1
|
Sathianathan S, Meili Z, Romero CM, Juarez JJ, Bashir R. Racial and gender disparities in the management of acute pulmonary embolism. J Vasc Surg Venous Lymphat Disord 2024; 12:101817. [PMID: 38296110 DOI: 10.1016/j.jvsv.2024.101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 12/15/2023] [Accepted: 12/26/2023] [Indexed: 02/19/2024]
Abstract
OBJECTIVE The aim of this study was to assess race and sex disparities in use and outcomes of various interventions in patient with acute pulmonary embolism (PE). METHODS We included 129,445 patients with acute PE from the NIS from January 2016 to December 2019. Rates of inferior vena cava (IVC) filter placement, catheter-directed thrombolysis (CDT), CDT with ultrasound, systemic thrombolysis, surgical embolectomy, percutaneous thrombectomy, extracorporeal membrane oxygenation, and mechanical ventilation were compared between race and sex subgroups, along with length of hospital stay, major bleeding events, mortality, and other adverse events. Multivariate linear regression analysis was used to adjust for variables that were significantly different between race and sex, including demographic factors, comorbidities, socioeconomic factors, and hospital characteristics. RESULTS Compared with White male patients, all subgroups had significantly higher odds of in-hospital mortality highest in Hispanic male patients (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.090-1.640; P < .01). All subgroups also had a higher odds of major bleeding events and increased length of stay. All subgroups also had lower odds of receiving CDT, lowest in Black female patients (OR, 0.740; 95% CI, 0.660-0.820; P < .001) and Hispanic female patients (0.780; 95% CI, 0.650-0.940; P < .001) compared with White male patients. There was no significant difference in the use of systemic thrombolysis among subgroups. CONCLUSIONS Black and Hispanic patients and female patients are less likely to undergo CDT compared with White male patients, in addition to having higher odds of mortality, major bleeding, and increased length of stay after management of PE. Further efforts are needed to mitigate disparate outcomes of PE management at not only an institutional, but at a national, level to promote health care equality.
Collapse
Affiliation(s)
- Shyama Sathianathan
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA
| | - Zachary Meili
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA
| | - Carlos M Romero
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA
| | - Jordan J Juarez
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Riyaz Bashir
- Division of Cardiovascular Disease, Temple University Hospital, Philadelphia, PA.
| |
Collapse
|
2
|
Khalid SI, Sathianathan S, Thomson KB, McGuire LS, Soni MC, Mehta AI. 5-year stroke rates in nonvalvular atrial fibrillation after watchman compared to direct oral anticoagulants. J Cardiol 2024; 83:163-168. [PMID: 37541428 DOI: 10.1016/j.jjcc.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The WATCHMAN device (Boston Scientific; Marlborough, MA, USA) is noninferior to warfarin in preventing ischemic strokes while reducing bleeding risks associated with long term anticoagulation in nonvalvular atrial fibrillation (AFib). The device's performance compared to direct oral anticoagulants (DOAC) is less well known. OBJECTIVE To compare 5-year major bleeding and ischemic stroke rates in patients with nonvalvular AFib who received a WATCHMAN device or DOAC therapy after a major bleeding event. METHODS This retrospective, multicenter, 1:1 matched cohort study was derived from the PearlDiver Mariner database from 2010 to 2020. Patients with nonvalvular AFib on oral anticoagulation who had a major bleeding event were identified. Those who received either WATCHMAN or DOAC after resolution of the bleeding event were selected. The two groups were exactly matched 1:1 based on various comorbidities. Rates of ischemic stroke, transient ischemic attack (TIA), major bleeding, and hemorrhagic stroke were compared over 5 years. RESULTS Each cohort consisted of 2248 patients after 1:1 matching. The mean CHADS2-VASC score was 4.81 ± 1.25. At 5 years, the WATCHMAN cohort had significantly lower rates of major bleeding events [OR 0.24 (0.21, 0.27)], TIAs [OR 0.75 (0.58, 0.95)], and ischemic strokes [OR 0.72 (0.61, 0.86)]. There was no significant difference in hemorrhagic strokes [OR 1.14 (0.83, 1.58)]. CONCLUSION Even in a high-risk population, the WATCHMAN is comparable to DOAC therapy in the primary prevention of hemorrhagic strokes and may provide benefit in the rates of bleeding events, TIAs, and ischemic strokes.
