Tuberculosis Control Program Research Articles

A soft-computation hybrid method for search of the antibiotic-resistant gene in Mycobacterium tuberculosis for promising drug target identification and antimycobacterial lead discovery.

Tuberculosis (TB) control programs were already piloted before the COVID-19 pandemic commenced and the global TB response was amplified by the pandemic. To combat the global TB epidemic, drug repurposing, novel drug discovery, identification and targeting of the antimicrobial resistance (AMR) genes, and addressing social determinants of TB are required. The study aimed to identify AMR genes in Mycobacterium tuberculosis (MTB) and a new anti-mycobacterial drug candidate. In this research, we used a few software to explore some AMR genes as a target protein in MTB and identified some potent antimycobacterial agents. We used Maestro v12.8 software, along with STRING v11.0, KEGG and Pass Server databases to gain a deeper understanding of MTB AMR genes as drug targets. Computer-aided analysis was used to identify mtrA and katG AMR genes as potential drug targets to depict some antimycobacterial drug candidates. Based on docking scores of -4.218 and -6.161, carvacrol was identified as a potent inhibitor against both drug targets. This research offers drug target identification and discovery of antimycobacterial leads, a unique and promising approach to combating the challenge of antibiotic resistance in Mycobacterium, and contributes to the development of a potential futuristic solution.

Implementation of the Pulmonary TB Control Program in Noebeba Health Centre, Noebeba District, South Central Timor Regency

Angka penemuan kasus TB Paru di Puskesmas Noebeba masih rendah dan belum mencapai target minimal nasional yang ditetapkan yaitu 70%. Penelitian ini bertujuan untuk mendeskripsikan pelaksanaan program pengendalian TB Paru di Puskesmas Noebeba Kecamatan Noebeba Kabupaten TTS Tahun 2021. Jenis penelitian ini merupakan penelitian kualitatif dengan pendekatan studi kasus. Informan pada penelitian berjumlah 4 orang yaitu Kepala Puskesmas/Dokter, Pengelola Program TB, dan 2 Perawat yang ditentukan menggunakan teknik purposive sampling berdasarkan kriteria yang telah ditetapkan. Kriteria dalam penelitian ini yaitu orang-orang yang terlibat langsung dalam program pengendalian TB Paru di Puskesmas Noebeba dan bersedia menjadi informan penelitian. Pengumpulan data menggunakan teknik wawancara, observasi, dan dokumentasi. Analisis data dilakukan dengan cara reduksi data, penyajian data, dan penarikan kesimpulan dan verifikasi. Penelitian ini dilaksanakan pada bulan Desember 2021 hingga Januari 2022. Hasil penelitian menunjukkan bahwa Puskesmas mengalami kekurangan dana dan mikroskop belum tersedia, kesulitan ekonomi untuk biaya transportasi pemeriksaan, kurangnya pengetahuan dan kesadaran masyarakat untuk mau berobat atau memeriksakan dirinya ke Puskesmas. Diharapkan lebih meningkatkan upaya penemuan kasus secara aktif, pengadaan mikroskop, dan penyuluhan.

Nationwide Treatment Outcomes of Patients With Multidrug/Rifampin-Resistant Tuberculosis in Korea, 2011-2017: A Retrospective Cohort Study (Korean TB-POST).

The treatment outcomes of patients with multidrug/rifampin-resistant (MDR/RR) tuberculosis (TB) are important indicators that reflect the current status of TB management and identify the key challenges encountered by TB control programs in a country. We retrospectively evaluated the treatment outcomes as well as predictors of unfavorable outcomes in patients with MDR/RR-TB notified from 2011 to 2017, using an integrated TB database. A total of 7,226 patients with MDR/RR-TB were included. The treatment success rate had significantly increased from 63.9% in 2011 to 75.1% in 2017 (P < 0.001). Among unfavorable outcomes, the proportion of patients who failed, were lost to follow up, and were not evaluated had gradually decreased (P < 0.001). In contrast, TB-related death rate was not significantly changed (P = 0.513), while the non-TB related death rate had increased from 3.2% in 2011 to 11.1% in 2017 (P < 0.001). Older age, male sex, immigrants, low household income, previous history of TB treatment, and comorbidities were independent predictors of unfavorable outcomes. Of the 5,308 patients who were successfully treated, recurrence occurred in 241 patients (4.5%) at a median 18.4 months (interquartile range, 9.2-32.4) after completion treatment. The treatment outcomes of patients with MDR/RR-TB has gradually improved but increasing deaths during treatment is an emerging challenge for MDR-TB control in Korea. Targeted and comprehensive care is needed for vulnerable patients such as the elderly, patients with comorbidities, and those with low household incomes.

