Outcome Of Tuberculosis Patients Research Articles

Pharmacokinetics-pharmacodynamics of first-line antitubercular drugs: a comparative study in tuberculosis patients with and without concomitant diabetes mellitus.

To observe the variability in the plasma concentrations and pharmacokinetic-pharmacodynamic (PK-PD) profiles of first-line antitubercular drugs in pulmonary tuberculosis (TB) patients with and without diabetes mellitus (DM). Newly diagnosed pulmonary TB patients aged 18-60years with or without DM were included in the study. Group I (n = 20) included patients with TB, whereas group II (n = 20) included patients withboth TB and DM. After 2 weeks of therapy, plasma concentrations and other PK-PD parameters were determined. Improvements in clinical features, X-ray findings, sputum conversion, and adverse drug reactions (ADRs) were assessed after 2 months of therapy. Isoniazid displayed non-significantly higher plasma concentrations in diabetic patients, along with a significantly (P < 0.05) longer elimination half-life (t1/2). Rifampicin plasma concentrations at 4, 8, and 12 h were significantly (P < 0.05) lower, and it displayed significantly (P < 0.05) lower area underthe curve (AUC0-12 and AUC0-∞), shorter t1/2, higher clearance (Cl), and a lower AUC0-∞/MIC ratio in diabetic patients. Pyrazinamide and ethambutol showed non-significantly higher plasma concentrations, AUC0-12, AUC0-∞, and t1/2 in diabetic patients. The improvements in clinical features, X-ray findings, sputum conversion, and ADRs were comparable in both groups. The presence of DM in TB patients affects the PK-PD parameters of isoniazid, rifampicin, pyrazinamide, and ethambutol variably in the Indian population. Studies with a larger number of patients are required to further elucidate the role of DM on the PK-PD profile of first-line antitubercular drugs and treatment outcomes in TB patients with concomitant DM. CTRI/2021/08/035578 dated 11/08/2021.

Factors Affecting Treatment Outcomes for Tuberculosis Patients: A Retrospective Cohort Study

Background: Tuberculosis (TB) is one of the ten leading causes of death globally. The present study aims to examine the treatment outcomes in TB patients and to determine the factors associated with unsuccessful treatment outcomes. Materials and Methods: This study was a retrospective registry-based cohort study conducted in Ordu pro-vince of Turkey between 2017-2021. Logistic regression analysis was used to explore the risk factors asso-ciated with unsuccessful outcomes. Results: A total of 400 TB patients were included in the analysis. The observed overall treatment success rate (TSR) (cured or treatment completed) was 87.7% (351). 49 patients (12.3%) had unsuccessful treatment results (death, failure or loss to follow-up). Age&amp;gt;65 years (odds ratio [OR] =12.2, 95% confidence intervals [CI] =4.03-36.85), male gender (OR = 2.2, 95% CI = 1.05-4.45) and being foreign-born (OR = 9.2, 95% CI = 1.16-73.72) were identified as risk factors associated with unsuccessful outcomes in patients (p&amp;lt;0.05). Conclusions: Age&amp;gt;65 years, male gender and foreign-born patients tend to have unsuccessful treatment outcomes. Careful monitoring of patients with any of these characteristics and taking special precautions for them may help to decrease unsuccessful treatment outcomes.

Dietary Assessment of Tuberculosis Patients Receiving Treatment at a Tertiary Care Center in New Delhi

Introduction: Undernutrition and tuberculosis (TB) are interrelated, with a bidirectional relationship. Despite its potential impact on nutritional status and TB patient outcomes, there is limited information available on the dietary patterns of TB patients in the Indian TB program. This study aims to address this knowledge gap by evaluating dietary patterns and factors associated with reduced dietary intake among TB patients in a tertiary care center. Methodology: This was a cross-sectional study conducted in a directly observed treatment short center working under the National Tuberculosis Elimination Program. A semi-structured, pretested interviewer-administered questionnaire was used to collect data related to the demographic profile and dietary patterns of 49 patients. Results: The mean calorie intake among the patients was 1525.2 (±897) kcal, whereas the required mean calorie intake was 2231.6 (±409.2) kcal. The mean protein requirement was 66.9 (±15.2) g, whereas the mean protein intake was only 39.2 (±15.4) g. Conclusion: To strive toward the goal of TB elimination in India, the nutritional care of the patient cannot be undermined. The need of the hour is to enforce the nutritional supplementation as well as support program by the government at the national level.

