Treatment outcomes and predictive factors for multidrug-resistant TB and HIV coinfection in Rio de Janeiro State, Brazil

BACKGROUND: Brazil ranks 14th worldwide in the number of TB cases and 19th in terms of TB-HIV co-infected cases. This study aims at identifying clinical and demographic factors associated with unsuccessful treatment outcomes (loss to follow-up, treatment failure and death) of HIV-positive patients with multidrug-resistant TB (MDR-TB) in Rio de Janeiro State, Brazil. METHODS: This was a retrospective cohort study of MDR-TB cases notified from 2000 to 2016 in RJ. Cox proportional hazard regression models were used to assess risk factors associated with unsuccessful treatment in HIV-positive patients with MDR-TB. RESULTS: Among 2,269 patients, 156 (6.9%) were HIV-positive and had a higher proportion of unsuccessful treatment outcomes (52.6%) than HIV-negative cases (43.7%). All HIV-positive cases with extensively drug-resistant TB (XDR-TB) had unsuccessful treatment outcomes. Multivariate analysis shows that previous MDR-TB treatment (HR 1.97, 95% CI 1.22–3.18) and illicit drugs use (HR 1.68, 95% CI 1.01–2.78) were associated with a greater hazard of unsuccessful treatment outcomes, while 6-month culture conversion (HR 0.48, 95% CI 0.27–0.84) and use of antiretroviral therapy (ART) (HR 0.51, 95% CI 0.32–0.80) were predictors of reduced risk. CONCLUSIONS: Unsuccessful treatment was higher among HIV patients with MDR-TB than among HIV-negative patients. Prompt initiation of ART and effective interventions are necessary to improve treatment adherence and prevent retreatment cases

Multidrug-Resistant Tuberculosis in Portugal: Patients' Perception of the Challenges Faced during Treatment

Introduction: The increase in drug-resistant tuberculosis (TB) threatens global progress in eliminating TB, and constitutes a major challenge for patients, health-care workers and health services. Treatment for multidrug-resistant TB (MDR-TB) can last almost 2 years, and is more expensive, more toxic, and less effective than treating TB caused by drug-sensitive bacilli. This study aims to analyze patients’ narratives about the challenges they face during MDR-TB treatment and identify the support factors that help patients being treated in the most populous district of Portugal. Methods: Semi-structured interviews were conducted with patients being treated for MDR-TB. The interviews were coded using thematic analysis. They were audio-recorded, transcribed, and transported into NVivo v12 for data management and coding. Results: Depression, social discrimination, and the side effects of drugs are the main challenges faced by patients with MDR-TB. A good relationship of the patients with the health team, emotional support, and supervised treatment stand out as the factors that generate better adherence and treatment success. Conclusion: In addition to modern diagnostic techniques and new treatments, MDR-TB can be fought by focusing on the care and needs of patients. We suggest that the Lisbon Tuberculosis Program adopts the following measures: build the health-care team’s capacity to identify symptoms of depression early, increase public awareness of the disease, expand the multidisciplinary team, and expand the options for individualized social support for patients

Eliminating tuberculosis in Latin America: making it the point

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Vector-acoustic Reverse-time Migration of Volve OBC Dataset without Up/Down Decomposed Wavefields

Methods for wavefield injection are commonly used to extrapolate seismic data in reverse time migration (RTM). Injecting a single component of the acoustic field, for example, pressure, leads to ambiguity in the direction of propagation. Each recorded wavefront is propagated both upward and downward, and spurious (or ghost) reflectors are created alongside real reflectors in the subsurface image. Thus, wavefield separation based on the combination of pressure and particle velocity data is generally performed prior to imaging to extract only the upgoing field from multicomponent seabed or towed marine seismic recordings. By instead combining vector-acoustic (VA) data with monopole- and dipole-type propagators in the extrapolation of shot or receiver gathers, we show that wavefield separation (or deghosting) can instead be performed “on-the-fly” at limited additional cost. This strategy was successfully applied to a line of a North Sea ocean-bottom cable data set, acquired over the Volve field. We then evaluate additional advantages over standard RTM with decomposed fields such as improved handling of the directivity information contained in the acquired VA data for clearer shallow sections and better focused space-lag common image gathers, and imaging of the downgoing component without the need for additional finite-difference modeling via mirror migration. Finally, we prove the robustness of our method with respect to sparse and irregular receiver sampling. </jats:p

Constructing an information matrix for multivariate DCC-MGARCH (1, 1) method

The analytic form of Fisher Information Matrix (IM) for DCC-MGARCH (1, 1) was suggested. After that, it was applied for simplifying the general algorithm: the statistical hypothesis about constant correlation matrix usage was put forward and statistical verification was made. IM was employed for Russian share market: to do investigations the five equilibrium portfolios was compounded from four different shares in each case. Computations made showed that there are three types T1–T3 of trading days on the market and day type changing from T1 to T2 and vice versa is happening over the time moments T3. Moreover, the clustarisation effect of multivariate volatility that was investigated by scientists from all around the world in the univariate case was discovered and described