深圳市流动人口肺结核耐药情况及相关因素分析

目的 了解深圳市流动人口肺结核耐药情况及主要影响因素,为完善流动人口结核病防控策略提供科学依据。 方法 将深圳市2010年确诊登记的682例流动人口痰培养阳性肺结核患者（初治595例,复治87例）作为研究对象,进行菌种鉴定和4种一线抗结核药物敏感性试验;并通过现场问卷调查收集相关信息,采取logistic回归分析获得流动人口肺结核患者耐药的主要影响因素。 结果682例结核分枝杆菌感染的流动人口涂阳肺结核患者中,总耐药率为17.74%（121/682）,其中初治耐药率15.29%（91/595）,复治耐药率34.48%（30/87）;耐多药率为5.87%（40/682）,其中初治耐多药率4.20%（25/595）,复治耐多药率17.24%（15/87）;单耐药率为9.24%（63/682）;多耐药率为2.64%（18/682）。4种药物的耐药率顺位依次是链霉素、异烟肼、利福平和乙胺丁醇。复治患者的耐药率显著高于初治患者（χ²=19.15,P＜0.01）。多因素logistic回归分析显示,女性（OR=1.623,95%CI=1.023～2.598,P＜0.05）、复治患者（OR=3.648,95%CI=2.133～6.237,P＜0.01）和有中断治疗史的患者（OR=2.847,95%CI=1.718～4.718,P＜0.01）与耐药性之间存在相关性,差异有统计学意义。 结论 深圳市流动人口肺结核总体耐药率和耐多药率相对较高,女性、复治化疗史和初治中断治疗是流动人口耐药肺结核的主要影响因素。     

湖南省湘潭县农村地区肺结核发病情况及影响因素分析

目的 了解农村地区肺结核发病情况及危险因素。 方法 采用巢式病例对照研究方法，对湖南省湘潭县农村地区人群72859名随访观察1年，队列中80例新发肺结核患者作为病例组；从该队列中采用简单随机抽样的方法抽取400名健康人作为对照。对有关暴露因素进行单因素和多因素非条件logistic回归分析。 结果 农村地区肺结核发病率为109.80/10万（80/72 859），男性、女性发病率分别为168.11/10万（63/37 476）、48.05/10万（17/35 383）。单因素分析显示不同年龄（Wald χ²=22251，P<0.001，OR=1.759）、性别（Wald χ²=16.145，P<0.001，OR=0.310）、文化程度（Wald χ²=21.937，P<0.001，OR=0.468）、婚姻状况（Wald χ²=8.320，P=0.004，OR=0.358）、职业（Wald χ²=10.297，P=0.001，OR=0.377）、结核病患者接触史（Wald χ²=7.535，P=0.006，OR=4.166）、结核病病史（Wald χ²=14.637，P<0.001，OR=57.000）、吸烟史（Wald χ²=4.525，P=0.033，OR=1.730）、可疑症状（Wald χ²=46.630，P<0.001，OR=12.758）人群的肺结核发病情况差异均有统计学意义；多因素分析有统计学意义的变量有性别（β=-1.142，Wald χ²=12.904，OR=0.319、95%CI=0.171～0.595）、文化程度（β=-0.743，Wald χ²=14.355，OR=0.476、95%CI=0.324～0.699）、婚姻状况（β=-1.138，Wald χ²=7.537，OR=0.320、95%CI=0.142～0.722）、结核病病史（β=2.852，Wald χ²=5.563，OR=17.329、95%CI=1.619～185.441）、可疑症状（β=1.728，Wald χ²=16.333，OR=5.630、95%CI=2.435～13.016）。 结论 女性、文化程度高和无配偶是肺结核发病的保护因素，有结核病病史和可疑症状是肺结核发病的危险因素。     

