Management Of Tuberculosis Patients Research Articles

Characteristics and contributing factors of adverse drug reactions: an analytical study of patients with tuberculosis receiving treatment under the National TB Program of India

Background Tuberculosis (TB) continues to pose a serious threat to the public health system in India. Although the National Tuberculosis Elimination Program (NTEP) is providing a wide range of interventions from early diagnosis to complete treatment to reduce morbidity and mortality from TB, adverse drug reactions (ADR) remain a challenge in treatment adherence and completion. Methods An observational cross-sectional study was conducted in selected districts of Gujarat state. A total of 593 reported TB patients were recruited with an adjusted unified distribution based on the type of cases, site of diseases, and service facility through a simple random sampling method. A semi-structured questionnaire tool was used to collect socio-demographic, clinical, and ADR-related data from the TB patients. Data was analyzed for the frequency, percentage, chi-squared, and adjusted odds ratio to find the association between the variables. Results The majority of the study participants were male (87.2%), aged 15 to 60 (57.8%), daily laborers (22.4%), and married (64.2%). Over 75% of individuals had pulmonary TB, with 87% having experienced their first episode, 83% being new cases, and 44.7% having a history of addiction. ADR with mild symptoms was reported by more than a quarter (29%) of TB patients during the intensive phase (77%). The association between ADR experience and drug susceptibility was significant (p<0.005) and drug-resistant TB patients experience two times more ADRs than drug-sensitive TB patients (OR 2.04). Binomial logistic regression was carried out to describe the association between various variables and occurrence of ADRs. Conclusion The study highlighted a need to enhance health care providers’ capacity and program structure for managing ADRs among TB patients. In order to completely eliminate TB across the country, it also emphasized the attention for a holistic and all-encompassing strategy for managing TB patients at the field level.

Tuberculosis Infection Control: Experiences and Considerations from a Web Based Tool Implementation.

Tuberculosis (TB) remains a significant global health challenge. Indeed, according to the World Health Organization (WHO), TB is classified as the second most common cause of death worldwide due to a single infectious agent in 2022, following COVID-19. To effectively manage tuberculosis patients, it is necessary to ensure accurate diagnosis, prompt treatment initiation, and vigilant monitoring of patients' progress. In 2017, the TB Ge network was implemented and launched in two primary hospitals within the Liguria Region in Italy, with the main purpose to manage tuberculosis infections. This system, organized as a web-based tool, simplifies the manual input of patient's data and therapies, while automating the integration of test results from hospitals' Laboratory Information Systems (LIS), without requiring human intervention. The goal of this paper is to highlight the outcomes achieved through the implementation of the TB Ge network in a period seriously affected by the COVID-19 pandemia and outline future directions. More specifically, the aim is to extend its adoption to all hospitals in the Liguria Region, thus improving the management of tuberculosis infections across healthcare facilities.

Understanding the complexities of post-tuberculosis lung disease: Implications for global health

Post-tuberculosis lung disease (PTLD) presents a significant challenge in the management of tuberculosis patients, with far-reaching implications for global health. This editorial explores the multifaceted nature of PTLD, encompassing its pathophysiology, clinical manifestations, diagnostic complexities, and implications for public health. PTLD arises from pulmonary damage due to an active tuberculosis infection, leading to inflammation, scarring, and fibrosis within the lungs. Clinical manifestations vary widely, ranging from chronic respiratory symptoms to severe respiratory failure, often resembling chronic obstructive pulmonary disease or restrictive lung disease. The diagnosis of PTLD is hindered by its heterogeneous presentation and overlap with other respiratory conditions, necessitating a comprehensive evaluation through pulmonary function tests and radiological imaging. PTLD imposes a substantial burden on global health systems, particularly in regions with high tuberculosis prevalence, contributing to increased morbidity and mortality rates. Management strategies focus on alleviating symptoms, preserving lung function, and preventing disease progression through pharmacological interventions, pulmonary rehabilitation, and, in select cases, surgical interventions. Preventive measures include effective tuberculosis control measures, vaccination against respiratory pathogens, and addressing social determinants of health. Overall, a comprehensive understanding of PTLD is essential for improving patient outcomes and reducing disease burden, highlighting the importance of concerted efforts to raise awareness, enhance diagnostic capabilities, and develop effective management strategies for this complex condition.

