Low prevalence of diabetes mellitus in patients with tuberculosis in Cotonou,Benin

Setting: The three Basic Management Units (BMUs) of the National Tuberculosis Programme (NTP) in Cotonou, Benin.Objective: To determine the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients in Cotonou.Design: A cross-sectional study of consecutively registered TB patients treated for a minimum of 2 weeks between June and July 2014 in the three BMUs, with measurement of their fasting blood glucose (FBG). A patient was considered as having DM if venous FBG was ⩾7 mmol/l or if they reported a known history of DM.Result: There were 159 patients assessed: 114 with new smear-positive pulmonary tuberculosis (PTB), 5 with new smear-negative PTB, 8 with extra-pulmonary TB, 21 retreatment patients with fully susceptible bacilli and 11 with multidrug-resistant TB. Of these, respectively 31 (19%), 18 (11%) and 10 (6%) were human immunodeficiency virus co-infected, smokers and hypertensive. Eight patients (5%) had impaired fasting glucose and three (1.9%) had DM (FBG ⩾ 7 mmol/l), of whom two were already known to have the disease and one was newly diagnosed.Conclusion: DM may not be an important risk factor for TB in Cotonou. A larger study on TB and DM in the whole country is needed.     

The burden and treatment outcomes of extra-pulmonary tuberculosis in Bhutan

Setting:

All tuberculosis (TB) registration sites in Bhutan.

Design:

Cross-sectional study involving a retrospective review of TB registers and TB treatment cards.

Objectives:

To determine: 1) the number and proportion of all TB cases registered as extra-pulmonary TB (EPTB) from 2001 to 2010, 2) the age and sex of the patients and the categories and types of EPTB registered in 2010, and 3) their treatment outcomes.

Results:

The proportion of all TB cases registered as EPTB over a period of 10 years varied from 30% to 40%. In 2010, 505 patients were registered with EPTB, of whom 50% were male, 21% were children, and 96% were new EPTB cases. TB lymph node enlargement and pleural effusion were the two most common types of EPTB, accounting for 67%, followed by abdominal TB and spinal/bone/kidney disease. The overall treatment success rate was 90%, and was generally similar with respect to sex, age and different types of EPTB.

Conclusion:

Bhutan has a high proportion of patients registered as having EPTB, for whom treatment outcomes are satisfactory. Further work is needed to better understand how EPTB is diagnosed throughout the country.     

Childhood tuberculosis in Bhutan: profile and treatment outcomes

Setting:

All hospitals and health centres under the National Tuberculosis Control Programme (NTCP) in Bhutan.

Objective:

To describe the number and proportion of childhood tuberculosis (TB) cases registered under the NTCP in 2010, their demographic and clinical characteristics and any associations with treatment outcomes.

Design:

Retrospective cohort study involving a review of TB treatment cards and registers.

Results:

Of 1332 TB cases registered, 187 (14%) were children aged <15 years, 75 (40%) were aged <5 years, and 180 (96%) were new cases; nearly half were extra-pulmonary TB, with lymphadenitis being the most common form. The overall treatment success rate was 93%, and none of the demographic and clinical characteristics were associated with treatment outcomes. A few recording deficiencies were identified.

Conclusion:

TB in children is well recognised in Bhutan, and their treatment outcomes were excellent.     

Time to unsuccessful tuberculosis treatment outcome,Cambodia, China,and Viet Nam

Objective:

To determine the frequency and characteristics of patients with unsuccessful tuberculosis (TB) treatment.

Methods:

Random selection of TB case registers among all treatment units in Cambodia, two provinces in China, and Viet Nam. The data of two calendar years were analyzed to assess unsuccessful outcomes and their time of occurrence.

Results:

Among the 33 309 TB patients, treatment was unsuccessful in respectively 10.1%, 3.0% and 9.1% of patients in Cambodia, China and Viet Nam. The risk of death was highest in Cambodia, higher among males than females, increased with age, and was more common among retreatment cases than new cases, and among patients with a high than a low sputum smear microscopy grade. Half of all deaths occurred in the first 2 months in Cambodia and within 11 weeks in China and Viet Nam. Median time to default was 3 months in Cambodia and Viet Nam, and about 2 months in China.

Conclusions:

Treatment was highly successful in the three study countries, with a low proportion of death and default. As the majority of defaulting occurs at the beginning of treatment, all countries should critically review their current policy of treatment support in this period.     