Call for Integration of Screening of Other Respiratory Diseases of Epidemic Potential in TB Traditional Clinics

Introduction: Medical advances in the last six decades have made tuberculosis (TB) a curable disease. We conducted a Systematic Literature Review to examine the potential impact of the COVID-19 pandemic on TB programmes. Methods: We conducted a Systematic Literature Review to examine the potential impact of the COVID-19 pandemic on TB programmes. We searched online publication databases and World Health Organisation publications on the interaction of TB and COVID-19 pandemic. Results: Our survey shows that during the period of the pandemic the world saw reversal of gains following the disruption of TB programmes. This was due to applied lockdowns and reduced financing to the programmes. During the years of the pandemic (2020 to 2021) both diseases killed comparably close to 1.5 million people each. Justifiably, priority was given to dealing with the COVID-19 pandemic whose epidemiology was poorly understood. Global funding to TB control reduced while a record level of global resources ever to be allocated to one disease in a space of two years was amassed to fighting the COVID-19 pandemic. Conclusion: Available evidence in literature show considerable disruption of well-running TB programmes when the world was affected by the pandemic. To avoid repeating similar mistakes when the world experiences another COVID-like pandemic we strongly advocate for integrating TB and Severe Acute Respiratory Syndrome-related Coronaviruses (SARSr-CoV) control programmes. This is justifiable from many reasons including the observations that both diseases 1) affect the lungs and can worsen the treatment outcomes of each other, 2) are biggest killers among unvaccinated individuals, 3) carry a similarly high very level of stigma within communities, and 4) need adequate funding to control. In addition, SARSr-CoV prevention and control can benefit from longstanding structures and patient management methods that have been built to fight TB and vice versa.

Early Detection Information System for Delayed Sputum Conversion Risk Factors

Key indicators of tuberculosis control programs, two of them are success and cure rate. Moreover, to measure response to TB treatment, sputum conversion in the first two months is widely used. Low social determinants, presence of co-morbidities, medication nonadherence are risk factors that usually late identified and caused sputum conversion delay. This research aims to design an innovation early-detection system for sputum conversion risk factors in TB patients supported by an expert system. This research is operational research, involving all head of TB programs and head of primary health centres in Bandar Lampung, Indonesia. Research variables consist of social determinants and risk factors of sputum conversion delay. Method and data collection refer to first and second stage of system development life cycle. Results of focus group discussion obtain input and output system design. Input system design consists of risk factors list and yes or no answers choices based on TB patient’s examination. Meanwhile, output system design are expert recommendations based on input system. This information system provides both immediate detection as well as immediate expert recommendations, which will finally increase the chances of sputum conversion in the first two months of TB patient’s treatment.

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.

Screening for Latent and Active Tuberculosis in Paediatric Contacts of Tuberculosis Patients: A Cross-sectional Study

Introduction: Globally, World Health Organisation (WHO) estimate suggests that, one million cases of Tuberculosis (TB) occur among children (approximate 10% of the total 9.6 million TB cases). As per Revised National Tuberculosis Control Programme (RNTCP), high importance and priority is given to the household contacts and paediatric age group (especially &lt;6 years). Since, transmission can happen at any time from index case to the contact (before diagnosis or during treatment), all contacts of TB patients should be screened. Aim: To focus on the screening of paediatric contacts of TB positive patients by Mantoux test and to find out active and latent TB. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India. The duration of the study was 16 months, from February 2020 to June 2021. Participants, who were proven cases, either sputum positive or clinically diagnosed and were less than 18 years of age were included. Contacts in whom Isoniazid Preventive Therapy (IPT) had been started were excluded. The candidates who tested Mantoux positive and had symptoms of TB were further screened by following test chest X-ray, Ultrasonography (USG) abdomen, Microscopy for Acid Fast Bacilli (AFB), Cartridge Based Nucliec Acid Amplification Test (CBNAAT), Cerebrospinal Fluid (CSF) analysis and contrast Magnetic Resonance Imaging (MRI). The data collected was analysed statistically with Statistical Package for Social Sciences (SPSS) version 26.0 and the level of significance was determined p-value &lt;0.05 as insignificant, p-value &gt;0.05 as significant and p-value &lt;0.001 as highly significant. Results: A total of 82 contacts were included. Out of these, 60 children had no organ system involvement, whilst 11 had lymphadenopathy, five had respiratory involvement and six had abdominal involvement. Out of 82 contacts, 23 children tested Mantoux positive and 59 tested negative. Out of 23 Mantoux positive contacts 16 (19.51%) had latent TB and only 1 (2.44%) had active TB. Conclusion: A significant number of children in contact with TB positive patients were found to have latent TB, and it is possible that, there can be activation from latent to active TB later on in these children.

