D Menzies

..There is consensus on the need to address social determinants of tuberculosis (TB) to achieve TB control, but evidence based on interventions is lacking...

..9/100,000. The objectives of this study were to describe the epidemiology of TB among homeless persons in Montreal and assess patterns of transmission and sharing of key locations...

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..Little empirical information is available about direct and indirect TB-related costs that patients face in these high-income countries. We assessed the direct and indirect costs of immigrants with TB in the Netherlands...

..We sought to compare four screening interventions for travelers from low-incidence countries, who visit countries with varying tuberculosis incidence...

..We estimated potential costs and benefits of DOTS expansion in Haiti from the government, and societal perspectives...

..Hence, LTBI therapy should be given only to those with positive tests for LTBI. We conclude that LTBI therapy is considerably underutilized in many settings, particularly in low and middle income countries...

..Treatment of latent tuberculosis infection with isoniazid for 9 months is complicated by poor patient adherence and the need for close follow-up of side effects, especially hepatotoxicity. Shorter and safer regimens are needed...

..We conducted a systematic review of treatment regimens for active TB, to assess the effect of duration and intermittency of rifampin use on TB treatment outcomes...

..These reviews can help identify research priorities as areas where knowledge is uncertain, and also those topics where little additional work is required...

..In conclusion, completion of therapy was significantly better with 4 months of rifampin and major side effects were somewhat lower. Further studies are needed to assess the safety and efficacy of the 4-month rifampin regimen...

..We have estimated tuberculosis (TB)-related expenditures by governments and other third parties in Canada in 2004, in order to compare spending on different activities, by various jurisdictions, and in different regions...

..Until recently, the tuberculin skin test was the only test for detecting latent tuberculosis (TB) infection, but 2 ex vivo interferon-gamma release assays (IGRAs) are now commercially licensed...

..Tuberculosis (TB) in health care workers (HCWs) was not considered a serious problem following the advent of effective antibiotic therapy. Interest was re-stimulated by the occurrence of several major nosocomial outbreaks...

..Current therapy for latent TB infection (LTBI) is long, and requires close follow-up. This results in sub-optimal adherence-the major reason for failure of therapy...

..We assessed whether ultraviolet germicidal irradiation (UVGI) of drip pans and cooling coils within ventilation systems of office buildings would reduce microbial contamination, and thus occupants' work-related symptoms...

..Accurate interpretation of TST requires consideration of three dimensions-the size of the skin reaction, the positive predictive value (PPV) and risk of disease...

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..We predict substantial public health benefits from changing from the 8-month to the 6-month regimen. However in almost all settings the current standardised retreatment regimen will no longer be adequate...

..We compared the cost-effectiveness of TST and IGRA in different populations and clinical situations, and with variation of a number of parameters...

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..We quantified the prevalence and predictors of LTBI and level of adherence to medical evaluation in a population of IDUs in Montreal...

..We have analyzed the association between changes in population health and health service indicators, and concomitant changes in TB incidence between 1990 and 2005...

..In Quebec, 6.2% of all tuberculosis (TB) isolates from Canadian-born patients are resistant to pyrazinamide (PZA) alone. The clinical significance of PZA-monoresistant (PZA(MR)) TB is unknown...

..Standard treatment for latent tuberculosis infection (LTBI) is 9 months daily isoniazid (9INH). An alternative is 4 months daily rifampin (4RMP), associated with better completion and less toxicity; however, its efficacy remains uncertain...

..The microscopic observation drug susceptibility (MODS) assay and the thin-layer agar (TLA) assay are inexpensive, rapid microcolony-based culture methods...

..Montreal, Canada, has a mean annual tuberculosis (TB) incidence of 9 per 100,000 population, 1996-2007...

..Our findings support the roll-out of rapid drug susceptibility testing at the moment of diagnosis to detect any form of INH and RIF resistance in all countries with moderate or greater burdens of drug-resistant TB...

..The cost-effectiveness of either strategy would be greatly enhanced by increased adherence to chemoprophylaxis recommendations. Radiographic screening of groups with a high prevalence of tuberculous infection will then likely save money...

..CONCLUSION: Centralised post-immigration surveillance requires more accurate referrals, and more consistent provider performance...

..The risk for and determinants of transmission of tuberculosis in hospitals caring for moderate numbers of patients with tuberculosis remain uncertain...

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..The decision to perform TST on casual contacts should consider the likelihood of prior mycobacterial exposure in the population, as well as the duration of exposure...

..We conclude that a clonally related family of PZA-monoresistant M. tuberculosis isolates in Quebec represents historic rather than recent transmission...

..More effective alternatives include contact tracing delivered through primary care and increased investment in global tuberculosis control...

..Intraclass correlation coefficients were 0.66 for the SF-36 physical component summary, 0.79 for the mental component summary, and 0.73 for the EQ-5D. These instruments appeared reliable in a highly selected group of TB patients...

..There is little published information on the costs of multidrug-resistant tuberculosis (MDR-TB) for patients and their families in low- or middle-income countries...

..However, TST specificity is reduced by bacille Calmette-Guérin (BCG) vaccination and exposure to non-tuberculous mycobacteria (NTM)...

..Institutional risk of TB transmission was poorly correlated with number of patients with TB and better correlated with indicators of patient care such as delayed diagnosis and treatment and overall TB-related patient mortality...

..To determine and compare the sensitivity and specificity of four common mycobacterial antigens with three RD-1 region antigens in the serological diagnosis of active pulmonary tuberculosis (PTB) in the Gambia...

..In Canada, tuberculosis (TB) is increasingly an urban health problem. Montreal is Canada's second-largest city and the second most frequent destination for new immigrants and refugees...

