Wednesday, March 31, 2010
Doctor de Leon and anti-TB drug resistance
Doctor de Leon is a Mexican paediatrician who has dedicated her life to saving other people's lives particularly the youngest and most vulnerable of any society - the children. Nine months ago, she developed a cough that her colleagues diagnosed as an allergy. Overall, her health was deteriorating, she lost weight day-by-day despite her efforts to nourish herself the best that she could. Since she was not feeling well, she ordered the sputum smear exams for herself, and they came back positive. Read more
She started TB treatment but her sputum smears and her health status did not improve and after six months of anti-TB treatment, a first-line drugs sensitivity test (DST) result came back positive for multi-drug resistant tuberculosis (MDR-TB).
On 22 March 2010, two days before the World TB Day, Dr de Leon was admitted to a specialty hospital in Mexico City with haemoptysis, weight of 99 pounds and a chest x-ray which showed 10mm cavities.
On the World TB Day 2010, and every day for that matter, Dr de Leon could be providing care to patients affected by tuberculosis or attending the different events planned for this day in the country. Instead, she is a patient in isolation, waiting and hoping that her TB status is not extensively drug-resistant tuberculosis (XDR-TB).
Dr de Leon wants to be cured and will continue her fight to live, not only for herself and her mission in life but also to be able to see her two young children, three and four years old, grow up.
Alberto Colorado - CNS
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Wednesday, March 24, 2010
The Union to launch international trial of 9-month MDR-TB treatment regimen
While tuberculosis has been curable for more than 60 years, drug-resistant strains are far more difficult and costly to treat. Currently used treatment regimens can take up to two years to complete, placing a heavy burden on both patients and health systems.
The Union's evaluation of a standardised treatment regimen of anti-tuberculosis drugs for patients with multiple drug-resistant tuberculosis or STREAM will seek to determine whether a regimen developed and implemented by the Damien Foundation and the Institute of Tropical Medicine, and used with notable success in Bangladesh, can be used in different settings with comparable results.
"Obviously, this regimen represents a significant difference in time and resources for all involved", says Dr Nils E Billo, Executive Director of The Union. "But any treatment strategy must be carefully evaluated to ensure the most effective and feasible approaches are implemented, particularly in low-income settings where MDR-TB is most prevalent."
To prepare for and implement the single-arm, multicentre STREAM study, The Union is collaborating with the Medical Research Council of the United Kingdom. The four-year study will involve close to 600 patients in four different countries, which are in the process of being selected. Selection will be based on the country’s disease burden of TB, MDR-TB and TB-HIV co-infection, as well as other criteria such as ability to provide close supervision of patients, quality of lab facilities and the full support of the national tuberculosis programme..
The STREAM study is part of the USAID-funded initiative led by The Union called Technology, Research, Education and Technical Assistance for Tuberculosis – TREAT TB. Consistent with the goals of TREAT TB, the overarching goal of STREAM is to see that research, technology and education are increasingly used to improve the performance of patient management practices in the countries selected for the trial. The outcomes of the study are expected to provide important evidence to inform MDR-TB treatment recommendations from global technical agencies, including the World Health Organization and The Union and national policy and guidelines for MDR-TB treatment in high-burden countries.
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AIDS and Drug Resistance pose challenges to TB control in India
World TB Day, 24 March
On the eve of World TB Day - March 24, 2010 - the Indian Network for People living with HIV (INP+), in partnership with the ACTION (Advocacy to Control TB Internationally) project and Global Health Advocates have brought out results of the first of its kind study on barriers to accessing TB treatment services among people living with HIV, injecting drug users (IDU) and the general population. This year, 2010, is also declared as Year of the Lung. Read more
The study conducted in Imphal, Manipur and Erode, Tamil Nadu highlights the lack of penetration of TB control services among vulnerable populations. The study lead author Dr Venkatesan Chakrapani, Policy and Research Adviser, INP+, says: "The gap of knowledge among people living with HIV/AIDS of this key co-infection contributes directly to their higher mortality. Early treatment can avert a majority of these deaths. Newer technology is crucially required to diagnose the problem of drug resistance among both the general population and among people living with HIV."
