Background: Promoting a healthy lifestyle is one of the basic pieces in the family medicine activ... more Background: Promoting a healthy lifestyle is one of the basic pieces in the family medicine activity. In order to formulate and / or adjust some approaches in clinical practice of the family doctor in the Republic of Moldova, it was necessary to analyse the knowledge and practices of the family doctor regarding the obese patients counselling. Material and methods: Cross-sectional study was based on primary data collection. The study sample included 316 family doctors. The descriptive analysis was expressed in absolute values, percentages and standard errors, means and standard deviation of the mean. Statistical significance was considered to be p <0.05. Results: Family doctors feel best prepared in counselling patients on stress management (75.9 ± 2.40%), prescribing healthy diets (71.2 ± 2.55%), prescribing physical activity (71.0 ± 2.55%), cerebrovascular accident (CVA) prevention (68.9 ± 2.60%). They feel less prepared in counselling patients with regard to weight control (67....
The Republic of Moldova is among the 30 Rifampicin-Resistant and/or Multidrug-Resistant (RR/MDR) ... more The Republic of Moldova is among the 30 Rifampicin-Resistant and/or Multidrug-Resistant (RR/MDR) Tuberculosis (TB) high burden countries in the world. Despite free TB diagnostics and treatment, TB patients face substantial economic losses and this may impact overall treatment outcomes. We assessed if there is an association between TB-related catastrophic costs and TB treatment outcomes. We conducted a cohort study using data from patient records and a survey that quantified catastrophic costs among RR/MDR-TB affected households in the Republic of Moldova in 2016. We included adult patients (age ≥18 years) with RR/MDR-TB who had been in inpatient (intensive phase) or outpatient (continuous phase) treatment for at least 2 months. Unfavourable treatment outcome, such as failure, death or lost to follow-up, was the primary outcome variable. The definition of catastrophic TB-related costs followed the World Health Organisation (WHO) guidelines: costs due to TB ≥20% of annual household i...
International Journal of Environmental Research and Public Health, 2021
Treatment of drug-resistant tuberculosis is lengthy, insufficiently effective, and toxic. Since 2... more Treatment of drug-resistant tuberculosis is lengthy, insufficiently effective, and toxic. Since 2016, the World Health Organization has recommended shorter treatment regimens (STR). We assessed effectiveness and predictors of drug adverse events (DAE) among patients treated with STR. There were 95 consecutive rifampicin-resistant patients enrolled in STR in Tashkent between June 2018 and September 2019. Of these, 66.3% were successfully treated, 17.9% suffered failed treatment, 7.4% died, 5.3% were lost to follow-up and 3.2% were not evaluated. No recurrence was identified in 54 patients after 12 months of successful treatment completion. There were 47 reported DAE: the incidence rate was 6.15 DAE per 100 person-months-of-treatment. Any DAE was reported in 38 (40%) patients and grade 3/4 DAE were recorded in 21 (22.1%) patients. Median time to DAE was 101 (interquartile range 64–139) days. The most frequently encountered DAE were gastro-intestinal disorders, followed by hepatotoxici...
International Journal of Environmental Research and Public Health, 2021
Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in ... more Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in 10–12% of diagnosed tuberculosis (TB) patients. In this study among patients with respiratory TB who had surgical interventions in Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology of Uzbekistan (RSSPMCPP) from January to May 2017, we describe (i) reasons and types of surgical intervention, (ii) post-surgical complications, (iii) histological diagnosis before and after surgery, and (iv) treatment outcomes. There were 101 patients included in the analysis (mean age 36 years; 51% male; 71% lived in rural areas). The main indications for surgical intervention included pulmonary tuberculoma (40%), fibrocavitary, or cavernous pulmonary TB (23%) and massive hemoptysis (20%). Pulmonary resections were the most frequent surgical procedures: segmentectomy (41%), lobectomy or bilobectomy (19%), and combined resection (17%). Ten patients (9%) suffered post-s...
Mental health comorbidities are common among tuberculosis patients, with higher prevalence among ... more Mental health comorbidities are common among tuberculosis patients, with higher prevalence among people with rifampicin-resistant/multidrug-resistant (RR/MDR) tuberculosis. TB and depression share common risk factors adding to the overall disease burden. There is limited evidence about prevalence of depression and anxiety symptoms among tuberculosis patients in Romania. We assessed the prevalence of depression and anxiety symptoms and their evolution over the course of the treatment in RR/MDR-TB patients receiving in-patient care at the National Institute of Pneumonology (NIP) “Marius Nasta” in Romania during May-September 2020. We conducted a cohort study and used the Hospital Anxiety and Depression Scale (HADS) to assess the prevalence of depression and anxiety (defined as score≥ 8) symptoms at admission (baseline) and the second month of in-patient treatment (follow-up). Difference between baseline and follow-up depression and anxiety symptoms were assessed using McNemar test. B...
