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Cme tb 1

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Publicada em: Saúde e medicina
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Cme tb 1

  1. 1. TB (PART 1) 04/18/11
  2. 2. HISTORICALLY: <ul><li>Challenge of Tuberculosis </li></ul><ul><li>Through the Ages </li></ul><ul><li>IUATLD </li></ul><ul><li>1st Asia-Pacific Region </li></ul><ul><li>Conference </li></ul><ul><li>Kuala Lumpur </li></ul><ul><li>August 2, 2007 </li></ul><ul><li>Contents </li></ul><ul><li>􀂄 Tuberculosis through the ages </li></ul><ul><li>􀂄 Evolution of WHO policies for TB control </li></ul><ul><li>􀂄 From DOTS to the New Stop TB Strategy </li></ul><ul><li>• Phthisis </li></ul><ul><li>• Wasting </li></ul><ul><li>• Scrofula </li></ul><ul><li>• Pott’sdisease </li></ul><ul><li>• Lupus vulgaris </li></ul><ul><li>• Consumption </li></ul><ul><li>• The Captain of the Men of Death </li></ul><ul><li>• The White Plague </li></ul><ul><li>Tuberculosis: What’s in a Name ? </li></ul><ul><li>The disease was named </li></ul><ul><li>Tuberculosis in 1839 </li></ul><ul><li>by J. L. Schönlein </li></ul><ul><li>Tuberculosis: </li></ul><ul><li>An Ancient Killer </li></ul><ul><li>􀂄 Tubercular decay in skull and spinal </li></ul><ul><li>bones found in 4000 year old </li></ul><ul><li>Egyptian mummies </li></ul><ul><li>􀂄 Hippocrates around 400 BC: </li></ul><ul><li>“ Phthisis is the most common </li></ul><ul><li>disease of humans and it is </li></ul><ul><li>nearly always fatal” </li></ul><ul><li>Tuberculosis as Killer </li></ul><ul><li>in Arts </li></ul><ul><li>􀂄 Violetta in Verdi’s opera La </li></ul><ul><li>Traviata (1853) dies of TB </li></ul><ul><li>􀂄 Edvar Munch’s painting “Sick </li></ul><ul><li>Child” (1885) depicts his </li></ul><ul><li>sister dying of tuberculosis </li></ul>04/18/11
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  7. 7. MDG 6 <ul><li>Target 6C </li></ul><ul><li>To Halt And To Reverse The Incidence </li></ul><ul><li>Of TB </li></ul>04/18/11
  8. 8. SITUATION IN PERAK <ul><li>Kadar kejadian TB negeri Perak 2009 </li></ul><ul><ul><li>52.19 per 100,000 penduduk </li></ul></ul><ul><li>Kadar kematian TB negeri Perak 2009 </li></ul><ul><ul><li>2.09 per 100,000 penduduk </li></ul></ul><ul><li>Target Kebangsaan untuk Kadar kematian, < 3 per 100,000 </li></ul>04/18/11
  9. 9. By 2005, to detect at least 70% of new sputum smear positive TB cases Case Detection Rate Smear +ve detection has not reached 70% in 5 districts in Perak. All health facilities have been asked to screen all patients with cough more than 1 week and work towards a target of 3% AFB screening in all new outpatients.
  10. 10. Case Detection Rate (CDR) Target 58.3 % ( Jan - Okt 2010 ) 48/100,000
  11. 11. Cure Rate Target 85 % ( Jan - Jun 2009 )
  12. 12. TB Mortality Perak – (Jan- Okt 2010) Bil District Total TB Death Non TB Death Deaths Audited Deaths NOT Audited 1 Kerian 2 0 2 2 0 2 LMS 41 4 13 17 24 3 Hulu Perak 5 4 0 4 1 4 K Kangsar 7 2 1 3 4 5 Pk Tengah 7 3 4 7 0 6 Btg Padang 8 3 0 3 5 7 Hilir Perak 10 3 7 10 0 8 Manjung 20 10 10 20 0 9 Kinta 36 15 21 36 0 Total 136 44 58 102 34
  13. 13. <ul><li>Mengurangkan kes TB baru sehingga 50% dari jumlah kes tahun 2000 (1014 kes) sebelum tahun 2015. Jumlah Kes pada tahun 2010 adalah sebanyak 1389 kes </li></ul><ul><li>Mengurangkan 50% kematian disebabkan TB dari Jumlah kematian pada tahun 2000 iaitu 149. Jumlah kematian TB pada tahun 2010 adalah sebanyak 151 kes </li></ul>
  14. 14. Objektif Khusus <ul><li>Meningkatkan pengesanan Kes TB Berkahak Positif dari 72% ke 80% melalui saringan aktif & pasif. </li></ul><ul><li>Pengesanan kes TB diperingkat awal iaitu mengurangkan bilangan kes baru dengan keputusan “X-Ray Sangat Teruk” dari 8% ke 5% pada 2015 </li></ul><ul><li>Meningkatkan hasil rawatan dari 76% kepada 85% melalui pengendalian rawatan secara DOTS untuk semua pesakit TB dan mengurangkan kes keciciran tidak melebihi 2.5% </li></ul>
