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April 13, 1997 |
Short Cut to Success
A new regimen promises to turn
the tide against TBTHERE IS hope for TB patients who are waging a losing battle against this persistent disease. A new course of treatment that has been successfully tried out is as disparate places as New York and rural Tanzania could beat tuberculosis, a disease that kills over a million sufferers every year.
According to the World Health Organisation, the regimen is based on close monitoring of patients to ensure that they complete a course of four drugs lasting six to eight months.
In the last few months, researchers said, a mass of new date have shown sharp increases in the number of people cured with the regimen, known as the Directly Observed Treatment Short Course, or DOTS.
The development was announced at the WHO headquarters in Geneva recently and at the institute in Berlin named after Robert Koch, the German physician who announced his discovery of the bacilli that causes tuberculosis on March 24, 1882.
Dr Hiroshi Nakajima, director general of WHO, called the treatment "The biggest health break thought of this decade, in terms of the lives will be able to save," adding,' we anticipate that at least 10 million deaths from tuberculosis will be prevented in the next 10 years with the introduction and extensive use" of the new strategy.
Surprisingly, the regimen is no different from what has been practised in the US over the past few years.
Tuberculosis is an infectious disease usually transmitted through airborne bacteria. It destroys the lungs, leading to bleeding and asphyxiation, and muscle tissue wastes away.
Tuberculosis claims more lives than AIDS. One -third of the people who are infected with HIV, the virus that causes AIDS, and who are thus susceptible to infection, die from tuberculosis, said Dr Paul Nunn, leader of the WHO tuberculosis research and surveillance unit in Geneva.
It is a known fact that TB is the leading infectious killer of young people and adults that claims most of its victims in the Third World.
The Directly Observed Treatment program centres on four established, low-cost tuberculosis drugs-isoniazid, rifampiciin, parazindamide and either ethambutol or streptomycin-taken in conjunction with one another.
An advantage of the system is that a full course of treatment does not cost much, approximately Rs 400, much less than other kinds of treatment.
"The most important thin is to hold on to the patients," said one doctor who has seen many of his patients give up their daily regiment of drugs too soon because they felt a little better. But the bacillus is hardly dead then and comes back stronger and more virulent.
In fact, by breaking off a course of treatment patients encourage drug-resistant, incurable tuberculosis.
By opening a campaign to popularise the regimen, researchers indicated, the WHO hopes to perfuade countries that currently reject it, including Russia and India, to sign up.
The system, used in 70 countries and territories, differs markedly from other treatment,where the drug regimen is not standardised or where tuberculosis treatment is based on mass scannings by X-rays and hospitalisation of infected patients.
Data recently compiled by the WHO among 98 per cent of the world's population shows that the new regimen produces a cure rate of 77 per cent, compared with 41 per cent from other programs.
Once city that researchers here point to as showing the success of the regimen is New York, where the spread of HIV in the early 1990s caused a huge increase in TB, both the normal strain and its more lethal drug-resistant variety.
The outbreak was countered by close monitoring of patients, including outreach programs by health workers whose sole responsibility was to go to patients' houses and ensue that they took their medication, the researchers said.
ALAN COWELL
Sound treatment
THE TREATMENT of heart attacks has changed dramatically in the last 20 years. In the latest bold approach, doctors in Israel have blasted the coronary arteries with Ultrasound to break up blood clots. Tested in 15 patients, the high-frequency sound waves worked in 14 cases.
The treatment is still experimental but researchers in the US and in Europe have also been studying ultrasound to open blocked arteries.
To treat a heart attack, the ultrasound source must be guided into the blocked artery. Doctors insert a catheter into an artery in the upper thigh and snake it through the circulatory system up to the clot in the heart. At the tip of the catheter is an ultrasound probe that delivers two of three 60 - second bursts of ultrasound at a frequency of 45,000 cycles per second, enough to liquefy the clot. The procedure can take as little as 20 minutes; the patient stays awake and does not feel the ultrasonic vibrations.
Ultrasound is one of a series of techniques that cardiologists have developed to try to stop heart attacks in progress. When the attacks are caused by clots or fatty arterial deposits that cult off the blood supply to a portion of the heart the muscle will die unless blood flow can be restored within 12 hours.
Methods already in use to open closed vessels include clot-dissolving drugs and angioplasty, in which a balloon attached to a catheter is momentarily inflated inside an artery to flattern clots and deposits against the vessel wall. Devices called stents are also inserted permanently into narrowed arteries to prop them open.
The patients in the Israeli study underwent ultrasound treatment to destroy clots and then immediately and balloon angioplasty to open their narrowed arteries further. The director of the study, Dr Uri Rosenschein of the Tel Aviv Medical Center, who invented the probe, said the sound waves easily liquefied clots without harming surrounding tissue.
Doctors at Stanford University Medical School are now suggesting that ultrasound might be especially useful in heart attack patients with clots too large to treat with balloon angioplasty or drugs.
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