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Biomedical subjects

K Styblo

Publications and source records attributed to K Styblo.

At least 19 recordsLinked to original sources
PubMed1994

Tuberculosis trends in eastern Europe and the former USSR.

The aim of this paper is to assess trends in tuberculosis morbidity and mortality in the countries of Eastern Europe and the former USSR. Data on morbidity and mortality were obtained from reports of the Ministries of Health, a 1992 WHO questionnaire, national tuberculosis associations, and other sources. The quality of surveillance of tuberculosis cases differs widely between countries. Ranging from 19 to 80 per 100,000 population in 1990-1992, tuberculosis notification rates of most Eastern European and former USSR countries are higher than those of Western European countries. The lowest tuberculosis notification rate is reported in the Czech Republic, while the highest are reported in Romania and Kazakhstan. While in Albania, Croatia and Slovenia notification rates have continued to decline, in the remaining countries of Eastern Europe the declining trend has recently stopped. Nevertheless, countries such as the Czech Republic, Hungary, Poland and the Slovak Republic have experienced a distinct rate decrease when the 3-year average rate around 1985 is compared to that around 1990, despite the very recent levelling-off or increase. In Romania, the previous decline in notification rate ended in 1985 and in the period 1986-1992 an average 5.4% annual increase was observed. In this country, two-thirds of all cases still occur among young adults. Among the Baltic countries of the former USSR, the declining trend continues in Estonia, whereas in Latvia and Lithuania notification rates decreased less markedly from 1985 to 1990 than in the first half of the 1980s. Among the other European countries of the former USSR, Russia and Ukraine had a slow decline in the first half of the 1980s and a more pronounced one from 1985 to 1990. During the latter period of time, in Belarus and Moldova the decrease has been steeper. In the Caucasian countries of the former USSR, where underreporting and low case-finding are recognized, case rates have stabilized in Armenia, while in Azerbaijan and Georgia there was a decrease from 1985 to 1990. Among the Asian countries of the former USSR, Kazakhastan and Tajikistan reported a lower decline in case rates from 1985 to 1990 than from 1980 to 1985. Kyrgyzstan, Turkmenistan, and Uzbekistan reported increases in notification rates from 1985 to 1990: in Turkmenistan an average 5.5% annual increase in rate was observed between 1987 and 1991. Tuberculosis mortality is steadily increasing in Romania, Armenia, Kyrgyzstan, Latvia, Lithuania, Moldova, and Turkmenistan, while no decline is seen in most of the other countries of Eastern Europe and the former USSR.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

[BCG vaccination in West Germany?].

It is evident from follow-up studies of tuberculosis in the Netherlands (without BCG vaccination), Sweden (discontinuation of BCG vaccination since 1975) and in both parts of Germany (FRG discontinuation since 1975), as well as from the favourable tuberculosis situation in both parts of Germany (low tuberculosis incidence and very low infection risk) that general vaccination of babies is no longer warranted. For this reason the German Central Committee for Combatting Tuberculosis is considering in consultation with the Federal Bureau of Health to abstain from continuing to recommend general BCG vaccination of all newborn. BCG vaccination should be recommended only in enhanced-risk groups (children of foreign parents and children sharing their living quarters or household with a person suffering from acute, i.e. infectious tuberculosis).

Adolescent↗
PubMed1991

Cost effectiveness of chemotherapy for pulmonary tuberculosis in three sub-Saharan African countries.

The value of programmes to control pulmonary tuberculosis in developing countries remains the subject of debate. We have examined the cost-effectiveness of chemotherapy programmes for the control of pulmonary sputum-smear-positive tuberculosis in Malawi, Mozambique, and Tanzania. Effective cure rates of 86-90% were achieved with short-course chemotherapy and of 60-66% with standard chemotherapy. The average incremental costs per year of life saved were US $1.7-2.1 for short-course chemotherapy with hospital admission, $2.4-3.4 for standard chemotherapy with hospital admission, $0.9-1.1 for ambulatory short-course chemotherapy, and $0.9-1.3 for ambulatory standard chemotherapy. Chemotherapy for smear-positive tuberculosis is thus cheaper than other cost-effective health interventions such as immunisation against measles and oral rehydration therapy. Because the greatest benefit of chemotherapy is reduced transmission of the bacillus, treating HIV-seropositive, tuberculosis smear-positive patients would be only slightly less cost-effective than treating HIV-seronegative, tuberculosis-smear-positive patients.

