Sa Sulaiman

Duration of treatment in pulmonary tuberculosis: are international guidelines on the management of tuberculosis missing something?

BACKGROUND Despite evidence of an association between tuberculosis (TB) treatment outcomes and the performance of national tuberculosis programmes (NTP), no study to date has rigorously documented the duration of treatment among TB patients. As such, this study was conducted to report the durations of the intensive and continuation phases of TB treatment and their predictors among new smear-positive pulmonary tuberculosis (PTB) patients in Malaysia. STUDY DESIGN Descriptive, non-experimental, follow-up cohort study. METHODS This study was conducted at the Chest Clinic of Penang General Hospital between March 2010 and February 2011. The medical records and TB notification forms of all new smear-positive PTB patients, diagnosed during the study period, were reviewed to obtain sociodemographic and clinical data. Based on standard guidelines, the normal benchmarks for the durations of the intensive and continuation phases of PTB treatment were taken as two and four months, respectively. A patient in whom the clinicians decided to extend the intensive phase of treatment by ≥2 weeks was categorized as a case with a prolonged intensive phase. The same criterion applied for the continuation phase. Multiple logistic regression analysis was performed to find independent factors associated with the duration of TB treatment. Data were analyzed using Predictive Analysis Software Version 19.0. RESULTS Of the 336 patients included in this study, 261 completed the intensive phase of treatment, and 226 completed the continuation phase of treatment. The mean duration of TB treatment (n = 226) was 8.19 (standard deviation 1.65) months. Half (49.4%, 129/261) of the patients completed the intensive phase of treatment in two months, whereas only 37.6% (85/226) of the patients completed the continuation phase of treatment in four months. On multiple logistic regression analysis, being a smoker, being underweight and having a history of cough for ≥4 weeks at TB diagnosis were found to be predictive of a prolonged intensive phase of treatment. Diabetes mellitus and the presence of lung cavities at the start of treatment were the only predictors found for a prolonged continuation phase of treatment. CONCLUSIONS The average durations of the intensive and continuation phases of treatment among PTB patients were longer than the targets recommended by the World Health Organization. As there are no internationally agreed criteria, it was not possible to judge how well the Malaysian NTP performed in terms of managing treatment duration among PTB patients.

Chronic Hepatitis C Prevalence and its Correlation with CD4 Cells and Liver Enzymes Among HIV Positive Patients: A Malaysian Scenario

PIN5 ChroNIC hePatItIs C PrevaleNCe aNd Its CorrelatIoN wIth Cd4 Cells aNd lIver eNzymes amoNg hIv PosItIve PatIeNts: a malaysIaN sCeNarIo Khan A.H.1, Sulaiman S.A.2, Soo C.T.3, Akhtar A.1, Hamzah D.A.B.A.4, Khan K1 1Universiti Sains Malaysia, Minden, Malaysia, 2Universiti Sains Malaysia, Penang, Malaysia, 3medical department Penang hospital, penang, Minden, Malaysia, 4Urology Unit, Department of Surgery, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia, Kelantan Malaysia, Malaysia Objectives: To evaluate the occurrence and clinical outcomes of Hepatitis C (HCV) patients co-infected with Human Immunodeficiency Syndrome (HIV) in a tertiary care hospital. MethOds: A retrospective study of the patients with clinical histories of HIV co-infection with HCV following HAART therapy in Infectious disease Unit at Hospital Palau Pinang (HPP), Malaysia from the year 2007 to 2012. The clinical and demographic data was collected from patient’s records. In present study we analyzed the collected data by using SPSS software (Version 20) to determine the correlation of variables and measure their infection rates in a particular population. Results: The study involves a total of 708 HIV infected patients with the mean age of 40 ± 10.17 years together with 541(76.4%) males and 167(23.6%) females. There were 130(18.4%) patients co-infected with HCV. The assigned population involve in current study was Chinese 427(60.3%) followed by Indians 96(13.6%), Malay 151(21.3%) and minorities 34 (4.8%). There were three main modes of transmission including male heterosexual contact 506(71.5%), homosexual contact 47(6.6%) and intravenous drug users (IVDU) 114(16.1%). The mean CD4 count, ALT and AST levels in HBV-HIV co-infected patients were 374 ± 150.65, 64 ± 76.15, 129 ± 61.06 respectively. The calculated result shows the significant association of several factors like sex (p = < 0.001), IVDU (p = < 0.001) with co-infection of HIV-HCV. The co-morbidities observed in the current study were Pulmonary Tuberculosis (23.6%), Pneumocystis pneumonia (14.4%), Hyperlipidemia (4.4%), Dyslipidemia (3.2%), Anemia (4.5%), Ischemic Heart Disease (2.5%), Diabetes Mellitus (8.2%), Hypertension (6.5%), Asthma (1.4%), Oral Candiasis (5.2%), Syphillus (3.1%), Liver Cirrohsis (1.1%), Cerebral Toxoplasmosis (2.3%), Virological Failure (1.1%). cOnclusiOns: The incidence rate of HCV among HIV individuals were about 18.4% including 76.4% males and 23.6% females. There was a significant correlation between HCV among HIV-positive patients depending on various variables like gender, age, exposure to risk factors. (p< 0.001).