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.

Engaging community pharmacists in tuberculosis-directly observed treatment: a mixed-methods study.

This study aimed to evaluate the feasibility of implementing community pharmacy-based tuberculosis-directly observed treatment (TB-DOT) in Malaysia. Tuberculosis (TB) eradication is one of the top priorities in the public health agenda in Malaysia. While public-private mix (PPM) initiatives have been launched, community pharmacists remain undervalued assets in TB management. A two-phase mixed-methods study targeting community pharmacists was conducted in Malaysia between March and October 2021. The first phase was an online self-administered survey developed according to the Consolidated Framework for Implementation Research (CFIR). The second phase was a semi-structured interview to allow deeper understanding on the quantitative results. Quantitative data were analysed using descriptive analysis while qualitative data were analysed using thematic analysis with a semi-inductive approach. The data were triangulated to enhance comprehensiveness and credibility of the findings. The survey was completed by 388 community pharmacists, and 23 pharmacists participated in the interview. Most community pharmacists indicated their willingness to serve as TB-DOT supervisors (70.1%). Qualitative results supported the findings. Community pharmacy-based TB-DOT service was perceived as an avenue to improve TB management and outcomes and to enhance the professional role of pharmacists in TB service at primary care settings. This was also perceived as a feasible intervention with the potential to strengthen the National TB Control programme. This initiative needs be reinforced with adequate support from the public healthcare sector for a strong partnership in ensuring success.

Study the prevalence of rifampicin resistance among pulmonary tuberculosis patients by genexpert assay from a tertiary care hospital of North India.

Rifampicin (RIF) resistance (RR) tuberculosis (TB) has posed a great challenge to TB control programs globally. Evidence of RIF-RR can help as a surrogate marker to find out multidrug-resistance cases. The study aimed to determine the prevalence of RIF-RR in pulmonary TB (PTB) patients over the 4 years at Dr. RPGMC, Tanda, from the year 2018 to 2021. This was a retrospective study conducted at Dr. RPGMC, Tanda at Kangra, where we checked (from January 2018 to December 2021) clinically suspected PTB patients, whose samples were sent to the laboratory for GeneXpert assay to identify Mycobacterium TB/RIF (MTB/RIF) testing. Of the total 11,774 clinically suspected PTB specimens were collected, and identified by GeneXpert MTB/RIF assay, in which 2358 samples were MTB positive and 9416 were MTB negative. Among 2358 MTB-positive samples, 2240 (95%) samples were RIF sensitive, in which 1553 (65.9%) were males and 687 (29.1%) were females, 76 (3.2%) samples were RIF-RR, in which 51 (2.2%) were males and 25 (1%) were females, and 42 (1.8%) samples were RIF indeterminate, in which 25 (1%) were males and 17 (0.8%) were females. The rate of RIF-RR was found 3.2% of total samples which was more in males. The overall positivity rate was 20%, and the rate of positivity decreased from 32% to 14% over the 4 years in sputum samples. Hence, the GeneXpert assay was found to be very important tool to detect RIF-RR among suspected PTB patients.

Knowledge of Tuberculosis, Services of TB Control Programme and Associated Socio-Demographic Inequity among Rural Participants of Jaipur, Rajasthan, India: A Cross Sectional Study

Knowledge of Tuberculosis, Services of TB Control Programme and Associated Socio-Demographic Inequity among Rural Participants of Jaipur, Rajasthan, India: A Cross Sectional Study

Advances in TB testing.

