Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5\u201374.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care

Determining The Estimated Amount Of Tourists Allowed Simultaneously In Imereti Well-Arranged Caves

საქართველოს კარსტულ ფენომენებს შორის ანალოგი არ აქვთ ახალი ათონის, სათაფლიის და პრომეთეს მღვიმურ სისტემებს. Aახალი ათონის მღვიმე გასული საუკუნის 60-იან წლებში იყო აღმოჩენილი. საერთაშორისო სტანდარტების დონეზე მოწყობილი მღვიმის მიწისქვეშა დარბაზებს ყოველწლიურად ათასობით მნახველი ჰყავდა, ხოლო ექსპლუატაციით მიღებული წმინდა შემოსავალი 1 მილიონ რუბლს აჭარბებდა. საქართველოს მთაგრეხილებში ბენებრივმა პროცესებმა მრავალი საოცარი ძეგლი შექმნა, მათ შორისაა უცნობი, რთული მრავალშესასვლიანი და მრავალსართულიანი იმერეთის მღვიმეთა დაცული ტერიტორიები, როგორიცაა სათაფლიის სახელმწიფო ნაკრძალი, პრომეთეს მღვიმის, თეთრი მღვიმის, ცუცხვათის მღვიმის, ვანის, ნავენახევის, იაზონის და აშ. შემეცნებითი ტურიზმის განვითარებამ გამოიწვია ტურისტების ნაკადების ზრდა კეთილმოწყობილ მღვიმეებში (სათაფლია, პრომეთე, ნავენახევი)

Interlayer coupling in Tb/Fe bilayers and Tb/Au/Fe trilayers with sharp or rough interface

Bilayer films Fe/Tb (Tb on Fe) having sharp and Tb/Fe (Fe on Tb) having rough interface were prepared by molecular beam epitaxy to study interlayer magnetic coupling. Magnetic properties of these bilayers were characterized ex situ using ferromagnetic resonance (FMR), polar magneto-optical Kerr effect and SQUID magnetometer. The resulting perpendicular magnetic anisotropy (PMA) is discussed as an effect of interlayer magnetic coupling. PMA was observed in rough as well as in sharp interfaces and the anisotropy energies were estimated. When a monolayer of Au was interposed at the interface of both kinds, PMA was observed to disappear and the overall magnetic moment increased. It was also shown that in ultrathin films demagnetization factor depends on the substrate roughness and should be considered in the FMR data. Bilayer films Fe/Tb (Tb on Fe) having a sharp interface and Tb/Fe (Fe on Tb) having a rough interface are prepared by molecular beam epitaxy to study the interlayer magnetic coupling. The magnetic properties of these bilayers are characterized ex situ using ferromagnetic resonance (FMR). The polar magnetooptical Kerr effect, and a SQUID magnetometer. The resulting perpendicular magnetic anisotropy (PMA) is discussed as an effect of the interlayer magnetic coupling. PMA is observed at rough as well as at sharp interfaces, and the anisotropy energies are estimated. When a monolayer of Au is interposed at either kind of interface, the PMA is observed to disappear and the overall magnetic moment increases. It is also shown that in ultrathin films the demagnetizing factor depends on the substrate roughness and should be taken into account in the FMR data

Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5–74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care

Management of MDR-TB in HIV co-infected patients in Eastern Europe: Results from the TB:HIV study

Objectives Mortality among HIV patients with tuberculosis (TB) remains high in Eastern Europe (EE), but details of TB and HIV management remain scarce. Methods In this prospective study, we describe the TB treatment regimens of patients with multi-drug resistant (MDR) TB and use of antiretroviral therapy (ART). Results A total of 105 HIV-positive patients had MDR-TB (including 33 with extensive drug resistance) and 130 pan-susceptible TB. Adequate initial TB treatment was provided for 8% of patients with MDR-TB compared with 80% of those with pan-susceptible TB. By twelve months, an estimated 57.3% (95%CI 41.5–74.1) of MDR-TB patients had started adequate treatment. While 67% received ART, HIV-RNA suppression was demonstrated in only 23%. Conclusions Our results show that internationally recommended MDR-TB treatment regimens were infrequently used and that ART use and viral suppression was well below the target of 90%, reflecting the challenging patient population and the environment in which health care is provided. Urgent improvement of management of patients with TB/HIV in EE, in particular for those with MDR-TB, is needed and includes widespread access to rapid TB diagnostics, better access to and use of second-line TB drugs, timely ART initiation with viral load monitoring, and integration of TB/HIV care

Delayed diagnosis of tuberculosis in persons living with HIV in Eastern Europe: associated factors and effect on mortality—a multicentre prospective cohort study

Background: Early diagnosis of tuberculosis (TB) is important to reduce transmission, morbidity and mortality in people living with HIV (PLWH). Methods: PLWH with a diagnosis of TB were enrolled from HIV and TB clinics in Eastern Europe and followed until 24 months. Delayed diagnosis was defined as duration of TB symptoms (cough, weight-loss or fever) for ≥ 1 month before TB diagnosis. Risk factors for delayed TB diagnosis were assessed using multivariable logistic regression. The effect of delayed diagnosis on mortality was assessed using Kaplan–Meier estimates and Cox models. Findings: 480/740 patients (64.9%; 95% CI 61.3–68.3%) experienced a delayed diagnosis. Age ≥ 50 years (vs. < 50 years, aOR = 2.51; 1.18–5.32; p = 0.016), injecting drug use (IDU) (vs. non-IDU aOR = 1.66; 1.21–2.29; p = 0.002), being ART naïve (aOR = 1.77; 1.24–2.54; p = 0.002), disseminated TB (vs. pulmonary TB, aOR = 1.56, 1.10–2.19, p = 0.012), and presenting with weight loss (vs. no weight loss, aOR = 1.63; 1.18–2.24; p = 0.003) were associated with delayed diagnosis. PLWH with a delayed diagnosis were at 36% increased risk of death (hazard ratio = 1.36; 1.04–1.77; p = 0.023, adjusted hazard ratio 1.27; 0.95–1.70; p = 0.103). Conclusion: Nearly two thirds of PLWH with TB in Eastern Europe had a delayed TB diagnosis, in particular those of older age, people who inject drugs, ART naïve, with disseminated disease, and presenting with weight loss. Patients with delayed TB diagnosis were subsequently at higher risk of death in unadjusted analysis. There is a need for optimisation of the current TB diagnostic cascade and HIV care in PLWH in Eastern Europe