Table of Content

20 January 2010, Volume 32 Issue 1

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Clinical study on pulmonary tuberculosis with first retreatment in Shanghai Pulmonary Hospital

Zhang Zhongshun,Xiao Heping

Chinese Journal of Antituberculosis. 2010, 32(1):  1-5. 

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Objective To study the baseline data of inpatients who received retreatment of antituberculosis as the first time, so as to provide evidence for making standardized and reasonable chemotherapy regimen, and to increase cure rate and strengthen management work of prevention and treatment.  Methods We investigated and analysed retrospectively clinical characteristics and risk factors of inpatients with pulmonary tuberculosis who received the first retreatment in Shanghai Pulmonary Hospital from January 2003 to December 2005.   Results Among the inpatients with pulmonary tuberculosis,there were 498 patients who were retreated as the first time, accounting for 13.1% of all the inpatients with pulmonary tuberculosis during the same period. The rate of sputum smear positive was 52.8%. The drug resistant rates of streptomycin, isoniazid, rifampicin and ethambutol were 34.8%, 46.8%, 28.4% and 24.8% respectively. The drug resistant rate of isoniazid combinated with rifampicin was 26.2%. 51.7% of the patients had complications in various degrees and the most common complications were diabetes, basic liver disease and hypoproteinemia. Drug-reltated adverse effects before or after this hospitalization was 81 case-times. 35.1% of the patients had irregular antituberculosis treatment history caused often by drug-related adverse effects. The patients greater than 45-year old with first retreatment from Shanghai acconted for approximately 70%,and especially patients greater than 60-year old accounted for 43.7%. However, about 60% of patients from other cities was less than 45-year old.  Conclusion s The first time retreated inpatients have particular characteristics. Drug resistance, poor basic conditions, many complications, complicated extra-pulmonary tuberculosis, malnutrition, drug-related adverse reactions and irregular treatment are risk factors of retreated tuberculosis.

Analysis of 5 years implementation effect of TB control program in Shenzhen

Xu Li,Yang Yingzhou,Wu Qingfang,Zhang Yuhua,Guan Hongyun,Li Mingzhen

Chinese Journal of Antituberculosis. 2010, 32(1):  6-10. 

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Objective To analyze the implementing effect of 5 year TB control program in Shenzhen, and provide evidence basis for formulation of next step TB control strategy.   Methods Data from monthly, quarterly, and annual reports as well as the city’s year-end summary of TB control work and statistical yearbook were used to assess and analyze the devotion of governmental special TB working fund, capacity building, patients detection and management etc.   Results The Government developed work plan and devoted special fund of 43.416 2 million yuan in total; Organizational development and capacity building are further improved. DOTS coverage is 100%. A total of 15 364 active pulmonary tuberculosis patients were found, among which 72.3% were mobile population; 11 500 cases of smear positive pulmonary tuberculosis patients were found; Cure rate is 94.6% for local residence, 69.4% for mobile population; a total of 83 019 cases of suspected or confirmed tuberculosis were referred, among these referred cases, direct arrival rate after referral were 81.7% and 66.4% for local residence and mobile population respectively; 26 391 cases were tracked; referral rate in place for local residence and mobile population were 95.1% and 18.6% respectively. Within 5 year period, the detected number of active pulmonary tuberculosis and smear positive cases, cured cases, referred cases and cases tracked have increased substantially year by year (P all<0.05); however, the detection rate of smear-positive, the cure rate, direct arrival rate after referral and tracing arrival rate were all not significantly increased (P>0.05), even for mobile population, the tracing arrival rate showed a significant downward trend (P<0.05).   Conclusion s A large number of pulmonary tuberculosis cases were diagnosed, treated and cured within 5 years.however because of a substantial increase in the mobile population, the workload and difficulty of TB control increased as a result. There are many defects in the quality of work to be further improved.

Case-control study on psychological health status and influencing factors of the urban and the rural pulmonary tuberculosis patients

Song Kai,Zhao Jiaming,Shi Zuohong,Zhong Shuhua,Liang Yongkui,Li Jiawei,Huang Yan,Xu Yuqin,Dong Lisheng

Chinese Journal of Antituberculosis. 2010, 32(1):  11-15. 

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Objective To study psychological health status and influencing factors of urban and rural pulmonary tuberculosis patients in order to provide social-psychological base to improve the comprehensive treatment of the pulmonary tuberculosis patients.  Methods 1:1 paired matching between case and control. 300 cases of urban and rural pulmonary tuberculosis were selected randomly. A self-designed questionnaire, symptom checklist (SCL-90) and social support rating scale (SSRS) were used for a questionnaire survey. The database was established with Epidata 3.02. Data were analyzed by SPSS 13.0. Statistical Methods including t-test, analysis of variance and multiple stepwise regressions were used for analysis.  Results The 9 factors of pulmonary tuberculosis patients assessed by the SCL-90 all showed significant difference in comparison with the domestic standard model (P<0.05 or P<0.01).The scores of 9 factors, the total scores and number of positive factors of the rural group were significantly higher than the urban group(P<0.05 or P<0.01). Multiple linear stepwise regression analysis shows that the main influencing factors of psychological health status of the rural group is age, sex, income, living space, life satisfaction, degree of TB knowledge awareness. For the urban group, they are age and life satisfaction. The SSRS result shows that subjective support, objective support, support utilization and total score of social support of the rural group are much lower than the urban group (P<0.01).  Conclusion Pulmonary tuberculosis,patients have poor psychological health and low social support. Psychological health status of tuberculosis patients in rural areas are even worse due to many affecting factors. The psychological intervention, psychological support treatment and health education should be implemented along with the chemical treatment to improve the psychological health of patients with pulmonary tuberculosis and to boost the confidence to cure the disease.