全国初治涂阴肺结核病例登记现状分析

目的 分析全国各省初治涂阴肺结核病例登记现状,为评价初治涂阴肺结核病例诊断质量提供依据.方法 根据2004-2005年全国结核病防治规划报表中初治涂阴和初治涂阳肺结核病例登记资料,分析各省2年初治涂阴肺结核病例登记率变化和增长幅度;统计各省及不同地区初治涂阴与初治涂阳肺结核病例登记率;对各省初治涂阴与初治涂阳肺结核病例登记率进行直线回归分析.结果 2005年全国登记初治涂阴肺结核病例316 405例,登记率为24.27/10万,各省登记率在6.01/10万～72.17/10万;2005年登记初治涂阴病例数比2004年增加了19.9%,其中2个省登记数呈负增长,其余各省登记数增长了0.5%～62.3%;2005年全国初治涂阳病例登记率是涂阴病例登记率的1.5倍,其中23个省初治涂阳病例登记率高于涂阴病例登记率,8个省相反;初治涂阴病例占初治涂阳病人登记率的比例,京津沪地区为149.28%,非项目地区为83.6%,项目地区为50.3%;对涂阳和涂阴病例登记率进行直线回归分析,回归方程y=22.342＋0.563 6x.结论 对初治涂阴肺结核患者实行免费政策后,全国涂阴肺结核病例登记率提高.但各省初治涂阴病例登记率和增长幅度以及涂阴病例登记率与涂阳病例登记率的比例悬殊.由于涂阴病例诊断困难,对于涂阴病例登记率高或增长幅度大的地区,特别在DOTS执行时间短和人力资源有限的地区,应对涂阴病例诊断质量予以进一步检查和评价.     

新疆喀什地区肺结核及疑似患者转诊未到位影响因素的分析

目的 探讨新疆喀什地区综合医疗机构与结核病防治机构合作（简称“医防合作”）过程中肺结核患者和可疑患者转诊不到位的原因及影响因素。 方法 2010年5-7月在喀什地区喀什市、英吉沙县2个地区,经过国家卫生部专家调研分析后,协助新疆维吾尔自治区制定统一调查方案,采取分组随机选择的方法,对60例到位与60例不到位疑似肺结核患者,进行问卷调查。两组调查问卷根据方案均由国家统一设计,内容一致,共调查120例（60例到位,60例不到位）,有效回答问卷120例。调查者由经统一培训的结防专业人员共同完成。并由自治区CDC结核病防治人员对被调查对象及每张问卷内容进行审对。统计方法采用直接描述法和单因素、多因素logistic分析方法,采用SPSS 16.0进行分析。 结果 单因素logistic回归模型分析结果显示：到位组中认为自己服药能治愈肺结核的有18例、认为不能治愈的有39例、没考虑的3例;未到位组中认为自己能治愈肺结核有22例、认为不能治愈的有26例、没考虑的12例（OR=1.223,95%CI值为0.700～2.138,Wald χ²=8.40,P=0.015）;在到位组中转诊医生告知国家结核病免费诊疗政策的有48例、未告知12例,在未到位组中告知37例、未告知23例（OR=2.486,95%CI值为1.096～5.641,Wald χ²=4.88,P=0.027）。多因素logistic回归模型分析结果显示：认为自己服药不能治愈肺结核（β=-1.871,Waldχ²=7.069,P=0.008,OR=0.154,95%CI值为0.039～0.612）和转诊医生告知国家结核病免费诊疗政策是肺结核患者在非结核病防治机构转诊不到位的影响因素（β=0.886,Wald χ²=4.000,P=0.045,OR=2.424,95%CI值为1.018～5.774）。 结论 喀什地区网络报告肺结核疑似患者不到位的原因在于综合医疗机构的医务人员没有对患者进行耐心、细致的结核病健康教育,使患者对结核病的认识有很多误区而不愿去结核病防治机构就诊,从而导致喀什地区网络报告疑似肺结核患者转诊不到位。     

甘肃省外出肺结核患者完成疗程影响因素分析

目的 探讨影响甘肃省外出肺结核患者完成疗程的因素。 方法 采用问卷调查的方法 ，抽取结核病患病率高、外出肺结核患者较多的22个县进行调查。由专门的调查员负责询问，并根据调查对象的回答进行填写。 结果 外出时带有药品者完成疗程率显著高于外出时未带药者（OR=13.281，95%CI:5.557～31.739）；事先将外出信息告知督导治疗医生的患者完成疗程率显著高于未告知者（OR=5.025，95%CI:2.520～10.020）；异地为继续治疗结核病花费≥500元者完成疗程率要高于＜500元者（OR=2.554，95%CI:1.087～5.999）；患病前接受过有关结核病防治健康教育宣传者完成疗程率高于未接受者（OR=2.200，95%CI:1.112～4.352）。 结论 针对可能的高危人群，应提高警惕，注重加强医患关系沟通，及早发现有意外出的患者；加强健康教育，尽量让患者留在本地安心完成疗程；对于多次劝阻仍坚持外出的患者，为患者带有一定量药品，确保患者在转入地的继续治疗管理工作衔接。     