Ambulatory Care↗
PubMed1991

The impact of HIV infection on the global epidemiology of tuberculosis.

HIV is the strongest risk factor for tuberculous disease observed in the last 100 years in subjects infected with tubercle bacilli. Its impact upon tuberculosis incidence is so great that it has disrupted the balance between the tubercle bacillus and the community. The breakdown rate from tuberculous infection to active tuberculosis in persons infected dually is at least 30%. Although adequate chemoprophylaxis would prevent a considerable number of tuberculosis cases among these individuals, its application is not feasible in developing countries with a high prevalence of both tuberculous and HIV infections. Thus it seems that very little can be done against the increase in the incidence of tuberculosis caused by HIV. The only feasible measure to contain the transmission of tuberculous infection is to achieve a high cure rate and a high detection rate of smear-positive and other cases. This would enable us to contain-to an extent-the transmission of tuberculous infection. The results of IUATLD assisted National Tuberculosis Programmes in Tanzania and Malawi show that this can be achieved.

Adolescent↗
PubMed1990

The global aspects of tuberculosis and HIV infection.

HIV infection is the only factor which has been able to disturb the balance between the tubercle bacillus and man, in the absence of man-made interference. The impact of HIV infection on the epidemiological situation of tuberculosis is so large that, under certain conditions, the tools available at present for tuberculosis control will fail to restrain the increase in the incidence of tuberculosis caused by HIV infection. It is to be seen to what extent an efficient control programme in developing countries will be able to contain the transmission of tuberculosis infection, in particular the risk of tuberculous infection. The current risk of tuberculous infection and its trend is the most decisive factor in containing the deterioration of the epidemiological situation of tuberculosis in developing countries in the future, caused by HIV infection. In countries with high prevalence of both tuberculous and HIV infections it is imperative to achieve and maintain a high cure rate of all diagnosed smear-positive tuberculosis cases, with short-course chemotherapy. Since many tuberculosis cases among HIV-infected persons are smear-negative but culture positive, or smear-negative and culture-negative, or culture-positive or culture-negative, it is necessary, whenever possible, to improve case detection of smear-negative tuberculosis cases through screening by X-ray of the chest patients suspected of having tuberculosis, and to examine those with a pathology on the X-ray by microscopy and if possible, by culture for the tubercle bacilli. Research on the interactions of HIV and tuberculous infections is urgently needed.

Adolescent↗
PubMed1990

[Possible effects of acquired immunologic deficiency syndrome (AIDS) on tuberculosis in industrial and developing countries].

Tuberculosis is the most frequent infectious complication of AIDS and HIV infection in countries where che prevalence of tuberculous infection is high. HIV infection is the strongest risk factor for developing tuberculosis in individuals infected removly or recently with tubercle bacilli. An increased incidence of tuberculosis has been already documented in several African countries with a high prevalence of both tuberculous and HIV infections (Tanzania, Malawi). The increase in the incidence of tuberculosis is mainly due to the depression of cellular immunity caused by HIV infection in subjects infected with M. tuberculosis. The occurrence of tuberculosis in HIV-seropositive persons is more frequent in those remotely infected than in those recently infected or reinfected with M. tuberculosis. In developed countries, HIV infection will cause tuberculosis in only a relatively small number of persons, since the prevalence of tuberculosis infection is low in the age group up to approximately 45 years. HIV infection will, therefore, not substantially increase the number of tuberculosis cases.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Tuberculosis control in refugee settlements.

Tuberculosis and its management in refugees and other displaced persons in temporary settlements poses a challenge to organisations coordinating and providing care in refugee emergencies. This paper offers a consensus of the co-sponsoring agencies on practical recommendations for implementing measures aimed at both interrupting transmission of tuberculosis and treatment of individual patients.

Humans↗
PubMed1989

Overview and epidemiological assessment of the current global tuberculosis situation: with an emphasis on tuberculosis control in developing countries.