..In a pilot study, we determined conversions and reversions using QuantiFERON-TB Gold In-Tube((R)) (QFT) among household contacts of TB cases, and evaluated the effect of using various definitions and criteria for conversions...

..This emphasizes that healthcare workers involved in similar cough-inducing procedures performed for patients with suspected tuberculosis must wear appropriate personal respirators...

..National tuberculosis (TB) programmes (NTPs) in 100 countries...

..S.-funded efforts to expand the DOTS program in Mexico, Haiti, and the Dominican Republic could reduce tuberculosis-related morbidity and mortality among migrants to the United States, producing net cost savings for the United States...

..A mycobacterial "founder effect" is unlikely to account for the high proportion of shared isolates among Haitian-born Montrealers. Recent transmission remains the most likely explanation...

..Patients with human immunodeficiency virus (HIV) infection and tuberculosis have an increased risk of death, treatment failure, and relapse...

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..Caution should therefore be used in designing or interpreting the results of studies in which area-based SES measures are used to test hypotheses or control for confounding...

..Yield of PCR also increased with the greater number of induced samples tested. CONCLUSIONS: Repeated sputum induction could considerably improve diagnostic accuracy for pulmonary TB...

..Tuberculin screening in this population can be an effective strategy for identifying TST reactive individuals; however, screening efforts will have minimal impact without additional efforts in this high-risk group...

..We conclude that there is a lack of knowledge and several misconceptions about TB among our sample of urban Aboriginal peoples...

..A recent meta-analysis showed that IGRAs have high specificity, even among populations that have received bacille Calmette-Guérin (BCG) vaccination. Sensitivity was suboptimal for TST and IGRAs...

..After the introduction of autotransfusion of shed mediastinal blood following cardiac surgery, the incidence of mediastinitis increased. The role of autotransfusion in the increased occurrence of this serious complication was examined...

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..Reduced gastric acidity has been suggested as a risk factor, and we hypothesized that proton pump inhibitors, because of their potency, may be an independent risk factor for this problem...

..We believe that this independent validation of the LSP method should encourage researchers to adopt this system in investigations aimed at elucidating the role of strain variation in TB...

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..We stored auramine-stained slides and reexamined them over time. Slides stored in all environments faded quickly, with significant changes in the proportion of positive slides in as little as 1 week...

..0; 95% CI, 1.5 to 43). The incidence of pyrazinamide-induced hepatotoxicity and rash during treatment for active TB was substantially higher than with the other first-line anti-TB drugs, and higher than previously recognized...

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..Although interferon-gamma (IFN-gamma) assays are promising alternatives to the tuberculin skin test (TST), their serial testing performance is unknown...

..Finally, we outline the critical information needed to effectively address the problem of nosocomial transmission of TB in India...

..More judicious use of antibiotics and avoidance of prolonged high-dose corticosteroids may help prevent occurrences of IPA with its attendant serious morbidity and high mortality...

..Further studies are needed to evaluate the potential value of the LAM assay in individuals with advanced HIV or for diagnosis of paediatric TB...

..Therefore, the ideal BCG vaccine would produce a scar at the site of injection to identify individuals who have been vaccinated but would have no effect on tuberculin reactivity...

..Despite the increasing prevalence of drug-resistant tuberculosis, most low- and middle-income countries use standardized regimens, without assessment of drug susceptibility...

..Multidrug-resistant tuberculosis (TB) poses a major challenge to global TB control. We analyzed the association between estimated prevalence of initial or acquired MDR-TB, and treatment outcomes reported nationally...

..6-2.4. Our results support the hypothesis that some nonmalignant respiratory diseases may be independent risk factors for lung cancer...

..Administration of the visual analogue scale and standard gamble instruments appeared reliable in a selected group of tuberculosis patients. Major barriers to recruitment were language and mobility in this largely foreign-born population...

..If these can be overcome, preventive treatment holds the promise to substantially assist in the achievement of global control of TB...

..Urban primary health centres in Lusaka, Zambia...

..We did a systematic review and meta-analysis to investigate the accuracy of microscopic-observation drug susceptibility (MODS) and thin layer agar (TLA) assays for rapid screening of patients at risk of drug-resistant tuberculosis...

..This review focuses on TB, influenza, and SARS, because the published literature is extensive for these 3 infections. The lessons from these 3 are relevant for all nosocomial pulmonary infectious diseases...

..These results demonstrate the benefits from Canadian government support for DOTS implementation in low- and middle-income countries...

..These adverse effects must be recognised early, to reduce associated morbidity and mortality...

..These results provide insight into the evolution of genotypes in endemic strains and the potential for false clustering in molecular epidemiologic studies...

..This could expose patients to the risk of blindness...

..These latter two antigens were associated with risk factors for future active, but not current disease, suggesting that they might be useful to identify persons with higher risk of reactivation of latent TB...

..5 mmol/L predicted using the rules derived from the canine model. CONCLUSIONS: In patients with chronic stable hypercapnia, acid-base compensatory mechanisms appear to be more effective than would be predicted using the classic rules...

..Results tended to be lower for 45-80 years old patients. We conclude that diagnoses recorded in the Medical Services database of Quebec are valid to identify patients with asthma...

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..Currently, dozens of distinct commercial antibody detection tests are sold in developing countries. The question is "do they work?"..

..Available evidence reinforces the need to design and implement simple, effective, and affordable TB infection-control programs in health-care facilities in these countries...

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..At present, commercial antibody detection tests for extrapulmonary tuberculosis have no role in clinical care or case detection...

..A logical start is to determine the within-person variability of T-cell responses during serial testing...

..Emphasis should be placed on public awareness and education campaigns to facilitate passive diagnosis of symptomatic cases. Mycobacterium tuberculosis (MTB) continues to be a common concern for the global traveller...