Assessment of the status of presentation and management of tuberculosis patients in central India

Tuberculosis (TB) continues to pose a notable public health issue not just within India but on a worldwide scale. Analyzing the causes of presentation, management, and treatment delays of tuberculosis can offer valuable understanding into local trends and aid in crafting specific approaches for the successful management of TB. This research involves a cross-sectional examination conducted among TB patients residing in the regions served by the District Tuberculosis Centre, Wardha, and the directly observed treatment short course center in Sawangi. Information will be collected using a standardized questionnaire endorsed by the World Health Organization.

Mobile Application to Improve the Follow-up and Control Process in Patients with Tuberculosis

Tuberculosis is a severe and life-threatening illness that affects numerous individuals worldwide every day. The key objective of this study was to create a system that could enhance the monitoring and management of tuberculosis patients. To achieve this goal, the Mobile D methodology was utilized because of its effectiveness in project management. This methodology emphasizes test-driven development, continuous integration, and optimization to enhance software processes. The outcome of this research was a prototype of a mobile application specifically designed for individuals with tuberculosis. Professionals and people affected by the disease assessed the quality of the prototype. They evaluated its effectiveness, user-friendliness, design, and functionality and gave ratings of 4.77 and 4.69 on a Likert scale, respectively. These figures indicate that the prototype meets high-quality criteria. In conclusion, this research successfully created an efficient prototype that enhances the monitoring and control of tuberculosis patients. The prototype includes features such as real-time consultations for immediate interaction between physicians and patients, clinical history visualization, and medication reminders, all of which improve the user’s experience.

Tuberculosis Severity Predictive Model Using Mtb Variants and Serum Biomarkers in a Colombian Cohort of APTB Patients.

Currently, tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis (Mtb) that primarily affects the lungs. The severity of active pulmonary TB (APTB) is an important determinant of transmission, morbidity, mortality, disease experience, and treatment outcomes. Several publications have shown a high prevalence of disabling complications in individuals who have had severe APTB. Furthermore, certain strains of Mtb were associated with more severe disease outcomes. The use of biomarkers to predict severe APTB patients who are candidates for host-directed therapies, due to the high risk of developing post-tuberculous lung disease (PTLD), has not yet been implemented in the management of TB patients. We followed 108 individuals with APTB for 6 months using clinical tools, flow cytometry, and whole-genome sequencing (WGS). The median age of the study population was 26.5 years, and the frequency of women was 53.7%. In this study, we aimed to identify biomarkers that could help us to recognize individuals with APTB and improve our understanding of the immunopathology in these individuals. In this study, we conducted a follow-up on the treatment progress of 121 cases of APTB. The follow-up process commenced at the time of diagnosis (T0), continued with a control visit at 2 months (T2), and culminated in an exit appointment at 6 months following the completion of medical treatment (T6). People classified with severe APTB showed significantly higher levels of IL-6 (14.7 pg/mL; p < 0.05) compared to those with mild APTB (7.7 pg/mL) at T0. The AUCs for the ROC curves and the Matthews correlation coefficient values (MCC) demonstrate correlations ranging from moderate to very strong. We conducted WGS on 88 clinical isolates of Mtb, and our analysis revealed a total of 325 genes with insertions and deletions (Indels) within their coding regions when compared to the Mtb H37Rv reference genome. The pattern of association was found between serum levels of CHIT1 and the presence of Indels in Mtb isolates from patients with severe APTB. A key finding in our study was the high levels of CHIT1 in severe APTB patients. We identified a biomarker profile (IL-6, IFN-γ, IL-33, and CHIT1) that allows us to identify individuals with severe APTB, as well as the identification of a panel of polymorphisms (125) in clinical isolates of Mtb from individuals with severe APTB. Integrating these findings into a predictive model of severity would show promise for the management of APTB patients in the future, to guide host-directed therapy and reduce the prevalence of PTLD.