The risk of malaria transmission by blood transfusion at Cotonou, Benin

The risk of transmission of infectious agents by blood transfusion is a permanent preoccupation for diseases that we do not know how to cure, such as hepatitis B, hepatitis C and AIDS. However, few studies have been carried out concerning the risks of transmitting curable infectious diseases, such as malaria. We carried out a cross-sectional study of 355 healthy blood donors in the rainy season, in which we used thick and thin blood film smears to screen for malaria. We found that 33.5% of donors harbored trophozoites and were therefore capable of transmitting malaria via blood donation. There were 1,000 to 4,760 parasites per microliter of blood and there was no relationship between the load of parasitized red blood cells and clinical malaria. Plasmodium falciparum was the most common species identified (96.63% of cases). The results confirm that it is vital, in this age of resistance to anti-malaria drugs and HIV, to screen blood donations systematically. Patients receiving transfusions should be given anti-malaria treatment and donors should be encouraged to sleep under treated mosquito nets.     

Characteristics and treatment outcomes of tuberculosis retreatment cases in three regional hospitals,Uganda

Setting:

Three regional referral hospitals in Uganda with a high burden of tuberculosis (TB) and human immunodeficiency virus (HIV) cases.

Objective:

To determine the treatment outcomes of TB retreatment cases and factors influencing these outcomes.

Design:

A retrospective cohort study of routinely collected National Tuberculosis Programme data between 1 January 2009 and 31 December 2010.

Results:

The study included 331 retreatment patients (68% males), with a median age of 36 years, 93 (28%) of whom were relapse smear-positive, 21 (6%) treatment after failure, 159 (48%) return after loss to follow-up, 26 (8%) relapse smear-negative and 32 (10%) relapse cases with no smear performed. Treatment success rates for all categories of retreatment cases ranged between 28% and 54%. Relapse smear-positive (P = 0.002) and treatment after failure (P = 0.038) cases were less likely to have a successful treatment outcome. Only 32% of the retreatment cases received a Category II treatment regimen; there was no difference in treatment success among patients who received Category II or Category I treatment regimens (P = 0.73).

Conclusion:

Management of TB retreatment cases and treatment success for all categories in three referral hospitals in Uganda was poor. Relapse smear-positive or treatment after failure cases were less likely to have a successful treatment outcome.     

Clinical and immunological profile of HIV infected patients in Cotonou, Benin

OBJECTIVES: This study had for aim to identify the clinical status and the level of immuno-deficiency of HIV-infected patients on their first visit. METHODS: One hundred and thirty-six HIV+ patients were prospectively evaluated from November 1, 2001 to May 31, 2002. RESULTS: One hundred and thirty-four were infected with HIV1 and two with HIV2. The mean age on the first consultation was 37 +/- 2 years. The m/w sex ratio was 0.9. 46.3% were stage C. The main clinical symptoms were: weight loss (88%), fever (80%), cough (71%), diarrhea (51%). BMI was normal in 70% and KI > or =80% in 57% of the cases but immuno-deficiency was severe with CD4 cells count <200 per mm3 in 69%. The main diseases were digestive candidiasis (53%), pneumonia (18%), tuberculosis (12%), non-determined pneumonia (29%), prurigo (20%), zona (16%), cryptosporidiosis (4%), cerebral toxoplasmosis (3%), and Kaposi's sarcoma (1%).     

儿童卡介苗接种后异常反应诊治进展

结核病是严重的单一感染性病原体传染性疾病,给人类带来严重的社会和经济问题。卡介苗（BCG）是目前全球唯一应用于预防结核病的疫苗,但考虑BCG疫苗对结核病保护作用时长有限,对结核杆菌潜伏感染者的结核病发病保护能力较低,以及有免疫缺陷新生儿的接种风险等问题,研发新型抗结核病疫苗势在必行。本文针对目前不同人群的结核病新疫苗研究进展进行综述,旨在为加速新疫苗的研发、对不同特征人群结核病防控提供技术支撑。     

Genetic Characterization of Seoul Virus in the Seaport of Cotonou,Benin

Seoul virus is a zoonotic pathogen carried by the brown rat Rattus norvegicus. Information on its circulation in Africa is limited. In this study, the virus was detected in 37.5% of brown rats captured in the Autonomous Port of Cotonou, Benin. Phylogenetic analyses place this virus in Seoul virus lineage 7.     