浙江省永康市初治涂阴肺结核病人诊断结果分析

永康市自2005年7月1日开始,对初治涂阴活动性肺结核病人实行技术小组会诊制度,使涂阴肺结核病人及时得到正确诊断,减少误诊（包括漏诊、过诊）现象发生。现就技术小组诊断结果进行分析。     

全国初治涂阴肺结核病例登记现状分析

目的分析全国各省初治涂阴肺结核病例登记现状,为评价初治涂阴肺结核病例诊断质量提供依据。方法根据2004—2005年全国结核病防治规划报表中初治涂阴和初治涂阳肺结核病例登记资料,分析各省2年初治涂阴肺结核病例登记率变化和增长幅度;统计各省及不同地区初治涂阴与初治涂阳肺结核病例登记率;对各省初治涂阴与初治涂阳肺结核病例登记率进行直线回归分析。结果2005年全国登记初治涂阴肺结核病例316 405例,登记率为24.27/10万,各省登记率在6.01/10万72.17/10万;2005年登记初治涂阴病例数比2004年增加了19.9%,其中2个省登记数呈负增长,其余各省登记数增长了0.5%62.3%;2005年全国初治涂阳病例登记率是涂阴病例登记率的1.5倍,其中23个省初治涂阳病例登记率高于涂阴病例登记率,8个省相反;初治涂阴病例占初治涂阳病人登记率的比例,京津沪地区为149.28%,非项目地区为83.6%,项目地区为50.3%;对涂阳和涂阴病例登记率进行直线回归分析,回归方程y=22.342+0.563 6x。结论对初治涂阴肺结核患者实行免费政策后,全国涂阴肺结核病例登记率提高。但各省初治涂阴病例登记率和增长幅度以及涂阴病例登记率与涂阳病例登记率的比例悬殊。由于涂阴病例诊断困难,对于涂阴病例登记率高或增长幅度大的地区,特别在DOTS执行时间短和人力资源有限的地区,应对涂阴病例诊断质量予以进一步检查和评价。     

三省市医疗卫生机构工作人员结核病患病及影响因素分析

目的 了解医疗卫生机构工作人员结核病患病情况及影响因素。 方法 于2010年10月至12月,采用《医务人员结核感染控制调查问卷》,按照目的抽样方法,对抽取的北京市、内蒙古自治区和上海市22家医疗卫生机构的5235名医疗卫生机构工作人员进行调查,收集相关信息并分析。 结果 参加调查的5235名医疗卫生机构工作人员肺结核的年均患病率为664.76/10万(174/26 175),涂阳肺结核的年均患病率191.02/10万(50/26 175)。经多元素分析,可认为男性（调整OR=1.9, 95%CI=1.3~2.7, P<0.05）、单位为结核病防治机构（调整OR=1.8, 95%CI=1.1~2.8,P<0.05）或专科医院（调整OR=2.5,95%CI=1.1~3.6,P<0.05）、科室为结核门诊（调整OR=2.3, 95%CI=1.3~4.1,P<0.05）、与结核病患者近距离接触时间15 h及以上（调整OR=2.2, 95%CI=1.1~4.3,P<0.05）、科室无结核病感染控制制度（调整OR=1.7, 95%CI=1.2~2.3,P<0.05）、吸烟（调整OR=2.8, 95%CI=1.2~2.9,P<0.05）可增加医疗卫生机构工作人员患结核病风险。 结论 所调查医疗卫生机构工作人员结核病患病率高,结核感染控制工作不到位,需加强落实结核病感染控制措施,减少结核分枝杆菌感染。     

