The recommendations in this document are intended to guide the treatment of tuberculosis in settings where mycobacterial cultures, drug susceptibility testing, radiographic facilities, and second-line drugs are routinely available. In areas where these resources are not available, the recommendations provided by the World Health Organization, the International Union against Tuberculosis, or national tuberculosis control programs should be followed.
What's New In This Document
* The responsibility for successful treatment is clearly assigned to the public health program or private provider, not to the patient.
* It is strongly recommended that the initial treatment strategy utilize patient-centered case management with an adherence plan that emphasizes direct observation of therapy.
* Recommended treatment regimens are rated according to the strength of the evidence supporting their use. Where possible, other interventions are also rated.
* Emphasis is placed on the importance of obtaining sputum cultures at the time of completion of the initial phase of treatment in order to identify patients at increased risk of relapse.
* Extended treatment is recommended for patients with drug-susceptible pulmonary tuberculosis who have cavitation noted on the initial chest film and who have positive sputum cultures at the time 2 months of treatment is completed.
* The roles of rifabutin, rifapentine, and the fluoroquinolones are discussed and a regimen with rifapentine in a once-a-week continuation phase for selected patients is described.
* Practical aspects of therapy, including drug administration, use of fixed-dose combination preparations, monitoring and management of adverse effects, and drug interactions are discussed.
* Treatment completion is defined by number of doses ingested, as well as the duration of treatment administration.
* Special treatment situations, including human immunodeficiency virus infection, tuberculosis in children, extrapulmonary tuberculosis, culture-negative tuberculosis, pregnancy and breastfeeding, hepatic disease and renal disease are discussed in detail.
* The management of tuberculosis caused by drug-resistant organisms is updated.
* These recommendations are compared with those of the WHO and the IUATLD and the DOTS strategy is described.
* The current status of research to improve treatment is reviewed.
read more http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm
Tuesday, May 13, 2008
Treatment of Tuberculosis
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Saturday, March 29, 2008
Lessons in Home Cooking
The most healthful meal is the one you cook at home. But for those of us skilled at the art of takeout, the idea of cooking in our kitchens is daunting. Who has time after a busy day to shop, chop, prepare and cook?
The Times’s food writer Mark Bittman always makes cooking look easy as author of the weekly Minimalist column and his new blog Bitten. He’s also the author of several cookbooks, including “How to Cook Everything: Simple Recipes for Great Food.'’ I recently spoke with Mark about the how-to’s of home cooking, his favorite ingredients and a lot about beans.
Why do you think so many people find it tough to cook regularly at home?
I think there are a couple of lost generations. In the years after the war it became less and less popular to cook and more and more common to do things conveniently. Especially people born after 1960 or after, when reentering the workforce and using canned and frozen microwave stuff — they just didn’t see their mothers cooking.
For those of us who want to cook more, what’s your advice for getting started?
I would say start with a decent cookbook. Pick something you really like, and make the effort to be successful; you want positive reinforcement. Read the recipe carefully, set aside the time and make sure you’ve got the ingredients and the equipment and really walk yourself through it. What takes you two hours the first time may only take 15 minutes the third time.
What supplies should I always have in my kitchen? Are there any special pots or pans I need?
In “How To Cook Everything,” there are lists of what you need for your pantry and a list of the equipment. You can start with three or four pans, a couple different utensils. And you can start with 10 or 15 ingredients. The list includes pasta and rice, canned beans and tomatoes, spices, olive oil, eggs and butter, long-keeping vegetables like onions, potatoes and garlic and canned stock. You have to start with the right ingredients, and you have to invest a little money and a fair amount of time.
But that is usually the problem for most people. They say they don’t have time to cook. I know I often don’t.
Well, whatever it takes to get food on the table, you have to do something. I’m not saying calling the Chinese takeout guy is harder than cooking. But all things considered, it’s not that much different. Yesterday morning I woke up and cooked beans while getting ready to come to work. I got home really late, like at 7:45 p.m. I reheated the beans, washed some lettuce and broiled a piece of fish. I had stuff on the table in 15 minutes. People say, “I have no time.” It’s like exercise: you have to want to do it.
For me the worst part of cooking is shopping for groceries and figuring what ingredients I need for a meal.