The Practice and Modalities of African Traditional Medicine in Tuberculosis Treatment - A Traditional Medical Practitioners’ Perspective

Aims: This study sought to explore the role of the traditional medical practitioner (TMP) and document the modalities of tuberculosis (TB) treatment in traditional medicine (TM) in Harare, Zimbabwe. Study design: An ethnographic research survey of TMPs in Harare urban. Place and Duration of Study: Harare’s southern suburbs of Warren Park, Mufakose, Budiriro, Belvedere, Mbare (Mupedzanhamo) and Harare central business district, between April and June 2021. Methodology: Fourteen (14) experienced TB practitioners, registered with the Zimbabwe National Traditional Healers Association (ZINATHA) were recruited for the study. These included exclusive herbalists (36%), spiritualists (14%) and those who used a combination of spiritualism and herbalism (50%) in their practice. Data was collected through semi-structured in-person interviews. The practices and treatment modalities in the traditional treatment of TB were documented; and any linkages with the conventional medical system were identified. Results: Forty-six (46) plant species from 28 families were prescribed in various polyherbal combinations for a maximum of 6 months in difficult cases. TMPs were found to be relevant and knowledgeable in the treatment of TB. In addition to offering alternative or complementary treatment options to patients, TMPs were also agents of health education promotion, and collaborated to some extent with allopathic healthcare providers across the service delivery system from diagnosis to treatment of patients. Conclusion: If formalized, TMPs have the potential to make considerable contributions to TB treatment strategies and help improve treatment outcome in TB patients.

Pharmacogenetic Study of Drugs Affecting Mycobacterium tuberculosis.

Pharmacogenetic research has led to significant progress in understanding how genetic factors influence drug response in tuberculosis (TB) treatment. One ongoing challenge is the variable occurrence of adverse drug reactions in some TB patients. Previous studies have indicated that genetic variations in the N-acetyltransferase 2 (NAT2) and solute carrier organic anion transporter family member 1B1 (SLCO1B1) genes can impact the blood concentrations of the first-line anti-TB drugs isoniazid (INH) and rifampicin (RIF), respectively. This study aimed to investigate the influence of pharmacogenetic markers in the NAT2 and SLCO1B1 genes on TB treatment outcomes using whole-exome sequencing (WES) analysis. DNA samples were collected from 30 healthy Iranian adults aged 18-40 years. The allelic frequencies of single-nucleotide polymorphisms (SNPs) in the NAT2 and SLCO1B1 genes were determined through WES. Seven frequent SNPs were identified in the NAT2 gene (rs1041983, rs1801280, rs1799929, rs1799930, rs1208, rs1799931, rs2552), along with 16 frequent SNPs in the SLCO1B1 gene (rs2306283, rs11045818, rs11045819, rs4149056, rs4149057, rs2291075, rs201722521, rs11045852, rs11045854, rs756393362, rs11045859, rs74064211, rs201556175, rs34671512, rs71581985, rs4149085). Genetic variations in NAT2 and SLCO1B1 can affect the metabolism of INH and RIF, respectively. A better understanding of the pharmacogenetic profile in the study population may facilitate the design of more personalized and effective TB treatment strategies. Further research is needed to directly correlate these genetic markers with clinical outcomes in TB patients.

