Treatment Of Tuberculosis Patients Research Articles

Atorvastatin Potentially Reduces Mycobacterial Severity through Its Action on Lipoarabinomannan and Drug Permeability in Granulomas.

The majority of preclinical research has shown that Mycobacterium tuberculosis can modify host lipids in various ways. To boost its intramacrophage survival, M. tuberculosis causes host lipids to build up, resulting in the development of lipid-laden foam cells. M. tuberculosis binds to and enters the macrophage via the cell membrane cholesterol. Aggregation of cholesterol in the cell wall of M. tuberculosis and an increase in vascularity at the granuloma site reduce the permeability of rifampicin and isoniazid concentrations. However, very few studies have assessed the effect of statins on drug penetration. Here, we used atorvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, to observe its effect on the bacterial burden by increasing the drug concentration at the infection site. We looked into how atorvastatin could be used in conjunction with first-line drugs to promote drug permeation. In this study, we detected an accumulation of drugs at the peripheral sites of the lungs and impaired drug distribution to the diseased sites. The efficacy of antituberculosis drugs, with atorvastatin as an adjunct, on the viability of M. tuberculosis cells was demonstrated. A nontoxic statin dosage established phenotypic and normal granuloma vasculature and showed an additive effect with rifampicin and isoniazid. Our data show that statins help to reduce the tuberculosis bacterial burden. Our findings reveal that the bacterial load is connected with impaired drug permeability resulting from lipid accumulation in the bacterial cell wall. Statin therapy combined with antituberculosis medications have the potential to improve treatment in tuberculosis patients. IMPORTANCE Mycobacterium tuberculosis binds to and enters the macrophage via the cell membrane cholesterol. M. tuberculosis limits phagosomal maturation and activation without engaging in phagocytosis. Aggregation of cholesterol in the cell wall of M. tuberculosis and an increase in the vascularity at the granuloma site reduce the permeability of rifampicin and isoniazid concentrations. However, very few studies have assessed the effect of statins on drug penetration, which can be increased through a reduction in cholesterol and vascularity. Herein, we used atorvastatin, a 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor, to observe its effect on bacterial burden through increasing the drug concentration at the infection site. Our main research goal is to diminish mycobacterial dissemination and attenuate bacterial growth by increasing drug permeability.

Options in predicting the effectiveness of tuberculosis therapy: focus on patients with chronic obstructive pulmonary disease

Introduction. Tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) belong to the category of co-morbid mutually aggravating diseases with an unfavor-able prognosis for working capacity and life. Objective of this study was to assess the possibility of predicting outcomes of TB treatment in patients with COPD. Ma-terials and methods: 514 patients were included in a simple comparative retrospective study. Patients were divided into 2 groups: group 1 — patients with new-ly diagnosed TB without COPD (310 patients), includ-ing 149 men (48.1%) and 161 women (51.9%) (χ2=0.89, p=0.345), age (Me (25.0; 75.0)) 40.41 (29.00; 49.50); group 2 — 204 TB+COPD patients, including 180 men (88.2%) and 24 women (11.8%) (χ2=41.15, p=0.000), age (Me (25.0;75, 0)) 48.25 (38.00; 57.00). The main factors influencing the severity of the disease and the outcome of treatment were identified, and the signs were graded. Using analy-sis of variance, the conditional probability of a favorable and unfavorable outcome of TB treatment for various combinations of signs was calculated. Results: When us-ing multivariate analysis of variance, the cumulative addi-tional effect of the trigger (years of smoking — shortness of breath — CAT test) on outcome was 29.8%, compared with a single effect of the studied signs. Conclusion. The outcome of TB treatment in comorbid patients is deter-mined not only by adequate TB chemotherapy, but also by the state of the bronchopulmonary system, which de-termines the main functions of life to prevent disability and mortality.

