Treatment Of Pulmonary Tuberculosis Research Articles

The surfactant inhaled therapy in a complex lung tuberculosis treatment: clinical reviews

The article describes the clinical case reports of patients with respiratory tuberculosis who were hospitalized at the Regional Clinical Antituberculosis Center in Kursk. One of them was in the pediatric department for patients with tuberculosis of respiratory organs and the other in the 1st department for patients with multidrug-resistant tuberculosis. As pathogenetic therapy in the complex treatment of pulmonary tuberculosis, in the intensive phase of anti-tuberculosis chemotherapy, we added inhalation therapy with surfactant (medicinal product surfactant-BL lyophilisate for emulsion preparation, 75 mg, manufactured by Biosurf LLC, Russia) according to the instructions to the drug. Treatment of pulmonary tuberculosis is performed by multiple inhalations of surfactant-BL as part of complex therapy against the background of fully deployed antituberculosis drugs (ATD), i.e. when the patient empirically or based on data on drug sensitivity of the pathogen is selected 4-6 ATD that are well tolerated by the patient in the prescribed dose and combination. It should be noted that an adult patient during the intensive phase of anti-tuberculosis chemotherapy had COVID-19. Against the background of inhalation therapy with surfactant, it was possible to stabilize the clinical and radiological condition of the patients, and to improve their condition. Clinically it was expressed in reduction of coughing, increase of tolerance to physical exertion. For example, according to spirometry data on the admission of an adult patient and in dynamics, the vital capacity index (VCI) increased from an extremely sharp decrease (31.25%) to 75%, which corresponded to a very mild decrease. At the moment the patient from the children’s ward is completing a course of antituberculosis therapy with small residual changes in the lungs, and the adult patient was operated on at the Russian Ministry of Health at the Federal State Budgetary Institution “National Research Center of Pulmonary Medicine” for installation of a bronchial valve. Based on the above, we can conclude about the successful, pathogenetically sound use of surfactant-BL in patients with respiratory tuberculosis in both children and adults.

The outcome of different forms and regiments of antituberculous drugs in Assiut Governorate

Introduction The prescription of effective and well-tolerated antituberculosis (TB) treatment regimen is an important step in the management of TB. Objective To compare the outcome of fixed-dose combination (FDC) therapy versus standard treatment (ST) in treatment of pulmonary tuberculosis (PTB) and extrapulmonary TB in Assiut Governorate. Patients and methods In this prospective cross-sectional analytic study, 120 patients were included. Overall, 60 had PTB based on sputum-positive acid-fast bacilli, and 60 had extrapulmonary TB based on biopsy or culture from the affected sites. Patients were classified into two groups: 80 patients received FDC in the form of four-drug combinations in the intensive phase and the two-drug combination therapy in the continuation phase (group 1) and 40 patients received ST in the form of four separate drugs in the intensive phase and the two separate drugs in the continuation phase (group 2). Follow-up of clinical data, laboratory markers, sputum conversion in PTB during the course of treatment, drug tolerance, compliance, and developing of adverse effect was done in both groups. Results There is no statistically significant difference between both groups regarding improvement of the fever and anorexia and weight loss (P > 0.05 for each). Moreover, there are no statistically significant changes in the sputum conversion between both groups after 2, 4, and 6 months, respectively. There is a statistically significant increase in the percentage of the patients, with increase of alanine aminotransferase, aspartate aminotransferase, and bilirubin level along the course of the treatments in patients receiving FDC and ST (P < 001) but still within normal limits, and there is no need to stop or change the therapy. No significant difference between the two groups regarding the adverse effects such as nausea, vomiting, anorexia, blurred vision, peripheral neuropathy, arthralgia, and skin rash is recorded. Conclusion Both FDC and ST have comparable results, with no superiority of either one over the other.