The Convention of Regular Treatment with Sphetic Conversion During Intensive Tuberculosis Treatment

Purpose: The primary objective of this research is to investigate the relationship between medication regularity and sputum conversion following the intensive treatment phase of pulmonary tuberculosis (TB) at Banyu Urip Public Health Center in Surabaya. Recognizing the importance of sputum conversion as a key determinant of treatment success in pulmonary TB, this study aims to assess the impact of medication regularity on the achievement of sputum conversion among TB patients. Methods: This study adopts an analytic correlation approach with a cross-sectional design. The study population comprises tuberculosis patients receiving treatment at the Public Health Center. Data collection involves simple random sampling of 51 respondents, focusing on variables related to medication regularity and sputum conversion. Questionnaires based on the Morisky Medication Adherence Scale-8 (MMAS-8) and observation sheets are utilized as instruments. Data analysis is conducted using logistic binary regression to examine the relationship between medication regularity and sputum conversion. Results and Discussion: Among the 51 respondents, 70.6% demonstrated regularity in treatment, with 76.5% achieving sputum conversion. The Spearman rank test analysis indicates a significant relationship between medication regularity and sputum conversion (p = 0.011; p &lt; α = 0.05; r = 0.352). These findings suggest that adherence to medication is positively associated with successful sputum conversion following the intensive treatment phase of tuberculosis. Such results underscore the critical role of medication regularity in achieving positive treatment outcomes in TB patients. Implications of the Research: The research outcomes hold important implications for healthcare providers and policymakers involved in tuberculosis management and control. The findings highlight the significance of promoting medication regularity among TB patients to enhance treatment efficacy and increase the likelihood of sputum conversion. It underscores the importance of providing comprehensive counseling and support services to TB patients and their families, along with engaging other relevant stakeholders, to ensure adherence to treatment protocols throughout the course of therapy. Originality/Value: This study contributes to the existing literature by focusing on the relationship between medication regularity and sputum conversion specifically within the context of tuberculosis treatment. By employing logistic binary regression analysis and incorporating the MMAS-8 questionnaire, the research offers valuable insights into the factors influencing treatment outcomes in TB patients. The findings provide a basis for targeted interventions aimed at improving medication adherence and enhancing treatment success rates in pulmonary tuberculosis, thereby contributing to more effective tuberculosis management strategies.

Unveiling quality, clinical, and financial Impacts of Pulmonary Tuberculosis Clinical Pathway Implementation in Magelang Public Hospital, Indonesia

Tuberculosis (TB) is a popular endemic disease in Indonesia with increased risk outcomes. The clinical pathway (CP) is crucial to enhancing healthcare services and resource efficiency despite discrepancies in service variability reduction, clinical outcomes improvement, and cost saving. Therefore, this study aimed to assess pulmonary TB CP and evaluate its impacts on clinical and financial results, as well as barriers to implementation at Tidar Hospital in Magelang, Indonesia. A sequential explanatory mixed-method design was used from July 2022 to January 2023. The study began with a retrospective analysis of medical records of TB patients (total sampling, n=92). In-depth interviews (IDIs) were conducted with healthcare workers including the quality and medical committee, case manager, CP team, inpatient and non-inpatient nursing sub-coordinators, and pulmonary specialists. In addition, eight multidiscipline healthcare professionals attended the focus group discussions (FGDs). The audio recordings were transcripted verbatim and subjected to thematic analysis. The results showed that the quality and content of CP based on TB evaluation using the Integrated Clinical Pathway Assessment Tool (ICPAT) was 62.6%. Four themes were obtained: 1) CP implementation techniques, 2) supportive factors in the success of CP, 3) organization support in CP implementation, and 4) TB patient outcomes. Furthermore, procedure compliance after CP implementation was 33%. There were no significant differences in the length of stay (p=0.77), diagnosis investigation and therapy appropriateness (100%), mortality (4 vs 3 patients; p=0.589), and cost efficiency with an average cost of care (Rp 6.994.508,- vs Rp 5.521.091,-; p=0.083) before and after CP implementation. Readmission rates were low before and after deployment (1 vs. 2 patients). This study found no significant clinical or financial benefits in TB CP implementation. These results imply the need for hospital leadership and a multidisciplinary team to overcome CP implementation hurdles.