The present conditions and main influencing factors of contact investigations initiated from smear positive pulmonary tuberculosis cases

ChengJun,Wang Yinfa,Li Yongwen,Chu Lei

Chinese Journal of Antituberculosis. 2010, 32(1):  16-19. 

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Objective To explore the present conditions and main influencing factors of the close contacts investigation.  Methods A questionnaire was used to interview 310 smear positive tuberculosis patients and 869 close contacts of these patients.   Results Screening rate of close contacts was 45.3%, and averagely number of contacts investigated per index smear positive case is 2.8. The influencing factors for screening rate are symptom and awareness of infectious nature of pulmonary tuberculosis.   Conclusion s Health education for close contacts is very important in order to improve screening rate of close contacts.

The prediction model for short-term recurrence after cured in initial-smear-positive pulmonary tuberculosis

Wu Xiaoying,Tan Shouyong,Zhang Jinxin,Liang Minqing,Chen Qichen,Liu Guobiao,Wen Wenpei,Liang Guofei,Liang Guotian，Luo Shaoxia

Chinese Journal of Antituberculosis. 2010, 32(1):  20-24. 

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Objective To establish a prediction model of short-term recurrence of cured initial-smear-positive pulmonary tuberculosis.  Methods This research was a prospective longitudinal study. 3293 cured initial-smear-positive pulmonary tuberculosis cases from Jan.2005 to Dec. 2006 from Guangzhou City were followed-up for 2 years. Influencing factors of recurrence of cured initial-smear-positive pulmonary tuberculosis were explored from clinical and social aspects and a logistic regression model for prediction were developed.  Results The bacteriology recurrence rate is 4.6%. Short-term recurrence prediction model is logit P=-9.546+0.586X₁+1.959X₆+1.449X¹⁰+1.118X¹⁵+1.027X¹⁶+1.525X¹⁸+0.674X²²+2.042X²³ with good prediction Results .  Conclusion s The prediction model provided a scientific evidence-based basis to reduce the recurrence of tuberculosis and a targeted instruction for the control of tuberculosis epidemic.

The experience of undergraduates with tuberculosis:a phenomenological approach

Zhang Shaoru,Zhang Tianhua,Li Xiaohong,Zhang Jinjing

Chinese Journal of Antituberculosis. 2010, 32(1):  26-29. 

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Objective To explore experiences of Chinese undergraduates with tuberculosis(TB).  Method Phenomenological research method was adopted for an in-depth interview of 15 TB undergraduates from different institutions Results The five themes that emerged from the data were emotional complexity, biased TB awareness, affected daily life, lack of social support as well as positive influence of illness.  Conclusion There is a lack of TB related knowledge among TB undergraduates. During the process of illness and treatment, they bear great mental and psychological pressure. In the treatment and rehabilitation phase, there is also a serious conflict between treatment and college learning. Students should receive systematic health education. We should pay attention to patients’ psychological support.

Investigation and analysis of the phenomenon of cultural shock of hospital new tuberculosis patients and nursing strategy

Li Fengjuan,Yan Xiaoting,Nan Qin,Wang Xinhong

Chinese Journal of Antituberculosis. 2010, 32(1):  30-34. 

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Objective To investigate the culture shock phenomenon of new admitted pulmonary tuberculosis patients and provide scientific basis for nursing.   Methods 1 000 new patients are sampled and surveyed by questionnaire, 1 000 copy of valid questionnaires were collected（610 males and 390 females）. Results Approximately 61.1% new pulmonary tuberculosis patients admitted to hospital presents the phenomenon of culture shock, Sex、age、education level、economic status、ethnic are related factors of culture shock with significantly difference. Anxiety, fear, frustration, despair prevail in positive cases of culture shock which affectting the treatment effect in patients with tuberculosis seriously.   Conclusion s Culture shock phenomenon was closely related to factors such as patients unfamiliarity to hospitals culture and a lack of information,adaptability barriers, communication barriers, daily habits, attitudes and beliefs change, individual differences and other factors.According to transcultural nursing theory，personalized and humanistic care should be implemented for new admitted pulmonary tuberculosis patients centering on cultural care with comprehensive use of a variety of ways and means to help this group to enhance transcultural adaptability，reducing and even eliminating the symptoms of culture shock，going smoothly through transcultural adaptability period to obtain significant treatment effect and a speedy recovery.