Globally, tuberculosis (TB) was the leading cause of death from a single infectious agent until the coronavirus (COVID-19) pandemic. In 2020, an estimated 10 million people fell ill with TB and a total of 1.5 million people died from the disease. About one-quarter of the global population, almost two billion people, is estimated to be latently infected with Mycobacterium tuberculosis (MTB). Although latent TB infection (LTBI) is asymptomatic and noncontagious, about 5-10% of LTBI patients have a lifetime risk of progression to active TB. The diagnosis and treatment of active cases are extremely vital for TB control programs. However, achieving the End TB goal of 2035 without the ability to identify and treat the pool of latently infected individuals will be a big challenge. To do so, improved technology to provide more accurate diagnostic tools and accessibility are crucial. Therefore, this chapter covers the current WHO-endorsed tests and advances in diagnostic and screening tests for active and latent TB.

Impact of diabetes mellitus on treatment outcome of newly diagnosed smear-positive pulmonary tuberculosis patients: A case–Control study

Background: Tuberculosis (TB) and diabetes mellitus (DM) are major public health problems in developing countries such as India. The link of DM and TB is more prominent in these countries where TB is endemic, and the burden of DM is increasing. Studies regarding the effect of DM on smear conversion and treatment outcome of pulmonary TB (PTB) in India are limited. Aims: The study aimed to compare the conversion and treatment success among new smear-positive PTB patients with and without DM. Materials and Methods: A case–control study was conducted in the department of pulmonary medicine of a tertiary care hospital in eastern India between October 2019 and September 2020. All newly diagnosed smear-positive drug-sensitive PTB patients visiting the outdoor or being admitted were identified, and their initial smear status, history of diabetes, and glycemic status were recorded. All the patients were treated with category I regimen of the Revised National TB Control Program. Sputum smear was followed up at the end of intensive phase and at the end of treatment and compared between diabetic and nondiabetic patients. The software SPSS version 16 was used to analyze all the data. Results: Sixty newly diagnosed smear-positive PTB patients with DM and sixty smear-positive PTB without DM were included in this study. Smear conversion was seen in 24 (40%) out of 60 diabetic TB patients and 55 (91.7%) out of 60 nondiabetic TB patients. Treatment success was seen in 40 (66.7%) out of 60 diabetic TB patients and 56 (93.3%) out of the 60 nondiabetic TB patients. Conclusion: Smear conversion and treatment success rate are lower in diabetic TB patients as compared to nondiabetic TB patients.

Tuberculosis of Bones and Joints in Orthopedic

Background: Mycobacterium Tuberculosis (TB) is a major global health concern and burden on developing countries economy. Pakistan ranks in top 10 countries of the world with high load of TB and a big chunk of this disease process is extra pulmonary TB (EPTB). Among extra pulmonary sites, is bone and joint TB is very common yet under reported. Recent literature has found up to 35% of all extra pulmonary cases are bone and joint TB. Purpose: We aim to do an analysis of frequency of bone and joint TB in our institution in all new patients getting registered for treatment of TB. Methodology: This was retrospective analysis 8 years of Data collected in Gulab Devi Hospital Lahore. Data was analyzed using Microsoft excel software and results are tabulated. Findings: Total number of new registered patients of Extra-pulmonary Tuberculosis (EPTB) were 13000 (20%). Out of these EPTB patients, bone and joint TB diagnosis was made in 690(5.3%) patients. Out of these 690 patients, 400 (58%) cases were recorded in Indoor facility and 290 (42%) cases were seen in outdoor facility. Most common site is Spine 340 cases (85%) followed by Hip joint 16 cases (4%), knee joint 12 cases (3%) and upper limb 16 cases (4%). Practical Implication: Regarding management of newly registered cases, Gulab Devi hospital is working in collaboration with world Health Organization TB control program and Provincial TB control Program Punjab (PTP). All new cases are managed by multi-disciplinary team and after initial registration are referred to their relevant specialties. Conclusion: Axial skeleton remains the most common site in al literature and so is the conclusion of our analysis. Detailed research work is still needed in several aspects of this ancient disease to reduce the morbidity and mortality associated with it. Keywords: Bone and joint TB, Pulmonary Tuberculosis, Extra pulmonary Tuberculosis

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.