ПРОБЛЕМЫ ФОРМИРОВАНИЯ ИНТЕНСИВНОЙ ФАЗЫ РЕЖИМА ХИМИОТЕРАПИИ У ВПЕРВЫЕ ВЫЯВЛЕННЫХ ПАЦИЕНТОВ С ТУБЕРКУЛЕЗОМ ЛЕГКИХ

Presently the development of TB treatment regimens is aimed at systematization, standardization, and development of a unified approach to treatment throughout the country. TB treatment is difficult due to the proliferation of drug resistant mycobacteria. Drug resistance rates vary and depend on laboratory capacities in the region. The choice of a chemotherapy regimen is associated with the implementation of molecular genetic diagnostic methods, which allow drug resistance determination before treatment. According to the new clinical recommendations, some changes in chemotherapy regimens have been introduced. Treatment for pulmonary TB with multiple, pre-extensive, or extensive drug resistance (MDR, pre-XDR, or XDR) is significantly complicated. The article outlines issues of treatment tactics during the intensive phase of treatment of new pulmonary TB patients on the example of a TB dispensary with a well-equipped laboratory service.

Effect of persistent malnutrition on pulmonary tuberculosis treatment: A cross-sectional study in Weifang, China.

Malnutrition is associated with pulmonary tuberculosis (PTB). The aim of this study is to investigate the association between persistent malnutrition and the effect of PTB treatment. A total of 915 PTB patients were included. Baseline demographic information, anthropometry, and nutritional indicators were measured. The treatment effect was assessed by combinations of clinical manifestations, sputum smear, chest computerized tomography, gastrointestinal symptoms, and the indexes of liver function. Persistent malnutrition was considered when one or more indicators of malnutrition were lower than the reference standards in two tests on admission and after one month of treatment. Clinical symptom score (TB score) was used to assess the clinical manifestations. The generalized estimating equation (GEE) was used to assess the associations. In GEE analyses, patients with underweight had a higher incidence of TB score >3 (OR=2.95; 95% CI, 2.28-3.82) and lung cavitation (OR=1.36; 95% CI, 1.05-1.76). Hypoproteinemia was associated with a higher risk of TB score >3 (OR=2.73; 95% CI, 2.08-3.59) and sputum positive (OR=2.69; 95% CI, 2.08-3.49). Anemia was associated with a higher risk of TB score >3 (OR=1.73; 95% CI, 1.33-2.26), lung cavitation (OR=1.39; 95% CI, 1.19-1.63), and sputum positive (OR=2.23; 95% CI, 1.72-2.88). Lymphocytopenia was associated with a higher risk of gastrointestinal adverse reactions (OR=1.47; 95% CI, 1.17-1.83). Persistent malnutrition within one month of treatment can adversely affect anti-tuberculosis treatment. Nutritional status during anti-tuberculosis treatment should be continuously monitored.

Successful Anticoagulation With Warfarin After Switching From Rifampin to Rifabutin.

A case of a patient receiving warfarin for pulmonary embolism (PE) concomitantly with rifampin for treatment of active pulmonary tuberculosis (PTB) is presented. A successful clinical intervention whereby the patient achieved therapeutic anticoagulation after switching to an alternative rifamycin antibacterial, rifabutin, is described. The drug-drug interaction between warfarin and rifampin is well known and documented. However, to our knowledge, no case reports of the interaction between warfarin and rifabutin have been published, and literature describing this interaction is lacking. We describe the case of a 27-year-old African American female referred to a pharmacist-managed anticoagulation clinic for treatment of PE with warfarin. The patient was also being treated for active tuberculosis with rifampin, isoniazid, pyrazinamide, and ethambutol. Warfarin was initiated and over the course of 1 month was continuously increased to a total weekly dose (TWD) of 140 mg without ever achieving the target international normalized ratio (INR) of 2 to 3. In an attempt to reach the target INR, rifampin was switched to rifabutin to minimize the drug-drug interaction with warfarin. Six days after this switch, the target INR was achieved with a lower warfarin TWD of 115 mg. Rifabutin interacts with warfarin to a lesser degree than rifampin and may be considered as an alternative in patients taking warfarin who require treatment with a rifamycin. For patients in whom therapeutic anticoagulation with warfarin has been difficult, the use of rifabutin may be considered in place of rifampin when the concomitant use of a rifamycin is required.