Impact of diabetes mellitus on tuberculosis treatment outcomes: a cohort study in Bengaluru, India

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in regions with a high prevalence of diabetes mellitus (DM). This study aims to evaluate the impact of DM on the treatment outcomes of TB patients in Bengaluru, India. Methods: In this cohort study, we examined 592 patients with smear-positive pulmonary TB, half of whom had a comorbid diagnosis of DM. Conducted in the Bruhat Bengaluru Mahanagara Palike area, the study included patients registered under the national TB elimination programme (NTEP). Data were collected on demographic characteristics, treatment adherence, sputum positivity, and treatment outcomes over six months. Results: The study revealed a high prevalence of DM among TB patients. Significant associations were observed between DM and various challenges, including higher rates of sputum positivity, poor adherence to anti-TB and anti-diabetic medications, increased adverse drug reactions (ADRs), and a higher default rate. TB patients with DM had a 1.5 times higher risk of unsuccessful treatment outcomes compared to non-diabetics. Furthermore, the risk of poor outcomes, particularly relapse, increased substantially in the TB-DM group during the six-month follow-up. Conclusions: Our findings highlight the crucial need for integrated TB and DM management strategies. This includes routine DM screening for TB patients, personalized treatment regimens, and enhanced patient education and support. These measures are essential for improving treatment outcomes in TB patients with comorbid DM.

1867. Clinical Presentation and Outcome of Tuberculosis in Patients with Chronic Kidney Disease Stage 4 and 5: A Retrospective Cohort Study from a TB Endemic Country

Abstract Background Patients with chronic kidney disease (CKD) have high risk of developing TB and numerous studies have been done on presentation and outcome of both conditions. However there is a lack of data on regional burden of TB in this group of population. We set out to study on clinical presentation and treatment outcome of TB in patients with moderate to severe renal impairment from a large renal and dialysis center. Demographics and microbiological characteristics of Tuberculosis in patients with CKD Risk factors of mortality in patients with TB and CKD Methods This is a retrospective cohort study included all patients with CKD stage 4 and 5 and diagnosed active TB from May 2016 till June 2020. Transplant recipients were excluded. TB diagnosis was made as pulmonary tuberculosis (PTB), extra pulmonary TB (EPTB) and disseminated TB (DTB). Primary outcome was measured as treatment successfully completed, lost to follow up, all-cause mortality. Our secondary outcome was to evaluate microbiological characteristics and drug resistant pattern in PTB and EPTB. Microbiology of mycobacterium TB in CKD patients Characteristics of EPTB Results A total of 259 patients with stage 4-5 CKD of all age groups were identified. Mean age of study population was 34.68 +16.7 and a higher proportion of EPTB than PTBTB (61% and 37.1% respectively). Diagnosis of TB in majority of patients 118 (45.51%) were microbiological based and 46 (17.8%) isolates found to have culture positive among those, 16 (34.78%) were resistant to either single (26.08%) or multiple TB drugs (8.69%). Out of 259, 38 (14.7%) patients died during treatment and 12 (4.6%) patients lost to follow up. Our treatment success rate (treatment completed and cured) was 80.7%. Conclusion We have made few important observations such as diagnosis EPTB as predominant from in CKD. We have made microbiological based diagnosis in around half of our patients. Drug resistance and mortality was found to be high. Disclosures All Authors: No reported disclosures

Barriers and facilitators of implementing electronic monitors to improve adherence and health outcomes in tuberculosis patients: protocol for a systematic review based on the Consolidated Framework for Implementation Research.

