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Lancet Infect Dis ; 20(2): e47-e53, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31740252


Globally, high rates (and in the WHO European region an increasing prevalence) of co-infection with tuberculosis and HIV and HIV and hepatitis C virus exist. In eastern European and central Asian countries, the tuberculosis, HIV, and viral hepatitis programmes, including diagnostic services, are separate vertical structures. In this Personal View, we consider underlying reasons for the poor integration for these diseases, particularly in the WHO European region, and how to address this with an initial focus on diagnostic services. In part, this low integration has reflected different diagnostic development histories, global funding sources, and sample types used for diagnosis (eg, typically sputum for tuberculosis and blood for HIV and hepatitis C). Cooperation between services improved as patients with tuberculosis needed routine testing for HIV and vice versa, but financial, infection control, and logistical barriers remain. Multidisease diagnostic platforms exist, but to be used optimally, appropriate staff training and sensible understanding of different laboratory and infection control risks needs rapid implementation. Technically these ideas are all feasible. Poor coordination between these vertical systems remains unhelpful. There is a need to increase political and operational integration of diagnostic and treatment services and bring them closer to patients.

Bull World Health Organ ; 97(11): 737-745A, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31673189


Objective: To analyse the epidemiological trends of tuberculosis in the Siberian and Far Eastern federal districts, the areas with the highest disease burden in the Russian Federation. Methods: We applied principal coordinate analysis to study a total of 68 relevant variables on tuberculosis epidemiology, prevention and control. Data on these variables were collected over 2003-2016 in all 21 regions of the Siberian federal district and Far Eastern federal district (total population: 25.5 million) through the federal and departmental reporting system. We identified the regions with a favourable or unfavourable tuberculosis epidemiological profile and ranked them as low or high priority for specific interventions. Findings: The median number of tuberculosis notifications in the regions was 123.3 per 100 000 population (range: 54.5-265.7) in 2003, decreasing to 82.3 per 100 000 (range: 52.9-178.3) in 2016. We found large variations in the tuberculosis epidemiological profile across different regions. The principal coordinate analysis revealed that three aggregated indicators accounted for 55% of the variation. The first coordinate corresponded to tuberculosis prevalence and case notifications in the regions; the second to the severity of the disease among patients; and the third to the percentage of multidrug-resistant tuberculosis among tuberculosis patients. The regions where intervention was most urgently needed were Chukotka Autonomous Okrug, Jewish Autonomous Oblast and Tyva Republic. Conclusion: The variability in tuberculosis epidemiology across regions was likely due to differences in the quality of antituberculosis services. Precision in defining necessary interventions, as determined through the principal coordinate analysis approach, can guide focused tuberculosis control efforts.

Thorac Surg Clin ; 29(1): 47-58, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30454921


Multidrug-resistant tuberculosis (TB), extensively drug-resistant TB, and TB-human immunodeficiency virus (HIV) coinfection require a special approach in anti-TB treatment. Most patients cannot be successfully cured by conventional chemotherapy alone. They need a modern approach using minimally invasive therapeutic and surgical techniques. The novel approaches of collapse therapy techniques and minimally invasive osteoplastic thoracoplasty increase the effectiveness of complex anti-TB therapy. Achieving the required selective collapse of lung tissue in destructive pulmonary TB, especially in cases of drug resistance and/or HIV coinfection, leads to bacteriologic conversion, cavity closure, and successful cure.

Colapsoterapia/métodos , Toracoplastia/métodos , Tuberculose Pulmonar/cirurgia , Adulto , Antituberculosos/uso terapêutico , Tuberculose Extensivamente Resistente a Medicamentos/cirurgia , Tuberculose Extensivamente Resistente a Medicamentos/terapia , Feminino , Humanos , Pulmão/cirurgia , Masculino , Tuberculose Resistente a Múltiplos Medicamentos/cirurgia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Tuberculose Pulmonar/terapia
Thorac Surg Clin ; 27(2): 99-111, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28363378


A new modification of osteoplastic collapse thoracoplasty performed with a minimally invasive approach has been proposed. This operation is a variant of extrapleural thoracoplasty used in the treatment of destructive tuberculosis. The benefits of the proposed method, the surgical techniques, and the results of the authors' research are described. Compared with the conventional variant of osteoplastic thoracoplasty, the rates of bacteriologic conversion (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.72-1.97) and of the closure of cavities (OR, 2.13; 95% CI, 1.98-2.28) have been proved to be higher when the operation is performed with a minimally invasive approach.

Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Toracoplastia/métodos , Tuberculose Pulmonar/cirurgia , Adulto , Contraindicações , Humanos , Masculino , Complicações Pós-Operatórias