The sanatoriums method in dealing Tuberculosis

The age of Tuberculosis sanatoria began in 1849 when public health tried to isolate the sick persons from the healthy population. The fact that Tuberculosis is actually a contagious disease and can be transmitted from man to man was not yet known.

The idea of Tuberculosis being a curable disease and not a death sentence was first expressed by doctor Brehmer in 1854 after he suffered from the disease himself. As a student he caught Tuberculosis and was sent by his doctor to change the climate and live a healthy life in the Himalaya Mountains. He returned home cured and wrote a debate about how Tuberculosis can be cured.

Brehmer built a sanatorium for his tuberculous patients where they could get dietary food, fresh air, sun shines and a high elevated life.

The Tuberculosis suffering Doctor Trudeau opened the most famous sanatorium in America, Saranac Lake, where he also conducted laboratory testing and investigation concerning the cure of Tuberculosis. Patients in his sanatorium were strictly supervised, had to stay in bed the whole first three months to rest, eat healthy and drink high amounts of milk. Trudeau continued Koch’s studies of identifying the structure and physiology of Mycobacterium in order to understand how it could be killed.

All sanatoriums burned and disposed all the objects of the new income as it was proven the bacteria can for a period of time survive inside the clothes tissues, until it found a new host.

The sanatorium cure spread into entire Europe and America; it provided a dual action against Tuberculosis. Isolation of active cases from the healthy population made it possible to control the spreading of the disease. Secondly, sanatoriums provided the patients with regulate, hospital medical care and a better social and cultural environment.

Frequently, people were brought and interned in sanatorium against their will. Many persons could not understand the benefic consequences of this kind of cure, or even felt depressed. In an age without any sort of chemical medication the self-control, autosuggestion and a good moral played a tremendous role in the healing process.

The era of sanatoriums was over when the first antibiotic against Tuberculosis was discovered. Streptomycin successfully treated the infection and enabled patients to be treated in hospitals or receive home treatment. In order to prevent the development of resistance to antibiotics, a combination of efficient drugs is used in the medication lasting normally at least 6 months, even a whole year.

Read More

Details about tuberculosis treatment

The treatment of tuberculosis lasts a long period of time, from six to nine months but it gives remarkably good results in patients. Only in some cases drugs are not bared by the patient and side effects appear. In order to prevent them from happening the doctor monitorizes closely the evolution of the patient by performing blood, urine tests and thoracic x-rays.

The doctor must be announced when nausea, vomiting, fever and jaundice appear. Some patients might develop a skin rash and bruises from the drugs, others might feel numbness in hands or feet and others might have visual problems. The doctor needs to be informed if these kinds of situations appear because he will change the treatment and will replace the harmful drugs with others suitable for the patient.

In the process of treating tuberculosis, doctors use certain drugs that might give certain side effects. For example, Isoniazid can be responsible for the loss of appetite, for nausea, and for tingling in the hands and feet. Rifampicin can interfere with contraceptive pills treatment reducing their effect and can also stain the contact lenses of the patient. Ethambutol is known to cause visual problems so if you follow such a treatment you will periodically be checked by an ophthalmologist to determine whether you can continue the treatment with Ethambutol or not. Pyrazinamide can cause a loss of appetite, nausea, skin rashes and intense itching. Generally Pyrazinamide is recommended only in the first two months of treatment but make sure you inform the doctor if any of these symptoms occur to you.

If the patient takes other medication he must report this thing to the doctor because some pills might interfere with the anti-tuberculosis treatment and others might not be effective if they get in contact with the anti-tuberculosis pills.

The treatment must be followed as prescribed and taken for the period of time the doctor tells you so. Even if the patient feels better the treatment must be continued until the six months have passed because the germs that have cause tuberculosis are not killed until the treatment is done and they might continue to infect the patient and the people who come in close contact with the patient. Also, by taking the pills irregularly, the drug resistance might install and the doctor will have to change the treatment in order to make it effective again but the options are not numerous and the doctor will not have any more separate drugs to replace the others in a short while.

It is important for the patient not to drink any alcohol during the treatment as it can interfere with the drugs and cause toxicity, affecting the liver.

Read More

Drug Resistance In Tuberculosis

Definitions:
• Drug Resistant Tuberculosis

Cases of T.B. caused by an isolate of TB resistant to one of the first line anti TB drugs

PRIMARY DRUG RESISTANCE (P.D.R)
PDR is defined as resistance to one of the frontline drugs in person with TB who is not known to have previous treatment with ATT

NATURAL DRUG RESISTANCE IN WILD STRAINS (Spontaneous Mutation)
SECONDARY (ACQUIRED) DRUG RESISTANCE (A.D.R)
ADR is defined as acquiring increasing level of resistance to one or more drugs in a strain recovered from a patient undergoing ineffective therapy.