Ways to improve the effectiveness of treatment of patients with destructive pulmonary tuberculosis with multiple and broad drug resistance of the pathogen

SummaryTreatment of patients with destructive forms of drug-resistant pulmonary tuberculosis remains a difficult problem. The presence of a destruction cavity in the lung reduces the effectiveness of therapy and is a negative prognostic factor. The objective of the study: to search for the optimal tactics for the treatment of destructive drug-resistant pulmonary tuberculosis and to evaluate the impact of collapsing procedures and surgical interventions on the outcome of treatment according to immediate and long-term observations. Materials and methods. The study included 398 patients with destruc-tive pulmonary tuberculosis with registered multiple (MDR-TB) in 61.3% and extensively drug-resistant (XDR-TB) in 38.7% of patients. Depending on the treat-ment tactics chosen in the clinic, 2 groups of patients were formed who received individualized chemothera-py based on the results of drug susceptibility testing of the pathogen and were comparable in other significant evaluation criteria. The main group consisted of 269 pa-tients, whose management tactics included the staged use of invasive methods of treatment, the comparison group — 129 patients who received only adequately selected anti-tuberculosis chemotherapy due to the im-possibility of using invasive methods. Staged invasive treatment included collapsotherapeutic techniques used in the absence of regression of the tuberculosis process against the background of adequately selected chemo-therapy for 1.5–2 months, and, if the previous stage was ineffective, resection surgery 4–6 months after the start of treatment in the clinic. Results: In the main group, collapse therapy procedures were performed in 179/269 (66.5%) patients, and they were successful in 106/115 (92.2%) patients with MDR-TB and in 51/64 (79.7%) pa-tients with XDR TB (p=0.44). Surgical interventions were performed in 25/269 (9.3%) patients, which were effec-tive in 20/25 (80%). Postoperative complications were registered in 4/25 (16%) patients. In general, microbiolog-ical conversion of sputum and closure of decay cavities were registered in 245/269 (91.1%) patients of the main group and in 75 out of 129 (58.6%) of the comparison group. Conclusion. Timely correction of treatment tac-tics based on the staged application of collapse therapy and surgical methods made it possible to achieve a cure in 91.1% of previously ineffectively treated patients with destructive pulmonary MDR/XDR tuberculosis.

Concepções sobre tratamento e diagnóstico da tuberculose pulmonar para quem a vivencia

Abstract Objectives to analyze the conceptions of people experiencing treatment and diagnosis of pulmonary tuberculosis. Method this is a descriptive and exploratory research with a qualitative approach, developed in a School Health Center of Belém (Pará) with 30 patients. Data was collected during the period from September 2019 to January 2020 through a semi-structured interview with the aid of a script containing six questions, as well as the observation of the information contained in the medical record and in the tuberculosis record control book. For the analysis of the results, the Content Analysis technique was used according to Bardin's perspective. Result it was identified that the reduced knowledge about the disease and the presence of negative conceptions influence, in a significant way, the search for care or the adherence to treatment, interfering in daily and work activities. Conclusion it is concluded that the need for patients to (re)mean tuberculosis during treatment persists, and it is essential that the health team knows such conceptions in order to provide care that contemplates physical and bio-psychosocial aspects before the Tuberculosis Control Program of the unit.

Conceptions about treatment and diagnosis of pulmonary tuberculosis for those who experience it

Resumo Objetivos analisar as concepções de pessoas que vivenciam o tratamento e o diagnóstico da tuberculose pulmonar. Método trata-se de uma pesquisa descritiva e exploratória, com abordagem qualitativa, desenvolvida em um Centro de Saúde Escola de Belém (Pará) com 30 pacientes. Os dados foram coletados durante o período de setembro de 2019 a janeiro de 2020 por meio de entrevista semiestruturada com o auxílio de um roteiro contendo seis perguntas, assim como a observação das informações contidas no prontuário e no livro de controle de registro da tuberculose. Para a análise dos resultados, foi utilizada a técnica de Análise de Conteúdo segundo a perspectiva de Bardin. Resultado identificou-se que o reduzido conhecimento sobre a doença e a presença de concepções negativas influenciam, de forma significativa, a busca por cuidados ou a adesão ao tratamento, interferindo nas atividades diárias e laborais. Conclusão conclui-se que persiste a necessidade de os doentes (res)significarem a tuberculose durante o tratamento, sendo fundamental que a equipe de saúde conheça tais concepções, a fim de subsidiar cuidados que contemplem aspectos físicos e biopsicossociais ante o Programa de Controle da Tuberculose da unidade.