757例初治肺结核患者抗结核治疗效果影响因素分析

目的 了解初治肺结核的治疗动态并探讨影响其治疗效果的因素。 方法 以2009-2011年江苏省响水县疾病预防控制中心登记并随访管理的757例初治结核病患者作为研究对象,采用同时考虑事件结局、随访时间及截尾数据的生存分析模型进行单因素和多因素分析。 结果 757例患者中成功治疗720例,不良结果37例。Kaplan-Meier生存率曲线估计初治肺结核中位成功治疗时间为182 d,Log-rank单因素分析结果显示来源为转诊、因症就诊及其他途径患者的实际成功治疗数所占比例分别为24.17% (174/720),66.53% (479/720),9.31% (67/720),与各来源估计成功治疗比例分别为29.86%（215/720）,59.72%（430/720）,10.42%（75/720）之间分布差异具有统计学意义(χ²=23.19,P =0.000)。存在延迟与未存在延迟就诊患者的实际成功治疗数所占比例分别为26.67% (192/720)与73.33% (528/720),与延迟与否估计成功治疗比例 (31.25%,68.75%)之间分布差异具有统计学意义(χ²=11.33,P=0.001);Cox多因素分析显示45～岁（OR=1.213,95%CI=1.014～1.452）及≥60岁以上（OR=1.323,95%CI=1.069～1.636）年龄组的成功治疗率高于30岁以下,农民（OR=0.787,95%CI=0.650～0.953）及其他职业者(OR=0.755,95%CI=0.591～0.966)成功治疗率低于工人,因症就诊（OR=1.498,95%CI=1.275～1.760）的成功治疗率高于转诊患者,延迟就诊（OR=0.782,95%CI=0.658～0.929）的成功治疗率低于非延迟者。 结论 在当地肺结核初治过程中,应加强对农民、30岁以下年龄段、转诊来源及存在延迟就诊的患者的治疗管理。     

广东省非结核病防治机构网络直报肺结核患者到位情况及其影响因素分析

目的 分析广东省非结核病防治机构（简称“非结防机构”）网络直报肺结核患者到结核病防治机构（简称“结防机构”）就诊情况及其影响因素。方法 利用网络直报信息开展患者转诊追踪工作,以2011年广东省医疗机构应报告转诊肺结核或疑似肺结核患者106669例（均为广东省现住址患者）为研究对象、以患者到位率为指标、以logistic回归分析为方法进行分析评价。结果 广东省2011年有89825例已到结防机构就诊,总体到位率为84.2%（89825/106669）,追踪到位患者占所有到位患者数的42.5%（38179/89825）。转诊（OR＝7.993;95%CI：7.611～8.395）、有身份证号（OR＝1.049;95%CI：1.006～1.094）、有电话号码（OR＝1.534;95%CI：1.467～1.603）、有单位名称（OR＝1.222;95%CI：1.165～1.282）和地址详细（OR＝1.360;95%CI：1.297～1.425）是利于患者到位的影响因素。与其他地区相比,粤西地区的患者总体到位率偏低（OR＝0.903;95%CI：0.847～0.963）。乡镇卫生院社区卫生服务中心的患者总体到位率比县级及以上人民医院的总体到位率高（OR＝1.562;95%CI：1.465～1.666）。疑似患者总体到位率低于实验室诊断患者（OR＝10.006;95%CI：9.219～10.861）和临床诊断患者（OR＝2.458;95%CI：2.349～2.571）。15～岁组（OR＝0.338;95%CI：0.285～0.400）、35～岁组（OR＝0.282;95%CI：0.238～0.334）和55～岁组（OR＝0.243;95%CI：0.205～0.288）的患者总体到位率均低于＜15岁组。结论广东省患者转诊追踪工作仍有提升的空间,需采取综合管理措施以巩固和提高患者到位率,而督促非结防机构转诊患者、确保报告信息的完整准确和提升非结防机构诊断结核病能力等措施是提高患者到位的关键。     