Advancing tuberculosis management: the role of predictive, preventive, and personalized medicine.

Tuberculosis is a major global health issue, with approximately 10 million people falling ill and 1.4 million dying yearly. One of the most significant challenges to public health is the emergence of drug-resistant tuberculosis. For the last half-century, treating tuberculosis has adhered to a uniform management strategy in most patients. However, treatment ineffectiveness in some individuals with pulmonary tuberculosis presents a major challenge to the global tuberculosis control initiative. Unfavorable outcomes of tuberculosis treatment (including mortality, treatment failure, loss of follow-up, and unevaluated cases) may result in increased transmission of tuberculosis and the emergence of drug-resistant strains. Treatment failure may occur due to drug-resistant strains, non-adherence to medication, inadequate absorption of drugs, or low-quality healthcare. Identifying the underlying cause and adjusting the treatment accordingly to address treatment failure is important. This is where approaches such as artificial intelligence, genetic screening, and whole genome sequencing can play a critical role. In this review, we suggest a set of particular clinical applications of these approaches, which might have the potential to influence decisions regarding the clinical management of tuberculosis patients.

Handgrip strength deficit and time lag between symptom onset and starting of chemotherapy in pulmonary tuberculosis: A cross-sectional study in North India

Objectives: Wasting is the predominant systemic clinical manifestation of chronic diseases like tuberculosis (TB). Delay in diagnosis and therapy initiation may affect handgrip strength, severity and outcome of the disease. Limited data are available on this in the Indian context, despite a high prevalence of TB. This study aimed to estimate and correlate deficits in handgrip strength amongst sputum-positive and sputum-negative pulmonary TB patients in relation to the time lag between symptom onset and starting of antitubercular therapy (ATT). Materials and Methods: We conducted a cross-sectional study amongst newly diagnosed sputum-positive and sputum-negative pulmonary TB patients and age- and sex-matched apparently healthy volunteers. Handgrip strength of 341 newly diagnosed patients of TB was monitored within 1 week of starting ATT and analysed. Demographic details and clinical history of the participants were noted in the pre-designed form. The handgrip strength of 100 healthy volunteers was also taken for comparison. Results: The study findings suggest that deficits in handgrip strength amongst sputum-negative patients were more than sputum-positive patients in comparison to age- and sex-matched healthy controls. It took an average of 63 ± 27 days between the onset of symptoms and starting of ATT in sputum-negative patients in comparison to an average of 47 ± 12 days in sputum-positive patients. Conclusion: Early consultation by patients, rapid diagnosis of TB and the start of ATT, thereby decreasing the time lag between the symptom onset and start of ATT, may lead to a decreased deficit in handgrip strength with the improved overall health of patients. Extensive Information, Education and Communication activities and newer diagnostic modalities for early identification of cases and the start of chemotherapy are required for optimal management of TB patients.

Serum Protein Electrophoresis Bands As Biomarkers for Drug-Sensitive Pulmonary Tuberculosis.