Psychological Struggles Faced by Women in Tuberculosis Affected Family - A Study from Coimbatore District

Tuberculosis(TB) and mental illnesses seriously exceed globally and frequently exist. While poor psychic illness is known to moderate resistant function, whether psychological syndromes play a crucial role in Tuberculosis, the relative occurrence is unknown. Cohesion to Tuberculosis(TB) treatment is the vital cause of poor Tuberculosis outcomes, and initial support or treatment for Tuberculosis patients is vital to governments. On the other hand, there has been trivial study or exploration on the possessions of family, social and national policy supporting factors on Tuberculosis treatment observance. This scoping review aims to outline the most frequent mental issues encountered by Tuberculosis patients and women in Tuberculosis-affected families and assess the mental health effects of Tuberculosis treatment. Results Tuberculosis(TB) ranks as a deadly disease resulting in millions of deaths worldwide. However, the effect of Tuberculosis on the emotional status of patients and women in the family and involvement in improving treatment outcomes is ignored, especially in underdeveloped and developing countries.

COUNSELING ON FAMILY SUPPORT IN THE CURE OF PULMONARY TB PATIENTS AT LUBUK PAKAM HEALTH CENTER

Tuberculosis (TB) is a life-threatening disease, TB is also an infectious disease that can be transmitted to everyone, both at the age of children, adults and the elderly. Transmission can occur through the air when the sufferer or sufferer is coughing, talking, sneezing or spitting. Once the germs enter the respiratory system, they will attack the lungs and spread to the circulatory system. Factors that cause TB apart from agent (host) factors are also influenced by environmental factors. Treatment of TB patients takes at least 6 months, for 6 months the patient must take medicine regularly every day at the same time, because the length of the treatment process sometimes makes the patient feel bored and bored to take it, besides that this condition is a disease that can transmit it to other people makes them ostracized from their environment, this condition makes sufferers more down and resigned to their illness so that it can be dangerous and can even cause death. therefore the role of the family in providing support is very important, because the family is the closest person to the patient, so the family must know what support needs to be given to the patient. The purpose of community service is to increase knowledge, especially about family support in the healing process of TB patients. This activity was held in November at the Lubuk Pakam Health Center, the counseling participants were 121 patients and their families. Before counseling, the majority of participants said they did not know what kind of support was given to patients, but after counseling, the majority of participants became aware and ready to accompany patients until the doctor declared the patient cured. It is recommended that the patient's family or patient can continue to increase knowledge, especially about TB disease.

Associations of exposures to air pollution and greenness with mortality in a newly treated tuberculosis cohort.

Some previous studies had linked air pollutants and greenness to the risk of death from tuberculosis (TB). Only a few studies had examined the effect of particulate matter (PM2.5) on the mortality of TB, and few studies had assessed the impact and interaction of multiple air pollutants and greenness on the mortality of newly treated TB patients. The study included 29,519 newly treated TB patients from three cities in Anhui province. We collected meteorological data and five pollutants data from The National Meteorological Science Center and air quality monitoring stations. Greenness data were generated by remote sensing inversion of medium-resolution satellite images. We geocoded each patient based on the residential address to calculate the average exposure to air pollutants and the average greenness exposure for each patient during treatment. The Cox proportional risk regression model was used to evaluate the effects of air pollutants and greenness on mortality in newly treated tuberculosis patients. Our results found that the higher the concentration of air pollutants in the living environment of newly treated TB patients, the greater the risk of death: HR 1.135 (95% CI: 1.123-1.147) and HR 1.333 (95% CI: 1.296-1.370) per 10μg/m3 of PM2.5 and SO2, respectively. Greenness reduced the mortality among newly treated TB patients: HR for NDVI exposure 0.936 (95% CI: 0.925-0.947), HR for NDVI_250m exposure 0.927 (95% CI: 0.916-0.938), and HR for NDVI_500m exposure 0.919 (95% CI: 0.908-0.931). Stratifying the cohort by median greenness exposure, HRs for air pollutants were lower in the high greenness exposure group. Mortality in newly treated TB patients is influenced by air pollutants and greenness. Higher green exposure can mitigate the effects of air pollution. Improving air quality may help reduce mortality among newly treated TB patients.