Collapse
Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA.
| | - Shyama Sathianathan
- Department of Internal Medicine, Temple University Hospital, Philadelphia, PA, USA
| | - Kyle B Thomson
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL, USA
| | - Laura Stone McGuire
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mona C Soni
- Department of Cardiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Patil A, Romero CM, Shafi I, Sathianathan S, Zhao H, Lakhter V, Bashir R. Incidence and Predictors of Acute Limb Ischemia in Patients With Acute Myocardial Infarction-Insight from National Readmission Database. Am J Cardiol 2023; 204:333-338. [PMID: 37573611 DOI: 10.1016/j.amjcard.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/23/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
Acute limb ischemia (ALI) has been a rare complication of acute myocardial infarction (AMI), however, with the increasing use of mechanical circulatory devices it is seen more frequently. The incidence and predictors of ALI in patients with AMI in contemporary clinical practice are unknown. A retrospective review of patients with index hospitalization for AMI in the Nationwide Readmission Database from 2016 to 2019 was done. We evaluated the annual incidence of ALI and its impact on outcomes. We used multivariate logistic regression analysis to determine predictors of ALI. In 1,283,586 patients with AMI, 3,971 patients (0.31%) had ALI and 365 (0.03%) had limb amputation. The 3 major predictors of ALI were peripheral artery disease (odds ratio [OR] 11.91, 95% confidence interval [CI]: 10.78 to 13.51), intravascular microaxial left ventricular assist device (OR 4.39, 95% CI 3.86 to 5.00), and veno-arterial extracorporeal membrane oxygenation (OR 4.37, 95% CI 3.19 to 6.01). Intra-aortic balloon pump had a substantially lower predictive ability (OR 1.81, 95% CI 1.63 to 2.0, p <0.0001) than other forms of mechanical circulatory support. The mortality rate in patients with ALI was significantly higher than those without ALI (19.49% vs 4.85%, p <0.0001). Patients who developed ALI had higher rates of amputation (1.59% vs 0.02%, p <0.0001). This observational nationwide study showed that ALI is an important complication in patients with AMI and is more frequently seen in patients who have peripheral artery disease, and require a left ventricular assist device or venoarterial extracorporeal membrane oxygenation. This complication was also associated with significantly higher in-hospital mortality.
Collapse
Affiliation(s)
| | | | - Irfan Shafi
- Division of Cardiovascular Medicine, Wayne State University/DMC, Detroit, Michigan
| | | | - Huaqing Zhao
- Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | | |
Collapse
|
4
|
Sathianathan S, Meili Z, Romero CM, Juarez JJ, Bashir R. RACE AND SEX DIFFERENCES IN THE MANAGEMENT AND OUTCOMES OF PULMONARY EMBOLISM. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02336-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
5
|
Abstract
PURPOSE OF REVIEW The contribution of continuous flow left ventricular assist devices (c-LVAD) to vasoplegic syndrome and postoperative outcomes after orthotopic heart transplant (OHT) is contested in the literature. A standardized definition of vasoplegic syndrome (VS) is needed to better recognize and manage vasoplegic shock. RECENT FINDINGS Vasoplegic syndrome occurs after orthotopic heart transplant more frequently than after other surgeries requiring cardiopulmonary bypass. c-LVADs lead to small vessel endothelial dysfunction and desensitized adrenal receptors; however, their contribution to the development of vasoplegia is debated in clinical studies. Pulsatility may mitigate vascular dysfunction resulting from long-term continuous flow, and should be further explored in the clinical setting when considering risk factors for vasoplegic syndrome. The incidence of vasoplegic syndrome after orthotopic heart transplant is rising with the increasing use of c-LVAD bridge to therapy. Robust clinical studies are needed to advance our understanding and approach to mitigating VS after OHT.
Collapse
Affiliation(s)
- Shyama Sathianathan
- School of Medicine, Penn State College of Medicine, 500 University Dr, Hershey, PA, 17033, USA.
