Impact of molecular genetic methods on the initiation of chemotherapy in multiple drug resistant tuberculosis patients in Arkhangelsk Region

In the Arkhangelsk Region, the prevalence of multiple drug-resistant tuberculosis is one of the highest in the world. In 2016, the portion of multiple drug resistant tuberculosis made 33.1% among new cases and 59.5% among relapses. Using new molecular genetic diagnostic techniques allows reducing the time for diagnostics of tuberculosis and drug resistance and should result in the earlier start of adequate treatment. The goal of the study is to assess the impact of new diagnostic molecular genetic methods on the time period from the first referral for medical care till the start of MDR-TB treatment. It was assumed that the introduction of molecular genetic tests would lead to early initiation of treatment in MDR TB patients (the research project of the International Union Against Tuberculosis and Lung Diseases and Tuberculosis Control Program of Arkhangelsk Region on The PROVE-IT LPA; Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays). Subjects and Methods. The results of the diagnostic procedure using cultures were compared with the results of the procedure based on molecular genetic tests aimed to detect MDR-TB. 295 MDR TB patients were enrolled into the study, of them, 163 had culture and 132 had molecular genetic tests. Results. The use of molecular genetic tests in smear-positive patients (AFB+) resulted in the reduction of the time period before initiation of MDRTB treatment by 50 and 66 days (median) versus culture by BacTAlert and absolute concentration on Lowenstein-Jensen medium respectively (p <0.001). Patients with a negative smear (AFB-), in whom MDR TB was detected by molecular genetic methods started treatment by 78 days earlier (median) versus patients who had culture (Lowenstein-Jensen, p < 0.001). Despite the significant reduction in the time period, even using molecular genetic methods, it took 24 days for cases with AFB+ and 62 days for cases with AFB- to be notified and start treatment of MDR TB

The Use of Molecular Genetic Diagnostic Tests to Improve MDR TB Treatment Outcomes in Arkhangelsk Region

The use of molecular genetic tests as a part of tuberculosis patients examination made it possible to reduce the time for TB diagnosis and determination of drug resistance (DR) of M. tuberculosis (MTB) in Arkhangelsk Region. Early detection of multiple drug resistant tuberculosis (MDR TB) made it possible to prescribe the adequate chemotherapy regimen promptly and thus to improve treatment outcomes. The objective of the study: to evaluate the results of treatment of MDR TB patients in whom MDR TB was diagnosed by molecular genetic tests. It was assumed that the introduction of molecular genetic tests would result in improved treatment outcomes in MDR TB patients [(the research project of the International Union Against Tuberculosis and Lung Diseases and Tuberculosis Control Program of Arkhangelsk Region of the PROVE-IT LPA (Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays)]. Subjects: 295 MDR TB patients detected in Arkhangelsk Region were enrolled in the study. MDR TB was detected by molecular genetic tests in the main group (132 patients) and by culture in the control group (163 patients). Patients from both groups received the standard chemotherapy regimen. Chemotherapy outcomes were compared in both groups. Results. Treatment outcomes were better in the group (MGT group) where molecular genetic tests were used for drug susceptibility testing (p = 0.003) versus the comparison group where the culture was used. Effective treatment was documented more frequently (65.2%) in the MGT group versus the comparison group (44.8%). All-cause mortality was lower in the MGT group (7.6%) than in the comparison group (15.9%). There were no statistically significant differences between the groups in the time when sputum conversion (by smear and culture) was achieved. Key words: tuberculosis, multiple drug resistant M. tuberculosis, molecular genetic diagnostic test

Применение молекулярно-генетических методов диагностики с целью улучшения результатов лечения МЛУ-ТБ в Архангельской области