Tuberculosis (TB) has been regarded as 'a relentless scourge', increasing morbidity and mortality and burdening vulnerable populations. Poor adherence to TB treatment and ineffective traditional interventions hinders TB control. A novel TB approach called 'electronic monitors', equipping medication boxes with daily audio or visual reminders for electronically monitoring medication intake, seems promising in improving adherence and health outcomes and overcoming the weaknesses of traditional interventions. However, no review has systematically examined and synthesized the influencing factors of implementing electronic monitors. Implementation research offers the means to analyse the influencing factors of the implementation and its process, fitting well with the aim of this review. Therefore, the widely recognized Consolidated Framework for Implementation Research (CFIR), which offers a common taxonomy for evaluating intervention implementation, will be adopted to systematically identify barriers and facilitators of the electronic monitors for improving adherence and health outcomes in patients with TB. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature research will be conducted in five electronic databases (Ovid MEDLINE, CINAHL, EMBASE, Cochrane Library and Web of Science) to identify the barriers and facilitators of implementing electronic monitors in patients with TB. The CFIR will be used as a guide for categorizing and synthesizing the barriers and facilitators. Study screening, data extraction, quality appraisal and data analysis will be conducted by two independent reviewers. The use of additional reviewers will solve any disagreements between the two reviewers. Given the increased prominence of TB epidemiology and the adherence problem of electronic monitors, there is a solid rationale for synthesizing the existing studies via the CFIR. The findings and conclusion of this review will lay bare the achievements and effectiveness of implementing electronic monitors, as well as the attendant gaps and limitations. Further strategies for facilitating the implementation of electronic monitors will also be explored. This review will be of essential significance for research and practice, supporting future academic research initiatives centred on patients with TB and aiding electronic monitor design in lowering the morbidity and mortality associated with TB disease. PROSPERO: CRD42023395747.

Treatment outcomes and associated factors among tuberculosis patients attending Gurage Zone Public Hospital, Southern Nations, Nationalities, and People's Region, Ethiopia: an institution-based cross-sectional study.

Tuberculosis remains the most important global health problem. Worldwide, tuberculosis is the cause of a single infectious agent and the ninth leading cause of death, ranking above human immunodeficiency virus. In high-burden settings, one of the mechanisms to control tuberculosis is to identify patients' problems during treatment. Nevertheless, the problem is still a countrywide issue, and there is a shortage of research to show treatment outcomes and associated factors of tuberculosis in Southern Nations, Nationalities, and People's Regions in the Gurage Zone. An institution-based, cross-sectional study was conducted to collect data from 347 medical records of tuberculosis patients from 20 July 2016 to 30 July 2021 at Gurage Zone Public Hospitals. The tool includes data about socio-demographic characteristics, as well as tuberculosis-related, and tuberculosis treatment outcome status. Data were analyzed using SPSS version 26, and multivariable logistic regression analyses were conducted to identify significantly associated variables with successful tuberculosis treatment outcomes. The adjusted odds ratio (AOR) with its 95% confidence interval (CI) at a p-value of < 0.05 was used to claim statistical association. In this study, the overall prevalence of successful tuberculosis treatment outcomes was 79.3%. HIV-negative tuberculosis patients (AOR = 4.33; 95% CI: 1.91, 9.79), patients aged < 20 years (AOR = 0.16; 95% CI: 0.04, 0.74), and married participants (AOR = 0.29; 95% CI: 0.10, 0.88) were significantly associated with successful tuberculosis treatment outcomes. The prevalence of successful tuberculosis treatment outcomes was low. HIV-TB co-infection, single marital status, and age >20 years negatively affected the treatment outcomes of tuberculosis, thus more effort and better attention should be given to better outcomes of tuberculosis patients, especially for HIV-TB co-infected participants.

The Trend, Characteristics and Treatment Outcomes in Patients with Tuberculosis Undergoing Thoracic Surgery in the Kyrgyz Republic between 2017 and 2021.

Surgery has played an important role in managing complicated tuberculosis in former Soviet Union countries, including the Kyrgyz Republic. However, published information is limited. This study aimed to document the trend, characteristics and outcomes of tuberculosis patients who underwent thoracic surgery, using routinely collected data. Between 2017 and 2021, 4-7% of tuberculosis patients in the Kyrgyz Republic underwent thoracic surgery in two centres in Bishkek and Osh. In 2021, case records were retrieved in 264 (78%) of 340 patients undergoing thoracic surgery in the country. The most common indications for surgery were pleural exudate/empyema in 127 (44%) and tuberculoma in 83 (32%). Most patients (73%) underwent surgery within 30 days of starting TB treatment. Two-thirds of patients underwent radical surgery, and surgical outcomes were excellent in 99% of patients with one death. Post-operatively, 63 (23%) patients had no TB detected by the histology, with the two most common specified conditions being lung cancer and pulmonary hydatid disease. TB treatment was stopped in these patients. Of the 201 patients with confirmed TB after surgery, TB-treatment success was documented in 163 (81%), died/failure/lost to follow-up in 10 (5%) and not evaluated in 28 (14%). This study shows that thoracic surgery is feasible, safe and effective in the routine programme setting. Recommendations are made to strengthen referral and monitoring systems.