India has the highest cases of tuberculosis worldwide. According to WHO (2022), the incidence of tuberculosis in India is 210 per 100,000 population. Their incidence of new positive smear cases is 75 per 100,000 population per year. In tuberculosis, the level of albumin decreases while globulin increases leading to a low albumin to globulin (A/G) ratio, and electrophoresisof serum proteins aregood diagnostic approach and provides essential information for monitoring treatment outcomes. The present study includes 50 cases of pulmonary tuberculosis and 50 age-sex-matched healthy controls. Initially, serum protein estimation and electrophoresis were performed in newly diagnosed patients and controls. All drugs were given as National Tuberculosis Elimination Programme (NTEP) guidelines and blood samples were collected at two-month, four-month, and six-month intervals, and different serum protein fractions were compared and analyzed. The total serum protein was significantly lower in the cases than in the controls; 6.12±0.61 vs. 7.02±0.56 g/dL (p˂0.0020, t-value=3.12). The mean serum albumin was also significantly lower in the cases compared to the controls; 1.65±0.69 vs. 3.87±0.47g/dL (p˂0.0001, t-value=10.98). The α1 globulin started to rise after four months of treatment and at six months level was 0.262±0.32 g/dL. The level of γ globulin continuously decreases after antituberculous treatment to 1.56±0.67 gm/dL at six months. The cause of the decrease in total protein and albumin may be due to malnutrition leading to low cellular immunity. Serum protein leveland protein electrophoresis should be analyzed as routine tests inpatients before, during, and after treatment.It helps us in identifying patients at risk of pulmonary tuberculosis as well prognosis of the disease.This study is avaluable guide in deciding the effective management of tuberculosis patients with drug treatment plans and appropriate dietary intake. Hence, it highlights the complex relationship that exists between poverty and disease.

A randomized controlled trial to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among TB patients.

Background: The study was designed to evaluate the impact of pharmacist-led clinical interventions on the health-related quality of life among tuberculosis patients in Pakistan. Methods: A randomized, controlled prospective study was carried out in a Pakistan Institute of Medical Sciences hospital tuberculosis (TB) control center. Participants who visited the TB center between September 2020 and December 2021 were randomly assigned to two clusters, the usual care group (UC group) vs. the intervention group (pharmaceutical care group), in a 1:1 ratio by a simple envelope technique. In the intervention group, a patient received centered care that encompassed informed decision-making, which can increase the quality of care and monitoring of adverse drug events. However, the control group received routine TB treatment at the hospital. The EuroQol-5D-3L instrument was used to assess the health-related quality of life (HRQoL) at the baseline and in the third and sixth months of the treatment time period. Results: A total of 503 patients were eligible, of which only 426 patients were included in this study. At the end of the study, n = 205 of the patients in the intervention group and n = 185 of those in the control group were analyzed. In the intervention group, the EQ-5D-3L health utility score improved significantly (p < 0.001) (from the baseline mean ± SD, 0.40 ± 0.36, to 6months of treatment, 0.89 ± 0.09, while in the control group from 0.42 ± 0.35 to 0.78 ± 0.27). In multivariate regression analysis, the variables that remained statistically associated (p < 0.001) with the HRQoL (unstandardized β [95% confidence interval]) of the control group were as follows: gender, female vs. male (-0.039 [-0.076 to -0.003]); body weight, less than 40kg vs. more than 40kg (-0.109 [-0.195 to -0.024]); patients with any comorbidity vs. without comorbidity (-0.136 [-0.252 to -0.020]); and smokers vs. non-smokers (-0.204 [-0.291 to -0.118]). The study did not find any statistically significant associations between the intervention group's variables and the HRQoL. Conclusion: Patient-centered care interventions led by pharmacists as part of care coordination enhanced the HRQoL for TB patients significantly. According to this study, clinical pharmacists should be included in the interdisciplinary clinical staff for TB patient management.

Competencies of Indian Medical Graduates in delivering Effective Tuberculosis care: A mixed method study among doctors at Chennai, India