The use of molecular genetic tests as a part of tuberculosis patients examination made it possible to reduce the time for TB diagnosis and determination of drug resistance (DR) of M. tuberculosis (MTB) in Arkhangelsk Region. Early detection of multiple drug resistant tuberculosis (MDR TB) made it possible to prescribe the adequate chemotherapy regimen promptly and thus to improve treatment outcomes.The objective of the study: to evaluate the results of treatment of MDR TB patients in whom MDR TB was diagnosed by molecular genetic tests. It was assumed that the introduction of molecular genetic tests would result in improved treatment outcomes in MDR TB patients [(the research project of the International Union Against Tuberculosis and Lung Diseases and Tuberculosis Control Program of Arkhangelsk Region of the PROVE-IT LPA (Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays)].Subjects: 295 MDR TB patients detected in Arkhangelsk Region were enrolled in the study. MDR TB was detected by molecular genetic tests in the main group (132 patients) and by culture in the control group (163 patients). Patients from both groups received the standard chemotherapy regimen. Chemotherapy outcomes were compared in both groups.Results. Treatment outcomes were better in the group (MGT group) where molecular genetic tests were used for drug susceptibility testing (p = 0.003) versus the comparison group where the culture was used. Effective treatment was documented more frequently (65.2%) in the MGT group versus the comparison group (44.8%). All-cause mortality was lower in the MGT group (7.6%) than in the comparison group (15.9%). There were no statistically significant differences between the groups in the time when sputum conversion (by smear and culture) was achieved.Использование молекулярно-генетических методов (МГМ) в алгоритме обследования пациентов с туберкулезом (ТБ) позволило сократить время диагностики ТБ и определения лекарственной устойчивости (ЛУ) M. tuberculosis (М БТ) в Архангельской области. Благодаря раннему выявлению случаев ТБ с множественной лекарственной устойчивостью (МЛУ-ТБ) МБТ появилась возможность своевременно назначать соответствующий режим химиотерапии, что может улучшить результаты лечения.Цель исследования: оценка результатов лечения пациентов с МЛУ-ТБ, которым ЛУ МБТ определена с помощью МГМ. Предполагали, что внедрение МГМ приведет к улучшению результатов лечения больных с МЛУ-ТБ [научный проект Международного союза борьбы с туберкулезом и болезнями легких и туберкулезной программы Архангельской области «The PROVE-IT LPA» (Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays - значимые результаты подтверждения данных о влиянии метода гибридизации линейными зондами)].Методы. В исследование включено 295 пациентов с МЛУ-ТБ, выявленных в Архангельской области. В основной группе (132 человека) МЛУ-ТБ выявлен с помощью МГМ, в контрольной группе (163 человека) - культуральными методами. Пациентам обеих групп назначен стандартный режим химиотерапии. Результаты химиотерапии сопоставлены в обеих группах.Результаты лечения были лучше в группе, где применялись МГМ (МГМ-группа) определения лекарственной чувствительности (p = 0,003), при сопоставлении с группой сравнения, в которой использовали культуральный метод. Эффективный курс химиотерапии регистрировался чаще (65,2%) в МГМ-группе при сопоставлении с группой сравнения (44,8%). Смертность от всех причин была ниже в МГМ-группе (7,6%) при сопоставлении с группой сравнения (15,9%). Статистически значимых различий времени конверсии мокроты (бактериоскопия и посев) между группами не было

ВЛИЯНИЕ ВНЕДРЕНИЯ МОЛЕКУЛЯРНО-ГЕНЕТИЧЕСКИХ МЕТОДОВ НА СРОКИ НАЧАЛА ХИМИОТЕРАПИИ БОЛЬНЫХТУБЕРКУЛЕЗОМ С МЛУ МБТ В АРХАНГЕЛЬСКОЙ ОБЛАСТИ