Impact of Lifestyle Change Intervention on Tuberculosis Treatment Outcome in Tuberculosis Patients with Diabetes Mellitus Comorbidity in South West Nigeria

It is well documented in the literature that there is poor treatment outcome in patients with Tuberculosis and Diabetes (TBDM) comorbidity due to the observed interference of drugs for Tuberculosis (TB) treatment on anti-diabetic drugs and elevated glucose level reduces the efficacy of anti- tuberculosis drugs leading to poor TB treatment outcome, and that insulin therapy is not affected by this drug interaction. Importantly, access to Insulin is a challenge due to its prohibitive out-of-pocket cost. The only alternative sustainable treatment for TBDM patients in resource-limited communities is lifestyle-based intervention. This study evaluated the impact of lifestyle intervention on TB treatment outcomes in patients with TBDM comorbidity. This study is a quasi-experimental intervention involving two cohorts of 25 TBDM patients each, as control and experimental cohorts. Their enrolment was from Tuberculosis patients from health facilities in Lagos and Oyo states. The questionnaires were administered before the commencement of the Intervention and at 8 weeks. The sputum Acid Fast Bacillus (AFB) was checked, and chest x-ray (CXR) done before Intervention and Sputum AFB at 8 weeks. The Control group showed no difference in the means of the sputum AFB 95%CI: 0.12(- 0.12 – 0.36; p&gt;0.05), which was an indication of poor treatment outcome. The difference in the means of the sputum AFB in the intervention group was statistically significant 95%CI: -0.8(-0.9 - -0.6; p&lt;0.05). The intervention with educational and behavioral lifestyle modifications significantly improved the outcome of treatment of TB in TBDM comorbidity. Keywords: Behavioral change, Tuberculosis, Diabetes, comorbidity, Treatment outcome.

Effect of Lifestyle Modification Intervention on Diabetes Mellitus Treatment Outcomes in Tuberculosis Patients with Diabetes Mellitus in Southwest Nigeria

There is an observed poor treatment outcome of Diabetes mellitus (DM) in patients with Tuberculosis and Diabetes (TBDM) comorbidity due to interference of drugs used in the treatment of Tuberculosis (TB) with first- line drugs used in the treatment of DM. Insulin does not interact with TB drugs, but it is not accessible and affordable to low–resource communities due to high cost. Hence a lifestyle-based intervention, which this study evaluated to determine its effect on Diabetes control in these individuals. It is a quasi-experimental intervention with two groups of 25 participants each as experimental and control cohorts, enrolled from Tuberculosis Healthcare centers in Lagos and Oyo states. The questionnaires were administered after the baseline Glycated hemoglobin (HBA1c) has been measured, repeated after 12 weeks, and analyzed with SPSS software. In the control cohort, the difference in the means of HBA1c was statistically significant at 95%CI: 1.1(0.2 – 2.1; p&lt;0.05), indicating a worsening of blood glucose control. The difference in the means of educational scores was not significant 95%CI: -0.04(-2.8 – 2.7; p&lt;0.05), showing no uptake. In the intervention group, the difference in the means of the HBA1c was statistically significant 95%CI: -2.4(-3.1 – 1.6: p&lt;0.05), indicating improvement in glucose control. The difference in the means of the educational and behavioral score was significant statistically 95%CI: 40.6(37.7 – 43.6; p&lt;0.05) indicating uptake of behavioral changes. The intervention with educational and behavioral lifestyle modifications improved the blood glucose control as an adjunct to the conventional treatment with drugs compared to the control group. Keywords: Behavioral change, Lifestyle, Treatment, Tuberculosis-Diabetes comorbidity.

