Tuberculosis among the Roma population in Macedonia

Our aim was to find out what is their participation in the total number of TB patients, what is their incidence and are they a risk group for TB and possible reasons for that

The importance of the diagnosis and treatment of latent tuberculosis infection on the tuberculosis control

Latent tuberculosis infection (LTBI) is defined as a condition of a permanent immune response stimulated by tuberculosis mycobacteria (TB) antigens without the presence of a clinical manifest active disease It is estimated that 2 billion people, or one third of the world's population, are latently infected with TB bacteria During life, the risk of reactivation of TB in people with confirmed LTBI is 5-10%, and that most will develop illness during the first five years after the initial infection .The systematic detection and treatment of LTBI is an important component of the World Health Organization's new "End of TB" strategy (WHO). To diagnosis of latent tuberculosis infection both tests are used: Tuberculosis skin test (TST), and QuantiFERON-TB(QFT-Quantiferone) which belongs to the group of the IGRA tests (interferon -gama release assay). Indications for diagnosis and treatment are: family contacts from 0 to14 years, infants , children and adults carriers of HIV virus and other people with medical risk factors. For the treatment of LTBI, in our country, the standard 6 month regime with Isoniazid, and as an alternative, a 3 month regimen with Isoniazid and Rifampicin are administered. 9- month regime with Isoniazid is applied in people with HIV infection. In 2017, in our country, 45 people with LTBI were examined and treated. 41 (91%) were family contacts with pulmonary smear positive tuberculosis and in 4 (9%) who were with-medical risk factors for the treatment of LTBI (HIV positives, or people who were treated with anti-TNF therapy). For the diagnosis of LTBI, two tests were applied .In 9 (20%) QuantiFERON-TB and by all examined was positive, that confirms the fact of greater sensitivity in comparison with TST. At 41, TST was made, of which 20 or 46% was positive. The LTI treatment was implemented with two regimes , 24 (54%) were treated with a six- months daily regime with INH (Isoniazid), and 21 (46%) with a three-month daily regime with two anti-tuberculosis drugs (INH and Rifadin ). Those who were HIV positive treatment with INH were administered for 9 months. According to the outcome of the treatment, in 28 (62%) the treatment is completed, and in 17 (38%) was discontinued due to non-cooperation, and due to the control negative results of TST Conclusion: The diagnosis and successful treatment of LTBI is an important component of the new strategy for the WHO "End of TB". The low percentage of successfully treated persons with LTBI in our country, in 2017 (62.2%) imposes the need to improve the management of persons with LTBI, with the aim of achieving its eradicatio

Улогата на здравствените работници во едукација на пациенти со алергиски реакции

Имуниот систем е составен од разни типови на специјализирани клетки, протеини, ткива и органи. Неговата главна функција е детекција на штетните микроорганизми и нивно уништување.Кога имуниот систем погрешно ќе детектира одреден алерген како штетен, тогаш и покрај тоа што алергенот не е опасен за организмот, се активираат имунолошки реакции со цел уништување на „штетниот патоген“

Tuberculosis in the Prisons in the Republic of Macedonia, 2008-2017

BACKGROUND: Tuberculosis (TB) is a major health problem in penitentiary institutions (prisons), and its prevalence was reported to be multiple times higher compared to that of the general population. Conditions such as overcrowding, malnutrition and limited access to medical care which often exist in prisons increase the risk of reactivation, transmission and poor prognosis of tuberculosis disease among inmates.AIM: The main objective of this study was to present the epidemiological situation of TB in the prisons from 2008 till 2017 in the Republic of Macedonia (RM).PATIENTS AND METHODS: There are 13 different penitentiary institutions in the RM with a total capacity to house 2600 prisons inmates. Management of TB in the prisons is part of the National TB program in RM, and the Institute for Lung Diseases and Tuberculosis in Skopje is in charge of it. All prisoners with TB in the RM are registered in the Central Register for TB within this Institute. We use the data from the Central Register, and with the method of description, we present the epidemiological data and clinical characteristics of the prisoners about TB in prisons in RM for 10 years’ period.RESULTS: From 2008 till 2017 there were 58 TB cases registered in prisons in total. The absolute number of TB cases in the prisons is not big, but the incidence rate is higher than 100/100,000 population, or several times bigger than in the general population (except in 2012 and 2016). In 2017 there were 10 TB cases registered in the prisons with an incidence rate of 323.9/100,000 population which is many times higher than in the general population in RM. The majority of inmates with TB were young men with risk factors for TB infection or TB disease before incarceration such as drug abuse, alcohol, smoking, but there was no association with HIV infection. The most of the patients diagnosed in prison were new cases (54), secondary TB due to reactivation from the latent TB infection or secondary TB due to the environment. From 2008-2017 there were 82.75% successfully treated TB cases in the prisons, and there were no cases of multi-drug resistant tuberculosis (MDR-TB).CONCLUSION: The results from our study showed that the TB control in the prisons in RM is good with satisfactory treatment outcome. On the other hand, the high incidence rate showed that the prisons in RM provide conditions for TB transmission and with other additional risk factors present place for high TB prevalence. The study findings can be used for planning more effective TB control interventions for the prison population in RM

