Table of Content

10 June 2009, Volume 31 Issue 6

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Analysis on trend failure tendency of new smear positive TB cases in Bao’an district, Shenzhen from 2002 to 2006

Lu Tanwang, Zhang Lei, Long Weijun, Zhao Meigui, Wen Guihua, Chen Wensheng

. 2009, 31(6):  321-322. 

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Objective To analyze the epidemical tendency of treatment-failure of new smear positive TB cases in Bao’an district, Shenzhen from 2002 to 2006, and to provide scientific evidence for development of prevention and control measures in the future. MethodsThe reporting data of PTB cases during 2002—2006 were described and tested by Chi-square method, partitions of χ² method with SAS9.0 software. ResultsThe treatment failure rate of new smear positive TB cases was increasing from 1.9% in 2002 to 8.0% in 2006. The rate in male was higher than that in female. ConclusionsMore attention should be paid on the increasing trend of treatment failure of new smear positive TB cases, analysis on factors of patients, health care facilities and drugs should be undertaken to find causes, so that effective measures will be taken to increase cure rate.

Analysis on clinic-visiting of 150 suspected pulmonary tuberculosis

Chen Huijuan, Li Yang

. 2009, 31(6):  323-326. 

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Objective To analyze clinic-visiting of suspected pulmonary TB in the county and township hospitals. MethodsThe questionnaires were carried out among 150 clinical visitors with suspected pulmonary TB from 8 townships in Guizhou province. Results“Treatment opportunity cost” for clinic-visiting at county-level was 16.8 times as much as those at township-level. 58.7% visitors with suspected pulmonary tuberculosis went to basic medical units as the first diagnosis unit, and 44.7% suspected were delayed before the first diagnosis. There were only 30.7% TB patients diagnosed at the center of TB control at county-level and 16.7% TB patients delayed at the same level.The average cost for suspected visitors at township-level was 149.13 yuan. Sputum inspections were made for 67.9% suspected. ConclusionIt is convenient to carry out sputum inspection for patients at township-level, but most of patients couldn’t get free examinations. It’s very serious that TB patients’diagnosis were delayed at non-antituberculosis institutions.

Tuberculosis screening of people subjected to reeducation in certain jail in Shandong

Wang Haiying¹, Jiang Caihua¹, Wang Junling¹, Zhao Jing², Deng Yunfeng¹, Liu Zhimin¹

. 2009, 31(6):  327-330. 

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Objective To explore the status of prevalence and spread of Tuberculosis（TB） and latent tuberculosis infection(LTBI) among people subjected to reeducation in certain jail in Shandong. MethodsThere were 324 inmates in the supervised section，10 inmates had been diagnosed as TB cases in the first quarter of 2008, other 314 inmates were screened with chest X-ray, HIV test, TST, ELISPOT test (T-SPOT.TB test), and epidemiological investigation was conducted for each person. For people who had the symptoms of coughing and sputum and TB cases, sputum or throat swabs were collected for culture, isolates were performed on identification and drug susceptibility test, Mycobacterium tuberculosis (MTB) was genotyped. ResultsHIV screening Results were negative for all 314 people screened; 3 sputum culture Results were positive with three strains of MTB isolated, strain A belonged to non-Beijing family, the genotype is unique 222325163333658, strain B and C were Beijing family and belonged to one cluster with the genotype 223325173533978; two active TB patients were found during the screening activities; concomitant TST and T-SPOT.TB Results were available for 312 subjects, 87 subjects(27.9%) tested positive by the T-SPOT.TB while 255 subjects (81.7%) tested positive by TST. The concordance between the two tests in this study was 42.3%（95%CI，36.8%-47.8%）. ConclusionsIn the supervised section of the jail, the rate of LTBI was 27.6% （86/312）regarding positive T-SPOT.TB result as the standard for defining LTBI; the period attack rate of TB was 3.70%(12/324); combining the traditional epidemiological investigation with molecular epidemiological technique, the Conclusion was that some cases were endogenous recrudescence and some were caused by recent MTB infection, there was partial spread of TB existed in this supervised section. Further measures on TB treatment, prevention and control should be adopted.

Analysis of drug resistance of patients with tuberculosis hospitalized in Beijing Geriatric Hospital

Cao Wenli, Xu Qingjie, Kang Lijun, Li Aling, Xiang Xi, Wu Junfeng, Shi Liheng

. 2009, 31(6):  331-333. 

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Objective To understand the distribution and influential factors of patients with drug resistance among TB patients in our hospital. Methods1125 patients with sputum culture positive from 4195 patients with pulmonary tuberculosis from Aug.2002 to Aug.2008 were divided into initial drug resistance group, acquired drug resistance group, drug resistance group, and multi-drug resistance group according to different standards. The data of resistant test of four anti-TB drug for these patients was analyzed with clinical epidemiology method. Results1. There were 566(50.3%) cases in the drug resistance group and 135(12.0%) cases in the MDR-TB group(χ²=13.457, P<0.05) with statistically significant difference in resistance rate of the two groups.2. Age distribution is mainly the elderly, 3. Of any drug, the order of accumulated drug resistance is S>H>R>E.4. High concentration of levofloxacin resistance is 32.5%, and low concentrafion is 9.0%.Conclusions The drug-resistance rate and multi-drug resistance tate aftuberculosis is still high, further analysis is needed. The rate of drug resistance of high concentration of Levofloxacin is low, which would have deep effect on the therapy of MDR-TB.

