TB situation in Albania, 2001-2008.

SETTING: Albania, population 3.4 million. OBJECTIVE: To describe DOTS (directly observed treatment-short course chemotherapy) implementation, treatment outcomes and epidemiological situation in Albania from 2001 to 2008. DESIGN: DOTS strategy was introduced in 2001 and gradually expanded. A retrospective analysis of treatment outcomes and epidemiological data on TB patients was analyzed for this period. RESULTS: DOTS was expanded to 76% of the country in 2008. Treatment success among new smear-positive patients ranged from 82% in 2001 to 86% in 2007. The incidence of TB in Albania decreased from 17 per 100,000 inhabitants in 2001 to 12/100,000 in 2008 and estimated case detection for smear positive cases improved from 42% in 2001 to 75% in 2007. CONCLUSIONS: The TB incidence has fallen progressively since DOTS was initiated. Treatment outcome was better in DOTS areas compared to Non-DOTS areas and overall treatment outcome was improved during DOTS implementation. Despite gradually, DOTS was successfully implemented and full expansion is necessary.

Net fluid accumulation and outcome. A randomized clinical trial.

Outcome measures are the first step in determining the consequences of health care. These include mortality, morbidity, and quality of life. As major burns are life-threatening conditions, the main priority in discussing outcome measures is mortality as a problem-specific measure. A number of studies have shown that mortality is predominantly determined by many variables obtained as "admission" predictors" as also by numerous variables obtained during the hospital course. Net fluid accumulation (NFA) is one of the many important factors that correlate with clinical outcome. The purpose of this paper is thus to evaluate NFA during resuscitation with Ringer's lactate (RL) and its relationship with mortality. We hypothesized that rigorous monitoring of fluid replacement therapy might result in lower fluid retention, which could be effective in the prognosis of severely burned patients. In this prospective randomized study, the patients were divided into two groups of 55 cases each. In RL group 1, the patients were resuscitated using the Parkland formula in adults and the Galveston Shriner formula in children, without modifications, while in RL group 2 the formula was utilized as a starting-point only and the amount of fluid was modified in each case on the basis of the clinical situation and urine output. It was found that there was a statistically significant difference in NFA between the two groups (p = 0.001), as also a statistically significant difference between the amount of fluids given and the complications (p = 0.08). The majority of patients who died (70%) presented higher NFA values in the period of resuscitation. There was a statistically significant difference between mortality and total body surface area burned (p = 0.036), comorbidities (p = 0.015), cause of burn (p = 0.004), inhalation injury (p = 0.027). The degree of NFA correlated, with a linear positive relationship, with morbidity (Kendall's tau_br = 0.143, p = 0.019) and, with a negative relationship, with mortality (Kendall's tau_br = 0.234, p = 0.001). Mortality as the primary endpoint was 16% in group 1 and 9% in group 2. Giving the smallest amount of fluids necessary for adequate resuscitation can be effective in creating a successful and specific therapy for all burn patients. With regard to morbidity and mortality, predictor factors, as also the method of resuscitation, have an influence in maintaining constant NFA values.

External quality control of Mycobacterium tuberculosis drug susceptibility testing: results of two rounds in endemic countries.

SETTING: Quality assurance for the World Health Organization (WHO)/International Union Against Tuberculosis and Lung Disease (The Union) global tuberculosis (TB) drug resistance surveillance programme. OBJECTIVE: To monitor the quality of drug susceptibility testing (DST) in different countries. METHODS: In 2002-2003 and 2005-2006, 20 Mycobacterium tuberculosis strains were sent by the WHO/Union Supranational Reference Laboratory of Rome to TB reference laboratories in Albania, Bahrain, Kosovo, Mozambique, Oman, Qatar and Turkey for external quality control (EQC). RESULTS: In 2002-2003, the specificity, sensitivity, efficiency, reproducibility and predictive values for resistance/susceptibility were >or=90% for streptomycin (SM), isoniazid (INH) and ethambutol (EMB). In 2005-2006, all statistical values were >or=96% for SM, INH, rifampicin and EMB. CONCLUSION: EQC improved the quality of M. tuberculosis DST in the participating countries.