Efficacy of Tuberculosis Treatment in Patients with Drug-Resistant Tuberculosis with the Use of Bedaquiline: The Experience of the Russian Federation

The authors analyzed data published in studies from 2014 to 2022; 41 publications were included in total and 17 articles corresponded to the study design. The results of treatment of 1404 tuberculosis patients with MDR/XDR TB were described. Bedaquiline was used according to the standard scheme with a description of the treatment results after 24-26 weeks. Treatment efficacy was estimated according to accepted criteria. The analysis showed that the treatment efficacy on conversion was achieved in 79.5% of cases (95% Cl 76.5-82.3), and recovery was observed in 82.0% of cases (95% Cl 78.6-85.1). Departure from the therapy was observed in rare cases (9.8%; 95% Cl 7.9-12.2). Deaths were recorded in 6.5% of cases (95% Cl 4.9-8.3), which were associated with the severe disease and concomitant pathology in 74.3%. The development of adverse events was noted in half of the patients (55.7%); however, bedaquiline cancellation occurred in a few cases (7.0%; 95% Cl 3.0-13.0). From analyzing data in patients with MDR and XDR TB, the efficacy of treatment was 89.9% (95% Cl 85.9-93.2) and 71.9% (95% Cl 66.2-77.1), respectively. Use of bedaquiline in treatment makes it possible to achieve recovery of patients with MDR/XDR TB in 82.0% of cases with patients dropping out of treatment in 9.8%. At the same time, in patients with MDR TB, recovery was achieved in 89.9% of cases, while in patients with XDR TB, 71.9% of cases recovered.

Accuracy of monocyte to lymphocyte ratio for tuberculosis diagnosis and its role in monitoring anti-tuberculosis treatment: Systematic review and meta-analysis.

High monocyte to lymphocyte ratio (MLR) values may be associated with the risk of active tuberculosis (TB) infection in adults, infants, and postpartum women with HIV infection. It may also serve as an indicator of the effectiveness of anti-TB treatment. Thus, the main aim of this study is to ascertain the accuracy of MLR for the diagnosis of TB and its role in monitoring the effectiveness of anti-TB therapy. This systematic review and meta-analysis followed the preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. All statistical analyses were performed using STATA 11 and Meta-DiSc software. The Quality assessment of Diagnostic Accuracy Studies tool was used to evaluate the methodological quality of the included studies. The area under the hierarchical summary receiver-operating characteristic hierarchical summary ROC curve [(HSROC) curve (AUC)] was also calculated as an indicator of diagnostic accuracy. A total of 15 articles were included in this study. Accordingly, the result showed that elevated MLR is associated with increased risks of TB disease [odd ratio = 3.11 (95% CI: 1.40-6.93)]. The pooled sensitivity and specificity of MLR for identifying TB were 79.5% (95% CI: 68.5-87.3) and 80.2% (95% CI: 67.3-88.9), respectively. The AUC of HSROC was 0.88 (95% CI: 0.857-0.903), indicating the excellent diagnostic performance of MLR for TB. This study also showed that there is a significant reduction in the MLR value after anti-TB treatment in TB patients (standardized mean difference = 0.68; 95% CI: 0.007, 1.43). Generally, MLR can be considered as a crucial biomarker to identify TB and monitor the effectiveness of anti-TB therapy.

Activation of Nrf2 modulates protective immunity against Mycobacterium tuberculosis infection in THP1-derived macrophages.

Tuberculosis (TB), caused by mycobacterium tuberculosis (M. tuberculosis) infection, is one of the leading causes of death globally and poses a threat to public health. During infection, M. tuberculosis causes redox imbalance and dysfunctions of protective immunity. Transcription factor nuclear factor erythroid 2 (NF-E2)-related factor (Nrf2) is a major modulator of cellular redox homeostasis via transcriptional induction of cytoprotective genes to protect cell against the damage from insults. Thus, we hypothesize that Nrf2 may regulate protective immunity against M. tuberculosis. RNA-seq and immunoblotting results suggested that the expression of Nrf2 protein increased after M. tuberculosis infection, and decreased upon long-term M. tuberculosis infection, while Keap1 protein maintained a low expression level during M. tuberculosis infection. Furthermore, Nrf2 activator sulforaphane (SFN) decreased proinflammatory cytokines production, phagocytosis and host cell apoptosis, while increasing ROS levels and promoting autophagy in THP1 macrophages infected with M. tuberculosis. In addition, SFN-activated Nrf2 augmented bacterial killing by macrophages, which might be due to the regulation of protective immunity via Nrf2. Combined, our results extend the understanding of the complex innate immunity regulation by Nrf2 against mycobacterial infection. Also, these findings suggested that the regulation of Nrf2 signaling cascade could be used as a therapeutic target for the treatment of TB patients and the development of better anti-TB vaccines.

