RECHALLENGING TREATMENT PLAN FOR MULTIDRUG-RESISTANT TUBERCULOSIS IN DIABETIC PATIENT: A CASE REPORT

Multidrug-resistant tuberculosis (MDR-TB) currently considers as the biggest issue and its subcategory, rifampicin-resistant TB (RR-TB). MDR-TB is defined as a resistant to isoniazid (H) and rifampicin (R), while the latter is resistant to rifampicin (R) only. Poorly controlled diabetes mellitus increases the risk of TB and leads to poor TB treatment outcomes as well it is consider potentially threating TB control. Difference in patients’ response and side effect developments toward anti-TB (ATB) medications requires rechallenging procedure that can be complicated at times. The management of MDR-TB can be complicated, especially, when the patient cannot tolerate the short regimen. Difference in patients’ response and side effect developments toward ATB medications requires rechallenging procedure which can have prolonged treatment time, hospital stay, and make patients exposed to hospital-acquired infection. This challenges and obstacles, however, could be prevented earlier by having strong DOTS strategy to prevent the development of resistance and reactivation of TB

The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

<p>Abstract</p> <p>Background</p> <p>There is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.</p> <p>Methods</p> <p>An integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate.</p> <p>Results</p> <p>A linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB treatment alone (77.5% vs. 8.7%; p < 0.001). Furthermore, at the end of TB treatment (6 months or later), there were significantly higher rates of treatment default (15.2% vs. 2.5%; p = 0.019) and treatment failure (6.5% vs. 0%; p = 0.019) in the DOTS group than in the SCIDOTS group.</p> <p>Conclusion</p> <p>This study provides evidence that connecting TB-tobacco treatment strategy is significant among TB patients who are smokers. The findings suggest that the integrated approach may be beneficial and confer advantages on short-term outcomes and possibly on future lung health of TB patients who quit smoking. This study may have important implications on health policy and clinical practice related to TB management among tobacco users.</p

Prevention of Radiocontrast-Induced Nephropathy after Coronary Angiography: N-Acetylcysteine plus Saline Hydration versus Saline Hydration

Purpose: To compare the incidence of radiocontrast-induced nephropathy (RCIN) in patients undergoing coronary angiography pretreated with N-acetylcysteine NAC plus saline hydration or saline hydration alone and to determine the association between various risk factors and RCIN. Methods: Patients were retrospectively evaluated over a one-year period. RCIN was defined as an acute rise in serum creatinine of at least 0.5 mg/dl or more than 25 % from baseline value. SPSS software, version 13 was used for data analysis. Results: Overall, 299 patients were studied. Thirteen patients (4.3%) developed RCIN. RCIN was 3.3 % in patients treated with hydration, and 8.3 % in patients treated with NAC plus hydration (p = 0.09). In patients with RCIN, the changes in creatinine and % change in creatinine after 24 h were significantly lower in the NAC plus hydration group (p = 0.039 and p = 0.042, respectively). RCIN was significantly associated with male gender (p = 0.017), history of renal failure (p = 0.006), ischemic heart disease (p = 0.003), and diuretic treatment (p = 0.013). Conclusion: NAC plus saline hydration may not be more effective than saline hydration alone in decreasing RCIN after coronary angiography. Additional efforts to find an ideal preventive treatment are needed

Diabetes Knowledge and Practice in Malaysian and the United Arab Emirates Diabetic Patients

ABSTRACT The aim of the study is to investigate and to compare the current levels of the knowledge, attitude and the practice of people with diabetes in Malaysia and the United Arab Emirates. A cross-sectional prospective study, 403 diabetic patients were participating in this study, 202 Malaysian and 201 from the UAE. The data showed significant differences at the levels of the Knowledge, and the Practices between Malaysian and the UAE respondents with (P&lt;0.001), while the good attitude was missing amongst the UAE respondents. This study had found that more than three quarter of Malaysian respondents (77.2%) were had a family history of diabetes compared to the UAE counterpart (64.7%). Interestingly, a high significant differences (P&lt;0.001) were found in the Knowledge, Attitude and Practice scores between Malaysian and the UAE counterpart. The mean scores presented as (Mean ±SD) were higher in Malaysian than in the UAE study group; were knowledge scored (25.6±3.3 vs. 20.3±2.9), attitude (4.3±1.2 vs. 2.9±0.1) and practice (4.3±1.3 vs. 4.1±1.0). The UAE diabetic patients included in the study appeared to have poor knowledge, attitude and practice regarding their disease. These findings can be used to promote discussion in the profession and with stakeholders about any future diabetes care or to plan intervention strategies to promote awareness and reduce incidence of diabetes in this country. However, further work is needed to gauge the levels of the knowledge, attitude and the practice of people with diabetes in both countries

Public Awareness and Practices Towards Self-Medication with Antibiotics Among Malaysian Population: Questionnaire Development and Pilot Testing

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