Analysis of sputum smear situation of tuberculosis in Urumchi

Liu Hong，Lei Zhigang

Chinese Journal of Antituberculosis. 2010, 32(1):  35-38. 

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Objective To analyze the situation of sputum smear spots in Urumchi, and to explore the measures for the next step. Methods Data from sputum examination register and quality control of sputum examination were collected and evaluated. Results Twenty-nine township sputum smear sites were set up in Urumchi in 2006. 20 058 smears had been examined till the end of 2008, with 869 smear positive smears. 563 smears were examined in township sputum smear sites with 46 positive smears. The smear positive rates were from 5.3％ to 40.3％ at different levels, with the highest at provincial level and the lowest at township level. 2 693 smears were selected for quality control, and 15 had qualitative errors.  Conclusion s Sputum smear site should be set up in non-tuberculosis institutions under county level or community health centers. The tuberculosis control and prevention institutions should carry out monitoring and quality control to ensure the quality of sputum smear.

Analysis on nosocomial infectious pathogens and drug susceptible test in the inpatients with pulmonary tuberculosis

Chen Zifang,Wei Haidong,Lao Haili,Hu Lizhen,Wang Songtao,Zhou Lei

Chinese Journal of Antituberculosis. 2010, 32(1):  40-44. 

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Objective To evaluate distribution characteristics of nosocomial infectious pathogens and drug resistance in patients with pulmonary tuberculosis in order to guide clinical use of drugs. Methods One handred and thirty-nine clinical isolated strains with positive culture from patients with pulmonary tuberculosis in our hospital were compared with 209 clinical isolated strains with positive culture from patients with non-pulmoary tuberculosis.  Results Of 139 clinical isolated strains from patients with pulmonary tuberculosis, 86(61.9%) strains were Gram-negative bacteria, including Pseudomonas aeruginosa(22.3%), Klebsiella pneumoniae(13.7%), Acinetobacter(10.8%), Escherichia coli(6.5%), Stenotrophomonas maltophilia(3.6%), and Enterobacter cloacae(2.1%), and 32 were Gram-positive bacteria, including Staphylococcus aureus(12.2%), Enterococcus(5.8%) and Staphylococcus epidermidis(2.1%), and fungi were 21(15.1%). The rates of infection were high in pulmonary tuberculosis patients combined with diabetes, COPD, bronchiectasis and pulmonary tuberculosis patients with bilateral lung lesions. They were 65.6%, 87.5%, 64.7% and 57.4%, respectively. Among non-pulmonary tuberculosis patients with lower respiratory tract infection, Gram-positive bacteria accounted for 34.0% and the fung was 6.4%. The proportion of Gram-positive bacteria infection in patients with pulmonary tuberculosis decreased (23.0%), however, the proportion of fungal infection increased(15.1%). Conclusion The pulmonary tuberculosis with lower respiratory tract infection associated with a variety of factors, and the bacterial resistance is also serious. It is necessary to take measures ofinfection control for clinical patients.

Diagnosis and treatment of pulmonary angiosarcoma(1 case report and a literature review)

Wang Wei,Li Ning,Liang Jianqing,Wang Jinhe,Huang Yuqing

Chinese Journal of Antituberculosis. 2010, 32(1):  45-48. 

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Objective To review the clinical features, pathological characteristics, diagnosis and differential diagnosis and treatment of pulmonary angiosarcoma.  Methods The clinical data in 5 cases was retrospectively analyzed with a literature review.  Results The clinical symptoms of pulmonary angiosarcoma were chest pain、cough and emptysis. Multiple nodules and plaque may be seen on Chest CT.Microscopically,the tumor was composed of blood vessel endothelium cells with obvious dysplasia, many irregular blood vessels varied in size were inosculated each other and formed vascular web.The immunohistochemical Results showedpositive CD34、CD31 and vimentin positive in cases. Conclusion Pulmonary angiosarcoma is a rare and high malignant soft tumor with poor prognosis, the diagnosis mainly depends on pattology.It needs to be differential diagnosted with lung adenocarcinoma, pulmonary tuberculosis, and mycosis etc.

Study on detection of Mycobacterium tuberculosis from operational specimens

Wu Xiaoguang,Lu Yu,Gao Mengqiu,Wang Zitong,Han Ming,Ma Liping

Chinese Journal of Antituberculosis. 2010, 32(1):  49-51. 

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Objective To study the clinical value on the detection ofMycobacterium tuberculosisfrom the operational specimens.  Methods Mycobacterium tuberculosisin operational specimens from 12 patients who had received chemotherapy were detected using L-J culture,liquid culture and RT-PCR.  Results Mycobacterium tuberculosiswere found by both the L-J culture and liquid culture. ICL and ACR were highly expressed in some specimens.  Conclusion  Operational specimens are useful for culture ofmycobacterium tuberculosisand its persistance detection,and it is valuable to guide the chemotherapy after the operation.