  15. 15. Objektif Khusus <ul><li>Meningkatkan pengetahuan Pengamal Perubatan berkaitan penyakit TB melalui “Pendidikan Kesihatan Berterusan” dan mengadakan Kursus Sehari untuk TB setiap bulan bagi setiap daerah </li></ul><ul><li>Meningkatkan kesedaran masyarakat mengenai penyakit TB melalui Pendidikan Kesihatan dan kerjasama dengan agensi-agensi bukan kerajaan. </li></ul>
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  17. 17. Case Study 1 <ul><li>11year old school boy </li></ul><ul><li>Admitted to Hosp.A on 20/6/2008 </li></ul><ul><li>Presented with 4 months history of </li></ul><ul><ul><li>On off fever especially at night with chill and rigors </li></ul></ul><ul><ul><li>Productive cough </li></ul></ul><ul><ul><li>LOA ,LOW , Lethargic, malaise </li></ul></ul><ul><li>Hist Of Present Illness: </li></ul><ul><ul><li>17.02.08 - fever, URTI </li></ul></ul><ul><ul><li>18.02.08 - URTI with sputum </li></ul></ul><ul><ul><li>18.03.08 - right sided chest pain, syr. Bena given </li></ul></ul><ul><ul><li>26.03.08 - cough with greenish sputum, syr bena and ampicillin given </li></ul></ul><ul><ul><li>21.04.08 - cough, fever, vomiting. Syr phenergen, amoxicillin </li></ul></ul><ul><ul><li>19.06.08 - X-ray ordered, sputum AFB, **** TCA 1 WEEK </li></ul></ul>
  18. 18. Case Study 1 <ul><li>Multiple clinics and OPD visits with same complaints, mostly treated as URTI </li></ul><ul><li>CXR:showed </li></ul><ul><ul><li>Multiple cavities and consolidations at right and left upper lobes, and right middle lobe. </li></ul></ul><ul><ul><li>Fibrotic changes at the left upper lobe. </li></ul></ul><ul><ul><li>Pleural Effusion-right lung. </li></ul></ul><ul><ul><li>Sputum AFB: >50/3L for 3/7 </li></ul></ul>Diagnosis : Advance PTB
  19. 19. <ul><li>Contact defaulted 2 nd screening. </li></ul><ul><li>Was contacted and advised to come, but still did not turn up. </li></ul><ul><li>Visited a GP in February with complain of cough, and was referred to a private hospital for X-ray. </li></ul><ul><li>X-ray: shows consolidation at Rt.upper lobe with fibrosis. Cavitating lesion seen at the rt. upper lobe. </li></ul><ul><li>Pulmonary TB </li></ul>Contact Tracing Is Very Important CASE STUDY 2
  20. 20. Be Aware Of TB And Think Of TB
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  23. 24. <ul><li>Inhomogenous opacities with cavitation seen in both upper zones, more on the right side. </li></ul><ul><li>Impression: Active pulmonary tuberculosis </li></ul><ul><li>(MODERATELY ADVANCED) </li></ul>
  24. 26. <ul><li>Inhomogenous opacities seen at the left mid zone. There is a cavitating lesion within the opacities </li></ul><ul><li>Impression: Active Pulmonary </li></ul><ul><li>Tuberculosis </li></ul><ul><li>(MILD) </li></ul>
  25. 28. 22 & 23 <ul><li>There are multiple diffuse tiny nodular opacities 1-2 mm throughout both lung fields </li></ul><ul><li>Impression: Miliary Tuberculosis </li></ul><ul><li>(FAR ADVANCED) </li></ul>
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  28. 31. 04/18/11 RECOMMENDATIONS <ul><li>Active case detection : </li></ul><ul><li>Sputum AFB for symptomatic patients in </li></ul><ul><li>OPD ~ spot speciment & 2 nd sp </li></ul><ul><li>~ target 3% of all new outpt </li></ul><ul><li>attendance </li></ul><ul><li>CXR ~ To use CXR findings as one of the key </li></ul><ul><li>performance indicators </li></ul><ul><li>To increase index of suspicion on outpatients with Cough > 5 days </li></ul>
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  31. 34. 04/18/11 Risk of progression of TB infection to disease <ul><li>Life-time risk of 10% in </li></ul><ul><li>immunocompetent adults; 5% risk in first </li></ul><ul><li>2 years after infection </li></ul><ul><li>Risk especially high in early childhood </li></ul><ul><li>Risk increased in certain medical </li></ul><ul><li>conditions </li></ul>
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