Effect of combination of tuberculosis control and new-type rural cooperative medical system in Henan

Sheng Xiling, Ma Shiwen, Xu Jiying, Ma Liping

. 2009, 31(6):  334-336. 

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Objective To summarize the current experience of combination of tuberculosis (TB) control and new-type rural cooperative medical system (CMS) in some cities and counties in Henan, in order to further modify and improve the present program and to formulate feasible policies for the province. MethodsFieldwork experience exchanging and workshop about the combination was held, and the survey and evaluation were organized in 6 counties in Puyang. ResultsThe combination of TB control and new-type rural CMS increased the consulting number of patients by 15%, the referring rate by 20.7%, the referring arrival rate by 5.4%, and the rate of taking drugs regularly by 1.7%. ConclusionsIt is totally new that the combination of TB control with new-type rural CMS. It is urgent that to extend the project in the whole province with the support of health administrative departments.

Study on barriers to anti-TB treatment for rural-to-urban migrant TB patients in Shanghai

Chen Jing¹, Wei Xiaolin, Li Hongdi, Sun Chenguang, Zhang Zeshen, Chen Ping, Shen Mei, Mei Jian

. 2009, 31(6):  337-340. 

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Objective To explore the barriers to anti-TB treatment for rural-to-urban migrant TB patients in Shanghai. Method34 rural-to-urban migrant lived in six districts were in-depth interviewed. ResultsMany migrant patients experienced high treatment costs both before and after their TB diagnosis. Migrant patients experienced high living costs in Shanghai. Migrant patients had a limited knowledge of TB and the free treatment policy, and hold various attitudes to reimbursement procedure. ConclusionsRural-to-urban migrant TB patients are facing tremendous economic difficulties during the diagnosis and treatment process in Shanghai. The free treatment policy has little if any effect in reducing migrant patients’ financial stress. It’s imperative to contain the general public hospitals and provide social welfare to migrants to support their treatment.

The study on awareness status on tuberculosis and countermeasures in Tianjin

Li Shanglun, Wan Ying

. 2009, 31(6):  341-345. 

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Objective To explore the awareness status on tuberculosis(TB) prevention and control among public in Tianjin, and to provide scientific evidence for expanding and perfecting health promotion and promoting health education in future. MethodsQuestionnaire investigation was carried out among the study subjects selected by multiatage stratified systematic randomized sampling in Tianjin. ResultsThe awareness rate of key messages on TB prevention and control among 4591 permanent residents from the age of 12 to 65 was 58.2％, the awareness rate of 3 main key messages was 6.9％; the rate of having reasonable attitude among the publics was 24.2％; the main sources of TB knowledge was learning from other people (62.8％),television(55.6％) and radio(37.7%）. ConclusionsHealth education should be strengthened to different people by various ways and focused on special groups such as the female, the poor, the less educated and workers, so that whole society participate in TB prevention and control. In this way case finding rate and treatment success rate will be increased, and the target of controlling TB prevalence and protect people’s health will finally be achieved.

Analysis on abnormal personality characteristics of tuberculosis patients

Wang Yueming¹, Sun Yueji, Zhang Hongjuan

. 2009, 31(6):  346-350. 

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Objective sTo explore personality characteristics of tuberculosis, and to analyze Results of MMPI in tuberculosis patient. Methods120 new TB patients who were diagnosed and treated by Dalian tuberculosis hospital were randomly selected. Questionnaire was used to collect the general information of patients. Minnesota multiple personalities measurement scale (MMPI) was applied to test the personality of tuberculosis, the Results were entered into the computer to calculate the standard T score, which was compared with the domestic norm. ResultsTuberculosis patient’s MMPI test Results showed significantly higher in the hipochondria(Hs), hysteria(Hy), the psychotic disorder(Pd), neurasthenic (Pt), schizophrenia (Sc) and mania(Ma) comparing with the norm(P<0.05), while man-feminize (Mf) and society introverted(Si) showed significantly lower than the norm(P<0.01); the double-point evaluation suggested abnormality as 18.3% of Hs- Pt,15% of Hs- Pd,5% of Pt- Sc, and 3.3% of D- Pt and Pd-Pt. Male showed higher score in Hs，D，Hy，Si than female. Higher D score was in patients with low education level. ConclusionsTuberculosis case group shows abnormal personality characteristic comparing with norm and there is regularity for the abnormal personality of TB patients.

The application of balloon dilatation through fiberoptic bronchoscopy in tuberculous tracheobronchial scar stenosis

Zhang Tianhua¹, Yu Guozheng²

. 2009, 31(6):  351-354. 