Among the people who spoke at the release on the need for innovation and research to tackle TB were Dr SK Brahmachari, Director General, CSIR, and Dr Jayanth Banavaliker, Medical Superintendent of the Rajan Babu Institute for Pulmonary Medicine and Tuberculosis (formerly RBTB Hospital), New Delhi.
Releasing the report on behalf of ACTION Project and INP+, Dr SK Brahmachari, DG, CSIR said it is a commendable job done. He added that, "There is a huge challenge, how to develop more specific diagnostics and treatment which is affordable and detects quickly. This is the most important research and development required."
Commenting on the need for more rapid and effective treatment for TB, Prof SK Brahmachari, DG, CSIR said that clinical trials have shown that the combination with Pepperine (an ayurvedic extract) in one of the TB drugs not only makes the treatment more effective with half the current dosage but also cheaper by nearly 23%. This combination is expected to have fewer side-effects and prevent reoccurrence, with specific benefits for women.
"With more and more people reporting drug resistance, it is imperative that newer technologies are adopted to make early diagnosis of drug resistance a reality," says representatives from Global Health Advocates (GHA), one of the advisors on this study. "All the gains from having a national TB control effort can be decimated by the problem of drug resistance. This is the tipping point of the battle against TB in India, and we need new ways of diagnosing people with TB", GHA representative adds.
Discussing the intensity of tuberculosis in India, Dr Banavaliker stressed, "Tuberculosis is curable and the disease can be contained if managed adequately throughout. Early initiation and proper treatment is the best prevention of tuberculosis and resistant TB."
"In-as-much that drugs, diagnostics and research are going to be critical to TB control, we need to have far more involvement of civil society and a greater engagement of political will. TB must be taken on wholeheartedly and comprehensively by society and politicians if we are to avert an MDR crises," said Vivek Dharmaraj of the Advocacy to Control TB Internationally (ACTION) project.
TB remains one of the greatest public health challenges. Paradigm shifts in thinking are urgently needed. Across the world innovative approaches are being initiated to tackle TB. Massive investment in new drugs, rapid and robust diagnostic tools and research is imperative.
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Tuesday, March 16, 2010
World Tuberculosis (TB) Day is on 24 March in Year of the Lung (2010)
2010 is Year of the Lung
The Forum of International Respiratory Societies (FIRS) convening at the 40th Union World Conference on Lung Health in Cancun, Mexico, declared the year 2010 as the Year of the Lung. This was done to recognize that hundreds of millions of people around the world suffer each year from treatable and preventable chronic respiratory diseases. This initiative acknowledges that lung health has long been neglected in public discourses, and understands the need to unify different health advocates behind one purpose of lung health, informed Dr Nils Billo, Chair of FIRS. The FIRS partners include the International Union Against Tuberculosis and Lung Disease (The Union), American Thoracic Society (ATS), Asian Pacific Society of Respirology (APSR), Asociacion Latinoamericana de Torax (ALAT), European Respiratory Society (ERS), Pan African Thoracic Society and American College of Chest Physicians (ACCP).
The New York Times carried a series of articles on different parts of human body, but forgot the lungs! It is difficult to remain alive without lungs for more than few seconds!
The Declaration signed by the partners of the Forum of International Respiratory Societies (FIRS) read as following:
[Begin]
WE NOTE WITH GRAVE CONCERN THAT:
Hundreds of millions of people around the world suffer each year from treatable and preventable respiratory diseases, including tuberculosis (TB), asthma, lung cancer, H1N1, pneumonia, chronic obstructive pulmonary disease (COPD).
WE RECOGNIZE THAT:
Despite the magnitude of suffering and death caused by lung disease, lung health has long been neglected in public discourse and in public health decisions.
WE CALL UPON OUR PARTNERS TO:
Enact smoking cessation legislation and programs to reduce the prevalence and stigma of tobacco-related lung diseases.