| | - Geetha Bhat
- Heart and Vascular Institute, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Robert Dowling
- Heart and Vascular Institute, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| |
Collapse
|
6
|
Mondal P, Midya V, Khokhar A, Sathianathan S, Forno E. Predictors of Diffusing Capacity in Children With Sickle Cell Disease: A Longitudinal Study. Front Pediatr 2021; 9:678174. [PMID: 34136443 PMCID: PMC8200630 DOI: 10.3389/fped.2021.678174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/04/2021] [Indexed: 02/02/2023] Open
Abstract
Background: Gas exchange abnormalities in Sickle Cell Disease (SCD) may represent cardiopulmonary deterioration. Identifying predictors of these abnormalities in children with SCD (C-SCD) may help us understand disease progression and develop informed management decisions. Objectives: To identify pulmonary function tests (PFT) estimates and biomarkers of disease severity that are associated with and predict abnormal diffusing capacity (DLCO) in C-SCD. Methods: We obtained PFT data from 51 C-SCD (median age:12.4 years, male: female = 29:22) (115 observations) and 22 controls (median age:11.1 years, male: female = 8:14), formulated a rank list of DLCO predictors based on machine learning algorithms (XGBoost) or linear mixed-effect models, and compared estimated DLCO to the measured values. Finally, we evaluated the association between measured or estimated DLCO and clinical outcomes, including SCD crises, pulmonary hypertension, and nocturnal desaturation. Results: Hemoglobin-adjusted DLCO (%) and several PFT indices were diminished in C-SCD compared to controls. Both statistical approaches ranked FVC (%), neutrophils (%), and FEF25-75 (%) as the top three predictors of DLCO. XGBoost had superior performance compared to the linear model. Both measured and estimated DLCO demonstrated a significant association with SCD severity: higher DLCO, estimated by XGBoost, was associated with fewer SCD crises [beta = -0.084 (95%CI: -0.13, -0.033)] and lower TRJV [beta = -0.009 (-0.017, -0.001)], but not with nocturnal desaturation (p = 0.12). Conclusions: In this cohort of C-CSD, DLCO was associated with PFT estimates representing restrictive lung disease (FVC, TLC), airflow obstruction (FEF25-75, FEV1/FVC, R5), and inflammation (neutrophilia). We used these indices to estimate DLCO, and show association with disease outcomes, underscoring the prediction models' clinical relevance.
Collapse
Affiliation(s)
- Pritish Mondal
- Division of Pediatric Pulmonology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Vishal Midya
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Arshjot Khokhar
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Shyama Sathianathan
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| |
Collapse
|
7
|
Sathianathan S, Van Scoy LJ, Sakya SM, Miller E, Snyder B, Wasserman E, Chinchilli VM, Garman J, Lennon RP. Knowledge, Perceptions, and Preferred Information Sources Related to COVID-19 Among Healthcare Workers: Results of a Cross Sectional Survey. Am J Health Promot 2020; 35:633-636. [PMID: 33353367 DOI: 10.1177/0890117120982416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To compare COVID-19 related knowledge, perceptions, and preferred information sources between healthcare workers and non-healthcare workers. DESIGN Cross-sectional survey. SETTING Web-based. SUBJECTS Convenience sample of Pennsylvanian adults. MEASURES Primary outcomes were binary responses to 15 COVID-19 knowledge questions weighted by a Likert scale assessing response confidence. ANALYSIS Generalized linear mixed-effects models to assess comparisons between clinical decision makers (CDM), non-clinical decision makers working in healthcare (non-CDM) and non-healthcare workers (non-HCW). RESULTS CDMs (n = 91) had higher overall knowledge than non-CDMs (n = 854; OR 1.81 [1.51, 2.17], p < .05). Overall knowledge scores were not significantly different between non-CDMs (n = 854) and non-HCW (n = 4,966; OR 1.03 [0.97, 1.09], p > .05). CONCLUSION The findings suggest a need for improved education about COVID-19 for healthcare workers who are not clinical decision makers, as they play key roles in patient perceptions and compliance with preventive medicine during primary care visits.