Progress Related to the Treatment of Pulmonary Tuberculosis by Traditional Chi-nese Medicine

Progress Related to the Treatment of Pulmonary Tuberculosis by Traditional Chi-nese Medicine

An Elusive Case of Pleural Effusion

The incidence of distant metastasis in head and neck Squamous Cell Carcinoma (SCC) is relatively low. The most frequently involved sites for distant metastasis are lungs, followed by bone and liver. The most important predictive factors for distant metastasis appear to be site of the primary tumour (hypopharynx), advanced T- and N-classification, locoregional control and histologic grade. A 61- year-old male, chronic smoker, presented with complaints of grade 4 mMRC (Modified Medical Research Council) dyspnoea. He had left-sided buccal mucosal SCC (locally advanced) and was on palliative chemotherapy. He had undergone treatment for pulmonary tuberculosis seven years back. He was tachypneic and clinical examination revealed absent breath sounds in the left hemithorax. Chest radiograph showed a massive left pleural effusion which was found to be exudative after therapeutic thoracocentesis. Cytology tests were negative for malignant cells. Positron Emission Tomography (PET) scan showed uptake along the left pleura (SUV Max-5.06) and left buccal mucosa (SUV Max -4.1). Thoracoscopic frozen section pleural biopsy revealed metastatic squamous cell carcinomatous deposits in the pleura. On table pleurodesis was done with doxycycline. The patient was continued on palliation with no recurrent effusion. However, he succumbed to the disease after eight months. This case report describes a rare case of malignant pleural effusion from a primary buccal mucosal SCC without any concurrent lung involvement.

КОРОТКИЕ КУРСЫ ХИМИОТЕРАПИИ ТУБЕРКУЛЕЗА ОРГАНОВ ДЫХАНИЯ НА ОСНОВЕ ФТОРХИНОЛОНОВ У ДЕТЕЙ ИЗ ОЧАГОВ С МНОЖЕСТВЕННОЙ ЛЕКАРСТВЕННОЙ УСТОЙЧИВОСТЬЮ ВОЗБУДИТЕЛЯ У ИСТОЧНИКА ИНФЕКЦИИ: ВОЗМОЖНОСТИ ИСПОЛЬЗОВАНИЯ

Objective: to justify the potentials for use of fluoroquinolone-based short-course chemotherapy for the treatment of pulmonary TB in children from nidi of multi-drug resistant TB. Materials and methods. We carried out a cohort prospective study of 18 patients aged 2–5 years with newly diagnosed pulmonary TB with history of exposure to multidrug resistant TB in 2018–2020. The criteria for inclusion were as follows: local or small TB processes without bacterioexcretion, potential to form the initial combination containing at least four TB drugs including fluoroquinolones, use of TB drugs consideringpreserved drug susceptibility in the infection source. The criteria for exclusion: presence of diseases requiring long-term immunosuppressive therapy, administration of bedaquiline at any point of treatment. We used individualized chemotherapy regimens: 4 drugs in the intensive phase and 3 drugs in the continuation phase. The treatment course was 9–12 months. Results. All the patients completed treatment with effective outcomes, no relapse was detected one year later. Intoxication symptoms were removed after 3 months, positive X-ray dynamics was observed after 3 and 6 months in 66.7% of patients. Conclusion. We proved the effectiveness of fluoroquinolone-based short-course chemotherapy regimens in children with local or small forms of TB and history of exposure to multidrug resistant TB. The criteria for the total treatment duration (9 or 12 months) were the duration of the intensive phase and the duration of fluoroquinolone administration. If the intensive phase of treatment was less than 3 months or the administration of fluoroquinolones was less than 6 months, the total treatment duration was prolonged to 12 months.

Ocular toxicity among patients taking anti-tubercular treatment.