[Ends]
There are a range of health and environmental factors that affect our lung health. This includes tuberculosis (TB), tobacco smoke, biomass fuel smoke, chronic obstructive pulmonary disease, asthma, pneumonia among other respiratory infections. The evidence of their potentially devastating effects on global public health is increasing and they require a coordinated approach for control. These diseases all occur in predominantly resource-poor countries. They are perpetuated by poverty and inadequate resources and their control and management require coordinated approach among health programmes at all levels.
Statistically, there is 1 TB-related death that takes place every 18 seconds, 1 HIV death every 16 seconds, 1 child dies of pneumonia every 15 seconds and 1 smoking-related death every 13 seconds. The enormous public challenge posed by the combined epidemics of tobacco smoking, HIV, TB and COPD, is undoubtedly alarming.
More than 2 billion people or a third of the world's total population, are infected with mycobacterium tuberculosis. Tuberculosis is now the world's seventh-leading cause of death. It killed 1.8 million people worldwide last year, up from 1.77 million in 2007. It is one of the three primary diseases that are closely linked to poverty, the other two being AIDS and malaria.
Tobacco smoking is unquestionably the primary risk factor for COPD. More than 5 million deaths are attributed to tobacco use every year. Smokers have two fold higher risk of developing active TB disease. Tobacco smokers have 2 times more risk of dieing of TB. Tobacco smoke increases the risk of pneumonia, influenza, menningococcal meningitis, among others. Evidence is accumulating that smoking is a risk factor for TB. However there is no published data on the cellular interactions of tobacco smoke and mycobacterium tuberculosis. The risk to develop active TB disease is higher when tobacco smoking is combined with alcohol.
Dr Donald Enarson stressed that tobacco smoking cessation is an important part of the comprehensive tobacco control programme, and not the only part. So all components of the comprehensive tobacco control measures should be implemented for improving public health outcomes. Dr Enarson was referring to MPOWER report from Tobacco Free Initiative (TFI) of WHO which outlines the MPOWER package, a set of six key tobacco control measures that reflect and build on the WHO Framework Convention on Tobacco Control (FCTC, global tobacco treaty). Another delegates remarked that MPOWER is in line with the global tobacco treaty - FCTC - and we should be demanding implementation of the treaty to which governments have committed to enforce. The WHO FCTC is the first public health and corporate accountability treaty, said a delegate from India. Comprehensive tobacco control programmes can yield major public health outcomes, as 30% of male TB patients die of tobacco smoking.
Asthma is yet another major lung health challenge. It is a chronic disease that affects airways. When people have asthma, the inside walls of their airways become sore and swollen. That makes them very sensitive, and they may react strongly to things that they are allergic to or find irritating. When airways react, they get narrower and lungs get less air. This can cause wheezing, coughing, chest tightness and trouble breathing, especially early in the morning or at night. When asthma symptoms become worse than usual, it's called an asthma attack. In a severe asthma attack, the airways can close so much that vital organs do not get enough oxygen. People can die from severe asthma attacks.
More than 300 million people around the world have asthma, and the disease imposes a heavy burden on individuals, families, and societies. The Global Burden of Asthma Report, indicates that asthma control often falls short and there are many barriers to asthma control around the world. Proper long-term management of asthma will permit most patients to achieve good control of their disease. Yet in many regions around the world, this goal is often not met. Poor asthma control is also seen in the lifestyle limitations experienced by some people with asthma. For example, in some regions, up to one in four children with asthma is unable to attend school regularly because of poor asthma control. Asthma deaths are the ultimate, tragic evidence of uncontrolled asthma.
According to the Global Burden of Asthma Report, the majority of asthma deaths in some regions of the world are preventable. Effective asthma treatments exist and, with proper diagnosis, education, and treatment, the great majority of asthma patients can achieve and maintain good control of their disease. When asthma is under control, patients can live full and active lives.
Pneumonia claims two million children under five each year, yet no new drug, vaccine or special diagnostic test is needed to save their lives. The answers are at hand, and effective treatment is both inexpensive and widely available.
Host of other conditions that affect the lungs, are preventable, and often treatable.
Let us hope that 2010 Year of The Lung initiative of FIRS puts the spotlight on the long neglected part of human body which New York Times missed, the lungs.
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