Collapse
Affiliation(s)
| | - Lauren Jodi Van Scoy
- Department of Medicine, 12311Penn State College of Medicine, Hershey, PA, USA.,Department of Humanities, 12311Penn State College of Medicine, Hershey, PA, USA.,Department of Public Health Sciences, 12311Penn State College of Medicine, Hershey, PA, USA.,Qualitative and Mixed Methods Core, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Surav Man Sakya
- School of Medicine, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Erin Miller
- Qualitative and Mixed Methods Core, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Bethany Snyder
- Department of Medicine, 12311Penn State College of Medicine, Hershey, PA, USA.,Qualitative and Mixed Methods Core, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Emily Wasserman
- Department of Public Health Sciences, 12311Penn State College of Medicine, Hershey, PA, USA.,Qualitative and Mixed Methods Core, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, 12311Penn State College of Medicine, Hershey, PA, USA
| | - John Garman
- School of Medicine, 12311Penn State College of Medicine, Hershey, PA, USA
| | - Robert P Lennon
- Department of Family and Community Medicine, 12311Penn State College of Medicine, Hershey, PA, USA.,Penn State Law, The Pennsylvania State University, University Park, PA, USA
| |
Collapse
|
8
|
Ballard Z, Bazargan S, Jung D, Sathianathan S, Clemens A, Shir D, Al-Hashimi S, Ozcan A. Contact lens-based lysozyme detection in tear using a mobile sensor. Lab Chip 2020; 20:1493-1502. [PMID: 32227027 PMCID: PMC7189769 DOI: 10.1039/c9lc01039d] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We report a method for sensing analytes in tear-fluid using commercial contact lenses (CLs) as sample collectors for subsequent analysis with a cost-effective and field-portable reader. In this study we quantify lysozyme, the most prevalent protein in tear fluid, non-specifically bound to CLs worn by human participants. Our mobile reader uses time-lapse imaging to capture an increasing fluorescent signal in a standard well-plate, the rate-of-change of which is used to indirectly infer lysozyme concentration through the use of a standard curve. We empirically determined the best-suited CL material for our sampling procedure and assay, and subsequently monitored the lysozyme levels of nine healthy human participants over a two-week period. Of these participants who were regular CL wearers (6 out of 9), we observed an increase in lysozyme levels from 6.89 ± 2.02 μg mL-1 to 10.72 ± 3.22 μg mL-1 (mean ± SD) when inducing an instance of digital eye-strain by asking them to play a game on their mobile-phones during the CL wear-duration. We also observed a lower mean lysozyme concentration (2.43 ± 1.66 μg mL-1) in a patient cohort with dry eye disease (DED) as compared to the average monitoring level of healthy (no DED) human participants (6.89 ± 2.02 μg mL-1). Taken together, this study demonstrates tear-fluid analysis with simple and non-invasive sampling steps along with a rapid, easy-to-use, and cost-effective measurement system, ultimately indicating physiological differences in human participants. We believe this method could be used in future tear-fluid studies, even supporting multiplexed detection of a panel of tear biomarkers toward improved diagnostics and prognostics as well as personalized mobile-health applications.
Collapse
Affiliation(s)
- Zachary Ballard
- Department of Electrical and Computer Engineering, University of California, Los Angeles, USA.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Sathianathan S, Nasir R, Wang S, Kunselman AR, Ündar A. In vitro evaluation of Capiox FX05 and RX05 oxygenators in neonatal cardiopulmonary bypass circuits with varying venous reservoir and vacuum‐assisted venous drainage levels. Artif Organs 2019; 44:28-39. [DOI: 10.1111/aor.13404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/30/2018] [Accepted: 11/29/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Shyama Sathianathan
- Department of Pediatrics Penn State Health Pediatric Cardiovascular Research Center, Penn State Health Children’s Hospital Hershey Pennsylvania
| | - Rafay Nasir
- Department of Pediatrics Penn State Health Pediatric Cardiovascular Research Center, Penn State Health Children’s Hospital Hershey Pennsylvania
| | - Shigang Wang
- Department of Pediatrics Penn State Health Pediatric Cardiovascular Research Center, Penn State Health Children’s Hospital Hershey Pennsylvania
| | - Allen R. Kunselman
- Department of Public Health and Sciences Penn State Health Children’s Hospital Hershey Pennsylvania
| | - Akif Ündar
- Department of Pediatrics Penn State Health Pediatric Cardiovascular Research Center, Penn State Health Children’s Hospital Hershey Pennsylvania
- Department of Surgery and Bioengineering Penn State Health Children’s Hospital Hershey Pennsylvania
| |
Collapse
|
10
|
Ballard ZS, Shir D, Bhardwaj A, Bazargan S, Sathianathan S, Ozcan A. Computational Sensing Using Low-Cost and Mobile Plasmonic Readers Designed by Machine Learning. ACS Nano 2017; 11:2266-2274. [PMID: 28128933 PMCID: PMC5451292 DOI: 10.1021/acsnano.7b00105] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Plasmonic sensors have been used for a wide range of biological and chemical sensing applications. Emerging nanofabrication techniques have enabled these sensors to be cost-effectively mass manufactured onto various types of substrates. To accompany these advances, major improvements in sensor read-out devices must also be achieved to fully realize the broad impact of plasmonic nanosensors. Here, we propose a machine learning framework which can be used to design low-cost and mobile multispectral plasmonic readers that do not use traditionally employed bulky and expensive stabilized light sources or high-resolution spectrometers. By training a feature selection model over a large set of fabricated plasmonic nanosensors, we select the optimal set of illumination light-emitting diodes needed to create a minimum-error refractive index prediction model, which statistically takes into account the varied spectral responses and fabrication-induced variability of a given sensor design. This computational sensing approach was experimentally validated using a modular mobile plasmonic reader. We tested different plasmonic sensors with hexagonal and square periodicity nanohole arrays and revealed that the optimal illumination bands differ from those that are "intuitively" selected based on the spectral features of the sensor, e.g., transmission peaks or valleys. This framework provides a universal tool for the plasmonics community to design low-cost and mobile multispectral readers, helping the translation of nanosensing technologies to various emerging applications such as wearable sensing, personalized medicine, and point-of-care diagnostics. Beyond plasmonics, other types of sensors that operate based on spectral changes can broadly benefit from this approach, including e.g., aptamer-enabled nanoparticle assays and graphene-based sensors, among others.