Introduction: In spite of the various advances in the Tuberculosis (TB) management system in our country, we are still struggling to achieve the End TB strategy. Addressing the health provider difficulties in TB care will definitely be potential tool to control TB. Objective: To assess the competency, challenges and solutions of Indian medical graduates to provide effective Tuberculosis care. Method: It is a mixed methodological study conducted among the Bachelor of Medicine and Bachelor of Surgery (MBBS) graduates practising in various parts of Chennai, Tamil Nadu, India. The competency of the Indian medical graduates in delivering TB care was assessed using a content validated e-survey questionnaire disseminated through social media affinity groups and free listing;pile sorting and in-depth interview was done in the qualitative part. Results:The proportion of participants having good, fair and poor competency in providing effective TB care was 35%,19% and 46%, respectively. Various challenges in attaining good competency were enlisted by the participants through free listing, a smaller number of TB patients in private medical college has attained the highest Smith S value followed by other eleven challenges. Based on the pile sorting and indepth interview various solutions have been suggested, with most of them emphasizing on compulsory TB chest clinic posting followed by others measures. Conclusion: The major reason identified in difficulties in delivering TB care was inadequate exposure in managing TB patients, incomplete knowledge on notification,referral and followup system. These lacunae can be overturned by compulsory posting in TB clinics during internship period, provision of required personal protective equipment (PPE) for doctors and patients in TB wards and outpatient department, mandatory teaching on updates of TB management.

Effect of a training intervention for finding the missed cases of tuberculosis amongst patent medicine vendors in Delta State, Nigeria.

The undiagnosed and untreated tuberculosis (TB) cases underpin the experience of accelerating deaths. Everyone should be engaged in managing TB patients to revert the current trend. In this context, we assessed the outcome of an education intervention on the knowledge of TB and referral practice of presumptive TB cases to directly observed therapy strategy amongst patent medicine vendors (PMVs). The study was quasi-experimental, conducted amongst 647 PMVs in Delta State, Nigeria. A structured questionnaire was administered to obtain baseline data on knowledge of TB. An educational intervention on knowledge of TB was then given. A post-intervention assessment of TB knowledge was subsequently conducted using the same questionnaire. The exact number of referrals of presumptive TB cases by PMVs and the number that tested positive amongst the referred presumptive TB cases, 3 months before and after the training were obtained from the state TB database. SPSS v. 26 was used for data analysis. The pre-training knowledge average score was 15.45 ± 6.45, while the post-training average score was 19.44 ± 7.03 (P < 0.001). The pre-training average number of presumptive cases referred was 146 ± 124.7, and the post-training was 205.67 ± 255.4, P = 0.41. The pre-training average number of cases that turned out positive was 9.5 ± 6.3, and the post-training was 13.5 ± 11.3, P = 0.42. There was a significant improvement in PMVs' knowledge of TB post-intervention. However, while an increase in the number of cases referred and positives detected was observed, this was not significant. Periodic training and updates to PMVs in keeping with current trends and best practices in TB management are recommended.

Impact of COVID-19 Coinfection on Management of Tuberculosis Patients Registered at DOTS Center in a Tertiary Care Hospital

Introduction: This study was conducted to determine the impact of coronavirus disease 2019 (COVID-19) and the ensuing lockdown on tuberculosis (TB) management undergoing treatment under the National Tuberculosis Elimination Program (NTEP) and vice-versa. Aims: To study (1) the occurrence of COVID-19 and its severity among patients suffering from TB and (2) the impact of a pandemic on TB management under NTEP. Materials and methods: A retrospective observational study was conducted in patients registered at Directly observed therapy short-course (DOTS) center from 1st April 2020 to 31st July 2021 at ESIC Medical College and Hospital, Faridabad, Haryana, India, using a semi-structured predesigned questionnaire administered telephonically. Results: Out of 387 TB patients registered at the DOTS center, 191 participated in the study. The occurrence of COVID-19 in patients with TB was 10 (5.2%), of which five (50%) were symptomatic; four (40%) had pulmonary TB, and six (60%) had extrapulmonary TB. Nine (90%) patients had mild and one (10%) moderately severe disease requiring hospitalization. Amongst 191 patients, 29 (15.2%) missed anti-TB treatment (ATT); 15 (51.7%) could not access the DOTS center due to restrictions, and seven (24.1%) due to personal reasons, eight (27.5%) forgot to take medication, and one (0.34%) migrated elsewhere. Conclusions: The occurrence of COVID-19 in patients with TB was found to be 5.2% in this study. The severity of COVID-19 was mostly mild and the mortality rate in patients with a coinfection of TB and COVID-19 was 10%. The COVID-19 pandemic had a negative impact on TB management under NTEP due to the imposed lockdown. The limitation of this study was the small sample size.