Introduction: In 2017 the rate of tuberculosis (TB) in Armenia according to the national surveill... more Introduction: In 2017 the rate of tuberculosis (TB) in Armenia according to the national surveillance system was 28 per 100 000 population, yet the number estimated by WHO was 36 per 100 000 population. The aim of the study was therefore to assess the underreporting of TB cases in Armenia in 2017. Methodology: A retrospective inventory study was conducted by comparing TB cases reported electronically to the National Tuberculosis Program (NTP) via the national TB database e-TB Manager to 1) those recorded in two additional electronic national databases: the TB reference laboratory database and TB hospital database, 2) paper-based registers from Basic Management Units. The rate of underreporting was calculated as the number of TB patients not reported in the e-TB manager over the sum of both reported and unreported cases. Results: Of 760 TB cases identified in TB -laboratory and TBhospital databases, 691 TB cases were known to the e-TB Manager, meaning there were 69 cases not official...
International Journal of Environmental Research and Public Health, 2021
Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical ch... more Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on a...
International Journal of Environmental Research and Public Health, 2021
Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to endi... more Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to ending TB in the World Health Organization (WHO) European Region. Objectives and design: a comparative analysis of TB notification rates during 2014–2018 and of treatment outcomes in the civilian and penitentiary sectors in the WHO European Region, with an assessment of risks of developing TB among people experience incarceration. Results: in the WHO European Region, incident TB rates in inmates were 4–24 times higher than in the civilian population. In 12 eastern Europe and central Asia (EECA) countries, inmates compared to civilians had higher relative risks of developing TB (RR = 25) than in the rest of the region (RR = 11), with the highest rates reported in inmates in Azerbaijan, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, and Ukraine. The average annual change in TB notification rates between 2014 and 2018 was −7.0% in the civilian sector and −10.9% in the penitent...
American journal of respiratory and critical care medicine, Jan 6, 2018
Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported ... more Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less and cure rates are even lower. We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by WHO and alternative simplified definitions. 380 patients with MDR-TB were recruited and followed-up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median 111 vs. 28 days), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying WHO outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence count...
Background: Multidrug and extensively resistant tuberculosis (MDR&XDRTB) represents one of th... more Background: Multidrug and extensively resistant tuberculosis (MDR&XDRTB) represents one of the major causes of poor treatment outcomes for tuberculosis (TB) control programs. Objective: To analyze the trend and impact of MDR&XDR TB on the TB control program indicators in Republic of Moldova. Design: Were assessed principal TB control indicators on a countrywide level during the last decades (1990-2012) with a focus on MDR& XDRTB. The data of national TB registry and National Reference TB Laboratory (inclusively regarding strains genotyping) were used. Results: The prevalence of MDRTB among TB new cases was 0,5% in 1995 and became 6.3 between new cases and 36.7% between retreatment cases in 2001. During last 10 years, the prevalence of MDRTB has had an unprecedented increase up to 26.1% between new cases and 63.4% retreatment cases in 2011. The number XDRTB patients increased during last 5 years and became on level of 12.8% in 2012. Genotyping of M.tuberculosis strains demonstrated that genotype Beijing and Ural are predominating among strains isolated from MDRTB patients – 66, 0%. Between TB resistance cases the number of migrants patients was very high – 42%. The rate of mortality was in 1990 on level 4.9% and increased up to 20,2% in 2007. In 73% of deathly cases, the MDR&XDRTB was confirmed. Conclusion: The additionally, new measured need to be implemented urgently for stop the increase level of MDRTB cases. Efforts to control the epidemic could be complemented by implementation of infection control programs, re-designing of healthcare facilities, rolling-out of rapid tests for diagnosing of MDRTB and implementation of the ambulatory treatment for TB patients on a national level.
Background: Promoting a healthy lifestyle is one of the basic pieces in the family medicine activ... more Background: Promoting a healthy lifestyle is one of the basic pieces in the family medicine activity. In order to formulate and / or adjust some approaches in clinical practice of the family doctor in the Republic of Moldova, it was necessary to analyse the knowledge and practices of the family doctor regarding the obese patients counselling. Material and methods: Cross-sectional study was based on primary data collection. The study sample included 316 family doctors. The descriptive analysis was expressed in absolute values, percentages and standard errors, means and standard deviation of the mean. Statistical significance was considered to be p <0.05. Results: Family doctors feel best prepared in counselling patients on stress management (75.9 ± 2.40%), prescribing healthy diets (71.2 ± 2.55%), prescribing physical activity (71.0 ± 2.55%), cerebrovascular accident (CVA) prevention (68.9 ± 2.60%). They feel less prepared in counselling patients with regard to weight control (67....
