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TB Clinical and Epidemiology Lunch Meetings (6-25-14)

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Total Posts: 5

Joined 2014-05-06

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Case Description: Dr. Evans shares the research findings from IFHAD, the Innovation For Health And Development research group, and discusses why socioeconomic development drives TB rates more that TB control programs.
Speaker: Dr. Carlton Evans

     
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Total Posts: 21

Joined 2014-05-04

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Had attended this lecture while at Hopkins. The rapid diagnostic test was interesting and would like to use in our set-up as well .
The idea of giving incentives for treatment completion and nutritional support may not be a viable option for the National programme in India, however there are various NGO’s who help the government programme by supplying food as well as support in kind.
Very nicely presented work from Peru.

     
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Total Posts: 24

Joined 2014-05-05

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recently i came across one article where incentives are given to TST test as travel allowance as patient has to come back for reading the indutration .nicely framed article.

     
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Total Posts: 14

Joined 2014-05-07

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This lecture puts forth many interesting ideas and with it a series of questions too-
a. The ventilation in household settings is no doubt important. But there are some setups viz. urban slums where improving ventilation is not a practical idea. There are no windows to open in overcrowded homes! The houses are literally like match boxes stacked together.
b. A take home message-A focus on new diagnostics, new drugs even incentives just to improve compliance without a thought tor the overall socioeconomic development of the community will not have the desired impact.
c. Multi-nutrient supplementation doesn’t really protect one from TB but we hope boosting immunity with good immunity through proper nutrition would do so. It would be interesting to understand the mechanism of action?
d. Mechanical ventilation, UVGI requires good repair and maintenance; other wise there can be disastrous consequences in resource limited settings.
e.Another take home message: We need to segregate TB suspects from other patients ; patients with MDR TB from those with drug sensitive TB and even patients with XDR TB from those with MDR and drug sensitive TB. How can this multilevel segregation be made feasible?

     
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Total Posts: 10

Joined 2014-05-06

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It was a treat to listen to this talk as we had attended this lecture live when we were visiting Baltimore and the question on sanitorium and natural sunlight and ventilation was asked by me!
1.I was wondering that it is a mammoth task to eliminate poverty even though it is a very good idea,why not start with simple measures to prevent transmission of MDR TB in heath care setting.Use of cough etiquette and mask should be compulsory when the patient comes to the clinic for DOTS medicine.it would be important to have cough inspectors at govt clinics where free treatment is provided.fast tracking of patients is a must.more dots providing clinics are needed so that there is not much crowding and waiting peroid.
2.it should be an universal policy to do sputum culture at the time of starting treatment instead of just empirically starting first line treatment and continuing with it.The colour test that was discussed in this presentation that detects INH and rifa resistance at low cost will really be practical.,why cant it be more widely introduced?
3.I would like to know the ogawa HAIN test more in detail and its availability in India.
4.Is it not a good idea to use exhaust fans and cross ventilator airflow apparatus in resource constraint high burden countries like India than UV light.
5.I think it is more appropriate for the health care provider to give home based DOTS to MDR patients till they become sputum negative instead of calling them to DOTS center where there is a risk of super infection to first line sensitive patients
6.high protien diet and vitamin supplementation need to be dispensed in the same way as DOT treatment is given eg a protein drink or vitamin pill.,

  dr Anita basavaraj