Tuberculosis remains a major public health problem in Nepal and anti-tubercular drugs used for the treatment of pulmonary and extrapulmonary tuberculosis can be associated with ocular toxicity. This prospective study aimed to evaluate the incidence of ocular toxicity among patients receiving anti-tubercular therapy and to assess the change in visual functions and ocular imaging before and after use of anti-tubercular therapy. A total of 89 eyes of 45 TB patients taking anti-tubercular therapy were enrolled. Detailed history and examination including best-corrected visual acuity (BCVA), colour vision (Farnsworth D-15t), contrast sensitivity (Pelli-Robson chart), Goldman visual field analysis and spectral domain optical coherence tomography for retinal nerve fibre layer (RNFL) analysis were assessed at baseline and at 6 months after starting anti-tubercular therapy. Visual evoked potential (VEP) was performed in suspected cases. The mean age of the patients was 29.13±14.00 years and 62.2% were males. The mean weight of the subjects was 54.37±10.36 kg, mean daily dosage of ethambutol was 17.91±1.74 mg/day/kg and mean administration duration was 2.71±1.54 months. The incidence of ocular toxicity was 2.24%. Bilateral retrobulbar optic neuropathy occurred in a 27-year female of 55 kg receiving ethambutol (20 mg/kg/day) for 6 months for Pott's spine. Her best-corrected visual acuity in both eyes was reduced to 6/36 from 6/6 and developed non-specific color vision defect, decreased contrast sensitivity, bilateral cecocentral visual field defect and mean decrease in retinal nerve fibre layer thickness compared to the baseline data. In rest cases, a statistically significant decrease in mean retinal nerve fibre layer thickness in both eyes suggested the evidence of subclinical toxicity. Though less common, ethambutol toxicity can occur in patients under anti-tubercular therapy in the form of retrobulbar optic neuritis. Decreased contrast sensitivity and thinning in the mean retinal nerve fibre layer thickness can be the indicator of subclinical toxicity.

Importance of Aspergillus-Specific Antibody Screening for Diagnosis of Chronic Pulmonary Aspergillosis after Tuberculosis Treatment: A Prospective Follow-Up Study in Ghana.

Chronic pulmonary aspergillosis (CPA) often occurs in patients that have been previously treated for pulmonary tuberculosis (PTB). A limited number of studies have looked at the development of CPA at different times following the completion of a PTB treatment course. This prospective longitudinal study aimed to determine the incidence of CPA at two timepoints, at the end of the PTB treatment (T1) and six months post-treatment (T2). Patients with confirmed PTB from a previous study who were placed on anti-TB medication were followed up and screened for CPA at T1 and T2 by assessing their symptoms, evaluating their quality of life, and screening them for Aspergillus infection by performing antibody testing and cultures. CPA was defined by the Global Action for Fungal Infections (GAFFI) diagnostic algorithm. Forty-one patients were enrolled, of whom thirty-three patients (80%) and twenty-eight patients (68%) were resurveyed at T1 and T2, respectively. The rate of new CPA was 3.3% (1/33) and 7.4% (2/27) at T1 and T2, respectively, with an overall incidence of 10.7% (3/28) among the patients at both T1 and T2. A positive Aspergillus-specific antibody test was an indicator for CPA in all three patients. Aspergillus-specific antibody screening during and after the end of an anti-TB treatment regimen may be important for early detection of CPA in high-PTB-burden settings.

Magnitude and factors associated with post-tuberculosis lung disease in low- and middle-income countries: A systematic review and meta-analysis.

Emerging evidence suggests that after completion of treatment for tuberculosis (TB) a significant proportion of patients experience sequelae. However, there is limited synthesized evidence on this from low-income countries, from Sub-Saharan Africa, and in HIV infected individuals. We seek to provide an updated comprehensive systematic review and meta-analysis on the magnitude and factors associated with post-TB lung disease (PTLD) in low- and middle-income countries (LMICs). We searched PubMed, Embase and CINAHL for studies from LMICs with data on post-TB lung health in patients who had previously completed treatment for pulmonary TB. Data on study characteristics, prevalence of PTLD-specifically abnormal lung function (spirometry), persisting respiratory symptoms and radiologic abnormalities were abstracted. Statistical analysis was performed using Microsoft Excel and R version 4.1 software, and random effects meta-analysis conducted to compute pooled prevalence of PTLD, evaluate heterogeneity, and assess factors associated with PTLD. We identified 32 eligible studies with 6225 participants. Twenty-one studies were from Africa, 16 included HIV infected participants, spirometry was conducted in 20 studies, symptom assessment in 16 and chest imaging in eight. Pooled prevalence of abnormal lung function was 46.7%, persistent respiratory symptoms 41.0%, and radiologic abnormalities 64.6%. Magnitude of any type of PTLD varied by HIV status (HIV- 66.9%, HIV+ 32.8%, p = 0.0013), across geographic setting (SE Asia 57.5%, Southern America 50.8%, and Africa 38.2%, p = 0.0118), and across urban-rural settings (symptom prevalence: rural 68.8%, urban 39.1%, mixed settings 27.9%, p = 0.0035), but not by income settings, sex or age-group. There is high burden of post-TB persistent respiratory symptoms, functional lung impairment and radiologic structural abnormalities in individuals living in LMICs. Burden varies across settings and by HIV status. This evidence may be valuable to advocate for and inform implementation of structured health care specific to the needs of this vulnerable population of individuals.