These days I cook a lot of things that are already in the house. I eat a lot of eggs, vegetables, beans and pasta. A lot of people think cooking is complicated. But this is the thing. Once you learn what you’re doing you realize it’s not. As I said, I woke up yesterday and made beans. Even if you take a can of beans and throw it in a pot with cherry tomatoes (you don’t even have to cut them up), some garlic and olive oil — there’s nothing wrong with that. Broil a piece of fish, wash some lettuce, and you have a fine meal. If your kids don’t like fish, then use shrimp or a piece of meat. I’ve gotten so used to cooking simply I almost never do anything else. Even when people come over for dinner — they get the same things I cook for myself. If I made what I just described to you and you were coming over for dinner, you’d probably think, “He cooked. How nice.'’ People worry about this too much.
How many different types of meals should we know how to make? Is variety important?
Whatever makes you happy. If you know how to broil a piece of fish or meat, if you know how to make a stir-fry and a couple pasta dishes and maybe a rice dish, and if you know how to deal with beans and make a salad, at that point you are well on your way.
When you are cooking, do you ask yourself whether it’s healthy, or do you just want it to taste good?
I always thought if you were aware of what you were putting in your mouth you’re not going to eat badly. Nobody can cook what they cook in fast-food joints and restaurants, in general, because you just don’t have the same ingredients. But if you looked at what it means to put a half a cup of butter in a dish, you would just look and say, “I’m going to use less.'’ When you cook yourself, you just don’t put the same kind of crappy things in there that people put in food that is prepared for you.
Do you have a favorite ingredient?
I go through an awful lot of olive oil, a stunning amount. I’m eating a lot of legumes.
You’ve talked a lot about beans. How do you cook them? Don’t you have to soak them?
You don’t have to soak them, but it makes it faster if you do. If you soak small dried beans overnight, I wager you could get them most of the way cooked by the time you and your daughter got out of the house in the morning. There’s a lot of stuff you can start and stop in the morning, especially beans and grains.
I have to confess, I’m not much of a bean eater. Maybe I need to start. Why are you such a fan?
It’s the flavor, the satisfaction, the non-meatness, the high-fiberness. When you get into cooking you start to see the subtle differences among things. At first I didn’t know anything about fish, then I learned 50 species, and then it mattered if it was bay scallops or sea scallops or pink scallops. That’s where I’m at these days with vegetables and legumes. I didn’t pay much attention to cooking them for most of my adult life, and now I’m starting to understand the subtle differences.
Okay, so what beans should we all be trying?
Chickpeas are the best. Now I’m into these huge beans called gigantes. You eat three of them and it’s like you had a small potato. But you can take a pound of chickpeas, cook them on a Saturday and stick them in the refrigerator tossed with olive oil, and you can eat them all week long.
Do you have a particular food indulgence?
I have a lot of friends in the food business, so I get my share of treats. At home it’s almost like I’m happy with pretty much everything I cook. It’s not that it’s so great. It’s the knowledge that I put something together, it’s simple and I put something on the table and there we are, sitting and eating it. It’s something I’ve loved doing for a long time, and I’m still into it.
Saturday, March 22, 2008
Pizza for Breakfast? Yes!
I know what you're thinking: pizza? For breakfast? But the truth is that you can crack open last night's leftovers in the a.m. if you want to.
I know lots of women who skip breakfast, and they have a ton of different excuses for doing it. Some say they don't have time, others think they're "saving" calories by eliminating a meal, still others just don't like breakfast food.
But the bottom line is, eating in the morning is crucial when you're trying to trim down. "Eating just about anything in the range of 300 to 400 calories would be better than nothing at all," says SELF contributor Katherine Brooking, R.D., who developed the super-easy eating plan for this year's SELF Challenge. And even pizza can be healthy if it's thin-crust, loaded with veggies, and you stick to one slice.
Breakfast is one meal I never miss (my favorite morning combo includes Fage nonfat yogurt topped with fresh fruit and low-carb granola, yum!), and the same goes for most weight loss success stories.
Research shows that eating breakfast revs up your metabolism, keeps you from overeating later in the day and may even help sleekify your abs. Researchers at the University of Southern California at Los Angeles found that breakfast skippers have bigger tummies than those who regularly have a morning meal.
So eat something in the morning, anything. I know plenty of pals who end up forgoing it altogether to have just coffee or cola. I say, try heating up last night's leftovers-it may sound crazy, but if it works for you, do it!
Bonus: I find if I tell myself, "You can always eat it tomorrow," I put away the leftovers instead of eating more that night. Try it...you may save yourself some prebedtime calories. And watch your body reap the fat-burning benefits. What are your favorite breakfast foods?