TRANSMITTED DRUG RESISTANCE (T.D.R)
TDR is said to have occurred when a single or multi drug resistant strain is recovered from patient who is high risk contact of other individual known to be shedding strain with comparable patterns of drug resistance

MULTI DRUG RESISTANCE (M.D.R)
MDR defined as resistance to two or more first line drugs. Now usually used when resistance to Rifampicin & INH is seen with or without resistance to other drugs.

Cross Resistance:
Capreomycin & Viomycin
Thiacetazone & Ethionamide

Epidemiology US:
Prevalence decreasing in US b/c of effective measures.
1991 National survey of all TB cases revealed
PDR to 1 or more drugs in 13.4%
PDR to RH in 3.2 % of Isolates
New York highest incidence 33 % of isolates 1 drug
26% to INH
19 % to RH

Epidemiology US:
In 1997 decreased to 10%
INH most common 8%
R 1.7%
S 5.9%
E 1.6%
RH 2.5%


Epidemiology UK:
GRANGES & YATES 1993 In South East ENGLAND
8.5% of Immigrant Indian subcontinent population with tuberculosis had drug resistance

Epidemiology World Wide:

Epidemiology Local:
• Rifampicin 10/125 8%
• INH 32/184 17.3%
• Ethambutol 11/124 8.8%
• Strep 8/59 13.5%
• Sensitive to all drugs 137/184 74.4%
• Resistant to 1 drug 35/184 19.8%
• Resistant to 2 drugs 9/184 4.8%
• Resistant to 3 drugs 3/184 1.6%

Institue Of Chest Disease Kotri:
16.4 % Pts did not convert to 5 drugs suggesting high prevalence of resistance

At Ash 100 Isolates Of Patients In Relapse / Retreatment Group:
No of resistance cases 60 60%
Resistance to single drug 38 38% 63%
Resistance to two drugs 18 18% 30%
Resistance to three drugs 2 2% 3.3%
Resistance to four drugs 2 2% 3.3 %
INH Resistance 14 28% 46.6%
Rates of Primary MDR are generally low; median 1.4%
Secondary MDR TB much more common median 13.0%
Highest proportion
Latvia 54%
South Korea 28%
Russia 27.7%

Predisposing Factors:
• Type of bacterial Population
• Insufficient Concentration of Drug
• Patients Drug inactivation status

Patient Factors:
• Contact with resistant case
• Irregular drug intake
• Premature drug stoppage
• Poor absorption (Intestinal TB Excessive vomiting).
• Economic reasons.

Disease Factors:
• In Cavitatory TB
• Drug concentration fluctuates
• Higher no. of bacteria.
• PH Factor
• Thickened Pleura
• Barrier to effective drug penetration

Iatrogenic Factors:
• Treatment with one effective drug
• Inadequate dosage
• Inadequate duration
• Use of cross resistant drugs

Inadequate Prescribing Practice:
• In 1995 25% of new cases of TB were initially treated with 2-3 drugs regimen
• 2 Surveys by AKUH among GP & Interns
• Once resistance develops, prescribing errors, usually by inexperienced physicians can exacerbate situation.
• Review of patients referred to National Jewish Hospital (Denver) for management of complex MDR-TB documented an average of 3.93 prescribing errors per patient.

Erratic Compliance:
• New York study by Brudrey showed that out of 178 patient only 11 % compliant
• Drug often taken erratically and often singly

Nosocomial Transmission:
• In Prisons
• In Hospitals
• In Nursing Homes

HIV Infection is often associated with a high prevalence of drug resistance
• Patient fails to improve
• Patient improves initially but has recurrence of symptoms
• Patient fails to become smear negative
• Patients who have taken treatment previously
• Previously treated patients who have been non compliant.

Implication Of MDR:
• Prolonged hospital stay & Isolation
• Loss of benefit of short course chemotherapy
• High cost of treatment
• Low success rate
• High relapse rate

Diagnosis:
• Once suspected it is easy to diagnose
• Diagnosis follows same lines as standard TB
• AFB culture and sensitivity should be sent

Treatment:
General Principles
• Isolation to prevent spread of disease prolonged hospital admission.
• D.O.T with effective drugs.
• If already taking treatment add at least two new drugs.
• Adjust treatment according to sensitivities when available.

