Background. Globally, >30 000 children fall sick with multidrug-resistant (MDR) tuberculosis every year. Without robust pediatric data, clinical management follows international guidelines that are ...based on studies in adults and expert opinion. We aimed to identify baseline predictors of death, treatment failure, and loss to follow-up among children with MDR tuberculosis disease treated with regimens tailored to their drug susceptibility test (DST) result or to the DST result of a source case. Methods. This retrospective cohort study included all children ≤15 years old with confirmed and probable MDR tuberculosis disease who began tailored regimens in Lima, Peru, between 2005 and 2009. Using logistic regression, we examined associations between baseline patient and treatment characteristics and (1) death or treatment failure and (2) loss to follow-up. Results. Two hundred eleven of 232 (90.9%) children had known treatment outcomes, of whom 163 (77.2%) achieved cure or probable cure, 29 (13.7%) were lost to follow-up, 10 (4.7%) experienced treatment failure, and 9 (4.3%) died. Independent baseline predictors of death or treatment failure were the presence of severe disease (adjusted odds ratio aOR, 4.96; 95% confidence interval CI, 1.61–15.26) and z score ≤−1 (aOR, 3.39; 95% CI, 1.20–9.54). We did not identify any independent predictors of loss to follow-up. Conclusions. High cure rates can be achieved in children with MDR tuberculosis using tailored regimens containing second-line drugs. However, children faced significantly higher risk of death or treatment failure if they had severe disease or were underweight. These findings highlight the need for early interventions that can improve treatment outcomes for children with MDR tuberculosis.
A 6-second spirometry test is easier than full exhalations. We compared the reliability of the ratio of the Forced expiratory volume in 1 second/Forced expiratory volume in 6 seconds (FEV1/FEV6) to ...the ratio of the FEV1/Forced vital capacity (FEV1/FVC) for the detection of airway obstruction.
The PLATINO population-based survey in individuals aged 40 years and over designed to estimate the prevalence of post-Bronchodilator airway obstruction repeated for the same study participants after 5-9 years in three Latin-American cities.
Using the FEV1/FVC<Lower limit of normal (LLN) index, COPD prevalence apparently changed from 9.8 to 13.2% in Montevideo, from 9.7 to 6.0% in São Paulo and from 8.5 to 6.6% in Santiago, despite only slight declines in smoking prevalence (from 30.8% to 24.3%). These changes were associated with differences in Forced expiratory time (FET) between the two surveys. In contrast, by using the FEV1/FEV6 to define airway obstruction, the changes in prevalence were smaller: 9.7 to 10.6% in Montevideo, 8.6 to 9.0% in São Paulo, and 7.5 to 7.9% in Santiago. Changes in the prevalence of COPD with criteria based on FEV1/FVC correlated strongly with changes in the FET of the tests (R(2) 0.92) unlike the prevalence based on a low FEV1/FEV6 (R(2) =0.40).
The FEV1/FEV6 is a more reliable index than FEV1/FVC because FVC varies with the duration of the forced exhalation. Reporting FET and FEV1/FEV6<LLN helps to understand differences in prevalence of COPD obtained from FEV1/FVC-derived indices.
People in Nature Silvius, Kirsten; Bodmer, Richard; Fragoso, José
2004., 20041214, 2004
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South and Central American (including Mexico) approaches to wildlife conservation are rooted in traditions of resource use derived from interactions between complex biological, cultural, and ...socioeconomic systems. South and Central American peoples inhabit a land rich in biological diversity and complexity, with several nations considered megadiversity countries (e.g., Brazil, Colombia, and Ecuador) (see Mittermeier, Robles-Gil, and Mittermeier 1997). The most extensive tropical forests and wetlands of our planet occur in South and Central America. Unlike the situation in many parts of the world, most of these ecosystems still function as intact ecological entities little disturbed by human activities (Mittermeier et al. 1998). The Amazon rain forest, for example, extends over 2500 km from east to west and about 2000 km from north to south. It is the largest continuous tropical forest on earth and the second largest forested ecosystem after the Eurasian Boreal forest. The world's largest wetland, the Pantanal, is located in south central Brazil and northern Paraguay, and the Andean Mountain range supports some of the most extensive montane forests and grasslands in existence. With the exception of high altitude Andean habitats and Atlantic forests, these "natural areas" are relatively unfragmented and continue functioning as continental level "natural" ecosystems. Many are considered as some of our planet's last great wilderness areas (Dinerstein et al. 1995; Mittermeier et al. 1998). The "intact" condition of South American biomes is unusual, given the high levels of species extirpations and ecosystem fragmentation that have occurred in North America, Europe, Africa, and much of the rest of the world.
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