Characteristics and contributing factors of adverse drug reactions: an analytical study of patients with tuberculosis receiving treatment under the National TB Program of India

Background Tuberculosis (TB) continues to pose a serious threat to the public health system in India. Although the National Tuberculosis Elimination Program (NTEP) is providing a wide range of interventions from early diagnosis to complete treatment to reduce morbidity and mortality from TB, adverse drug reactions (ADR) remain a challenge in treatment adherence and completion. Methods An observational cross-sectional study was conducted in selected districts of Gujarat state. A total of 593 reported TB patients were recruited with an adjusted unified distribution based on the type of cases, site of diseases, and service facility through a simple random sampling method. A semi-structured questionnaire tool was used to collect socio-demographic, clinical, and ADR-related data from the TB patients. Data was analyzed for the frequency, percentage, chi-squared, and adjusted odds ratio to find the association between the variables. Results The majority of the study participants were male (87.2%), aged 15 to 60 (57.8%), daily laborers (22.4%), and married (64.2%). Over 75% of individuals had pulmonary TB, with 87% having experienced their first episode, 83% being new cases, and 44.7% having a history of addiction. ADR with mild symptoms was reported by more than a quarter (29%) of TB patients during the intensive phase (77%). The association between ADR experience and drug susceptibility was significant (p&lt;0.005) and drug-resistant TB patients experience two times more ADRs than drug-sensitive TB patients (OR 2.04). Binomial logistic regression was carried out to describe the association between various variables and occurrence of ADRs. Conclusion The study highlighted a need to enhance health care providers’ capacity and program structure for managing ADRs among TB patients. In order to completely eliminate TB across the country, it also emphasized the attention for a holistic and all-encompassing strategy for managing TB patients at the field level.

Assessment of Treatment Outcomes of Multidrug-Resistant Tuberculosis in Bangladeshi Population: A Retrospective Cohort Study

Introduction: Every year millions of people fall sick with Tuberculosis (TB). Multidrug-resistant tuberculosis (MDR-TB) has a life threatening public health crisis globally. Objective: To determine the successful treatment outcomes of MDR-TB in Bangladeshi population. Methods: This retrospective cohort study was conducted at the National Institute of Diseases of the Chest and Hospital (NIDCH) Mohakhali, Dhaka, on 224 patients enrolled within July 2014 to June 2015. Data were collected by face-to-face interview and reviewing medical records. Results: A total of 224 MDR-TB patients’ histories were studied, among them male and female were 71% and 29% respectively. The average age was 37.6± 13.7 years. Of the total MDR-TB patients, 49(21.9%) were successfully treated, 124 (55.4%) had completed, 3(1.3%) had treatment failure, 5(2.2%) were lost to follow-up, 1(0.4%) was XDR-TB and 29 (12.9%) died. This study also found out that the patient with advanced age (≥55;p&lt;0.001), living in rural areas (p&lt;0.01), history of missing dose(p&lt;0.001) and co-morbidity after treatment (p&lt;0.05) were significantly associated with poor treatment outcomes of MDR-TB. Conclusion: The study concluded that the successful treatment outcomes were 77.2% and the mortality rate was 12.9% of MDRTB patients. Living in rural areas and missing dose were significantly associated with poor treatment outcomes. So, the study demonstrated that it is necessary to ensure the completion of whole treatment course to manage TB patients effectively in order to prevent MDR-TB. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 57-60

Resistance and tolerance of Mycobacterium tuberculosis to antimicrobial agents-How M. tuberculosis can escape antibiotics.

