The records of 123 pulmonary tuberculosis patients initially diagnosed during three
and half years from December 1965 to June 1969 at this clinic has been analysed
retrospectively for a study of the general out-come of these patients and of any
influencial factors on it particulary induced by a specialist of tuberculosis disease.
(Total cases)
The ratio of initially diagnosed cases to total pulmonary tuberculosis cases registered
at this clinic was 13.27%. There were definitly more males than females fe with the
ratio of 4 to 1.
The largest age group was between 16 and 30 years with 52.03%, the next one was
31 to 45 years with 30.89%, and there were only 7 cases under 15 years age because
this was an adult clinic.
There were 39.02% of minimal, 56.1% of moderately advanced, and only 4.88% of far
advanced by extent of disease according to USA, NTA Classification.
Those figures showed some differences to compare with the results of 1965 national
tuberculosis survey and total tuberculosis cases registered at this clinic by higher ratio
of male patients, slightly younger younger age group of the majority, and smaller per
centage of far advanced cases.
The sputum examination was done in 79.33% of the patients and 59.45% of them
were reported as positive. It was much higher rate of successful sputum examination
and finding positive than other clinics due to a better physician-patient relationship in
this clinic. 75.66% of sputum positive cases were sensitive to SM, PAS, INH and
24.14% were resistant to one or two drugs, which is quite similar with several other
reports in this country.
When grouped according to the mode of onset of disease 54.47% were gradual, 21
14% were found on mass-x-ray, same 21.14% were hemoptic, remaining 3.25% were
acute pneumonic. The usefulness of mass-x-ray on case finding in this country was
again conformable.
If the diseases were classified according to the dynamic status by author's method,
only 58.54% were easily changeable, and 15.44% were hardly changeable, so, even
among the initially diagnosed cases the remarkable improvement of the pulmonary
lesions could be expected only in about 60 to 70% in general.
There were only 4.88% of these patients that were referred by fellow physicians while
95.12% were sent by the patient self or by their relatives or friends.
The place of initial diagnosis appered to be important factor to influence the duraction
of continued treatment at this clinic with the P value less than 0.005, that is, among the
patients whose diagnosis was initially mads at this clinic, 72.0% of them continued their
treatment for more than five months at this clinic while only 20.55% of the referred one
did so. It was also thought to be due to the difference of the physician-patient
relationship developing at the moment of the first diagnosis besides the distance of the
patient's residency.
For the reason of terminating the treatment, 32.52% were selftransferred to other
clinics including selfmedications, 13.01% needed no treatment due to insignificant disease,
7.31% were uncoroperative, 6.5% were economiclly very poor, 3.25% were still
continueing their treatment with unsuccessful results, and only 37.4% completed the
treatment with satisfactory results. Although the ratio of successful case were not
suffiently large enough it was far superior than the results obtained at the health center
clinics or at other clinics in this country.
(The patients continued the treatment for more than 9 month% at this clinic)
There were 51 cases who continued their treatment for more than 5 months at this
clinic. The sex ratio, the frequency af age group, and the extent of disease was quite
simillar with above total cases.
The sputum examination was done in 92.16% with 70.59% positives and 70.0% of
them showed sensitive to SM, PAS, INH., 15.0% resistant to both of SM. and INH.
The regimens of chemotherapy were not statistically planned but followed some
general principles, that is, SM. injection was girt,9n daily for first 2 to 3 months then
switched to biweekly or discontinued according to the circumstances and the majority
patients were given the combination of 5% and INH.
There were 62.75% of SM-INH regime, 19.61% of SM-INH-PAS, in a few cases
ETM or MBT was given instead of PAS because of strong suspesion of primary
resistant infection, and in 7.84% INH single was prescribed for the disease appeared to
be very minimal.
As an overall effectiveness of above treatment, sputum conversion occurred in 86.11%
and roentgenological improvement was obtained in 74.51%, 31.37% moderate and 43.14%
marked degree, and those improvement were achieved within 6 months of the treatment
in the majority cases with 81.57% of x-ray improvement and 87.1% of sputum
conversion.
There were no case of roentgenological progression at the end of the treatment,
although 2 cases showed zig-zag courses due to interupted irregelar treatment.
However there were 5 cases, 13.89% of persistently sputum positive cases although
most of them showed moderate degree x-ray improvement.
The reason for those failures were considered as insuficient period of treatment in 2
cases, inadquate chemotherapy in one case, interrupted irregular treatment and
overworking in 2 cases.
An analytic study of the factors influential to the results of treatment without
considering the differences of the drug regimes showed a moderate significant
relationship between the changeability classification of disease and the x-ray
improvement with P value less than 0.05 while the extent of disease or the mode of
onset had no significancy.
(In conclusion of above observations)
The author clamed that the value of tuberculosis specialist could be recognizable in
establishing a better physician-patient relationship important to have adquate
examinations of the disease and to give regular continued patient care.
And it was strongly recommended to provide better environment for the tuberculosis
patients to minimize their individual burdens, economic as well as psycologic, that is,
improved accomodations of tuberculosis hospital maned by specialists, besides the
improvement of present ambulatory treatment system to provide sufficient prolonged
treatment and for better control of tuberculosis diseases.
|