Clinical Characteristics of COVID-19 in Active or Previously Treated Tuberculosis Patients in Turkey

Clinical Characteristics of COVID-19 in Active or Previously Treated Tuberculosis Patients in Turkey

Interdisciplinary approach to revealing cardiac pathology in TB patients during the COVID-19 pandemic

The tuberculosis (TB) dispensary patients are often diagnosed with cardiac diseases, but the regulatory documents associated with TB care refer to the procedures and standards of examination and treatment of TB patients or patients with suspected TB while the management of associated chronic diseases is carried out in other medical institutions. There is lack of continuity between doctors of different specialties. Patients face organizational problems of accessibility and quality of medical care. The creation of Department of Medical and Social Care and Rehabilitation in TB dispensary with therapeutic profile specialists became especially urgent in the period of coronavirus pandemic.Aim. The aim of the study was to estimate the expediency and effectiveness of Department of Medical and Social Care and Rehabilitation in detection and treatment of comorbid cardiac pathology in patients of TB dispensary during coronavirus (COVID-19) pandemic.Material and Methods. All patients of the St. Petersburg TB dispensary No. 5 were examined according to specially developed algorithm to detect and treat the cardiac pathology comorbid with TB. Results. Cardiac diseases comorbid with tuberculosis were detected using an integrated multidisciplinary approach to examination of TB patients during the pandemic of coronavirus infection. Examination, consultation, and necessary treatment were carried out directly in TB dispensary allowing to avoid disease exacerbations and complications during the entire period of monitoring.Conclusion. The establishment of Department of Medical and Social Care and Rehabilitation in TB dispensary No. 5 showed the relevance and timeliness of this measure. The coronavirus genesis of some cardiac diseases required to revise the management tactics of affected tuberculosis patients.

Experience and Perception of Healthcare Workers on the Challenges of Follow-Up and Treatment of Tuberculosis Patients in Southern Ethiopia: An Exploratory-Descriptive Qualitative Study.

BackgroundThere is a scarcity of research evidence on TB follow-up and treatment challenges from a healthcare worker’s perspective in Ethiopia. Therefore, this study aimed to explore and describe the experience and perception of healthcare workers on the challenges of follow-up and treatment of TB patients in Southern Ethiopia.Material and MethodsA qualitative exploratory-descriptive study was employed among 26 purposely selected Healthcare Workers (HCWs) from Wolaita Sodo University-Comprehensive Specialized Hospital and Achura, Boloso Sore, and Tida Health Centers in December 2021 and January 2022. Initially, the maximum variation purposive sampling technique was employed, then based on the data requirement of the study it was enriched by a theoretical sampling method. The required data were collected through one-on-one face-to-face audio-taped in-depth interviews. Data analysis was conducted by using a qualitative data analysis framework for the applied research method. NVivo Software Version 11 was used to ease data organization and analysis. Detailed textual narration of subthemes, and themes was done using direct verbatim quotations in the respective headings and subheadings.ResultsIn the current study, three major themes and eleven sub-themes emerged from the data. The three major themes include the experience of healthcare workers, perceived challenges, and suggestions for improvement of TB patients’ follow-up and treatment. Healthcare worker’s experience, compliance with infection prevention protocols, fear of contracting and/or spreading TB, public awareness of TB, socio-economic burdens, providers-related problems, shortage of medical supplies, unconducive physical work environment, provision of holistic support for the patients, provision of in or out of service training, and supportive supervision were the sub-themes.ConclusionThis study explored the multidimensional challenges adjoining follow-up and treatment of TB patients. Regular monitoring and supportive supervision accompanied by appropriate and timely decisions and feedback are vital to ensure effective follow-up and treatment of TB patients in Ethiopia.