In the Arkhangelsk Region, the prevalence of multiple drug-resistant tuberculosis is one of the highest in the world. In 2016, the portion of multiple drug resistant tuberculosis made 33.1% among new cases and 59.5% among relapses. Using new molecular genetic diagnostic techniques allows reducing the time for diagnostics of tuberculosis and drug resistance and should result in the earlier start of adequate treatment.The goal of the study is to assess the impact of new diagnostic molecular genetic methods on the time period from the first referral for medical care till the start of MDR-TB treatment. It was assumed that the introduction of molecular genetic tests would lead to early initiation of treatment in MDR TB patients (the research project of the International Union Against Tuberculosis and Lung Diseases and Tuberculosis Control Program of Arkhangelsk Region on The PROVE-IT LPA; Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays).Subjects and Methods. The results of the diagnostic procedure using cultures were compared with the results of the procedure based on molecular genetic tests aimed to detect MDR-TB. 295 MDR TB patients were enrolled into the study, of them, 163 had culture and 132 had molecular genetic tests.Results. The use of molecular genetic tests in smear-positive patients (AFB+) resulted in the reduction of the time period before initiation of MDRTB treatment by 50 and 66 days (median) versus culture by BacTAlert and absolute concentration on Lowenstein-Jensen medium respectively (p &lt;0.001).Patients with a negative smear (AFB-), in whom MDR TB was detected by molecular genetic methods started treatment by 78 days earlier (median) versus patients who had culture (Lowenstein-Jensen, p &lt; 0.001). Despite the significant reduction in the time period, even using molecular genetic methods, it took 24 days for cases with AFB+ and 62 days for cases with AFB- to be notified and start treatment of MDR TB.Распространенность туберкулеза (ТБ) с множественной лекарственной устойчивостью возбудителя (МЛУ) в Архангельской области – одна из самых высоких в мире. В 2016 г. доля МЛУ-ТБ составила 33,1% среди новых случаев и 59,5% среди рецидивов ТБ. Использование новых молекулярно-генетических диагностических методов (МГМ) позволяет сократить время диагностики ТБ и лекарственной устойчивости возбудителя заболевания и должно привести к раннему началу адекватного лечения.Цель исследования: оценка влияния новых МГМ диагностики на изменение времени от первого обращения за медицинской помощью до начала лечения МЛУ-ТБ. Предполагали, что внедрение МГМ приведет к раннему началу лечения больных с МЛУ-ТБ (научный проект Международного союза борьбы с туберкулезом и болезнями легких и туберкулезной программы Архангельской области «The PROVE-IT LPA; Policy Relevant Outcomes from Validating Evidence on Impact of Line Probe Assays – значимые результаты подтверждения данных о влиянии метода гибридизации линейными зондами)».Материалы и методы. Результаты использования диагностического алгоритма с применением культуральных методов были сопоставлены с результатами алгоритма, основанного на МГМ выявления МЛУ-ТБ. В исследование включено 295 больных с МЛУ-ТБ, из которых у 163 мокрота исследована культуральными методами, а у 132 – с помощью МГМ.Результаты. В группе больных с положительным результатом микроскопии мокроты (КУМ+) применение МГМ привело к сокращению срока до начала лечения МЛУ-ТБ на 50 и 66 дней (медиана) по сравнению с культуральными методами BacTAlert и методом абсолютных концентраций на среде Левенштейна – Йенсена (ЛЙ) соответственно (p &lt; 0,001).Больные с отрицательным результатом микроскопии мокроты (КУМ-), у которых МЛУ-ТБ был выявлен с помощью МГМ, начинали лечение на 78 дней раньше (медиана) по сравнению с больными, у которых применялись культуральные методы (ЛЙ, p &lt; 0,001). Несмотря на значительное сокращение сроков, даже с использованием МГМ потребовалось 24 дня для случаев КУМ+ и 62 дня для случаев с КУМ- для регистрации и начала лечения МЛУ-ТБ

The presentation, diagnosis and management of non-traumatic wrist pain: an evaluation of current practice in secondary care in the UK NHS

AbstractObjectivesThe study aims were to assess the burden of non-traumatic wrist pain in terms of numbers of referrals to secondary care, and to characterise how patients present, are diagnosed and are managed in secondary care in the United Kingdom National Health Service.MethodsTen consecutive patients presenting with non-traumatic wrist pain were identified retrospectively at each of 16 participating hospitals and data was extracted for twelve months following the initial referral.ResultsThe 160 patients consisted of 100 females and 60 males with a median age of 49, accounting for approximately 13% of all new hand/wrist referrals. The dominant wrist was affected in 60% of cases and the mean symptom duration was 13.3 months. Diagnoses were grouped into: osteoarthritis (OA) (31%), tendinopathy (13%), ganglion (14%), ulnar sided pain (17%) and other (25%). The OA group was significantly older than other groups, while other groups contained a predominance of females.The non-surgical interventions in decreasing frequency of usage were: steroid injections (39%), physiotherapy (32%), splint (31%) and analgesics (12%). Of those who underwent surgery, all patients had previously received non-surgical treatment, however 42% had undergone only one non-surgical intervention.ConclusionNon-traumatic wrist pain represents a significant burden to secondary care both in terms of new patient referrals and in terms of investigation, follow up and treatment. Those presenting with osteoarthritis are more likely to be older and male, while those presenting with other diagnoses are more likely to be younger and female

The impact of a line probe assay based diagnostic algorithm on time to treatment initiation and treatment outcomes for multidrug resistant TB patients in Arkhangelsk region, Russia