Treatment Outcome of Tuberculosis in Patients with Diabetes under RNTCP in a Tertiary Care Centre, Chengalpattu, India: A Prospective Cohort StudyTreatment Outcome of Tuberculosis in Patients with Diabetes under RNTCP in a Tertiary Care Centre, Chengalpattu, India: A Prospective Cohort Study

Introduction: Diabetes increases the risk of Tuberculosis (TB) by three times, and this bidirectional association is currently one of the major concerns. A stronger evidence base is required to clarify the impact of Diabetes Mellitus (DM) on the treatment outcome of TB. Aim: To compare the treatment outcome among diabetic and non diabetic patients on Category-I TB treatment based on the Revised National Tuberculosis Control Program (RNTCP). Also, to assess the various factors influencing the treatment outcome of TB among diabetic patients. Material and Methods: A prospective cohort study was conducted on 75 newly diagnosed TB patients enrolled for Category-I treatment Department of Pulmonary Medicine, Chengalpattu Medical College, Chengalpattu, Tamil Nadu, India, between October 2018 to November 2019. All patients with TB underwent blood glucose screening at treatment initiation and were categorised into two groups: with diabetes and without diabetes. Demographic details, family history of DM, smoking, alcohol consumption, and clinical profile were collected using a semi-structured questionnaire and followed-up for six months to assess their treatment outcome. The treatment outcome was compared statistically based on diabetes status using the Chi-square test. Results: The mean age of the study population was 49.9±0.5 years, with the majority being male 56 (74.7%). More than half of the study population belonged to a low socio-economic status. Among the study population, 42 (56%) were diabetic, with a mean blood glucose level of 242.7±80.5 mg/dL. Eighty-two percent had Pulmonary TB, with a 68% smear positivity rate among diabetic patients. In terms of treatment outcome, 44 (58.7%) were cured, 15 (20%) completed treatment, 10 (13.3%) were lost to followup, and 6 (8%) expired during the treatment course. Conclusion: Smear positivity and pulmonary TB were predominant among patients with diabetes. Treatment completion was lower, and mortality was higher among diabetic patients with TB.

Tuberculosis treatment outcomes and patient support groups, southern India.

To assess treatment outcomes in tuberculosis patients participating in support group meetings in five districts of Karnataka and Telangana states in southern India. Tuberculosis patients from five selected districts who began treatment in 2019 were offered regular monthly support group meetings, with a focus on patients in urban slum areas with risk factors for adverse outcomes. We tracked the patients' participation in these meetings and extracted treatment outcomes from the Nikshay national tuberculosis database for the same patients in 2021. We compared treatment outcomes based on attendance of the support groups meetings. Of 30 706 tuberculosis patients who started treatment in 2019, 3651 (11.9%) attended support groups meetings. Of patients who attended at least one support meeting, 94.1% (3426/3639) had successful treatment outcomes versus 88.2% (23 745/26 922) of patients who did not attend meetings (adjusted odds ratio, aOR: 2.44; 95% confidence interval, CI: 2.10-2.82). The odds of successful treatment outcomes were higher in meeting participants than non-participants for all variables examined including: age ≥ 60 years (aOR: 3.19; 95% CI: 2.26-4.51); female sex (aOR: 3.33; 95% CI: 2.46-4.50); diabetes comorbidity (aOR: 3.03; 95% CI: 1.91-4.81); human immunodeficiency virus infection (aOR: 3.73; 95% CI: 1.76-7.93); tuberculosis retreatment (aOR: 1.69; 1.22-2.33); and drug-resistant tuberculosis (aOR: 1.93; 95% CI: 1.21-3.09). Participation in support groups for tuberculosis patients was significantly associated with successful tuberculosis treatment outcomes, especially among high-risk groups. Expanding access to support groups could improve tuberculosis treatment outcomes at the population level.

Need to Think Outside the Box: Clinical Presentation and Outcome of Tuberculosis in Patients With CKD

Need to Think Outside the Box: Clinical Presentation and Outcome of Tuberculosis in Patients With CKD

Antibiotic resistance acquisition versus primary transmission in the presentation of extensively drug-resistant tuberculosis.

