Hospital Practices and Research

Abstract Background: In 2023, there were 8.2 million Tuberculosis (TB) cases, primarily in South-East Asia. The World Health Organization (WHO) is advocating for increased funding, enhanced diagnostics, and improved healthcare to eradicate TB by 2035. Wealthy nations exhibit lower relapse rates, while poorer countries face higher risks. The challenges of drug-resistant TB and COVID-19 are complicating treatment efforts.
Objectives: This study aims to examine TB recurrence rates in Iran and neighboring countries using data from the WHO. The objective is to comprehend the rate of disease recurrence and the correlations among the results of the studied countries from 2010 to 2023.
Methods: Data on TB relapse cases from 2010 to 2023 in Iran and neighboring countries were analyzed using SPSS v27. Correlations were assessed using Pearson and Spearman tests.
Results: The study highlights TB relapse trends per 100,000 people in the Middle East and Central Asia from 2010-2023. The UAE and Jordan witnessed significant decreases in cases, while Oman and Egypt reported modest declines. Iran initially showed improvement in rates but later experienced an increase, indicating treatment challenges. Lebanon, Saudi Arabia, and Kuwait also achieved lower rates, but Iraq's rates remain high. Yemen and Qatar saw increases, prompting concerns about control. Turkey and Azerbaijan showed improvement, whereas Afghanistan and Pakistan experienced rising cases, suggesting a need for improved strategies. Accordingly, socioeconomic and healthcare factors play a critical role in effectively managing TB.
Conclusion: Enhancing diagnostic and treatment infrastructure in remote, high-incidence areas is crucial for addressing TB recurrence. Training healthcare workers, implementing Directly Observed Therapy (DOT), monitoring drug resistance, addressing social determinants, and conducting awareness campaigns are essential strategies for enhancing community education and treatment adherence.

Abstract Background: Tuberculous, parapneumonic and traumatic loculated pleural-effusions pose therapeutic challenges due to resultant pleural-thickening and compromised lung-function for life. Tuberculosis is widely prevalent in developing countries, necessitating appropriate, effective, and economical treatment for loculated pleural-effusion to reduce the burden and sequelae.
Objective: An uncontrolled and blind before-after intervention study to determine the effectiveness of intrapleural fibrinolytic therapy (IPFT) using urokinase in loculated pleural effusions was conducted at a tertiary-care respiratory center after obtaining approval and written informed consent.
Methods: Fifty-one patients with loculated pleural effusion were administered with repeated cycles of three doses of 1 Lakh IU of urokinase intrapleurally until complete drainage of pleural fluid. Pre- and post-IPFT clinical and radiological responses were compared using removal of fluid, ultrasound, and chest radiography were compared. The Kolmogorov-Smirnov test and paired t test with significance at a P value less than 0.05 were applied to test statistically significant differences in proportions and means, respectively.
Results: Tuberculosis was the most common etiology leading to loculated pleural effusion (80%), and 82.4% of tuberculosis patients required at least two cycles of IPFT. Complete resolution in chest radiograph after IPFT was observed in 80.4% of patients. Chest pain (13.7%) and fever (9.8%) were the most common undesired effects associated with IPFT. A statistically significant reduction in mean intrapleural fluid levels pre- and post-IPFT from 184±81 ml to 67±52 ml was observed.
Conclusion: IPFT with urokinase is an effective treatment modality in patients with post-tubercular loculated pleural effusions. IPFT has minimal and tolerable undesired effects and prevents sequelae such as pleural thickening and consequent compromise of respiratory function.