BACKGROUND: In the Arkhangelsk region of Northern Russia, multidrug-resistant (MDR) tuberculosis (TB) rates in new cases are amongst the highest in the world. In 2014, MDR-TB rates reached 31.7% among new cases and 56.9% among retreatment cases. The development of new diagnostic tools allows for faster detection of both TB and MDR-TB and should lead to reduced transmission by earlier initiation of anti-TB therapy. STUDY AIM: The PROVE-IT (Policy Relevant Outcomes from Validating Evidence on Impact) Russia study aimed to assess the impact of the implementation of line probe assay (LPA) as part of an LPA-based diagnostic algorithm for patients with presumptive MDR-TB focusing on time to treatment initiation with time from first-care seeking visit to the initiation of MDR-TB treatment rather than diagnostic accuracy as the primary outcome, and to assess treatment outcomes. We hypothesized that the implementation of LPA would result in faster time to treatment initiation and better treatment outcomes. METHODS: A culture-based diagnostic algorithm used prior to LPA implementation was compared to an LPA-based algorithm that replaced BacTAlert and L&ouml;wenstein Jensen (LJ) for drug sensitivity testing. A total of 295 MDR-TB patients were included in the study, 163 diagnosed with the culture-based algorithm, 132 with the LPA-based algorithm. RESULTS: Among smear positive patients, the implementation of the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 50 and 66 days compared to the culture-based algorithm (BacTAlert and LJ respectively, p&lt;0.001). In smear negative patients, the LPA-based algorithm was associated with a median decrease in time to MDR-TB treatment initiation of 78 days when compared to the culture-based algorithm (LJ, p&lt;0.001). However, several weeks were still needed for treatment initiation in LPA-based algorithm, 24 days in smear positive, and 62 days in smear negative patients. Overall treatment outcomes were better in LPA-based algorithm compared to culture-based algorithm (p = 0.003). Treatment success rates at 20 months of treatment were higher in patients diagnosed with the LPA-based algorithm (65.2%) as compared to those diagnosed with the culture-based algorithm (44.8%). Mortality was also lower in the LPA-based algorithm group (7.6%) compared to the culture-based algorithm group (15.9%). There was no statistically significant difference in smear and culture conversion rates between the two algorithms. CONCLUSION: The results of the study suggest that the introduction of LPA leads to faster time to MDR diagnosis and earlier treatment initiation as well as better treatment outcomes for patients with MDR-TB. These findings also highlight the need for further improvements within the health system to reduce both patient and diagnostic delays to truly optimize the impact of new, rapid diagnostics

A Research Agenda for Helminth Diseases of Humans: Diagnostics for Control and Elimination Programmes

Diagnostic tools appropriate for undertaking interventions to control helminth infections are key to their success. Many diagnostic tests for helminth infection have unsatisfactory performance characteristics and are not well suited for use in the parasite control programmes that are being increasingly implemented. Although the application of modern laboratory research techniques to improve diagnostics for helminth infection has resulted in some technical advances, uptake has not been uniform. Frequently, pilot or proof of concept studies of promising diagnostic technologies have not been followed by much needed product development, and in many settings diagnosis continues to rely on insensitive and unsatisfactory parasitological or serodiagnostic techniques. In contrast, PCR-based xenomonitoring of arthropod vectors, and use of parasite recombinant proteins as reagents for serodiagnostic tests, have resulted in critical advances in the control of specific helminth parasites. The Disease Reference Group on Helminths Infections (DRG4), established in 2009 by the Special Programme for Research and Training in Tropical Diseases (TDR) was given the mandate to review helminthiases research and identify research priorities and gaps. In this review, the diagnostic technologies relevant to control of helminth infections, either available or in development, are reviewed. Critical gaps are identified and opportunities to improve needed technologies are discussed

Measuring the resource potential in commercial and industrial wastes from food related businesses

This paper reports on the results of a project to map the resource potential in commercial and industrial (C&I) wastes produced by small businesses in England. The main objectives of the project include developing a robust methodology for auditing the waste stream from SMEs, mapping key resources in the wastes produced, and integrating this data with that on municipal waste to highlight opportunities for combined recovery. The methodology was tested in Hampshire on food and food-related SMEs, including the manufacturing, retail and hospitality sectors. It provides a framework in which these businesses, local authorities and the waste management industry can work to optimise the recovery and re-use of key resources