The Republic of Moldova is among the 30 Rifampicin-Resistant and/or Multidrug-Resistant (RR/MDR) ... more The Republic of Moldova is among the 30 Rifampicin-Resistant and/or Multidrug-Resistant (RR/MDR) Tuberculosis (TB) high burden countries in the world. Despite free TB diagnostics and treatment, TB patients face substantial economic losses and this may impact overall treatment outcomes. We assessed if there is an association between TB-related catastrophic costs and TB treatment outcomes. We conducted a cohort study using data from patient records and a survey that quantified catastrophic costs among RR/MDR-TB affected households in the Republic of Moldova in 2016. We included adult patients (age ≥18 years) with RR/MDR-TB who had been in inpatient (intensive phase) or outpatient (continuous phase) treatment for at least 2 months. Unfavourable treatment outcome, such as failure, death or lost to follow-up, was the primary outcome variable. The definition of catastrophic TB-related costs followed the World Health Organisation (WHO) guidelines: costs due to TB ≥20% of annual household i...
International Journal of Environmental Research and Public Health, 2021
Treatment of drug-resistant tuberculosis is lengthy, insufficiently effective, and toxic. Since 2... more Treatment of drug-resistant tuberculosis is lengthy, insufficiently effective, and toxic. Since 2016, the World Health Organization has recommended shorter treatment regimens (STR). We assessed effectiveness and predictors of drug adverse events (DAE) among patients treated with STR. There were 95 consecutive rifampicin-resistant patients enrolled in STR in Tashkent between June 2018 and September 2019. Of these, 66.3% were successfully treated, 17.9% suffered failed treatment, 7.4% died, 5.3% were lost to follow-up and 3.2% were not evaluated. No recurrence was identified in 54 patients after 12 months of successful treatment completion. There were 47 reported DAE: the incidence rate was 6.15 DAE per 100 person-months-of-treatment. Any DAE was reported in 38 (40%) patients and grade 3/4 DAE were recorded in 21 (22.1%) patients. Median time to DAE was 101 (interquartile range 64–139) days. The most frequently encountered DAE were gastro-intestinal disorders, followed by hepatotoxici...
International Journal of Environmental Research and Public Health, 2021
Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in ... more Surgical interventions are performed as an adjunct to pharmacological treatment in Uzbekistan in 10–12% of diagnosed tuberculosis (TB) patients. In this study among patients with respiratory TB who had surgical interventions in Republican Specialized Scientific-Practical Medical Centre of Phthisiology and Pulmonology of Uzbekistan (RSSPMCPP) from January to May 2017, we describe (i) reasons and types of surgical intervention, (ii) post-surgical complications, (iii) histological diagnosis before and after surgery, and (iv) treatment outcomes. There were 101 patients included in the analysis (mean age 36 years; 51% male; 71% lived in rural areas). The main indications for surgical intervention included pulmonary tuberculoma (40%), fibrocavitary, or cavernous pulmonary TB (23%) and massive hemoptysis (20%). Pulmonary resections were the most frequent surgical procedures: segmentectomy (41%), lobectomy or bilobectomy (19%), and combined resection (17%). Ten patients (9%) suffered post-s...
Mental health comorbidities are common among tuberculosis patients, with higher prevalence among ... more Mental health comorbidities are common among tuberculosis patients, with higher prevalence among people with rifampicin-resistant/multidrug-resistant (RR/MDR) tuberculosis. TB and depression share common risk factors adding to the overall disease burden. There is limited evidence about prevalence of depression and anxiety symptoms among tuberculosis patients in Romania. We assessed the prevalence of depression and anxiety symptoms and their evolution over the course of the treatment in RR/MDR-TB patients receiving in-patient care at the National Institute of Pneumonology (NIP) “Marius Nasta” in Romania during May-September 2020. We conducted a cohort study and used the Hospital Anxiety and Depression Scale (HADS) to assess the prevalence of depression and anxiety (defined as score≥ 8) symptoms at admission (baseline) and the second month of in-patient treatment (follow-up). Difference between baseline and follow-up depression and anxiety symptoms were assessed using McNemar test. B...
Introduction: In 2017 the rate of tuberculosis (TB) in Armenia according to the national surveill... more Introduction: In 2017 the rate of tuberculosis (TB) in Armenia according to the national surveillance system was 28 per 100 000 population, yet the number estimated by WHO was 36 per 100 000 population. The aim of the study was therefore to assess the underreporting of TB cases in Armenia in 2017. Methodology: A retrospective inventory study was conducted by comparing TB cases reported electronically to the National Tuberculosis Program (NTP) via the national TB database e-TB Manager to 1) those recorded in two additional electronic national databases: the TB reference laboratory database and TB hospital database, 2) paper-based registers from Basic Management Units. The rate of underreporting was calculated as the number of TB patients not reported in the e-TB manager over the sum of both reported and unreported cases. Results: Of 760 TB cases identified in TB -laboratory and TBhospital databases, 691 TB cases were known to the e-TB Manager, meaning there were 69 cases not official...