北京市WHO结核病药物耐药性监测研究

目的获得2004年北京市结核分枝杆菌复合菌群耐药性数据。方法对北京市2004年登记菌阳患者分离的结核分枝杆菌复合群,采用WHO/IUATLD规定的1%比例法进行H、R、S和E耐药性检测。结果共纳入1 197例病例,样本总体耐药率是20.1%,MDR耐药率为3.5%,其中初始耐药率为17.9%,初始MDR耐药率为2.3%,获得性耐药率为35.1%,获得性MDR耐药率为11.7%。结论北京市流行的结核分枝杆菌复合群的耐药比例、特别是初治患者的MDR耐药率较低;获得性R耐药与获得性MDR耐药之间存在较高的相关性。     

Intracardiac echo-guided image integration: optimizing strategies for registration

Introduction: Image integration is being used in ablation procedures. However, the success of this approach is dependent on the accuracy of the image integration process. This study aims to evaluate the in vivo accuracy and reliability of the integrated image.
Methods and Results: One hundred twenty-four patients undergoing radiofrequency (RF) ablation catheter ablation for atrial fibrillation (AF) were recruited for this study from three different centers. Cardiac computerized tomography (CT) was performed in all patients and a 3D image of the left atrium (LA) and pulmonary veins (PVs) was extracted for registration after segmentation using a software program (CartoMerge, Biosense Webster, Inc.). Different landmarks were selected for registration and compared. Surface registration was then done and the impact on integration and the landmarks was evaluated.
The best landmark registration was achieved when the posterior points on the pulmonary veins were selected (5.6 ± 3.2). Landmarks taken on the anterior wall, left atrial appendage (LAA) or the coronary sinus (CS) resulted in a larger registration error (9.1 ± 2.5). The mean error for surface registration was 2.17 ± 1.65. However, surface registration resulted in shifting of the initially registered landmark points leading to a larger error (from 5.6 ± 3.2 to 9.2 ± 2.1; 95% CI 4.2–3.05).
Conclusion: Posterior wall landmarks at the PV-LA junction are the most accurate landmarks for image integration in respect to the target ablation area. The concurrent use of the present surface registration algorithm may result in shifting of the initial landmarks with loss of their initial correlation with the area of interest.     

Impact of atherosclerosis-related gene polymorphisms on mortality and recurrent events after myocardial infarction

Although previous epidemiologic studies have suggested an association between the onset of myocardial infarction (MI) and some genetic variations, the impact of these variants on recurrent cardiovascular events after MI has not been fully elucidated. We genotyped 87 polymorphisms of 73 atherosclerosis-related genes in consecutive acute MI patients registered in the Osaka Acute Coronary Insufficiency Study and compared the incidence of death and major adverse cardiac events (MACE) among the polymorphisms of each gene. After initial screening in 507 patients, we selected nine polymorphisms for screening in all 1586 patients. Multivariate Cox regression analysis revealed that G allele carriers at the position 252 of the lymphotoxin alpha (LTA) gene were independently associated with an increased risk of death (hazard ratio [HR]: 2.46; 95% CI: 1.24-4.86). In conclusion, a 252G allele of LTA is associated with an increased risk of death after AMI and may be a useful genetic predictor.     

Ventricular arrhythmia in patients with chronic renal failure treated with hemodialysis

From the group of 66 patients (pts) treated with in-hospital haemodialysis (HD), 30 pts were selected for 48 hrs monitoring of heart rhythm to register arrhythmias using Holter method. Cardiovascular complications were observed in 24 pts (80%) of the studied group; ischemic heart disease in 10 pts (33%), chronic cardiac failure in 8 pts (27%), left ventricular hypertrophy in 16 pts (53%) and hypertension in 24 pts. During 48 hrs of heart rhythm monitoring ventricular heart arrhythmias (VHA) were registered in 23 pts. 8 pts of this group had more then 100 additional ventricular beats for 24 hrs. VHA were registered before HD in 14 pts, during HD in 15 pts and after in 15 pts. The frequency of VHA pt/one hour of monitoring increased during and immediately after HD. There were no statistically significant differences between 23 pts with VHA and 7 pts without VHA with respect to the following parameters measured before HD: blood pressure, urea, calcium, kalium and magnesium blood concentrations. We found statistically significant difference between both groups of pts for creatinine values (p < 0.02); respectively 899.7 mmol/l SD 152 mmol/l versus 767 mmol/l SD 95.3 mmol/l and for interdialytic body weight increase (p < 0.012); respectively 2.65 kg SD 0.8 kg versus 2.04 kg SD 0.46 kg. Our initial results indicate that VHA appears in the majority of hemodialysed pts and that HD intensifies arrhythmogenic influence of irreversible renal failure on heart. It is also possible that non-adequate HD might be responsible for induction of ventricular heart arrhythmias during and after dialysis.     

