RESUMEN
OBJECTIVES: To describe demographics, clinical features, and treatment outcomes of patients with highly drug-resistant tuberculosis (TB) in Ukraine, and to evaluate risk factors for an unsuccessful outcome. METHODS: Data from patients with multi-, pre-extensively, or extensively drug-resistant TB were collected prospectively from TB dispensaries in 15 out of 24 Ukrainian oblasts (regions) from 2020 to 2021. Treatment outcomes were evaluated using WHO definitions. Risk factors for an unsuccessful outcome were identified using a multivariable logistic regression model. RESULTS: Among 1748 patients, the overall proportion of successful outcomes was 58% (95% confidence interval [95% CI] 56-60) (n = 1015/1748), ranging from 65% (95% CI: 62-69) (n = 531/814) for multidrug-resistant TB to 54% (95% CI: 49-58) (n = 301/563) for pre-extensively drug-resistant TB and 49% (95% CI: 44-55) (n = 183/371) for extensively drug-resistant TB. Results were similar across oblasts, with few exceptions. The strongest risk factors for an unsuccessful outcome were extensively drug-resistant TB (adjusted OR [aOR] 3.23; 95% CI: 1.88-5.53), total serum protein below 62 g/L in adults and below 57 g/L for children and adolescents (aOR 2.79; 95% CI: 1.93-4.04), psychiatric illness (aOR 2.79; 95% CI: 1.46-5.33), age at TB diagnosis >65 years (aOR 2.50; 95% CI: 1.42-4.42), and alcohol misuse (aOR 2.48; 95% CI: 1.89-3.26). DISCUSSION: The overall proportion of successful outcomes among Ukrainians treated for highly drug-resistant TB was 58%, notably better compared with previous years, but still low for extensively drug-resistant TB. Risk factors for unsuccessful outcomes highlight that addressing socioeconomic factors in TB management is crucial. Efforts in maintaining TB dispensaries during and following the ongoing war are highly warranted.
Asunto(s)
Pueblos de Europa Oriental , Tuberculosis Extensivamente Resistente a Drogas , Tuberculosis Resistente a Múltiples Medicamentos , Adulto , Niño , Adolescente , Humanos , Anciano , Antituberculosos/uso terapéutico , Ucrania/epidemiología , Estudios Retrospectivos , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Resultado del Tratamiento , Factores de Riesgo , Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológicoRESUMEN
OBJECTIVE: The aim: This research aims to analyze the challenges we came across due to the rapid spread among the population (including young people) of tobacco heating devices. PATIENTS AND METHODS: Materials and methods: Analysis of 20 literature sources containing information about tobacco heating systems was performed. The search for literary sources was carried out in two main scientific databases: Scopus and PubMed. The review included original articles, research, and official recommendations from medical associations. CONCLUSION: Conclusions: Tobacco heaters reduce harmful substances in the inhaled air compared to conventional tobacco cigarettes, but these new devices provide effective nicotine absorption, which prolongs a person's nicotine dependence and prevents smoking cessation. The main problem we face due to the rapid spreading of these devices - potentially tobacco heating systems can pose health risks and further research on such risks, especially long - term, are needed. Tobacco heating devices, regardless of their manufacturer and design, should be subject to restrictions similar to traditional cigarettes.