Collapse
Affiliation(s)
- Zachary S Ballard
- Electrical Engineering Department, ‡Bioengineering Department, and §California NanoSystems Institute (CNSI), University of California , Los Angeles, California 90095, United States
| | - Daniel Shir
- Electrical Engineering Department, ‡Bioengineering Department, and §California NanoSystems Institute (CNSI), University of California , Los Angeles, California 90095, United States
| | - Aashish Bhardwaj
- Electrical Engineering Department, ‡Bioengineering Department, and §California NanoSystems Institute (CNSI), University of California , Los Angeles, California 90095, United States
| | - Sarah Bazargan
- Electrical Engineering Department, ‡Bioengineering Department, and §California NanoSystems Institute (CNSI), University of California , Los Angeles, California 90095, United States
| | - Shyama Sathianathan
- Electrical Engineering Department, ‡Bioengineering Department, and §California NanoSystems Institute (CNSI), University of California , Los Angeles, California 90095, United States
| | - Aydogan Ozcan
- Electrical Engineering Department, ‡Bioengineering Department, and §California NanoSystems Institute (CNSI), University of California , Los Angeles, California 90095, United States
| |
Collapse
|
11
|
Khalil A, Sathianathan S. The problem of tuberculosis then and now in Libyan Arab Jamahiriya. Indian J Chest Dis Allied Sci 1982; 24:213-7. [PMID: 7166356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
12
|
Sathianathan S, Khalil A. A simple diagnostic culture method for use in a tuberculosis control programme. Bull World Health Organ 1981; 59:919-21. [PMID: 6802506 PMCID: PMC2396142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A simple, widely applicable method for the culture of tubercle bacilli was compared with the classical standard method in a controlled trial on 500 specimens. The method consisted of treating sputum samples with a detergent-alkali mixture, and inoculating this on to buffered medium. The technique was found to be as sensitive as the standard method for the isolation of tubercle bacilli, and also to reduce contamination rates. Consistent results were obtained in 10 026 routine specimens, confirming the diagnosis for 86.4% of the new patients within 3 weeks. Cultures were not affected by delayed incubation.
Collapse
|
13
|
Khalil A, Sathianathan S. Impact of anti-tuberculosis legislation in Libya on the prevalence of primary and acquired resistance to the three main drugs at a majortuberculosis centre. Tubercle 1978; 59:1-12. [PMID: 416530 DOI: 10.1016/0041-3879(77)90021-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The effect of legislative actions taken in 1973 on the prevalence of primary and acquired drug resistance was studied from the records on the Regional Tuberculosis and Chest Diseases Centre in Benghazi during the period June 1971 to August 1976. There were available for analysis 771 culture-positive cases of newly diagnosed pulmonary tuberculosis in Libyan nationals, and 789 cases of both Libyan nationals and others with positive cultures during treatment. The legislative actions included screening of all foreign and local workers for tuberculosis before employment or in the course of employement for those already employed and strict control of the use of antituberculosis drugs, which were not made available to private practitioners, private pharmacies, general dispensaries and general hospitals. The proportion of newly diagnosed cases with resistance to one or more of the 3 drugs streptomycin, isoniazid, PAS (resistance to PAS was negligible, occurring in only 0.7% of the whole series) during the first 3 months of the survey was 16.6%. During the first 9 3-month periods there was a small decrease of 0.15% per quarter. However, after adoption of the antituberculosis measures in mid-1973 the rate of decline accelerated to 0.61% per quarter, a 4-fold increase over the earlier rates (P less than 0.001 for comparison of rates). If the rate of decline observed in the first 9 quarters had continued unchanged the expected proportion resistant at the end of the period would have been 13.5%, compared with the observed proportion of 8.6%. The proportion of patients under treatment from whom resistant cultures were isolated was 33.3% in the first quarter. It remained at about this level until the 14th quarter, approximately a year after the legislation came into force, when the proportion began to decline. By the end of the period it was only 14.7%.
Collapse
|