV. Unfortunately, there is little public awareness and knowledge about the infection and its sequelae. It is well known that more than 90% of cases of anogenital warts are caused by HPV. HPV has been implicated in cancers of the cervix, vulva, vagina, penis, anus, and oropharynx. The virus is a necessary cause of cervical cancer. HPV DNA is detected in almost 100% of cases of cervical cancer. There have been major strides in recent years in the prevention of this infection and consequently, of diseases related to it. Vaccines are available and licensed in some countries. Two HPV vaccines are available: a quadrivalent (HPV types 6, 11, 16, and 18) vaccine and a bivalent (HPV types 16 and 18) vaccine. Both vaccines show a more than 90% protection against persistent HPV infection for up to 5 years after vaccination. The role of the vaccine in males is still controversial. The vaccination cost, however, is beyond the reach of many individuals in developing countries where 80% of cervical cancer cases of are found. Many countries in Africa are battling with HIV, malaria, tuberculosis, maternal mortality, and childhood illness. Nevertheless, with increased awareness, political will, and engagement by pharmaceutical countries, HPV vaccines may become affordable in these countries.     

Characteristics of immune function in the acute phase of Henoch-Schönlein purpura

Clinical Rheumatology - Henoch-Schönlein purpura (HSP) is still diagnosed using symptoms and signs together with some histopathological findings. The purpose of this study was to summarize the...     

Epidemiological analysis of the quality of HIV sero-surveillance in the world: how well do we track the epidemic?

OBJECTIVE: The objective of this paper was to analyse the quality of HIV/AIDS sentinel surveillance systems in countries and the resulting quality of the data used to make estimates of HIV/AIDS prevalence and mortality. METHODS: Available data on sero-surveillance of HIV/AIDS in countries were compiled in the process of making the end of 1999 estimates of HIV/AIDS. These data came primarily from the HIV/AIDS Surveillance Database developed by the United States Census Bureau, from a database maintained by the European Centre for the Epidemiological Monitoring of AIDS and all country reports on sentinel surveillance that had been provided to World Health Organization or UNAIDS. Procedures were developed to score quality of surveillance systems based on four dimensions of quality: timeliness and frequency; appropriateness of groups; consistency of sites over time; and coverage provided by the system. In total, the surveillance systems from 167 countries were analysed. RESULTS: Forty-seven of the 167 countries whose surveillance systems were rated were judged to have fully implemented sentinel surveillance systems; 51 were judged to have systems that had some or most aspects of a good HIV surveillance system in place and 69 were rated as having poorly functioning or non-existent surveillance systems. CONCLUSION: This analysis suggests that the quality of HIV surveillance varies considerably. The majority of countries most affected by HIV/AIDS have systems that are providing sufficient sero-prevalence data for tracking the epidemic and making reasonable estimates of HIV prevalence. However, many countries have poor systems and strengthening these is an urgent priority.