Treatment:
General Principles
• Never add one drug at a time.
• Treatment to be continued for longer period (12-24 months)
• INH is often useful even if the sensitivities don’t favour it.

Isoniazid Monoresistance:
• Rifamycin, Pyrazinamide and Ethambutol for 6 to 9 months or 4 months after culture conversion.

Rifampicin Monorisestancae:
• Most often seen in HIV positive patients.
• Uncommon but increasingly frequent.
• Because Rifampicin is corner stone of all six months regime, resistance requires prolongation of treatment.

Streptomycin, Isoniazid, Pyrazinamide for 9 months. (12 months for HIV +ve)
• SHE for 3 months followed by HE for 18 months.

Pyrazinamide Monoresistance“
• Requires 9 months of Isoniazid and Rifampicin.

Monoresistance To Other Agents:
• Single drug resistance to Ethambutol, Streptomycin, or second line agents is of little clinical significance.
• Patient can still be treated with 2 RHZ followed by 4 to 6 months of RH.
Suggested Treatment regimens for multidrug resistant tuberculosis
Suggested Treatment regimens for multidrug resistant tuberculosis

Prevention Of MDR:
• Educate the prescriber.
• Educate the patient.
• DOTS
• Availability of drugs.
• Using 4 drugs in initial phase, 3 in continuation & giving treatment for 9 months.
• More frequent use of Microbiology services.
• Drug levels.
• Reference Lab.

Read More

Balance you body ingredient and get a healthy life through natural supreme supplements

Magnesium is one of the most important minerals in the human body and plays a critical in over 350 essential biochemical reactions, including digestion, energy production, muscle function, bone formation, creation of new cells, and activation of B vitamins, relaxation of muscles and many functions of the body. Now, magnesium deficiency is very common because of our today’s lifestyle. Its deficiency causes a number of disorder in the body like low energy, fatigue, weakness, inability to sleep, anxious, nervousness, kidney stones and many more; however, Premenstrual Symptoms or PMS is now become prominent, and includes several physical and psychological symptoms like abdominal bloating, breast tenderness, headache, fatigue, irritability, anxiety and depression that commonly happen two to seven days previous to the beginning of menstruation.

The natural remedy for PMS, you should take proper supplement of calcium, magnesium and vitamins D and E. The cellular magnesium levels are lower in the women who are suffering from PMS; in today’s due to uncertain lifestyle, its not possible to take proper intake of food supplement which are badly need to our body. Now in health market so many pharmaceutical companies are available that offer you natural ingredient or needed supplement in the form of tablets and liquid diet. However, the liquid multivitamins has more absorption capability than the tablets and capsules but liquid supplements are more expensive, but now the effective liquid multivitamin of high absorption capacity are offer at reliable rate.

Moreover, an active ingredient of natural supplement is magnesium citrate; it’s permitted by European food safety authority (EFSA); the citrate is just a salt, works best when take on an empty stomach. Its function is categorized into two steps, the first one is to increase your magnesium levels to a perfect level, and the second one is to, to help keep your bowel movements regular. It works by increasing the water in the colon through the colon's tissues by the process of osmosis. It has a tendency to trap water into the intestine to induce the push on to have a bowel movement. The additional water helps to create more waste volume, which naturally stimulates bowel movement assist to treat colon and rectal problems. As the substance is not harmful to our body but one should take this with the prescription of health professional. By taking the proper intake of natural ingredient through an outside supplement, you would get relaxation in you muscle and nerves naturally and the next spontaneous effects less anxiety, relaxation feeling, a decrease in joint and muscle pains and an improvement in heart issues.

Read More

home remedy for Tuberculosis

According to scientific studies, three million people die from home remedy for Tuberculosis every year. A number of around eight million new discovered Tuberculosis conditions appear per year and 95% is estimated to be in developing areas. Countries like those in South America, Africa or Asia have the highest susceptibility to Tuberculosis due to the low living standards and the bad economic and social conditions.Ayurvedic herbal treatment has a definite and important role to play in the successful management of tuberculosis infection. This role has significance on several fronts. In the last five decades, it has become apparent that all currently available modern drugs for tuberculosis can be potentially toxic to the liver. This may lead to decreased appetite, inflammation of the liver, and in severe cases, irreversible damage and liver failure. There are several Ayurvedic medicines which act favorably on the liver, like Kutki These medicines, when added to the tuberculosis treatment regimes, instantly correct liver problems, and help in a rapid therapeutic response to treatment.