Tuberculosis treatment outcomes among pulmonary TB patients attending public hospitals in Kebbi State, Northern Nigeria: a four-year retrospective study

BackgroundIn Nigeria, effective case management and evaluation of pulmonary tuberculosis treatment outcomes are an integral part of controlling the spread of infectious diseases. The study reviewed the treatment outcomes of pulmonary tuberculosis and the factors associated with rates of successful and unsuccessful treatment outcomes in the 21 referral hospitals in Kebbi State, Nigeria.MethodsDocumented records of pulmonary tuberculosis patients from January 2018 to December 2021 in 21 Local Area Councils in Kebbi State, Northern Nigeria were reviewed. A structured questionnaire collated the socio-demographic and clinical data from the documented records. Descriptive statistics were used to compute and analyse the outcomes of successful and unsuccessful treatment. Logistic regression models were used to determine the association of socio-demographic and clinical data with the unsuccessful treatment outcomes.ResultsThe study reviewed data from 6114 records of TB patients. 1161 (18.9%) started treatment, 963 (82.9%) were males and 198 (17.1%) were females. Of the 1161 patients, 985 (18.2%) had documented treatment outcomes. 932 of 985 (95.1%) had a pulmonary infection. 64 (5.8%) patients with documented treatment outcomes were HIV seropositive. 903 (91.7%) were successfully treated, and 82 (8.3%) failed. Of the patients with failed treatment outcomes, 15 (1.5%) were lost to follow-up, 43 (4.4%) defaulted and 24 (2.4%) died. In the logistic analysis, the odds of unsuccessful treatment outcomes were higher among elderly patients (AOR = 2.00, 95% CI 1.37–2.92), patients with extrapulmonary infections (AOR = 2.40, 95% CI 1.12–5.39), and with old cases of pulmonary TB (AOR = 3.03, 95% CI 1.47–7.19) when compared to their groups.ConclusionsThe study reported a treatment success rate of 91.7% among TB patients attending public hospitals in Kebbi State. The outcome was higher than the projected success rate of 85% set by the WHO. However, one-fourth of the total patients reviewed were not documented for treatment. Therefore, the need to design an appropriate recruitment strategy to identify and enrol those patients for an effective and successful TB control program in Nigeria.

Analysis of the effectiveness of smoking cessation in patients with pulmonary tuberculosis in a hospital setting

According to the WHO, tobacco use is currently the leading cause (16%) of all adult deaths. Studies conducted in many countries and in the Russian Federation have revealed the association between smoking and pulmonary tuberculosis (PT). Due to the negative impact of tobacco smoking on the course of tuberculosis and the effectiveness of treatment, there is a need to develop approaches to smoking cessation in patients with PT. Aim. To evaluate the effectiveness of the treatment of PT in smoking patients in combination with nicotine replacement therapy in an inpatient setting. Methods. The study included 27 patients with a confirmed diagnosis of PT. The inclusion criteria for the study were: age 18 years and older, patients who are currently active smokers, and a confirmed diagnosis of PT. The exclusion criteria were the presence of asthma and oncological diseases, unconfirmed diagnosis of PT, and earlier history of tobacco use. In the study group, an analysis of the smoking status was carried out. This status was based on the length of smoking period, number of cigarettes per day, and calculation of the smoking patient index. The degree of nicotine addiction, the presence of withdrawal symptoms, and the motivation of patients to quit smoking were assessed. The principle of nicotine dependence treatment was to prescribe nicotine-containing drugs in a dose depending on the degree of nicotine addiction. The duration of treatment was 12 weeks. Results. After 4 months of PT treatment, the cessation of bacterial excretion was detected 2 times more often, the closure of decay cavities in the lung tissue - 2.5 times more often, the relief of systemic inflammatory reactions - 2 times more often in patients who quit smoking than in patients who continue to smoke. Conclusion. This study showed that the treatment of PT in smokers was more effective in combination with nicotine replacement therapy for smoking cessation than when the patients continued to smoke.