International Journal of Environmental Research and Public Health, 2021
Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical ch... more Tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection poses a growing clinical challenge. People living with HIV have a higher chance of developing TB, and once the disease has progressed, are at greater risk of having unfavorable TB treatment outcomes. Data on TB treatment outcomes among the HIV-associated TB population in Uzbekistan are limited. Thus, we conducted a cohort study among 808 adult patients with HIV-associated TB registered at the Tashkent TB referral hospital from 2013–2017 to document baseline characteristics and evaluate risk factors for unfavorable TB treatment outcomes. The data were collected from medical records and ambulatory cards. About 79.8% of the study population had favorable treatment outcomes. Antiretroviral therapy (ART) coverage at the admission was 26.9%. Information on CD4-cell counts and viral loads were largely missing. Having extrapulmonary TB (aOR 2.21, 95% CI: 1.38–3.53, p = 0.001), positive sputum smear laboratory results on a...
International Journal of Environmental Research and Public Health, 2021
Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to endi... more Setting: Tuberculosis (TB) morbidity in penitentiary sectors is one of the major barriers to ending TB in the World Health Organization (WHO) European Region. Objectives and design: a comparative analysis of TB notification rates during 2014–2018 and of treatment outcomes in the civilian and penitentiary sectors in the WHO European Region, with an assessment of risks of developing TB among people experience incarceration. Results: in the WHO European Region, incident TB rates in inmates were 4–24 times higher than in the civilian population. In 12 eastern Europe and central Asia (EECA) countries, inmates compared to civilians had higher relative risks of developing TB (RR = 25) than in the rest of the region (RR = 11), with the highest rates reported in inmates in Azerbaijan, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, and Ukraine. The average annual change in TB notification rates between 2014 and 2018 was −7.0% in the civilian sector and −10.9% in the penitent...
American journal of respiratory and critical care medicine, Jan 6, 2018
Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported ... more Multidrug-resistant tuberculosis (MDR-TB) is a major burden to public health in Europe. Reported treatment success rates are around 50% or less and cure rates are even lower. We performed a prospective cohort study, analyzing management and treatment outcomes stratified by incidence of patients with MDR-TB in Europe. Treatment outcomes were compared by WHO and alternative simplified definitions. 380 patients with MDR-TB were recruited and followed-up between 2010 and 2014 in 16 European countries. Patients in high-incidence countries compared with low-incidence countries were treated more frequently with standardized regimen (83.2% vs. 9.9%), had delayed treatment initiation (median 111 vs. 28 days), developed more additional drug resistance (23% vs. 5.8%), and had increased mortality (9.4% vs. 1.9%). Only 20.1% of patients using pyrazinamide had proven susceptibility to the drug. Applying WHO outcome definitions, frequency of cure (38.7% vs. 9.7%) was higher in high-incidence count...
Background: Multidrug and extensively resistant tuberculosis (MDR&XDRTB) represents one of th... more Background: Multidrug and extensively resistant tuberculosis (MDR&XDRTB) represents one of the major causes of poor treatment outcomes for tuberculosis (TB) control programs. Objective: To analyze the trend and impact of MDR&XDR TB on the TB control program indicators in Republic of Moldova. Design: Were assessed principal TB control indicators on a countrywide level during the last decades (1990-2012) with a focus on MDR& XDRTB. The data of national TB registry and National Reference TB Laboratory (inclusively regarding strains genotyping) were used. Results: The prevalence of MDRTB among TB new cases was 0,5% in 1995 and became 6.3 between new cases and 36.7% between retreatment cases in 2001. During last 10 years, the prevalence of MDRTB has had an unprecedented increase up to 26.1% between new cases and 63.4% retreatment cases in 2011. The number XDRTB patients increased during last 5 years and became on level of 12.8% in 2012. Genotyping of M.tuberculosis strains demonstrated that genotype Beijing and Ural are predominating among strains isolated from MDRTB patients – 66, 0%. Between TB resistance cases the number of migrants patients was very high – 42%. The rate of mortality was in 1990 on level 4.9% and increased up to 20,2% in 2007. In 73% of deathly cases, the MDR&XDRTB was confirmed. Conclusion: The additionally, new measured need to be implemented urgently for stop the increase level of MDRTB cases. Efforts to control the epidemic could be complemented by implementation of infection control programs, re-designing of healthcare facilities, rolling-out of rapid tests for diagnosing of MDRTB and implementation of the ambulatory treatment for TB patients on a national level.
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