Latent tuberculosis infection is when a person is infected with Mycobacterium tuberculosis but does not have symptoms of disease. They are said to be asymptomatic. Active tuberculosis disease is the full-blown disease which, if not treated, will kill half of the patients. One in ten latent infections will progress to active tuberculosis disease. Typical symptoms of an active tuberculosis patient include weakness, fever, chest pain, respiratory insufficiency, fever and cough. Strains of Mycobacterium tuberculosis have become multidrug-resistant making the disease particularly difficult to treat. Treatment includes chemotherapy and a combination of different types of drug. Tuberculosis is spread by infective particles produced through coughing by patients with active tuberculosis. The air-borne particles carrying the bacteria can be inhaled by other people.Almost all spreading of tuberculosis are hidden because its carriers do not show its indication and they are not infected. However, one of 10 people will come down with this disease along the time because of the weakness of his immune system.
From 1,8 million of death in 2008 or 4.930 death in a day, a half million of them are AIDS patients. Most tuberculosis usually attack young men that are in their most productive time and most of the deaths happen in developing countries. More than half of deaths happen in Asia, like Bangladesh, China, India, Indonesia, Pakistan, and Philippine.The World Bank estimates that the disease can lose 4-7% of gross domestic income of some countries that come down with. Tuberculosis that is incurable is usually caused by medicinal treatment by halves and it often happens to patients that stop their treatments when they feel better.

Tuberculosis is a preventable disease. There are a few measures one can take to protect their health. First, you should be tested regularly. If you have an immune suppressing disease, live or work in a prison or nursing home, were born in a TB prevalent country, or have other risk factors, then a Mantoux test should be done every six months.If you test positive without symptoms, speak with your doctor about treatments to reduce the risk of developing active tuberculosis. The most important step you can do for the public and yourself is to finish the entire course of medication.

Read More

Learn Tuberculosis Symptoms and Treatment

It is communicable disease that may occur in any part of the body. It is caused by a non-motile, slow growing acid-fast bacillus called the Mycobacterium tuberculosis. There are two classifications of Tuberculosis, those are Pulmonary Tuberculosis and Miliary or Hematogenous Tuberculosis. Pulmonary Tuberculosis, as the name implies, mainly involves the lungs. On the other hand, Miliary or Hematogenous Tuberculosis is non pulmonary and can affect any part of the body. Transmission is usually through the inhalation of microdroplets from an infected person. The transmission of the disease usually greatly increase when there is overcrowding, where people have poor nutritional statuses making their bodies weak against infection. The worse thing about this infection is that if the primary infection is inadequately treated then this leads to a multidrug resistant organism.

There are various tests that may be performed to diagnose the disease. The history is taken and a physical exam is conducted. A chest x-ray may also be done but will not be enough to diagnose the disease. A test called the Mantoux test or PPD may be done to rule out the disease. To confirm the disease a sputum smear from the patient will be tested for acid – fast bacillus, three positive results will confirm the disease.

Signs and symptoms are usually brought about by any type of pulmonary disease but there are hallmark signs and symptoms that may also support the diagnosis of Tuberculosis. The common signs and symptoms may include difficulty in breathing, progressive fatigue due to poor oxygenation, weight loss, lack of appetite, vomiting, indigestion, body weakness, productive cough, low-grade fever and chills, night sweats, and most probably blood streaked sputum.

Treatment of Tuberculosis is usually done with a multi drug therapy regimen. This multi drug therapy will be used to kill or inhibit the growth of the bacteria. The medications usually consist of Rifampicin, Pyrazinamide, Ethambutol, Isoniazid, and Streptomycin. Side effects from taking the medications are usually treated symptomatically. A point to remember is that all the drugs used to treat the disease is hepatotoxic. This means that the patient's liver will take a beating from the medications. This would follow that the patient needs to regulate his dietary intake.

Remedies that one could encourage the patient to take are, firstly, to follow and finish the treatment regimen which usually takes around six to twelve months. The patient's dietary intake should be adequately managed in order to support his nutritional needs while maintaining homeostasis so as to prevent further damage to the liver. Other methods to relieve the patient's symptoms would revolve around relieving and making it easy for the patient to breathe. These may be doing nebulizations, increasing oral fluid intake, positioning, and post nebulization physiotherapy. Also instruct the patient to cover his mouth and nose when coughing or sneezing, and to dispose the tissues used inside plastic bags. Generally, three months after completing the treatment regimen, the patient is advised to return to the hospital to get his sputum checked for positive acid – fast bacilli.

Read More