Frequency of MDR-TB/XDR-TB strains isolated from chronic pulmonary tuberculosis patients in Japan

PURPOSE: To observe the frequency of MDR-TB/XDR-TB strains isolated from chronic pulmonary tuberculosis patients in Japan. OBJECT: Ad hoc National Tuberculosis Survey 2000 on frequency of MDR-TB and XDR-TB strains. MATERIALS AND METHOD: Four hundred and thirty four clinical isolates were collected by the Ad hoc National Tuberculosis Survey 2000, the drug susceptibility testings (proportion method, MGIT Middlebrook, and BrothMIC NTM) were conducted on these strains. These clinical isolates were obtained from patients registered at Health Centers in Japan by the end of 1999 who were culture-positive in 1999 and were registered before January 1st, 1998. The isolates used in this study were selected from patients who were culture-positive at shortest 2 years after the registration. RESULT: The clinical isolates resistant to both INH and RFP were 321 out of 434 (74.0%). The 180 MDR-resistant clinical isolates were also resistant to levofloxacin and amikacin and/or kanamycin. These phenotypes are XDR-TB. No previously registered cases were 165, and previously registered cases were 143 and unknown cases were 13 out of 321 MDR-TB. In 180 XDR-TB cases, no previously registered cases were 95, previously registered cases were 78 and unknown cases were 7. In no previously registered cases, more than 50% cases started treatment in 1990s. Approximately 50% of previously registered patients started treatment in 1960s and 1970s. CONCLUSION: We performed drug susceptibility testing for 434 clinical isolates which were culture-positive at shortest 2 years after registration. No. of MDR-TB patients was 321 and that of XDR-TB patients was 180. The treatment outcome of these patients have to be followed up carefully at Health Centers. The frequency of amikacin resistance was relatively high. This may be due to either common use of amikacin or cross-resistance against streptomycin and kanamycin.     

Gingko biloba extract EGb 761 and pentoxifylline in intermittent claudication. Secondary analysis of the clinical effectiveness]

Clinical trials on the efficacy of EGb 761 and pentoxifylline are summarized in the context of their methods and results and compared with each other. All placebo-controlled, randomized and double-blind studies with the major target objective of "pain-free walking distance" were selected. The pentoxifylline studies were adopted from a survey of the existing literature in the English language, which has been brought up to date via DIMDI research. The studies on both active substances are fraught with similar difficulties as to method, and are not different as regards their quality. The increase in walking distance is highly variable, especially in the pentoxifylline studies. On average through each and all of the studies on both preparations, an increase of 45% (EGb 761) or 57% (pentoxifylline) in relation to initial values is here found. No differences in the documentation of efficacy and the clinical efficacy were discovered between the two substances, both of which are registered as effective substances in the treatment of peripheral arterial occlusion (pAO) in accordance with the Federal German Drugs Law (Arzneimittelgesetz, AMG) of 1976.     

Epidemic spread of a single clone of methicillin-resistant Staphylococcus aureus among injection drug users in Zurich, Switzerland.

We describe an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) among injection drug users (IDUs). From August 1994 through December 1999, we registered 31 IDUs with MRSA infections (12 with soft-tissue infection, 7 with pneumonia [fatal in 1], 7 with endocarditis [fatal in 1], 2 with osteomyelitis, 2 with septic arthritis, and 1 with ulcerative tonsillitis), with a marked increase in the number of IDUs registered during 1998 and 1999. Of 31 patients, 15 (48%) were infected with human immunodeficiency virus. A point-prevalence study among IDUs who frequented outpatient facilities in Zurich revealed an MRSA carriage rate of 10.3% (range, 0%-28.6%) in various facilities. In all but 1 case, pulsed-field gel electrophoresis banding patterns of isolates obtained from these patients were indistinguishable from isolates of the initial 31 IDUs registered. Risk factors for MRSA carriage were disability and prior hospitalization in a hospice. In summary, MRSA became endemic in IDUs in Zurich as a result of the spread of a single clone. This clone caused major morbidity and was responsible for a lethal outcome in 2 cases.     