Tuberculosis (TB) poses a serious threat to public health worldwide since it was discovered. Until now, TB has been one of the top 10 causes of death from a single infectious disease globally. The treatment of active TB cases majorly relies on various anti-tuberculosis drugs. However, under the selection pressure by drugs, the continuous evolution of Mycobacterium tuberculosis (Mtb) facilitates the emergence of drug-resistant strains, further resulting in the accumulation of tubercle bacilli with multiple drug resistance, especially deadly multidrug-resistant TB and extensively drug-resistant TB. Researches on the mechanism of drug action and drug resistance of Mtb provide a new scheme for clinical management of TB patients, and prevention of drug resistance. In this review, we summarized the molecular mechanisms of drug resistance of existing anti-TB drugs to better understand the evolution of drug resistance of Mtb, which will provide more effective strategies against drug-resistant TB, and accelerate the achievement of the EndTB Strategy by 2035. This article is categorized under: Infectious Diseases > Molecular and Cellular Physiology.

Integrated Management of Diabetes and Tuberculosis in Rural India - Results From a Pilot Study.

IntroductionThe World Health Organization and International Union against Tuberculosis (TB) recommends screening patients with TB for Diabetes Mellitus (DM) at the initiation of treatment. There are few pilot studies which screen TB patients for DM, but none of them have documented the feasibility of managing TB patients with DM in the Indian healthcare setting. Operational research is needed to determine the best way to manage individuals with both conditions. This pilot study aimed to develop, and field test an integrated, multidisciplinary program addressing the management of individuals with TB and DM and other associated chronic conditions in the Indian primary healthcare setting.MethodsThis pilot study used a randomized controlled trial design with mixed-methods evaluation and was conducted in Guntur district of Andhra Pradesh, a southern state of India. All the 120 patients newly diagnosed with TB from 10 participating villages were screened for DM and associated cardiovascular risk factors. Non-physician health workers were trained to follow-up patients for a period of 8 months to encourage treatment adherence, monitor treatment response including blood glucose levels and provide lifestyle advice.ResultsThe intervention was well-accepted by the providers and patients. However, there were no statistically significant variations observed for mean blood glucose levels (mean [SD]: 5.3 [−23.3 to 33.8]) of patients for both intervention and control group participants in this feasibility study. Awareness about diabetes and tuberculosis comorbidity and cardiovascular risk increased among the non-physician health workers in the intervention arm of the study.DiscussionThe co-management of TB-DM is acceptable to both the health providers and patients. With appropriate training, availability of infrastructure and planned intervention implementation, it is feasible to co-manage TB-DM within the existing primary health care system in India.

Evaluation of Mobile Application for the Management of Tuberculosis Patients in Tianjin During 2019-2020.

PurposePoor tuberculosis (TB) medication adherence increases the risk of treatment failure and development of drug-resistant TB, while universal implementation of directly observed therapy (DOT) is not feasible in China. EHealth technologies were reported to be promising patient-centered tools for improving adherence. However, only pilot studies have assessed patients’ experiences, and the results were discrepant.Patients and MethodsThis prospective-cohort study was conducted among TB patients at the outpatient department from 3 March 2019 to 30 May 2020 in Tianjin, China. Data were downloaded from the Tuberculosis Doctor App and TB Information Management System (TBIMS) and merged them by the TBIMS notification number. Logistic regression analysis was used to analyze the factors associated with regular drug-intake. Odds ratios and 95% confidence intervals were estimated with and without adjustment for age, gender, ethnicity and occupation.ResultsRevisit examination was more regularly and frequently in APP group than non-APP group. In APP group, 33.28% patients were regular drug-intake. The whole drug-intake rate was 84.84%. Tuberculosis pleurisy (aOR: 0.42, 95CI%=0.26–0.69) and retreated patients (aOR: 0.40, 95CI% =0.27–0.59) were more likely to have poor medication compliance. Local residents tend to have better medication compliance (aOR: 1.80, 95CI% =1.16–2.79).ConclusionAPP could improve TB patients’ revisit examination adherence. Medication adherence was poor in tuberculosis pleuritis and retreated patients, while local residents tend to have better medication adherence. To make full use of the mobile application in TB patient management, more incentive measures should be adopted for patients and doctors, respectively.