Mycobacterium tuberculosis is the leading cause of mortality worldwide due to a single bacterial pathogen. Of concern is the negative impact that the COVID-19 pandemic has had on the control of tuberculosis (TB) including drug-resistant forms of the disease. Antimicrobial resistance increases the likelihood of worsened outcomes in TB patients including treatment failure and death. Multidrug-resistant (MDR) strains, resistant to first-line drugs isoniazid and rifampin, and extensively drug-resistant (XDR) strains with further resistance to second-line drugs (SLD), threaten control programs designed to lower TB incidence and end the disease as a public health challenge by 2030, in accordance with UN Sustainable Development Goals. Tackling TB requires an understanding of the pathways through which drug resistance emerges. Here, the roles of acquired resistance mutation, and primary transmission, are examined with regard to XDR-TB. It is apparent that XDR-TB can emerge from MDR-TB through a small number of additional resistance mutations that occur in patients undergoing drug treatment. Rapid detection of resistance, to first-line drugs and SLD, at the initiation of and during treatment, and prompt adjustment of regimens are required to ensure treatment success in these patients. Primary transmission is predicted to make an increasing contribution to the XDR-TB caseload in the future. Much work is required to improve the implementation of the World Health Organization-recommended infection control practices and block onward transmission of XDR-TB patients to contacts including health-care workers. Finally, limiting background resistance to fluoroquinolones in pre-XDR strains of M. tuberculosis will necessitate better antimicrobial stewardship in the broader use of this drug class.

Impact of early diagnosis of impaired glucose regulation in tuberculosis: Comparison of clinical outcomes in people with tuberculosis in Tanzania

Diabetes mellitus (DM) has been known to compromise tuberculosis (TB) treatment outcomes. Association data are limited for early hyperglycaemia detection and TB treatment outcomes. Thus, we assessed treatment outcomes including time to sputum conversion and death in TB participants with or without hyperglycaemia. A prospective cohort study recruited TB participants receiving anti-TB treatment at health facilities in Tanzania between October 2019 and September 2020. Hyperglycaemia was defined as having pre-existing DM or pre-treatment random blood glucose of ≥7.8 mmol/L, in combination categorised as impaired glucose regulation (IGR). Those with IGR were further screened for hyperglycaemia severity using glycated haemoglobin. In case of unknown status, participants were tested for HIV. Time to death was determined at 6months of TB treatment. Of 1344 participants, 187 (13.9%) had IGR, of whom 44 (23.5%) were HIV co-infected. Overall treatment success was 1206 (89.7%), and was similar among participants with or without IGR (p> 0.05). Time to death for participants with and without IGR was 18 versus 28 days (p= 0.870), respectively. Age ≥ 40 years (p= 0.038), bacteriological positive (p= 0.039), HIV (p= 0.009), or recurrent TB (p= 0.017) predicted death or treatment success during TB treatment in adjusted multivariable models. IGR did not influence clinical outcomes in TB patients with or without IGR in a programme of early IGR diagnosis and integration TB, HIV and DM care. Early detection and co-management of multi-morbidities among people diagnosed with TB may reduce likelihood of poor treatment outcomes in a programmatic setting.

Clinical and statistical analysis of predictors oflethal outcomes in tuberculosis patients treated in medical units of the Russian Federal penitentiary system

The objective: to determine risk factors of lethal outcomes (predictors) in tuberculosis patients treated with chemotherapy regimens I, II, III during confinement in the Russian penitentiary system.Subjects and Methods: data on 6,069 patients registered for treatment in 2019 and 2020 were studied. Univariate and multivariate analyses were performed.Results. The following factors were found to have effect on mortality: age (aOR = 1.05; 95% CI 1.03-1.06), multiple localizations of tuberculosis (aOR = 11.08; 95% CI 5.12-24.20), concurrent HIV infection (aOR = 9.13; 95% CI 6.90-12.24), and positive sputum microscopy at registration (aOR = 5.18; 95% CI 3.93-6.81). The patient gender was found to have no effect (OR = 0.9; 95% CI 0.4-1.9; p = 1).