The burden of disease, economic costs and clinical consequences of tuberculosis in the Philippines

OBJECTIVE: To provide a multidisciplinary and comprehensive analysis on the impact of tuberculosis (TB) in a high incidence country. METHODS: Data from several large scale surveys, carried out between 1997 and 2001 in the Philippines, were used to: (1) perform a burden of disease (BoD) analysis, (2) model the economic costs to society due to lost wages, and (3) determine the clinical outcomes, including the costs of care, for a hypothetical cohort of TB cases. RESULTS: Over 500 000 disability-adjusted life years (DALYs) are lost due to illness and premature mortality from TB in the Philippines annually. This is equal to 9% of all years of life lost (YLL) in the Philippines. The combined economic losses due to premature mortality and morbidity total PhP 8 billion (approximately USD $145 million). Clinically, only 28% of patients with incident active TB are diagnosed and successfully treated, while 20% of patients will die without ever being diagnosed and 6% more will die after they are diagnosed because they do not receive adequate care. The costs of treating all expected cases requires between PhP 475-1625 million (approximately USD $8-29 million) annually. CONCLUSION: The high burden of disease from TB, large economic losses from mortality and morbidity from TB and the poor clinical outcomes all suggest that there is an urgent need for an increased investment in TB control. The costs of providing this treatment appear to be significantly lower than the current economic losses.     

中国结核病疾病负担现状

结核病是由结核分枝杆菌引起的传染病,以肺结核为主要形式。中国是全球结核病高负担国家之一。近年中国结核病估算发病率虽持续降低,但下降速度较为缓慢。结核病防治工作仍面临着估算发病数与报告发病数之间的差距增大、中老年人群发病率高、农牧民发病例数多、西部地区疾病负担较重等问题。此外,结核分枝杆菌潜伏感染、耐药结核病、结核分枝杆菌合并HIV感染、肺外结核等也在一定程度上加剧了结核病的疾病负担。本文对结核病流行现状、三环节两因素、疾病负担等方面进行综述,为结核病防控对策的制定提供参考。     

MDR-TB treatment needs in patients previously treated for TB in Cotonou,Benin

Setting:

Centre National Hospitalier de Pneumo-Phtisi-ologie, Cotonou, Benin.

Objective:

To determine the proportion of individuals needing treatment for multidrug-resistant tuberculosis (MDR-TB) among patients previously treated for TB.

Design:

A retrospective cross-sectional study of all patients previously treated for TB in Cotonou from 2003 to 2011.

Results:

Of 956 patients on retreatment, 897 (94%) underwent culture and/or a line-probe assay. For different reasons, 594 (66%) underwent drug susceptibility testing for rifampicin (RMP), of whom 95 (16%) had RMP resistance (68 multidrug-resistance [MDR] and 27 other RMP resistance) and therefore needed treatment for MDR-TB. These represent 39% of patients who failed/relapsed after standardised retreatment, and 20% of those who failed, 19% of defaulters and 11% of relapses after first-line treatment. Residence outside of Benin was associated with a higher risk of RMP resistance (RR 3.13, 95%CI 2.19–4.48, P < 0.01). From 2003 to 2011, the prevalence of RMP resistance decreased from 25% to 5% among patients living in Benin. Human immunodeficiency virus (HIV) prevalence was 25%; no association was found between HIV and RMP resistance. Of patients failing treatment, 48% were fully susceptible, 22% were monoresistant and 8% polyresistant.

Conclusion:

The majority of patients who fail retreatment or first-line treatment in Cotonou do not require empirical treatment for MDR-TB.     

浙江省结核患者疾病负担调查分析

目的调查结核病定点医院结核门诊初治肺结核患者的疾病负担,为客观评估定点医院诊治管理模式提供参考依据。方法研究采用分层整群抽样方法,根据人均GDP标准分层,将所有县区分发达与欠发达两类,从每个县的结核病定点医院抽取50例已经完成治疗的初治肺结核患者开展结核病疾病负担问卷调查。结果调查结果显示,首次就诊到结束治疗的过程中花费的医疗费用人均为4086元,其中31％的费用用于住院治疗,患者为治疗肺结核花费的医疗费用占了其家庭年总收入的13％。在结核病定点医院的治疗费用人均3020元。收入水平一定程度上影响了患者的疾病负担,此次调查的20％的患者家庭因治疗结核病而负债,近三分之一患者认为治病负担重。结论调查发现初治肺结核患者在结核病定点医院抗结核治疗费用与2005年相比没有明显增加,住院率却有了明显下降,所以不必过分担忧将结核病诊疗职能转移至综合性定点医院后结核病患者的疾病负担会大幅度增加,但是充分利用医保来切实降低结核病患者的疾病负担还是非常必要的。     