Treatment adherence in outpatient Tuberculosis patientsatHa Tinh Lung hospital in 2022 and some associatedfactors

Background: Treatment adherence is considered as important and pivotal in the treatment andmanagement of Tuberculosis (TB) patients. This is still a big challenge of VietnamNationalTuberculosisControl Program, especially in the newcontext of the prolongedCOVID-19pandemic.Objectives: To describe the status of adherence to treatment and to identify some factorsaৼectingto the treatment adherence of TB patients. Methods: Cross-sectional study design using quantitative combined with qualitativemethodswasapplied. All 109 TB patients were selected for interviews with a structured questionnaireand23 in-depth interviews were conducted with TB patients, patients' family members andhealthworkers. Evaluation of electronic information through assessment of adherence tomedicationuse,compliance with follow-up visits and compliance with periodic testing. Results: The study collected information from 109 TB patients, 10 patients' family membersand03health workers involved in the outpatient TB management process. Adherence rate of TBpatientswas 45.9%. Some factors aৼecting the treatment adherence of TB patients include: educationlevel, average income, other comorbidities, Tuberculosis knowledge and understandingof TBtreatment adherence, family and relatives' help and support; supportive social organizations;patients aৼected by the COVID-19 epidemic; the supervision and support of healthworkers, theform of reminders of medication time and follow-up visits; undesirable eৼects of anti-tuberculosisdrugs, patients are provided with information about TB by health workers andTBinformationcenters, and patients' satisfaction with the provision of medical services. Conclusions: The rate of adherence to treatment of TB patients is still low. It is necessarytohavesolutionsto enhance treatment adherence of TB patients, thereby improving the eৼectiveness of treatment.

Comparison of Ureum and Creatinine Levels in Patients with Pulmonary Tuberculosis in the Treatment Phase 0 and 6 Months

Pulmonary tuberculosis is a disease caused by Mycobacterium tuberculosis. Treatment for tuberculosis patients is given in the intensive and advanced stages. Anti-tuberculosis drugs can be nephrotoxic to cells in the kidneys. This research is an analytic observational study to know the comparison of urea and creatinine levels in pulmonary tuberculosis patients in the 0 and 6-month treatment phases at the Community Lung Health Center Purwokerto. The samples studied were 42 respondents who were taken by accidental sampling. This study was conducted from December 2021 to January 2022. Out of the 42 pulmonary tuberculosis patients who received treatment at 0 and 6 months, the majority of pulmonary tuberculosis patients were 28 patients (66.7%) had normal urea levels, and 38 patients (90.5 %) had normal creatinine levels. Urea levels in pulmonary tuberculosis patients during the 0-month treatment phase were 9 (2-24) mg/dL, while in the 6-month treatment phase, it was 8 (1-37) mg/dL. The creatinine level of pulmonary tuberculosis patients with 0-month treatment phase was 0.98 (0.64-1.62) mg/dL, while in the 6-month treatment phase it was 0.88 (0.62-1.92) mg/dL. There was no significant comparison of urea and creatinine levels in pulmonary tuberculosis patients with treatment phases 0 and 6 months (p>0.05).

Relationship between vitamin D receptor gene polymorphisms and second acid-fast bacilli smear-positive during treatment for tuberculosis patients.

Tuberculosis (TB) treatment is associated with Vitamin D. This study aimed to explore the relationship between Vitamin D receptor (VDR) gene polymorphisms and second acid-fast bacilli (AFB) smear-positive during treatment for TB patients. This was a cross-sectional study. Seven hundred and thirty-one TB patients whose single nucleotide polymorphism site (SNPs) of VDR gene were detected from December 2019 to December 2020 in XinJiang of China. The genotypic distributions in each group were tested separately for Hardy-Weinberg equilibrium. The tetragram test was used to construct haplotypes to evaluate the association between each haplotype and second AFB smear-positive occurrence. No significant deviations were observed with all the four polymorphism sites in the genotypic distributions (P>0.05). Linkage disequilibrium (LD) analysis showed that there was LD between SNPs of VDR gene (r2=0.74, D`>0.9). Each haplotype was not considered to be the influencing factor of second AFB smear-positive. There is no association between VDR gene polymorphism (ApaI, BsmI, FokI and TaqI) and second AFB smear-positive.

Bedaquiline: A Novel Diarylquinoline for Multidrug-Resistant Pulmonary Tuberculosis.