Impact of the COVID-19 pandemic on tuberculosis patients and tuberculosis control programs in Turkey, review and analysis

BackgroundMany infectious diseases, including Tuberculosis (TB), have been put in the background with the COVID-19 pandemic. This study aimed to evaluate the changes in the number of TB patients, the parameters of the TB patients and tuberculosis control programs in the first year of the COVID-19 pandemic in Turkey when compared to the previous year.MethodsAll TB patients who were recorded in Samsun province between March 1, 2019 and February 28, 2021 were included in this retrospective study. The data were analyzed in 2 groups as the COVID-19 period (March 2020 and February 2021) and the Pre-COVID-19 period (March 2019 and February 2020),the demographic and microbiological characteristics of the tuberculosis patients in both periods were compared according to months and years p < 0.05 was considered statistically significant.ResultsThe total number of TB patients was 320, although it was 172 in the Pre-COVID-19 period, it was 148 in the COVID-19 pandemic period. It was found that the TB incidence rate (IR) was 15.32%, the total number of examinations performed in TB dispensary decreased 33.54%, and the total number of contact examinations decreased by 53.54% during the pandemic period. The mean age of the patients decreased significantly during the COVID-19 period (p = 0.047), and it was found that culture positivity rates and smear positivity rates increased compared to the previous year (7.97%, p = 0.166, 1.86%; p = 0.507, respectively). SARS-CoV-2 PCR test result was found to be (−) in 46 (82.1%) of the 56 TB patients who were examined.ConclusionsIn the present study, it was found that the incidence of TB, the number of examinations, and the number of contact examinations decreased at significant levels. The decrease in TB patients was mostly in the first 3 months when COVID-19 precautions and restrictions were intense. As a conclusion, it was observed that the application of TB patients to the healthcare institution and TB control were affected negatively by the COVID-19 pandemic.

Detection and factors associated with tuberculosis and rifampicin resistance among presumptive patients at the Thailand-Myanmar border.

Tuberculosis (TB) continues to be a major public health problem in Thailand and many countries. Endemic TB and outbreaks of TB drug resistance in the borderlands are particularly important. The Thailand-Myanmar border has extensive cross-border travel that may accelerate TB's spread. This cross-sectional study aimed to determine the frequency and factors associated with TB, and rifampicinresistant TB (RR-TB) among presumptive tuberculosis patients in Mae Sot Hospital. Sputum was processed by microscopic examination and Xpert MTB/RIF assay. Laboratory results and socio-demographic characteristics were collected and analyzed. Univariate and multivariate analyses were performed to assess the association of the risk factors with TB and RR-TB. The significant variables at p-values < 0.05 in univariate analysis were selected for multivariate analysis. Of 365 presumptive patients enrolled, 244 (66.85%) were males and 199 (54.52%) were Burmese. Of these, 314 (86.03%) were registered as new cases and 183 (50.14%) worked as laborers. Sputum microscopy was positive in 132 (36.16%) cases. Based on Xpert MTB/RIF, the frequency of TB was 136 (37.26%) and RR-TB was 15 (11.03%). TB was more common in males than females. The majority of the cases belonged to the 26-50-year-old age group and migrant workers. In RR-TB detection, the rpoB mutations covered by probe E were the most frequently observed. Sequencing showed that the most highly mutated codon was codon 531 and Ser531Thr was the most common mutation. For risk factor analysis, working as laborers was significantly (p-value < 0.05) associated with TB (aOR 2.83; 95% CI 1.43-5.63) and previously treated cases were significantly associated with RR-TB (aOR 12.33; 95% CI 2.29-66.49). The high frequency of TB and RR-TB in migrants highlights the problem and factors associated with TB at the border and the need for efforts in TB control programs in this setting.