Source: http://health.yahoo.com
The Easiest Diet Secret
Produce, especially the veggie variety, is a dieter’s best friend. When people eat veggies with a meal, they consume a full 20 percent fewer calories overall — and still feel satisfied afterward, a study in The American Journal of Clinical Nutrition reveals.
I know that all that chopping and cooking feels like a drag, but it’s easier than you think to work in five cups of the fresh stuff a day.
At breakfast, have a fruit “smush” made with a medley of fresh berries and yogurt (the lean protein fills me up). Then, at lunch, have a great big salad with cucumbers, tomatoes, peppers, peas or whatever your favorite veggies are. Add grilled chicken or another lean protein to hold off afternoon hunger.
Start dinner with a veggie-packed soup, like minestrone, and make a side dish that you love (I’m a big fan of steamed spinach with a little salt). I also love ratatouille (especially in summer), but if you don’t have time for that, heat up some frozen veggies and sprinkle them with Parmesan or lemon juice for an easy, delicious, healthy side. My favorite brand of frozen veggies is from Cascadian Farm.
Source: health.yahoo.com
Sunday, March 16, 2008
Telling smokers "age" of lungs helps them quit
Smokers are more likely to kick the habit if they are told how "old" their lungs are, a British study found on Friday.
The concept of lung age -- measured by comparing a smoker's lungs to the age of a healthy person whose lungs function the same -- has helped patients better understand how smoking damages health, researchers had already found.
But that information is also effective in convincing smokers to quit, said Gary Parkes, a family physician in Hertfordshire outside London, who led the study published in the British Medical Journal.
"Telling smokers their lung age significantly improves the likelihood of them quitting smoking," Parkes and his colleagues wrote.
Smoking kills about four million people each year, according to the World Health Organization. Tobacco is highly addictive and the leading preventable cause of both cancer and heart disease.
The study in five general medical practices outside London involved 561 long-term smokers older than 35 and began with a simple test to record the volume and rate at which the volunteers exhaled air from the lungs.
One group received no detailed information about their results while the other people were given their lung age, shown a diagram of how smoking ages the lungs and told that quitting would slow the rate of damage.
Everyone was also strongly encouraged to quit and offered help to do so. One year later, saliva tests showed that 13 percent of the smokers told their lung age had quit while only 6 percent of people in the other group had stopped.
"Anybody who had good, understandable information seemed more inclined to give up," Parkes said. "The reason may be people had dreaded the worst and realized it was still worthwhile giving up."
The study counters research showing such health information does not prod them to quit and underscores the benefits of early screening because 16 percent of the people in the study had undiagnosed emphysema, Parkes said.
Giving people this kind of information could represent a cheap and easy way to get people to stop smoking and reduce smoking-related health problems that are putting pressure on health systems to treat.
"The cost, if you like, is certainly within the economic framework of a good deal," Parkes said.
Reuters
(Reporting by Michael Kahn; editing by Maggie Fox and Philippa Fletcher)
Popcorn ingredient causes lung disease: U.S. study
A chemical used to give butter flavor to popcorn can damage the lungs and airways of mice, U.S. government experts reported on Thursday.
Tests on mice show that diacetyl, a component of artificial butter flavoring, can cause a condition known as lymphocytic bronchiolitis, said the team at the National Institute of Environmental Health Sciences, part of the National Institutes of Health.
The condition can lead to obliterative bronchiolitis -- or "popcorn lung" -- a rare and debilitating disease seen in workers at microwave popcorn packaging plants and at least one consumer.
At least two microwave popcorn makers -- ConAgra Foods Inc and Weaver Popcorn Co Inc -- have said recently they would stop using diacetyl.
Laboratory mice made to inhale diacetyl vapors for three months developed lymphocytic bronchiolitis, the NIEHS team said.
"This is one of the first studies to evaluate the respiratory toxicity of diacetyl at levels relevant to human health," Daniel Morgan at NIEHS, whose team led the study, said in a statement.
Writing in the journal Toxicological Sciences, the researchers said findings suggest that workplace exposure to diacetyl contributes to the development of obliterative bronchiolitis.
The hard-to-treat condition causes vague symptoms such as cough and shortness of breath, and steadily worsens, according to the U.S. Centers for Disease Control and Prevention.
Congress has been working on a bill to order quick action by the Occupational Safety and Health Administration to limit exposure to diacetyl. The House of Representatives passed a bill last year but the Senate has not acted.
The Food and Drug Administration said last September it was investigating a report of a man who came down with the life-threatening disease after eating several bags of butter-flavored microwave popcorn each day.
(Reporting by Maggie Fox, editing by Will Dunham and John O'Callaghan)
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