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Objective To investigate the clinical value of balloon dilatation through fiberoptic bronchoscopy in tuberculous tracheobronchial scar stenosis. Methods11 patients were treated with balloon dilatation through flexible fiberoptic bronchoscopy under local anesthesia once a week and repeated 2～4 times continuously. The chest X-ray and CT were used to observe the situation of airway open and pulmonary reexpansion. Before the treatment and immediately after the last operation, airway diameters, dyspnea index, FEV₁ and FVC were evaluated in all patients. ResultsThe average operation time of the balloon dilatation was 2.7 for per patient. After the operation, the bronchus diameter increased obviously, and the symptoms alleviated. The X-ray and CT showed the pulmonary reexpansion. The immediate curative effect reached to 100% and the long-term 90.9%. The bronchus diameter, dyspnea index, FEV₁ and FVC were improved significantly(P＜0.05). ConclusionBronchoplasty with ballnoon dilatation though flexible fiberoptic bronchoscopy is a handy, effective and safe method to treat tuberculosis tracheobronchial scar stenosis and can be preferred.

Experience in treatment of 56 tuberculosis cases from Sichuan earthquake-hit areas

Wu Guihui¹, Chen Xuerong², Fu Yi¹, Xiao Jun², Chen Lei¹, Yue Ji¹,Tang Xiaoyan², Duan Yinqiao², Wang Youjuan²

. 2009, 31(6):  355-357. 

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Objective To investigate the clinical characteristics of patients tuberculosis from the earthquake-hit areas. MethodsThe clinical characteristics, treatments and prognosis of 56 tuberculosis cases from the earthquake-hit areas were analyzed retrospectively. ResultsThere was a high incidence (9.3%)of injuries(wounds and infections)associated with earthquake in patients with tuberculosis. All patients had anxiety and depression. There was a high therapy interruption rate(42.3%). None of the patients was transported to other provinces. ConclusionThe mortality rate could be reduceded by management of injuries associated with earthquake. We should pay more attention to psychological intervention to avoid psychological crisis. Strengthening the reconstruction of tuberculosis control and prevention institution and avoiding therapy interruption were helpful to decrease rates of retreatment and drug resistence. To prevent the prevalence of tuberculosis, patients with tuberculosis should not be transported to other provinces.

Analysis on risk factors of mortality for inpatients with active pulmonary tuberculosis complicated with respiratory failure

Zhang Liqun¹, Liu Zhenqian²

. 2009, 31(6):  358-362. 

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Objective To investigate the risk factors of mortality for inpatients with active pulmonary tuberculosis complicated with respiratory failure. MethodPatients with active pulmonary tuberculosis complicated with respiratory failure hospitalized between 2000 and 2006 were enrolled and analyzed retrospectively on the risk factor of mortality. Results184 patients were included and 88 patients died. The mean survival time of patients who died was 50.8 days(ranged 1 to 177 days),with 50% of the patients died within the first 30 days after admission. There were many significant differences in MDR-TB rate, multiple organ dysfunction failure (MODF),hospital acquired pneumonia(HAP), and APACHE II between the death and survival groups. The independent factors of mortality were: multiple relapse, advanced and military TB, HAP, prolonged mechanical ventilation,and MODF. ConclusionsThe mortality rate of the patients with active pulmonary tuberculosis complicated with respiratory failure was very high, and some factors affected its prognosis.

Clinical observation of therapy for pulmonary tuberculosis patient with rifampicin resistance

You Yonghong¹, Zheng Suhua, Xie Yanguang, Yang Yingzhou, Wang Xiaomeng, Li Fabin, Tan Weiguo, Liao Ziping, Duanmu Hongjin

. 2009, 31(6):  363-367. 

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Objective To investigate the effiacy and safety of the treatment regimen containing the second-line anti-tuberculosis drugs. Methods154 patients with drug resistant pulmonary tuberculosis (PTB) (at least resistant to rifampicin) from different centers were assigned randomly to a study group which were treated by a regimen containing the second line antituberculosis drugs, and a control group which received a regimen recommended by NTP. Sputum smear conversion and X-ray changes were evaluated. Results154 PTB patients with rifampicin-resistance were enrolled, and 114 patients completed, 40 patients were dropped out(26 from the control group and 14 from the study group) without statistically significant difference(P>0.05). The rates of sputum smear negative conversion in the study group and in the control were 81.7% and 70.0% without statistically significant difference（P>0.05）. The rates of sputum smear negative conversion were 90.3% and 90.0％ respectively in the study group and the control group for patients with limited focus on chest X-ray（P>0.05）, However, we found that the rates of sputum negative conversion were significantly higher in the study group( 77.5%) compared with the control (52.2%) for patients with extensive foci on chest X-ray（P<0.05）. The absorption of foci on chest X-ray cannot be seen significant difference between two groups. 17 patients were seen side effects in the study group, and 8 in the control group wihout significant difference (P>0.05). ConclusionThe regimen which included the second-line anti-tuberculosis drugs had the same safety as which recommended by NTP, and perhaps it is more effective for untreated patients with drug resistance, and those with extensive foci on chest X-ray.