Influence of COVID-19 for delaying the diagnosis and treatment of pulmonary tuberculosis-Tianjin, China.

The COVID-19 pandemic has disrupted the diagnosis, treatment, and care for tuberculosis (TB). Delays in seeking TB care may result in increased community transmission and unfavorable treatment outcomes. We sought to understand the influence of the COVID-19 pandemic on the proportion of patients with TB who delayed seeking the diagnosis and care for TB and explore the reasons for their postponement. We surveyed a representative sample of outpatients treated for pulmonary TB from June to November 2020 using an anonymous standardized questionnaire. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) of factors associated with the postponement of TB care. We used routinely collected surveillance data to assess trends of TB reports before and after the emergence of COVID-19 (2017-2019 vs. 2020-2022) in Tianjin, China. Among 358 participants who were diagnosed with pulmonary TB during the COVID-19 response, 61 (17%) postponed seeking TB diagnosis due to COVID-19, with 39 (64%) citing fear as the primary reason. Female sex (aOR:2.0; 95% CI: 1.1-3.7), previous antituberculosis treatment (aOR:3.2; 95%CI: 1.4-7.6), and TB diagnosis during the first-level response (aOR = 3.2, 1.7-6.2) were associated with the postponement. Among all 518 participants receiving antituberculosis treatment, 57 (11%) had postponed their regular healthcare visits due to COVID-19, 175 (34%) received no treatment supervision, and 32 (6%) experienced treatment interruption. Compared to 2017-2019, reported pulmonary TB declined by 36.8% during the first-level response to COVID-19, 23.5% during the second-level response, 14% during the third-level response in 2020, and 4.3% in 2021. The COVID-19 response reduced the number of people who sought and received diagnosis, treatment, and care for TB in Tianjin, China. Integrative programs to ensure access and continuity of TB services should be considered and dual testing for SARS-CoV-2 and M. tuberculosis may facilitate finding cases.

PULMONARY TUBERCULOSIS MASQUERADING AS A HILAR MASS: A CASE REPORT

Tuberculosis (TB) is well known as a diagnostic chameleon as it has often been found to mimic malignancy in its clinical and radiological features. Although the differences between pulmonary TB and lung cancer have been highlighted in various reports, TB often gets misdiagnosed as lung cancer and vice versa. It is therefore extremely important to discern the features of Pulmonary Tuberculosis and lung cancer. This case highlights the importance of early detection and prompt treatment of pulmonary tuberculosis in a health care worker. After initiating the patient on antituberculosis treatment, as a case of clinically diagnosed pulmonary tuberculosis, he responded to treatment and showed good clinical and radiological improvement.

MiR-124-Antagonist-Loaded Liposomal Nanoparticles Negatively Regulate the Toll-Like Receptor (TLR)-Signaling Pathway in Alveolar Epithelial Cells in Pulmonary Tuberculosis