This paper reviews the global epidemiological situation to tuberculosis, with an emphasis on the disappointing tuberculosis control achievements in developing countries over the last three decades. It is concluded tht in low prevalence developed countries it will take at least 35-40 years to eliminate tuberculosis because of endogenous exacerbation in subjects remotely infected. In developing countries most of the estimated 4 million new smear-positive and 4 million new smear-negative and extra-pulmonary cases with some 2-3 million deaths from tuberculosis occur each year. It is evident that a low cure rate is the most important reason for failure of tuberculosis control programmes in poor developing countries. Canetti stressed the urgent need to develop chemotherapeutic methods adapted to the conditions prevailing in developing countries. Based on a 9-year experience in IUATLD-assisted national tuberculosis programmes in 10 developing countries, it became apparent that the basic chemotherapeutic regimen consisting of Thiazina (combined tablet of isoniazid and thiacetazone) for 12 months supplemented by streptomycin for the first 2 months is not suitable for achieving a high cure rate in those countries. A high cure rate (90%) under routine conditions can be achieved with an inexpensive 8-month short-course regimen with a 2-month strictly supervised initial intensive phase with daily isoniazid, rifampicin, pyrazinamide and streptomycin, followed by 6 months of self-administered Thiazina daily. A substantial decrease in the risk of tuberculous infection in developing countries is essential, since we are facing their serious problems concerning tuberculosis with the increasing number of AIDS patients. BCG vaccination alone at least with the present type of vaccine, cannot substantially influence the epidemiological situation. It goes without saying that it should be applies to children to prevent tuberculosis whenever its use is justified for its purpose.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Surveillance of diagnostic and treatment measures in Bavaria, 1974-1976. Results 2 and 5 years after the start of chemotherapy.

A central surveillance register for all bacillary pulmonary tuberculosis cases reported in Bavaria (population in excess of 10 million) was established from 1974 to 1976. The aim of the study was to discover the quality and efficiency of health services delivery to the population in the field of tuberculosis under routine conditions, and to find out the relapse rate after cessation of chemotherapy in expatients who were found to be negative 2 years after starting chemotherapy. A total of 7850 German patients with bacillary pulmonary tuberculosis were diagnosed in Bavaria from 1974 to 1976 corresponding to an average annual rate of 25.7 per 100,000 population: 71% of them were smear-positive and 29% were positive by culture only. Reactivations formed 25% of all bacteriologically confirmed cases. Most (71%) smear-positive new cases were discovered because of symptoms. Of the 5157 cases of bacteriologically confirmed pulmonary tuberculosis reported during 1975 and 1976, 4% died from tuberculosis, 1% from sequelae of tuberculosis and 9% from causes other than tuberculosis. A further 3% of patients had drug side-effects, 3% were uncooperative, 2% emigrated or had no permanent address and 1% had no chemotherapy or no information on treatment. The overall results of treatment were very satisfactory: sputum conversion among 3991 patients in the group with complete treatment was achieved in 97.4% at 2 years, and in those with incomplete treatment in 96.2%. The duration of chemotherapy was long, i.e. 19 months or more in two thirds of the patients. The average reactivation rate during the 3rd, 4th and 5th follow-up years was 0.8% annually; it was higher among males than females and the rate increased with age. Of the 157 patients found to be bacteriologically positive at 2 years after the start of chemotherapy 46 died during the 3-year observation period and 109 were alive at 5 years, 23 of whom were harbouring tubercle bacilli.

Adult↗
PubMed1985

Osteotomy for kyphosis in ankylosing spondylitis.

Twenty-two patients suffering from progressive kyphosis due to ankylosing spondylitis underwent one or more lumbar osteotomies during 1957-1983. The primary thoracic kyphosis was 80 degrees (45 degrees-155 degrees). The mean correction obtained by one level osteotomy was 44 degrees (30 degrees-60 degrees). The mean loss of correction after 3 years was 5 degrees. The use of internal fixation reduced the loss of correction from 9 degrees to 1 degree, also allowing ambulatory after-care and a shorter period of immobilization in plaster or jackets. We had no fatal and relatively few non-fatal complications; three cases of retrograde ejaculation were observed however. All the patients reported subjective respiratory improvement.

Adult↗