A new drug Bedaquiline, a diarylquinoline agent has been approved by the Food and Drug Administration for the treatment of pulmonary multidrug-resistant tuberculosis. It has been given approval for use along with the basic regimen with only conditional access through the National Program for tuberculosis in India. The major problem with existing antitubercular drugs used for the treatment of multi-drug resistant tuberculosis is antimicrobial resistance, less efficacy, and poor side effect profile. Bedaquiline might be a solution to these issues. Bedaquiline is a first of its class drug with a unique and specific mechanism of action. It inhibits mycobacterial adenosine triphosphate (ATP) synthase's proton pump. There are many randomized clinical trials and cohort studies that reported a higher culture conversion rate with bedaquiline treatment as compared to the control group. Many meta-analyses and systematic reviews have reported higher culture conversion rate, higher cure rate, and lower mortality rate in patients with drug-resistant tuberculosis treated with a bedaquiline-containing regimen. Here is a detailed drug profile of bedaquiline to help health care workers treat tuberculosis patients.Keywords:

Study on Frequency of Impaired Lung Function in Treated Tuberculosis Patients in Tertiary Care Hospital of Pakistan

Background: Pulmonary impairment is a common manifestation in previously treated pulmonary tuberculosis (PTB) patients. Approximately 40-60% of patients with history of complete anti-tuberculosis therapy (ATT) developed the obstructive, restrictive or mixed patterns of lung disease.
 Objective: To determine the frequency and type of impairment of lung function in previously treated PTB patients.
 Methods: A descriptive cross-sectional study was conducted at Ojha Institute of Chest diseases, Dow University of Health Sciences, Karachi during the period of six months from April 2021 to September 2021. One hundred and forty four previously treated PTB patients with age of 18-60 years were selected through consecutive sampling. Spirometry of each patient was performed by trained spirometry technician and lung function was assessed by an experienced pulmonologist. Data was interpreted with SPSS v. 25.0.
 Results: Out of 144 previously treated PTB patients, male were 83 (57.6%) and female were 61 (42.4%). Impaired pulmonary function was present in 87 (60.4%) patients, out of which 49 (56.3%) patients had obstructive impairment; 23 (26.4%) patients had restrictive impairment while 15 (17.2%) patients had mix pattern.
 Conclusion: Prevalence rate of impaired pulmonary function was higher in treated PTB patients who have completed ATT. Obstructive pulmonary impairment was the most common pulmonary impairment followed by restrictive and mixed pulmonary impairment.

Problems of anti-tuberculosis therapy in patients on hemodialysis

The objective: to determine possibility of prescribing and safety of various anti-tuberculosis drugs and their combinations as part of a therapeutic or preventive course of anti-tuberculosis therapy (ATBT) in patients with end-stage chronic kidney disease (CKD) receiving hemodialysis replacement therapy in the settings with high prevalence of drug resistant strains of Mycobacterium tuberculosis.Subjects and Methods. 42 patients receiving hemodialysis replacement therapy were followed-up by Central Tuberculosis Research Institute: of them, 31 (73.8%) had active tuberculosis and 11 (26.2%) had residual post-tuberculous changes in the respiratory organs. During the follow-up, the nature and severity of adverse reactions to anti-tuberculosis drugs were assessed.Results. In the patients with end-stage CKD suffering from respiratory tuberculosis, drug resistant strains prevailed – 68.2%. Some of adverse events developed when taking anti-tuberculosis drugs were as follows: deterioration of uremia in 20.5% of cases, cardiovascular complications – in 17.9%, and neurotoxic reactions – in 15.4%. Progression of uremia occurred more often in the followed-up patients taking anti-tuberculosis drugs versus hepatotoxic reactions (p = 0.02). When treating tuberculosis patients with end-stage CKD, isoniazid was discontinued due to adverse events in 12.8% of cases and pyrazinamide in 12.8% of cases, other drugs were discontinued less frequently. Compilation of individual regimens of anti-tuberculosis drugs with the consideration of drug susceptibility testing results, contraindications, and concomitant diseases made it possible to provide an adequate anti-tuberculosis therapy for patients with end-stage CKD with tuberculosis infection in 92.9% of cases for a period of more than 6 months.

Prevalence of multidrug-resistant tuberculosis in East Africa: A systematic review and meta-analysis.

