The treatment results of patients with multidrug resistant tuberculosis and factors affecting treatment outcome.

The treatment of multi-drug resistant tuberculosis (MDR-TB) is complicated and results are not always satisfactory. We aimed to investigate treatment results of our patients, relapse rates, factors affecting treatment outcome. We evaluated prospectively, 142 patients, who had been hospitalised with diagnosis of MDR-TB in our clinic between January 1995-December 2000 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital in Istanbul, Turkey. All patients were male and human immunodeficiency virus negative. The mean age was 39 + or - 11 (16-65) years. A mean number of 5.5 + or - 0.8 (4-8) second line drugs, including one parenteral drug, were administered. Of 142 patients, 102 (71.8%) were classified as cured, 16 (11.3%) patients were defaulters, failure was seen in 10 (7.0%) patients and 14 (9.9%) patients died during treatment. Surgical resection was applied in 35 patients and cure was achieved in 88.5% of them. Of 102 patients who were cured, 89 (87.2%) were available for follow up and mean duration of follow up was 19.2 + or - 10.3 (12-72) months. Relapse was not detected in any of them. Patients with unsuccessful outcomes had a higher incidence and higher mean number of second-line drugs usage in previous regimens, higher incidence of antecedent prothionamide and ofloxacin usage, higher incidence of extensive radiologic involvement and withdrawal of responsible drugs due to adverse effects. Limited radiologic involvement, non-usage of antecedent prothionamide and adjuvant surgery were found as significant independent factors effecting successful treatment outcome. MDR-TB is a complex but a treatable disease. To know much more about the factors effecting treatment results and to arrange the proper conditions, are expected to make increases in the success rates of MDR-TB treatment.

[Follow-up hemoglobin concentrations in ICU: relationship between diagnostic blood loss and daily fluid balance]. / Yogun bakimda hemoglobin takibi: tanisal kan kaybi ve günlük sivi dengesi ile iliskisi.

UNLABELLED: To evaluate DeltaHb (daily changes of hemoglobin concentrations) in nonbleeding critically ill patients, and to investigate its relation with diagnostic blood loss (DBL) and fluid balance (FB). Hospital records of 34 nonseptic patients who stayed in respiratory intensive care unit (RICU) at least 72 hours with no evidence of acute bleeding, renal failure and bleeding diathesis, were evaluated retrospectively. Demographics, clinical features, acute physiology assessment and chronic health evaluation (APACHE) II scores, daily Hb levels, DBL and FB were recorded. Correlation statistics was performed between DeltaHb and DBL and FB. We compared the patients with DeltaHb > or =0.5 g/dL/day (group A) and the patients with DeltaHb < 0.5 g/dL/day (group B) in the first three days. The mean age was 55 +/- 14, Hb level was 13.2 +/- 1.7 g/dL at admission and 12.6 +/- 2.3 g/dL at discharge from RICU. DBL was 25.2 +/- 7.4 mL/d, and FB was 251 +/- 1783 mL/d for the first day in intensive care unit. DBL was lesser in subsequent days than in the first day but it wasn't significant. DeltaHb was -0.54 +/- 1.5 g/dL for the first three days, while it was -0.23 +/- 1.5 g/dL for subsequent four days (p= 0.9). DeltaHb in the first three days has no correlation with DBL and FB. Age, sex, APACHE II score, clinical features, DBL and FB were not differed between Group A and Group B. CONCLUSION: No relation was found between DeltaHb and DBL, and also FB; but studies like this are important to indicate that Hb concentrations may decrease in critically ill patients without any reason such as bleeding.