Risk factors for defaulting from anti-tuberculosis treatment under directly observed treatment in Hong Kong.

OBJECTIVE: To identify risk factors for defaulting from anti-tuberculosis treatment. SETTING: Directly observed treatment in Hong Kong Government chest clinics. DESIGN: Defaulters were recruited from a cohort of tuberculosis patients registered from 1 January to 31 March 1999. Three controls per case, matched for age and sex, were selected randomly from the cohort. Patient factors, initial tuberculosis characteristics and treatment-related variables were collected by review of medical records. RESULTS: On matching 102 defaulters and 306 controls, a logistic risk model of default that considered patient factors, initial disease characteristics and treatment-related factors identified seven risk factors: current smoking (OR 3.00, 95% CI 1.41-6.39), past TB with default (OR 6.23, 95% CI 1.95-19.91), poor initial adherence (OR 117.21, 95% CI 13.52-1015.92), fair initial adherence (OR 11.02, 95% CI 2.15-56.43), unknown initial adherence (OR 6.59, 95% CI 3.47-12.49), treatment side effects (OR 13.30, 95% CI 3.23-54.79), and subsequent hospitalisation (OR 0.27, 95% CI 0.11-0.67). Its predictive power was 85%. Another model that considered only factors on registration for treatment gave a lower predictive power of 70%. CONCLUSIONS: Treatment default could be predicted fairly accurately by considering patient and treatment-related factors.     

Epidemiology of polyps in the rectum and colon. Recovery and evaluation of unresected polyps 2 years after detection

In an endoscopic population screening study for colorectal polyps among 200 men and 200 women, 50-59 years of age, 215 polyps less than 5 mm in diameter were left in situ for the present 2-year follow-up examination. The attendance rate was 102 of 106 (96%) for polyp patients and 77 of 90 (86%) in the control group. Of 194 polyps, 143 (74%) in the 102 polyp-bearing individuals were recovered for histological evaluation and 57 polyps were registered as new. Ninety-nine (50%) of the polyps were hyperplastic, 45 (23%) were adenomas, and 45 (23%) were mucosal tags. Both growth and regression of polyps were registered. Regression was commoner in the distal part of the rectum than in the proximal part or distal sigmoid colon. Growth was similar for recovered adenomas and hyperplastic polyps, whereas mucosal tags more often showed diminution in size. No polyp had reached a size of more than 5 mm in 2 years, and no case of severe dysplasia or carcinoma was registered. The estimated total polyp mass more than doubled both for adenomas and hyperplastic polyps. It is concluded that the time interval between initial examination with removal of polyps 5 mm or larger in diameter and the first follow-up examination may safely be set at 2 years.     

Is chronic hepatitis C treatment as efficient in the general population as in randomised trials?

AIMS: The aim of this population-based study was to determine the effectiveness of antiviral therapy in non selected chronic hepatitis C patients. METHODS: The study was performed in all new patients with anti-HCV antibodies who had registered in a specialised viral hepatitis registry since 1994 and who lived in the French departments of C?te-d'Or and Doubs (1 005 817 inhabitants). RESULTS: 1251 of the 1508 recorded cases were studied; 262 were treated. Results of treatment were available in 238 cases, 157 were treated with interferon alone and 81 with interferon + ribavirine. Sustained virological response was observed in 18% of cases after interferon alone and 46.9% after interferon + ribavirine. In multivariate analysis, age under 40 and combined therapy were positively correlated to sustained virological response. Premature treatment discontinuation was associated with a lack of sustained response which was unrelated to gender or liver fibrosis. Fifty seven patients received combined therapy after unsuccessful monotherapy: sustained virological response rates were 33.3% in responders-relapsers and 23.7% in non-responders to initial therapy. CONCLUSIONS: This study showed that sustained response rates were similar in non selected patients from the general population and in highly selected patients from randomised trials. These results emphasize the necessity of increasing the ratio of treated patients which is still too low in general population.