The rate of multidrug-resistant tuberculosis is increasing at an alarming rate throughout the world. It is becoming an emerging public health problem in East Africa. The prevalence of multidrug-resistant tuberculosis among pulmonary tuberculosis positive individuals in the region has not been thoroughly investigated. The aim of this systematic review and meta-analysis is to estimate the pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed and previously treated pulmonary tuberculosis cases in East African countries. English published articles were systematically searched from six electronic databases: PubMed, EMBASE, Scopus, Science direct, Web of Science, and Google scholar. The pooled prevalence of multidrug-resistant tuberculosis and associated risk factors were calculated using Der Simonian and Laird's random Effects model. Funnel plot symmetry visualization confirmed by Egger's regression asymmetry test and Begg rank correlation methods was used to assess publication bias. A total of 16 articles published from 2007 to 2019 were included in this study. STATA 14 software was used for analysis. Out of 1025 articles identified citations, a total of 16 articles were included in final meta-analysis. The pooled prevalence of multidrug-resistant tuberculosis among newly diagnosed tuberculosis cases and previously treated tuberculosis patients was 4% (95%CI = 2-5%) and 21% (95%CI: 14-28%), respectively. Living conditions, lifestyles (smoking, alcohol use, and drug abuse), previous medical history, diabetes history, and human immunodeficiency virus infection were risk factors contributing to the higher prevalence of multidrug-resistant tuberculosis in East Africa. The review found a significant prevalence of multidrug-resistant tuberculosis in the region. An early diagnosis of tuberculosis and rapid detection of drug-resistant Mycobacterium tuberculosis is a critical priority to identify patients who are not responding to the standard treatment and to avoid transmission of resistant strains. It is also very important to strengthen tuberculosis control and improve monitoring of chemotherapy.

Studi Penggunaan Obat Anti Tuberkulosis (OAT) Tahap Lanjutan pada Pasien Baru BTA Positif

Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. Tuberculosis will cause pain and death if not treated properly. OAT (Antituberculosis Drugs) is a treatment for tuberculosis patients. OAT has different dosage regimens and types of drugs. Treatment of TB patients consists of two phases (intensive and continuation phases). The continuation phase was at to kill dormant bacteria to prevent recurrence in patients. The purpose of this study was to determine and evaluate the pattern of using OAT in patients newly diagnosed rwith smear-positive at the continuation phase. This study is an observational descriptive study with results showing that the pattern of using OAT-KDT in patients was 89% and OAT-Separated was 11%. The pattern of using the OAT-KDT dose was 1x3 2KDT tablets. Another combination of antibiotics given to the patient is cotrimoxazole at a dose of 1x960mg. The side effect of OAT is an increase in serum transaminase and nausea each with a percentage of 23%. Based on the research, it can be concluded that the pattern of using OAT in Tuberculosis patients has followed the guidelines for the management of Tuberculosis treatment.

An Old Defence Against New Infections: The Open-Air Factor and COVID-19.

Outdoors, the risks of transmission of COVID-19 and many other respiratory infections are low. Several environmental factors are known to reduce the viability of viruses and other infectious pathogens in the air. They include variations in temperature, relative humidity, solar ultraviolet radiation, and dilution effects. But one agent that reduces the viability of both viruses and bacteria outdoors, the germicidal open-air factor (OAF), has not been properly recognized for decades. This is despite robust evidence that the OAF can influence both the survival of airborne pathogens and the course of infections.The germicidal effects of outdoor air were widely exploited during the late 19th and early 20th centuries. Firstly, in the treatment of tuberculosis patients who underwent 'open-air therapy' in sanatoria; and secondly by military surgeons during the First World War. They used the same open-air regimen in specially designed hospital wards to disinfect and heal severe wounds among injured soldiers. It was also used on influenza patients during the 1918-19 pandemic. Later, in the 1950s, open-air disinfection and treatment of burns were proposed in the event of nuclear warfare. During the 1960s, the OAF briefly returned to prominence when biodefence scientists conducted experiments proving that open air has a potent germicidal effect. When this work ended in the 1970s, interest in the OAF again fell away, and it remains largely ignored.The COVID-19 pandemic has revived interest in understanding the transmission dynamics and survival of viruses in the air. The pandemic has also stimulated research in the science and practice of improved ventilation to control respiratory infections. Such work is incomplete without an appreciation of the inactivation of viruses and other pathogens by the OAF, but this needs further investigation as a matter of urgency. Research to better understand the conditions under which the OAF can be preserved indoors is urgently needed. We need to review building design with better regard to infection control and patient recovery. But we need to act without delay, as there is already sufficient evidence to show that public health generally would improve if more emphasis was placed on increased exposure to outdoor air.