2008 — 2015年贵州省学生肺结核疫情特征分析

  目的  了解贵州省2009 — 2018年儿童结核病流行特征,为儿童结核病防控工作提供参考依据。  方法  收集结核病管理信息系统登记的贵州省2009 — 2018年 ≤ 14岁儿童肺结核病例资料进行流行特征分析。  结果  2009 — 2018年贵州省共登记治疗儿童肺结核5 775例,年均登记率为7.39/10万,占全人群肺结核的平均比例为1.46 %,经趋势卡方检验,差异有统计学意义（χ² = 460.852,P < 0.05）。10年贵州省儿童肺结核患者总体呈下降趋势,2015 — 2018年出现缓慢上升趋势。每季度均有病例,主要集中在第一季度和第二季度;毕节市登记治疗的儿童肺结核患者最多,占全省儿童病例总数的37.44 %;男生占51.39 %,女生占48.61 %,男女比例为1.10 : 1;年龄分布均以10～14岁年龄组最多,男生组为2 258例,女生组为2 281例。发现方式主要是以因症就诊和转诊为主,初复治比为75 : 1,新涂阳儿童肺结核患者治疗成功率为91.02 %,复治涂阳治疗成功率为82.69 %。  结论  2009 — 2018年贵州省儿童结核病呈下降趋势,应针对10～14岁、男生、毕节市等三间分布特征采取针对措施。     

诊治与管理分开的模式对县级结核病防治工作影响

目的探讨对结核病人诊治与管理分开的模式,对县级结核病防治工作的影响。方法对宁国市实行综合性医院与疾控中心共同完成结核病防治项目的前后两年的资料进行分析。结果实施后结核病定点门诊初诊病人数增加了9．4％,其中主动到定点门诊就诊的可疑结核病人增加了71．60％,项目病人丢失率下降了57．14％;实施前该市人民医院一家的转诊到位数占全部非结防机构转诊到位数的39．72％,病人习惯于首诊到公立的综合性医院。结论县级公立的综合性医院承担结核病人诊治,疾控中心负责管理,能充分利用卫生资源,有利于县级结核病防治工作。     

Hypothyroidism: clinical and etiological aspects in Cotonou (Republic of Benin)

To evaluate the frequency of clinical manifestations and to study the etiological aspects of hypothyroidism in hypothyroid patients in Cotonou, we carried out a retrospective analysis of the medical reports on hypothyroid patients followed in our clinical practice. A total of 33 patients was thus studied, comprising 8 men (24%) and 25 women (76%) with mean age of 45,8 years for men and 40,4 years for women. The more frequent clinical manifestations observed were: face edema (45%), weight gain (45%), paresthesia (42%), fatigue (39%), lethargy (30%) and bradycardia (24%). Constipation (12%), sensation of cold (9%), depilation (6%) and dry skin (6%) were less frequently observed. Myalgia, hoarseness and menstrual irregularities were present in 15% of the cases respectively. Regarding the etiology, 82% of the cases were primary hypothyroidism and only 18% were of central origin. Thyroidectomy was the leading cause in our hypothyroid patients, representing 70% of all cases and 85% of primary hypothyroidism. Radioiodine treatment and autoimmune thyroiditis were equally found in 6% of the cases. Central hypothyroidism was related to a pituitary adenoma in four cases (12%) and to Sheehan syndrome in two cases (6%). As it can be expected, hypercholesterolemia was present in 82% of the patients but creatine phosphokinase elevation was more frequent (94% of the patients). Compared to the data reported in the literature, the frequency of the symptoms and signs of hypothyroidism seems to be underevaluated in our study and the frequency of autoimmune thyroiditis as a cause of hypothyroidism is low.     

浙江省儿童肺结核疫情现状分析

目的 了解浙江省儿童肺结核疫情现状,为加强儿童肺结核病的防控措施提供依据。方法 检索2008-2014年中国疾病预防控制系统中的传染病报告信息管理系统和结核病信息管理系统,获取0~14岁儿童肺结核病的报告发病、登记及治疗管理数据,并进行描述性统计分析。结果 2008-2014年浙江省共报告0~14岁儿童活动性肺结核1 338例（菌阳儿童肺结核345例）,其中登记、治疗的有981例,占报告数量的73.3%。0~14岁儿童肺结核年均报告发病率为2.3/10 万,其中菌阳病例年均报告发病率为0.6/10 万。0~14岁儿童肺结核报告发病率波动中有所下降,菌阳肺结核的报告发病率波动中有所上升。结论 儿童肺结核防控工作仍需要继续加大投入,有效的开展健康促进工作,提高发现治疗和管理水平,进一步降低儿童肺结核病的疫情。     

BTEX air concentrations and self-reported common health problems in gasoline sellers from Cotonou,Benin

To examine the relation between BTEX exposure levels and common self-reported health problems in 140 gasoline sellers in Cotonou, Benin, a questionnaire documenting their socioeconomic status and their health problems was used, whereas 18 of them went through semi-directed qualitative individual interviews and 17 had air samples taken on their workplace for BTEX analysis. Median concentrations for BTEX were significantly lower on official (range of medians: 54–207?μg/m³, n?=?9) vs unofficial (148–1449?μg/m³, n?=?8) gasoline-selling sites (p?vs official selling sites (p?相似文献