Clinical and economic burden of drug-susceptible tuberculosis in Indonesia: national trends 2017–19

The global incidence of tuberculosis is decreasing, yet it remains high in Indonesia. The Indonesian National Tuberculosis Program facilitates mandatory notification, which enables early detection and treatment, minimises complications, prevents transmission, and decreases deaths. This study aimed to assess the characteristics, trends, and economic burden of notified drug-susceptible tuberculosis cases registered in this system from 2017 to 2019. We performed a multiyear cross-sectional study focusing on drug-susceptible tuberculosis notified cases, incidence, geographical tuberculosis case distribution, treatment outcomes, and costs in Indonesia using data from Sistem Informasi Tuberkulosis (2017-19). The settings were Indonesian health-care facilities that provide tuberculosis control programmes and services. Eligible patients were those who were diagnosed with drug-susceptible tuberculosis and notified to Sistem Informasi Tuberkulosis. Between 2017 and 2019, notified cases increased from 429 219 to 523 614 individuals, corresponding to an increase in incidence from 167 cases per 100 000 to 196 cases per 100 000. In 2019, more than 250 cases per 100 000 inhabitants were notified in Jakarta, North Sulawesi, Gorontalo, and Papua. Treatment success rate increased from 363 098 (84·60%) of 429 219 in 2017 to 452 966 (86·51%) of 523 614 in 2019, with a relatively stable mortality, changing from 3·15% to 3·05%. HIV status was increasingly confirmed, with unknown status decreasing from 66·21% to 43·68%. The costs of visits and monitoring and drug regimens were relatively stable, with total direct medical costs slightly increasing from US$39·40 to $40·40 per case. Progress was made on drug-susceptible tuberculosis management in Indonesia. However, further intensified efforts, including case-finding, optimising diagnosis, and cost-effective tuberculosis management are required if Indonesia is to achieve the 2025 WHO End Tuberculosis Strategy target incidence of fewer than 55 cases per 100 000 people. These data are an important starting point for understanding drug-susceptible tuberculosis dynamics in Indonesia and optimising its management. Directorate General of Higher Education; Ministry of Education, Culture, Research, and Technology of the Republic of Indonesia.

Spatial distribution and computational modeling for mapping of tuberculosis in Pakistan.

Tuberculosis (TB) like many other infectious diseases has a strong relationship with climatic parameters. The present study has been carried out on the newly diagnosed sputum smear-positive pulmonary TB cases reported to National TB Control Program across Pakistan from 2007 to 2020. In this study, spatial and temporal distribution of the disease was observed through detailed district wise mapping and clustered regions were also identified. Potential risk factors associated with this disease depending upon population and climatic variables, i.e. temperature and precipitation were also identified. Nationwide, the incidence rate of TB was observed to be rising from 7.03% to 11.91% in the years 2007-2018, which then started to decline. However, a declining trend was observed after 2018-2020. The most populous provinces, Punjab and Sindh, have reported maximum number of cases and showed a temporal association as the climatic temperature of these two provinces is higher with comparison to other provinces. Machine learning algorithms Maxent, Support Vector Machine (SVM), Environmental Distance (ED) and Climate Space Model (CSM) predict high risk of the disease with14.02%, 24.75%, 34.81% and 43.89% area, respectively. SVM has a higher significant probability of prediction in the diseased area with a 1.86 partial receiver-operating characteristics (ROC) value as compared with other models.

Molecular Docking Interaction of Mycobacterium Tuberculosis Enoyl-Acp-Reductase Enzyme with Delamaind

One of the eldest human diseases is tuberculosis (TB), for which there is molecular evidence dating back more than 17,000 years. Unfortunately, TB is still one of the top 10 infectious diseases that kill people worldwide, second only to HIV, despite advances in detection and treatment. The World Health Organization (WHO) claims that TB is an international pandemic. It is the main cause of death for those with HIV. In India, the fight against TB has largely been divided into three eras throughout its history: the early era, before the development of x-ray and chemotherapy; the post- independence era, when national TB control programmes were started and put into place; and the current era, when an ongoing WHO-assisted TB control programme is in place. Today's DOTS in India. A new anti-tuberculosis (TB) medication called delamanid, a nitroimidazo-oxazole derivative, has strong in-vitro and in- vivo antitubercular action against drug-susceptible and -resistant strains of Mycobacterium tuberculosis. With intention to propose the most probable mechanism of action of delamanid the docking based computational analysis has been performed against enyl ACP reductase (InhA) as targeted protein. The molecular docking of delamanid with enyl ACP reductase (InhA) showed binding energy (Kcal/mol) -10.86 having molecular interaction Lys165, Ala198, Phe149, Pro193, Met199, Glu219, Pro156, Met103 &amp; Gly96. The concluding consequences of the existing research found out that the chosen molecule highly bounded with InhA thereby inhibiting the mycobacterial cell wall synthesis.