The use of BPaL containing regimen in the MDR/PreXDR TB treatments in Thailand.

The primary objective of this study was to evaluate the real-world effectiveness, side effects and challenges associated with the implementing of the groundbreaking BPaL-containing regimen in Thailand. Another aim was to investigate the characteristics and severity of the disease, the presence of abnormal extensive lesions in chest X-Rays and the influence of cavitation on sputum conversion. MATERIAL AND METHOD: The case series study included patients at TB clinic of Central chest institute of Thailand between August 2021-April 2023. All 28 Patients fullfilled the diagnostic criterial for MDR-TB by molecular tests and/or sputum culture. Sputum molecular test, utilizing GeneXpert MRB/XDR or Genotype MTBDRsl assay, was conducted. The 8 Pre-XDR patients who exhibited quinolone resistance and the 2 MDR-TB patients who encountered side effected from quinolone drugs were treated with BPaL regimen, while the remainder received BPaLM regimens. RESULTS: Among the 28 patients, 23 (82.1 %) successfully completed the treatment with favorable outcomes. However, one patient from the BpaL regimen died due to severe destroy lung lesion, and four patients from the BpalM regimen discontinued treatment. The investigation into the correlation between extension lesion, cavitation lesions, and culture conversion unveiled that the group with extension lesions and cavitation ≥4 cm had a diminished probability of achieving sputum culture conversion within 8 weeks in comparison to the group without attributes. The associated risk ratio was 0.56 (95 % CI, 0.14-2.27), p = 0.14. Although the study report minimal side effects, 6 patients (22.2 %) experienced peripheral neuropathy and a notable adverse reaction identified was optic neuritis, affecting 2 cases (7.1 %). SUMMARY: The administration of the BPaL-containing regimen resulted in rapid sputum conversion within 8 weeks and had minimal side effects.

Risk Factors for Multidrug-Resistant Tuberculosis among Patients with Pulmonary Tuberculosis at the Central Chest Institute of Thailand.

There are limited data available on the risk factors for multidrug-resistant tuberculosis (MDR-TB). Therefore, we here conducted a retrospective matched case-control study among adults with pulmonary TB who received treatment at the Central Chest Institute of Thailand (CCIT) between January 2007 and December 2013, in order to determine the risk factors associated with MDR-TB among patients with pulmonary TB. We identified 145 patients with pulmonary MDR-TB (cases) and 145 patients with drug-sensitive pulmonary TB (controls). Multivariate analysis identified the independent risk factors for MDR-TB as follows: (1) ≥ 2 episodes of prior pulmonary TB (odds ratio [OR] 39.72, 95% confidence interval (95% CI) 7.86-200.66), (2) duration of illness > 60 days (OR 3.08, 95% CI 1.52-6.22), (3) sputum acid fast bacilli smear 3+ (OR 13.09, 95% CI 4.64-36.91), (4) presence of lung cavities (OR 3.82, 95% CI 1.89-7.73), and (5) presence of pleural effusion (OR 2.75, 95% CI 1.06-7.16). Prior pulmonary TB management with a non-category I regimen (P = 0.012) and having treatment failure or default as treatment outcomes (P = 0.036) were observed in a higher proportion among patients with MDR-TB. Particular characteristics of lung cavities, including the maximum diameter ≥ 30 mm (P < 0.001), the number of cavities ≥ 3 (P = 0.001), bilateral involvement (P < 0.001), and ≥ 2 lung zones involved (P = 0.001) were more commonly observed in patients with MDR-TB. In conclusion, these clinical factors and chest radiographic findings associated with MDR-TB among patients with pulmonary TB may help physicians to provide proper management of cases for prevention of the development and spread of MDR-TB in future.

Genotype MTBDR plus (Hain) test in suspected MDR-TB patients.

BACKGROUND: Incidence ofMDR-TB in Thailand is higher Diagnosis ofmulti-drug resistance (MDR-TB) is often delayed because of insufficient investigations. Therefore, there is a need to introduce an efficient testing method. Genotype MTBDR plus (Hain test) is a new technology of line probe assay (LPAs) In general practice, it had questionable benefit on negative and positive direct smear specimens. OBJECTIVE: Evaluate the accuracy of the Hain test as compared to the conventional culture and drug susceptibility test (DST), and evaluate the judgment of the physician on starting MDR-TB treatment after receiving the result of the Hain test. MATERIAL AND METHOD: An observational prospective study was done of 100 suspected MDR-TB patients who visited the Central Chest Institute of Thailand between September and December 2012. Ninety-four patients were included in the present study. They were assessed by direct sputum smear test, Hain test, sputum conventional culture, and drug-susceptibility test (DST) in the first visit. Followed-up treatment until cure/definite treatment were observed for definite diagnosis. RESULTS: Hain tests identified 65 (69%) MTB positives, 25 (26%) MTB negatives, andfour (4%) Non-tuberculous Mycobacteria (NTM), respectively. Fourteen of 17 negative direct smear but positive Hain test samples were culture negative. We followed these 14 patients. Four patients with TB treatment were cured. Six patients received MDR treatment and improved. Two patients were misdiagnosed CA. Two patients had old scar TB lesion. Sensitivity, specificity, and accuracy ofHain test for MDR-TB detection compared to standard conventional culture were 95%, 86%, and 88%, respectively. Twelve patients were NTMculture positive. Most of them (75%) were M abscessus. Sixty-three percent of chest physicians used the result of the Hain testfor extended treatment ofstandard regimen in non-IR resistance or changing ofTB regimen. There was correlation between judgments of starting MDR-TB treatment and results of Hain test (p = 0.001), no correlation between judgments of physician and pattern (default/relapse/failure) ofprevious TB treatment history (p = 0.6), and periods oftime from first diagnosis of TB to develop suspected MDR-TB (p = 0.09) were demonstrated. CONCLUSION: We recommend Hain test to diagnose MDR-TB in highly suspected cases, and to wait for conventional culture results to confirm NTM. Hain test has benefit in negative direct smear

Benefit of serum-effusion albumin gradient in congestive heart failure patients.