Examining pulmonary TB patient management and healthcare workers exposures in two public tertiary care hospitals, Bangladesh.

Implementation of tuberculosis (TB) infection prevention and control (IPC) guidelines in public tertiary care general hospitals remain challenging due to limited evidence of pulmonary TB (PTB) patients' duration of hospital stay and management. To fill this evidence gap, this study examined adult PTB patient management, healthcare workers' (HCWs) exposures and IPC practices in two public tertiary care hospitals in Bangladesh.Between December 2017 and September 2019, a multidisciplinary team conducted structured observations, a hospital record review, and in-depth interviews with hospital staff from four adult medicine wards.Over 20 months, we identified 1,200 presumptive TB patients through the hospital record review, of whom 263 were confirmed PTB patients who stayed in the hospital, a median of 4.7 days without TB treatment and possibly contaminated the inpatients wards. Over 141 observation hours, we found a median of 3.35 occupants present per 10 m2 of floor space and recorded a total of 17,085 coughs and 316 sneezes: a median of 3.9 coughs or sneezes per 10 m2 per hour per ward. Only 8.4% of coughs and 21% of sneezes were covered by cloths, paper, tissues, or by hand. The HCWs reportedly could not isolate the TB patients due to limited resources and space and could not provide them with a mask. Further, patients and HCWs did not wear any respirators.The study identified that most TB patients stayed in the hospitals untreated for some duration of time. These PTB patients frequently coughed and sneezed without any facial protection that potentially contaminated the ward environment and put everyone, including the HCWs, at risk of TB infection. Interventions that target TB patients screening on admission, isolation of presumptive TB patients, respiratory hygiene, and HCWs' use of personal protective equipment need to be enhanced and evaluated for acceptability, practicality and scale-up.

Lipid Abnormalities in Tuberculosis Patients with Diabetes Mellitus: A Hospital-based Cross-sectional Study

Introduction: Tuberculosis (TB) is a chronic infectious disease that also causes lipid abnormalities. Limited studies are focusing on metabolic abnormalities in TB patients with Diabetes Mellitus (DM). While studying lipid abnormalities in pulmonary TB patients, there were no marked differences between serum levels of cholesterol, triglycerides, Low Density Lipoprotein (LDL) and High Density Lipoprotein (HDL). However, it was suggested that increased levels of lipoprotein (a) in patients with pulmonary TB may be a risk for atherosclerosis. Aim: To study the lipid abnormalities in TB patients with DM. Materials and Methods: This cross-sectional study was conducted in Department of Pulmonary Medicine at a tertiary care teaching institute {PES Institute of Medical Sciences and Research (PESIMSR} Andhra Pradesh, India, between October 2015 to March 2016 (six months). Four groups were made, Group I included 30 patients with TB and no DM, Group II included 25 patients with TB with DM, Group III had 30 patients with DM only and Group IV was control group with 30 healthy individuals. Lipid profile testing was done for all the participants and the values obtained were compared. Analysis of Variance (ANOVA) test was used to compare the means between the groups and Kruskal-Wallis test when data did not follow the normal distribution. The p-value &lt;0.05 was considered statistically significant. Results: Total 25 patients in group II had 18 male and 7 female with mean age of 48.5±11.12 years. The total cholesterol, triglycerides, Very Low Density Lipoprotein (VLDL) was high in group III (176.33±43.35 mg/dL, 221.733±39.2 mg/dL, 34.8±17.81 mg/dL respectively). The HDL was lowest in group II (27.88±8.03 mg/dL). However, the LDL values showed no significant difference between the groups (p-value=0.162). group I had Low Body Mass Index (BMI) (18.61±3.6 kg/ m2). The atherogenic index was high in group II especially in males. Conclusion: In patients with TB and DM, screening of lipid profile can provide markers of atherogenicity which may help to predict and prevent cardiovascular events. A good nutritious diet is recommended alongside chemotherapeutics in the treatment for TB patient's management and their lipid profile status should be monitored while managing the patients.