الفهرس 
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Abstract
Tuberculosis remains a major global health problem by causing ill-health among millions of people each year and ranking as the second leading cause of death from an infectious disease worldwide . Geographically, most people who developed TB in 2019 were in the WHO regions of South-East Asia (44%), Africa (25%) and the Western Pacific (18%), with smaller percentages in the Eastern Mediterranean (8.2%), the Americas (2.9%) and Europe (2.5%). 22 countries in WHO’s list of 30 high TB burden countries accounted for 21% of the global total Egypt one of them .Egypt has succeeded to achieve the global target and occupying a place in the target zone, as published in the Global Repot of WHO 2009 (which describes the data of 2007), to be classified as one of the 36 worldwide countries that has achieved the global targets in both case detection and treatment success in the year 2007. The case detection rate of positive cases in Egypt was 72% (global target is 70%) and treatment success rate was 87% (global target is 85%) .TB is an important global public health problem but has cure in almost 100% of the new cases if correct quimiotherapy is applied. The American Thoracic Society treatment guidelines recommend an initial phase for TB treatment which consists of rifampicin 10 mg/kg (maximum 600 mg), isoniazid 5 mg/kg (maximum 300 mg), pyrazinamide 15–30 mg/kg (maximum 2 g), and ethambutol 15–20 mg/kg (maximum 1.6 g) given daily for 8 weeks, followed by a continuous phase of isoniazid 15 mg/kg (maximum 900 mg) and rifampicin 10 mg/kg (maximum 600 mg) administered 2–3 times/week for 18 weeks .Drug-resistant TB continues to be a public health threat. Worldwide in 2019, close to half a million people developed rifampicin-resistant TB (RR-TB), of which 78% had multidrug-resistant TB (MDR-TB). Globally in 2019, 3.3% of new TB cases and 17.7% of previously treated cases had MDR/RR-TB. Drug-resistant TB care in Egypt in 2019 considred 264 Laboratory-confirmed cases MDR/RR-TB & 91% of them bacteriologically confirmed for rifampicin resistance / New cases and 59% of them bacteriologically confirmed for rifampicin resistance / Previously treated cases. The frequency of resistance to multiple drugs varies geographically, and acquired (secondary) resistance is more common than primary resistance. The results of the national Egyptian survey carried out and published in 2001, as regards Streptomycin resistance which was 18% in new cases, 48% in retreated cases, near to the INH resistance results which was 9.3% in new cases, 43% in retreated cases. There was a significant difference in TB cases age (higher) vs control & there is insignificant higher of mean age among cured subgroup than MDR subgroup. There is insignificant higher of mean age among cured subgroup than MDR subgroup . Also , presence of cavitation, degree of cavitation is statistically insignificant. Also , Unilateral cavities is insignificant higher in cured subgroup (23/50) than in MDR subgroup (16/50). Bilateral cavities by CXR is significant ( P value 0.008) higher in MDR subgroup (28/50) than in cured subgroup (15/50). First-line regimen is significantly higher ( Rifampicin 42/50 , Ethambutol 40/50 , Isoniazid 37 /50 ) in cured subgroup ( P value ˂ 0.001) while Second-line regimen is significantly higher ( Ethionamide 43/50, Cycloserine 40/50 , PAS 38/50 , levofloxacin 37/50, amikacin 35 /50 ) in MDR subgroup ( P value ˂0.001). Patients and control groups were selected 50 MDR cases , 50 Cured cases , 50 Control . All TB cases groups were pulmonary not extrapulmonary which subjected to history taking, esp, evaluation of chest radiography, intake of anti-TB drugs while control group are free. DNA extraction were done for 5ml whole blood specimens indeed, it is common to perform PCR, After that the product are digested with one or more restriction enzymes and analysed by electrophoresis. PCR/RFLP done for polymorphism in NRAMP1 (D543N & 30-UTR) , NAT2 (NAT2*7 & NAT2*6), (TNF-a & LTA) and MBL (allle A & allele C ) by (AvaII & FokI ) ( BamHI & TaqI ), Nco1,( BanI & MboII ) restriction enzyme respectively .There are nonsignificant difference in age, complication (CXR) between MDR-Cured cases group. There is a correlation between bilateral cavitation (more ) in relation to host genomics of MDR TB. NRAMP D543N genotype A/G & & allele G/G , 30-UTR genotype Del/TGTG & allele TGTG/TGTG , NAT2*6 genotype A/G , TNFA _308 genotype A/G and MBL.C genotype G/G polymorphisms are protective against occurrence of MDR TB . NAT2*6 genotype G/G & TNFA _308 genotype G/G and MBL.C genotype G/A polymorphism are predictors of MDR TB .NAT2 ( NAT2*7 ) & LTA+252 and MBL. A polymorphism genotyping are not predictors or protective.