The causes of death among patients with tuberculosis

Tuberculosis is one of the main causes of morbidity and mortality in different societies. In 2010, there were an estimated 12 million people living with active TB, including 8.8 million new cases and there were an estimated 1.4 million deaths. Identifying causes for death following diagnosis of TB is important for planning effective interventions to reduce death rates

Comparison of Results from Inpatient and Outpatient Treatment of Tuberculosis in Republic of Macedonia

BACKGROUND: The successful treatment of patients with active tuberculosis is one of the priorities in the Tuberculosis Control Programs. AIM: The aim was to establish whether there was a statistically significant difference in the treatment outcome in patients with tuberculosis who began their initial treatment phase and/or pursued it as inpatient, as opposed to patients with tuberculosis who underwent their entire treatment regime as outpatient. Moreover, our goal was to determine whether there is a statistically significant difference in the outcome from the treatment between patients with tuberculosis who were hospitalized up to one month, two months, or more than two months. MATERIALS AND METHOD: The study includes 355 patients, divided into two groups. The first group, which consists of 219 patients, began their initial treatment phase as inpatient, and then they continued the treatment as outpatient. The second group, 136 patients, underwent their entire treatment as outpatient. The treatment outcome is determined with every patient (cured, treatment completed, treatment default, treatment failed, died, treatment in progress). For the statistical data analysis and for establishing the significance of the findings regarding the differences between the two groups we used the Pearson Chi-Square Test and the Yates Corrected Test. RESULTS: The statistical analysis with the Pearson Chi-Square Test showed that the treatment outcome does not significantly depend on the model of treatment (p = 0.31). The statistical data analysis showed that there is no statistically significant difference in the achievement of conversion of the bacterial result of the sputum at the end of the initial phase of treatment regarding the studied groups (p = 0.89). The statistical data analysis showed that the length of inpatient treatment affects the outcome of the treatment and that the difference is statistically highly significant (p < 0.00005). CONCLUSION: There are no statistically significant differences in the sputum conversion and the treatment outcome among inpatient/outpatient with tuberculosis or outpatient only; however, the length of inpatient treatment is statistically significant regarding its effect on the treatment outcome

Evaluation of C-Reactive Protein in Patients with Chronic Obstructive Pulmonary Disease

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is associated with evidence of systemic oxidative stress, activation of circulating inflammatory cells and increased plasma level of proinflamatory cytokines which include C-reactive protein (CRP). CRP is one biomarker of extrapulmonary or systemic consequences of COPD that can be detected. AIM: The aim of this research is to determine whether the level of CRP statistically significantly correlates with the level of bronchial obstruction and the accompanying co-morbidities in patients with COPD. MATERIAL AND METHODS: This study included 80 patients with exacerbation of COPD, hospitalised at the Institute for Lung Diseases and Tuberculosis in Skopje. We measured the level of CRP in the blood in all of these patients in fasting conditions. The classification of COPD patients by the severity of airflow limitation was made according to the actual version of the Global initiative for chronic Obstructive Lung Disease (GOLD). The Student’s Independent Samples t-test was used for the statistic analysis of the data. RESULTS: In 52 (65%) of the patients with exacerbation of COPD we detected an increase of the mean value of CRP. The statistical analysis using the Student’s t-test showed statistically significant differences in the mean value of CRP in patients with different level of bronchial obstruction. Hypertension, hеart failure, diabetes mellitus, hyperlipidemia, coronary disease, and CVI were confirmed as co-morbidities in 45 (73.1%) of the patients, hypertension being the most frequent one (40%). The statistical analysis using the Student’s t-test showed statistically significant difference of the mean value of CRP (p< 0.01) depending on the number of co-morbidities. CONCLUSION: In 52 (65%) of the patients with exacerbation of COPD, were detected an increase of the mean value of CRP. The mean values of CRP statistically significantly correlate with the level of bronchial obstruction and the number of co-morbidities in patients with COPD

