急求!英译汉,不要google翻译或者机器翻译的,拜托了!在线等(4)ResultsSixty contacts were identified. Of 16 children, 11 were placed on RIF/PZA. Five did not return for treatment despite repeated efforts. Of 29 adults with L
急求!英译汉,不要google翻译或者机器翻译的,拜托了!在线等(4)ResultsSixty contacts were identified. Of 16 children, 11 were placed on RIF/PZA. Five did not return for treatment despite repeated efforts. Of 29 adults with L
急求!英译汉,不要google翻译或者机器翻译的,拜托了!在线等(4)
Results
Sixty contacts were identified. Of 16 children, 11 were placed on RIF/PZA. Five did not return for treatment despite repeated efforts. Of 29 adults with LTBI, 23 were placed on RIF/PZA, 3 did not return for therapy and could not be located, and 3 were treated with 4 months of rifampin. Rifampin was used because one person was treated by another health department and two returned for treatment several months after this outbreak.
The majority of children (64%) were born in the United States. Mean age was 6 years (range, 0.75 to 15 years). The adults with LTBI were a young, healthy group of recent immigrants. All were born in Mexico. Fifty-nine percent were male and mean age was 27 years (range, 17 to 50). No adults or children reported comorbidities; none were known to be HIV infected. Fifty-nine percent of the adults reported alcohol use before treatment. Although all adults were employed, none had health insurance.
Ten of 11 children completed 2 months of RIF/PZA,with few side effects (Table 1). One child, age 15,developed asymptomatic drug-induced hepatitis (ALT 216 U/L on day 25 of treatment), and RIF/PZA was suspended. Only 13 of 23 adults completed RIF/PZA treatment. Four adults were diagnosed with hepatitis between days 10 and 53, and RIF/PZA was suspended (Table 2). Once their liver enzymes normalized, two completed 4 months of rifampin, making the overall completion rate 65%. There were no associated hospi-talizations or deaths.
The four adults with hepatotoxicity had higher daily doses of pyrazinamide than those without (1365 mg v 948 mg, p=0.02). There were no significant differences in alcohol use, age, gender, or comorbidities. Three of the four adults with hepatotoxicity had serologic testing for hepatitis; none had evidence of acute hepatitis A,hepatitis B surface antigen, or hepatitis C antibody. All four denied drinking during treatment.
Estimated cost of an uncomplicated course of RIF/PZA was $219 per adult, compared to $122 for 4 months of rifampin. The health department needed additional funding to pay for RIF/PZA and blood draws. Health department employees reported linguistic and cultural barriers to treatment and monitoring.Additional Spanish interpreters and providers were hired to ensure communication about potential hepa-totoxicity. The health department also had to address contacts’ belief that giving blood every 2 weeks would“drain them of energy” (MRC). This strongly held belief made timely monitoring difficult. Many of the adults did not keep appointments and came to the clinic at unexpected times. It is not clear if this was due to cultural factors or patients’ work schedules. Health department employees felt that “it was challenging to follow the guidelines that recommend intensive monitoring for hepatitis.”
急求!英译汉,不要google翻译或者机器翻译的,拜托了!在线等(4)ResultsSixty contacts were identified. Of 16 children, 11 were placed on RIF/PZA. Five did not return for treatment despite repeated efforts. Of 29 adults with L
结果
共找到60名接触者,包括16名儿童,其中11名儿童接受了RIF/PZA治疗,而另外5名尽管做了多方努力,仍然没有回来接受治疗.患有LTBI的29位成年人中,23位接受了RIF/PZA治疗,3位没有返回接受治疗,也无法找到他们,而剩下的3位接受了4个月的利福平治疗.采用利福平的原因是其中一人由另外一家卫生部门治疗了,另外两人在结核病爆发两个月之后才回来接受治疗.大部分儿童(64%)在美国出生,平均年龄6岁(范围为9个月到15岁).患LTBI都是年轻健康的近期移民,都出生于墨西哥.其中59%是男性,平均年龄27岁(范围为17岁到50岁).没有任何成年人和儿童患有任何并发症,也无人感染HIV.59%的成年人在治疗之前饮酒.尽管所有成年人都有工作,却没有任何人有医疗保险.
接受RIF/PZA治疗的11名儿童中的10名完成了整个治疗过程,仅仅产生微乎其微的副作用.其中一名15岁的儿童产生了无症状药物性肝炎(在疗程第25天发现ALT 216 U/L),于是就中止了RIF/PZA的使用.23名成年人中,仅有13人完成RIF/PZA疗程.其中4人在第10到第53天之间由于诊断出肝炎而停止使用RIF/PZA.一旦他们的肝酶恢复正常,其中2人就接受了4个月的利福平治疗,使得总体治疗完成率达到65%.没有任何因治疗而导致的住院和死亡.
肝中毒的4位成年人比没有肝中毒的每日使用较多的吡嗪酰胺(1365毫克对比948毫克,p=0.02).饮酒量、年龄、性别、或者其他伴随疾病在这些人中区别不大.患肝中毒的4名成年人中,3名接受了血清学肝炎测试,没有任何人表现出以下任何迹象,突发甲肝,乙肝表面抗原,丙肝抗体.所有4人在治疗过程中都被禁止饮酒.
每个成年人的一次RIF/PZA普通疗程估算花费为219美元,而4个月的利福平疗程花费为122美元.卫生部门部门需要额外的资金来支付RIF/PZA以及抽血.卫生部门职工报告指出,存在语义理解和文化交流上的障碍,使得治疗和监测都不是很顺利,因此雇佣了额外的西班牙语翻译和服务人员来保证在有关肝中毒问题上的交流得以通畅.
卫生部门还不得不向接触人员说明每两周抽血一次并不会导致他们“弱不经风”,他们对这些说法太相信了,以至于定时的监测工作执行起来很困难.
很多成年人都不按照预约的时间、而是不知道什么时候就突然来了诊所.不清楚这是否由于文化因素还是由于病人的工作时间安排.卫生部门职工觉得“按照指南的建议对肝炎进行集中监测非常困难”.