| Publicació: |
[Barcelona] : Universitat Autònoma de Barcelona, 2013 |
| Descripció: |
1 recurs en línia (185 pàgines) |
| Resum: |
Introduction The prevalence of Multidrug resistant Tuberculosis (MDR-TB) is globally increasing. Transmission of resistant strains into the community is jeopardizing global TB control. The vast majority of cases are from developing countries where health systems are insufficient to diagnose, treat and support the patients. Object The main objective of this doctoral thesis is to analyze in deep the MDR-TB problem in developing countries and provide new knowledge in resistance prevention and better MDR-TB treatment results. Hypothesis The more efficient use of current knowledge and tools may contribute to the creation of health policies with impact on resistance prevention and better cure rates. Three different hypotheses were identified: • Hypothesis 1. The anti-TB fixed dose combinations (FDCs) may obtain similar efficacy than single drugs with operative advantages, reduced cost and reducing the resistance acquisition. • Hypothesis 2. Standardized MDR-TB treatments may obtain similar results than individualized also with operative advantages and less cost. • Hypothesis 3. It is possible to create scientific and quality documents for quick self-training and up date of clinicians in the management of MDR-TB. Methods According to the objective and hypothesis formulated, this thesis had worked in three research lines: 1. Systematic review on the FDCs efficacy for the TB treatment respect to single drugs 2. Cohort study and evaluation in terms of efficacy, effectiveness side effects and relapses of MDR-TB patients under standardized and individualized regimens 3. Creation of simple but high quality documents to increase the access of developing countries clinicians to most relevant knowledge regarding MDR-TB to avoid therapeutic errors and resistance amplification. Results Study 1: Systematic review on FDCs efficacy. The 100% of the studies found revealed equal efficacy in terms of culture convertion and cure. Relapses appear to be similar. Adherence acceptance and capacity to reduce resistance acquisition go in favour of FDCs. Other operative and logistic advantages and cost favour FDCs as well. Study 2: Cohort study and evaluation of all MDR-TB patients treated in Dominican Republic between august 2006 and June 2010. There were not found significative statistically differences in culture conversion regarding standardized or individualized treatments. Concerning patients with ended treatments, standardized obtained a treatment success rate of 74% whereas 66% was obtained for individualized. Each patient presented a median of 5 side effects. Cavitation on the chest x ray and more than 2 months for culture conversion were found as risk factor for unfavourable result. Relapse rate was close to 1%. Study 3: Creation of a review article on the subject of drug resistant TB management. List and presentation of the bacteriological bases for TB treatment and minimum requirements and knowledge to take into account to achieve high cure rates. Study 4: Scientific article addressing the simplification of the most correct and updated management of co-infected patients with MDR-TB and HIV in African scarce therapeutic and diagnose resource contexts. Study 5: Perspective article showing the differences on the presentation and management of MDR-TB patients coming from rich and poor countries. Solutions from rich countries, usually the only ones available on the literature or the gold standard are probably not the best solutions or can not be extrapolated to poor countries. Conclusion The articles included represent a scientific back up for anti-TB FDCs massive introduction and the use of standardized regimens for MDR-TB. Simple and quality articles have been created to increase access to MDR-TB management knowledge oriented to clinicians in developing countries. This doctoral thesis provides relevant scientific information towards a better control of MDR-TB in developing countries. |
| Nota: |
Tesi 0,05). Cada enfermo presentó una mediana de 5 efectos adversos. Cavitación en radiografía de tórax y no negativizar el cultivo antes del segundo mes fueron encontrados factores de riesgo para resultado desfavorable. La tasa de recaídas fue aproximadamente de un 1% tras un año de seguimiento. Estudio 3: Se llevo a cabo una revisión crítica acerca del manejo de pacientes con TB resistente. Listado y presentación de las bases bacteriológicas del tratamiento y mínimos conocimientos para un correcto manejo de casos. Estudio 4: Elaboración de un artículo científico abordando de forma simplificada el correcto manejo de pacientes con coinfección TB-MDR y VIH en contextos africanos de escasos recursos. Estudio 5: Se analizaron las diferencias en presentación y manejo de pacientes con TB-MDR procedentes de países ricos y pobres. Las soluciones de países ricos probablemente no sean extrapolables a países pobres. Conclusión: Los artículos científicos incluidos suponen un respaldo científico fundamental para las políticas sanitarias de uso masivo de MCFs en el tratamiento para la TB sensible y tratamientos estandarizados para TB-MDR. También se han creado artículos que facilitan el acceso a formación de clínicos en países en vías de desarrollo. Esta tesis doctoral aporta información científica relevante para un mejor control de la tuberculosis multidrogoresistente en países en desarrollo. Doctorat. Universitat Autònoma de Barcelona. Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva. 2013 |
| Drets: |
L'accés als continguts d'aquesta tesi queda condicionat a l'acceptació de les condicions d'ús establertes per la següent llicència Creative Commons  |
| Llengua: |
Castellà |
| Document: |
Tesi doctoral ; Versió publicada |
| Matèria: |
Tuberculosi ;
Tractament ;
Països en vies de desenvolupament ;
Resistència als medicaments |
| ISBN: |
9788449037535 |
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