Control of infection from nosocomial transmission of tuberculosis

Tuberculosis (TB) is still a huge health problem in the world. According to the World Health Organization (WHO), in 2015, 10.4 million new tuberculosis cases were registered. Most of the newly reported cases of TB are concentrated in 6 countries in the world: India, Indonesia, China, Nigeria, Pakistan and South Africa. In 2015, 1.8 million people died of TB. Among deaths 140,000 were children (1) By implementing the WHO strategy, known as Short Term Treatment Procedures under Direct Surveillance (DOT), almost all patients with tuberculosis can be treated. At the base of the DOT, the strategy is applied to short-term regimens under the direct control of health workers .Transmission of infection in tuberculosis is usually an aerobic pathway.Recent research in developing countries has shown that health care professionals (CARs) who take care of infectious TB patients have significantly higher isk of getting infected and getting sick from TB Therefore, WHO makes recommendations and guidelines to provide effective measures to prevent TB infection between the care professionals.These recommendations are based on a three-level control of the infection, consisting of administrative control, environmental control and personal protection of the respiratory organs. According to the basic healthcare activity provided by the Institute for Lung Disease and Tuberculosis (TB) in terms of diagnosing, treating and preventing tuberculosis, the working staff and / or patients coming to the Institute for various services are at risk of infection with tuberculosis bacteria. Therefore, consistent implementation of the measures recommended by the WHO and set out in the Control Program the infection of the nosocomial transmission of tuberculosis.The program for control of nosocomial infection with tuberculosis bacteria (MT) in the Institute should be realized with activities, hierarchically divided into three, оr four levels: managerial (organizational) activities at the level of a health institution, administrative measures, which reduce the risk of exposure to infection, environmental control measures, which prevents the risk of drooping way of spreading respiratory infections with MT and measures of personal protection against infection, which reduces the risk of inhalation of infectious particles Keywords: nosocomial infection, tuberculosis, isolation, administrative measure

Significance of contacts in the manifestation of tuberculosis as an infectious disease

The purpose of this study was to evaluate the importance of contact in the manifestation of tuberculosis, ie what age, which forms manifest tuberculosis and what is the time period from contact to manifestation of tuberculosis. For this purpose, the histories of 88 cases of tuberculosis in persons who have been in contact with tuberculosis, for the period 2010-2012. The contact was comfirmed at 7.5% of analyzed TB patients. 47.7% were male and 52.3% were female. 28.4% belonged to the age group of 0-14 years, 54.5% of the age group 16-44 years and 17% were older than 44 years. 92% were with pulmonary, and 8% with extrapulmonary tuberculosis. M. tuberculosis from sputum was isolated at 44.9%. The source of infection in a close family member was in 76%. In 12% source was another member of the family (grandmother, grandfather, aunt). In 12% source was a roommate from the prisoner’s room, or classmate or neighbor. In 75%, the source of infection in the family was one of the parents, in 15.6% was brother or siste, and at 9.4 % was one of the spouses. Analyzing the time period for manifestation of tuberculosis after the contact, in 56.7% tuberculosis is diagnosed to 3 months after the contact, in 23.3% in a period of 3 to 6 months, and after 6 months tuberculosis manifested in 20% of the respondents. Conclusion: Contact was confirmed at 7.5% of analysed TB patients. In 76% of the cases source was in the family, and the most common source was one of the parents (75.6%). After the contact tuberculosis usually manifests in the first three months (56.7%). Because the tuberculosis can manifest even after 6 months of contact, there is a need for contact tracing in an extended period of time

Influence of the risk factors and belonging to the risk groups in manifesting of the previously treated tuberculosis

After more than one decade of the epoch making discovery of the tuberculosis agent and more than fifty years of the introduction of the efficient antituberculotics, tuberculosis is still the leading agent for the mortality among adults all around the world ( nearly 3 million deats yearly). The estimated 8,8 milion new cases every year corespond to 52.000 deaths per week or more than 7.000 each day, which translates into more than 1.000 new cases every hour. In R. Macedonia, tuberculosis still has been relevant medical and social problem, although the number of registered patients with tuberculosis in the last years constantly has been decreasing. One of many contributing factors are risk factors and belonging to a risk groups, because in those cases tuberculosis spreads more easily than in the rest of the population