OBJECTIVE: To compare between light's criteria and serum-effusion (S-E) albumin gradient in diagnosis of transudate effusion in congestive heart failure (CHF) patients. MATERIAL AND METHOD: Eighty-six patients who had pleural effusion and suspected CHF were enrolled in the present study between October 2008- September 2010. Suspected CHF was defined by clinical or echocardiography. Inform consents were given by all volunteers. Exclusion criteria was previous thoracotomy or coronary bypass graft 3 months before present study. Thoracocentesis was done to evaluate transudate effusion by light's criteria and S-E albumin gradient > 1.2 mg/dl. RESULTS: 12 (13.95%), 56 (65.11%), 17 (19.76%) of all were pure pleural disease, pure CHF, combination of pleural disease and CHF. Sensitivity/specificity/accuracy of S-E albumin gradients and light's criteria in diagnosis of CHF (both pure and combined) were 90.1/33.3/80.2%, 64.7/80.0/67.4%. No correlation between amount of diuretic drug and "exudate" criteria from lights' (p = 0. 66). 25 (27.2%) patients were previous post thoracotomy or coronary bypass graft. 7 of 25 patients had loculated effusion. There was correlation between previous surgery with loculated effusion and effusion from combination of pleural disease and CHF (p = 0.22). CONCLUSION: There is benefit to use S-E albumin gradient > 1.2 mg/dl to diagnosis patients who were suspected CHF with or without pleural disease. The authors recommended to use S-E albumin gradients combined with Light's criteria in suspected CHF patients.

Accuracy of endobronchial ultrasound guided-transbronchial needle aspiration in mediastinal lymph node diagnosis.

OBJECTIVE: To evaluate the efficacy of Endobronchial ultrasound guided-transbronchial needle aspiration (EBUS-TBNA) for biopsy specimens with adequate evaluable lymphocytes and mediastinal lymph node diagnosis. MATERIAL AND METHOD: Prospective cohort study. Over 18 year old patients with mediastinal or hilar lymphadenopathy, with short axis diameter greater than 10 mm on chest CT were indicated to undergo EBUS-TBNA. When a node was detected, an aspiration was performed under ultrasound guided. The primary end point was the percentage of biopsy specimen with adequate evaluable lymphocytes that had been evaluated by cytopathologist. Secondary endpoint was the percentage of EBUS-TBNA diagnosis result. RESULTS: 82 patients with mediastinal or hilar lymphadenopathy underwent EBUS-TBNA. Average size of lymph node was 1.57 x 1.49 cm. The overall of the diagnostic accuracy was a percentage of biopsy specimen with adequate evaluable lymphocytes as 97.7%. For mediastinal lymph node diagnosis, the cytological evaluation demonstrated that the positive for malignancy, atypical or suspicious for malignancy, negative for malignancy and non-diagnosis were 37.2%, 9.3%, 2.3% and 51.2%, respectively. In case of positive for malignancy, non-small cell carcinoma, adenocarcinoma, bronchoalveolar cell carcinoma and small cell carcinoma were found 62.5%, 15.6%, 3.1% and 18.8%, respectively. Additionally, the pathological examination showed that positive for malignancy, atypical or suspicious for malignancy, negative for malignancy and non-diagnosis were found 35.4%, 7.3%, 3.6% and 53.7%, respectively. There were no complications during all of the procedures. CONCLUSION: High percentage of biopsy specimen with adequate evaluable lymphocytes can be obtained in EBUS-TBNA. This finding suggested that this method should be considered for mediastinal lymph node diagnosis.

Correlation between willing to smoking cessation and treatment outcome of health care workers in Thailandt.

OBJECTIVE: Evaluate relationship between motivation and success rate to quit smoking in 59 health care workers. MATERIAL AND METHOD: Prospective study of59 chest disease institute health care workers were assessed for motivation and enrolled into a program to quit smoking. Comprehensive counseling in combinations with a 3-months intake of drug varenicline" was used to help quit smoking. One-year follow-up was performed. RESULTS: Fifty-two percent of volunteers had a quit ladder questionnaire result of more than or equal to 8 (set quit date). There was significant correlation between willing patients who are motivated (quit ladder questionnaire more than or equal to 8) and success rate of smoking cessation in two weeks after treatment (p = 0.010, RR 2.323, 95% confidence interval 1.144-4.714). Success rate of smoking cessation after start of treatment was as high as 47.5% and sustained to 40.7% in one year. CONCLUSION: There was correlation between willingness and success in quitting. Varenicline help patients quit smoking.