miR-124 is intensively expressed in the alveolar epithelial cells of pulmonary tuberculosis. This study focused on exploring the negative regulation of miR-124-antagonist-loaded liposomal nanoparticles on the Toll-like receptor (TLR)-signal transduction pathway in the alveolar epithelial cells from pulmonary tuberculosis, aiming to provide theoretical evidence for the treatment of pulmonary tuberculosis. The purchased alveolar epithelial cells were grouped into Blank group, Empty-vector group, Bacillus Calmette-Guerin (BCG) group, Nanoparticle+MiR-124 Antagonist group, MiR-124 Antagonist group, and MiR-124 Agonist group. The liposomal nanoparticles were identified. The following aspects were investigated: mRNA level of miR-124, mRNA and protein levels of Myeloid differentiation factor 88 (MyD 88), Toll-like receptor the 6 (TLR 6) and their downstream molecules Nuclear Factor-κB (NF-κB) and Tumor necrosis factor TNF receptor-associated factor 6 (TRAF 6) secretion level of cytokines (NF-κB, IL-8, IL-1α, TNF-α and IL-6), as well as the regulatory link between miR-124-antagonists with TLR6 and MyD88. The liposomal nanoparticles were uniform in size, with an average particle size of (35.25±10.58) nm and an average Zeta potential of (−48.55±10.27) mV. The miR-124 level was the strongest in the MiR-124 Agonist group, while being the lowest in the Blank group. The miR-124 level was relatively higher in the BCG group and Empty-vector group, while being significantly reduced in the Nanoparticle+MiR-124 Antagonist group, which was higher than the Blank group. The miR-124 level in the MiR-124 Antagonist group was higher than that in the Nanoparticle+MiR-124 Antagonist group (P &lt;0.05). The mRNA and protein levels of MyD88, TLR6, NF-κB and TRAF6 were the highest in the MiR-124 Agonist group, while being the lowest in the Blank group. The transcription and translation levels of TRAF6, TLR6, NF-κB and MyD88 were relatively higher in the BCG group and Empty-vector group, while being significantly reduced in the Nanoparticle+ MiR-124 Antagonist group, which were higher than in the Blank group. The transcription and translation levels of TRAF6, TLR6, NF-κB and MyD88 were in the MiR-124 Antagonist group were higher than that in the Nanoparticle+MiR-124 Antagonist group (P &lt;0.05). The secretion levels of inflammatory factors (NF-κB, IL-8, IL-1α, TNF-α and IL-6) were the highest in the MiR-124 Agonist group, while being the lowest in the Blank group. The levels of these inflammatory factors were relatively higher in the BCG group and Empty-vector group, while being significantly reduced in the Nanoparticle+MiR-124 Antagonist group, which were elevated compared to that in the Blank group. The secretion quantities of these inflammatory factors in the MiR-124 Antagonist group were higher than that in the Nanoparticle+MiR-124 Antagonist group (P &lt;0.05).Dual luciferase experiments indicated that miR-124-antagonists may retard TLR6 and MyD88 to affect the immune response of pulmonary alveolar epithelial cells in pulmonary tuberculosis. The fluorescence intensity of mutant plasmid was significantly stronger than that of wild-type plasmid (P &lt; 0.05). In the alveolar epithelial cells from pulmonary tuberculosis, the miR-124-antagonistloaded liposomal nanoparticles can significantly reduce the expression of TLR6 and MyD88, and their downstream molecules (NF-κB and TRAF6), leading to the reduced secretion of the inflammatory factors. As a result, the inflammatory response of lung tissue was alleviated, while the immune function was restored. This regulation was achieved by the miR-124-antagonist-loaded liposomal nanoparticles via negatively regulating the TLR6/MyD88 pathways.

Estimation of Functional Exercise Capacity in Pulmonary Tuberculosis Survivors

Background: Pulmonary tuberculosis (PTB) is the main apprehension universally. Although treatable, tuberculosis (TB) endures depressingly and disturbs patients’ health-related quality of life (HRQoL) and functioning even after treatment.1 Resources have revealed that multidrug treatments can lead to unwanted adversative drug reactions such as arthralgia, neurological disorders, hepatotoxicity, and allergic reactions. TB affects the respiratory system, that is, airflow patterns, functional exercise capacity, and ultimately the QoL of patients even after the completion of the 4-month rifapentine-moxifloxacin TB treatment regimen and 6- or 9-month rifapentine, isoniazid, pyrazinamide, and ethambutol (RIPE) TB treatment regimen. Throughout the treatment of active PBT, lung function damage is usually restrictive. Materials and methods: A total of 86 PTB survivors were selected for the PTB survivors’ group, who had a history of taking complete treatment for PTB. Each survivor was evaluated for functional exercise capacity with a 12-minute walk test (MWT), 15-step oximetry test, and HRQoL questionnaire. Results: Pulmonary tuberculosis (PTB) causes variation in vitals and also has negative effects on physical functioning. The study results demonstrated that out of 86 total respondents, the majority (97–100%) had better oxygen levels pretest (12-MWT and pulse oximetry) with an average of 17–20 bpm. 47% of individuals were underweight, with posttest oxygen saturation reduced to 91–93% and respiratory rate increased to 26–30 bpm. QoL was also compromised. Conclusion: This present study concluded that PTBs and their treatment do affect the functional exercise capacity of the survivors. The respiratory rate and blood pressure are markedly increased, whereas the oxygen saturation and manual muscle strength are markedly reduced. PTB survivors also suffered from compromised health and QoL, that is, emotional and mental weaknesses.