Treatment Of Tuberculosis Patients Research Articles

Effort to Control Pulmonary Tuberculosis (TB) in the Community through Tuberculosis Alert Health Cadre Training

Tuberculosis (TB) alert health cadre training is an important thing that can be done to help control TB in the community. TB control includes increasing early detection and adherence to treatment for TB patients. To solve TB problems in the community, a synergy of roles is needed between health workers and the community, one of which is through empowering health cadres by increasing their capacity. We conducted interactive TB control health education training program that aim to improve health cadre knowledge, attitudes, and practice in early detection of TB and assistance to Drug Swallowing Supervisors/”Pengawas Menelan Obat (PMO)”. The training was provided using lecture method, two-way discussion, and demonstration for one day by internal medicine specialists, assisted by multi-professional students from medical and nursing program. A total of 36 health cadres from Sumberharjo village participated in this training. Before and after the training, cadres took pre-test and post-test. The survey results were analyzed statistically using descriptive quantitative methods for the respondent’s characteristics, whereas the score of knowledge, attitude, and practice were analyzed using nonparametric test. The median and the minimum-maximum of the pre-test score before training for knowledge was 10.5(7-13), attitude score was 15(11-15), and practice score was 15(8-15). Meanwhile, the median and the minimum-maximum post-test score after training for knowledge was 11(8-14), attitude score was 15(10-15), and practice score was 15(10-15). The results of statistic test obtained were p=0.003 for knowledge, p=0.272 for attitude, and p=0.111 for practice. It showed that there was a significant difference in the cadre's knowledge scores before and after training, but there were no significant differences in their attitudes and practice scores before and after training. Training for health cadres is recommended to increase capacity of health cadre, especially the knowledge of health cadre controlling TB in the community.

Clinical features and effectiveness of treatment of patients with pulmonary tuberculosis who have had COVID-19

In May 2023, WHO officially declared the end of the COVID-19 pandemic. Assessing the consequences of the pandemic remains scientifically and practically relevant. Patients who have recovered from COVID-19 are at risk of developing or relapsing tuberculosis (TB). A comparative retrospective-prospective study was conducted on 88 patients with pulmonary TB, including 45 patients after COVID-19. In 68.9% of those examined, COVID-19 was mild. Tuberculomas and focal pulmonary TB predominated in patients. Tuberculomas and focal pulmonary TB predominated in patients. The most common patterns on CT scans were ground-glass and severe changes. Among laboratory parameters, increases in fibrinogen, D-dimer, and C-reactive protein were more often observed. COVID-19, which was mostly mild, did not have a significant impact on the effectiveness of treatment for TB patients. At the same time, such patients had a more frequent development of adverse reactions during anti-tuberculosis chemotherapy and a complicated course of pulmonary TB.

2958. Investigating the mechanisms of persistent inflammation and the association with non-communicable diseases (NCDs), Tuberculosis (TB) recurrence, and other infections

Abstract Background TB continues to be a major cause of morbidity and mortality worldwide. Despite successful completion of anti-tuberculosis therapy (ATT), studies indicate that TB survivors (post-TB) have a significantly higher risk of mortality compared to the general population, primarily due to increased incidence of non-communicable diseases (NCDs; cardiovascular disease, cancer, lung disease) and recurrent infections. Furthermore, a considerable proportion of TB patients exhibit persistent inflammation even after ATT. Methods We enrolled 325 individuals with microbiologically confirmed pulmonary TB, diagnosed between 2014 and 2020. Blood samples were obtained at baseline and 12- months (6-months after completing antimicrobial therapy) to evaluate persistent inflammation. Plasma C-reactive protein (CRP) was used to measure inflammation. Lipid peroxidation (LP) was measured by oxidized (HNE) LDL. Redox capacity was measured via the Trolox assay. Immune activation was measured by the Indoleamine 2,3 dioxygenases (IDO) enzyme by measuring the Kynurenine-Tryptophan ratio. Results After successful TB treatment, 62% of participants exhibited persistent elevation of CRP (P< 0.001) (Figure 1a). Univariate analysis of the first 186 participants revealed no association between elevated post-TB inflammation and HIV status (Fig. 1B), gender, or age. Individuals with increased CRP levels had a lower redox capacity compared to those whose CRP normalized at the end of ATT (P< 0.001) (Figure 2). Analysis of Oxidized LDL in successfully treated TB patients demonstrated that low antioxidant capacity also had persistent LP (Figure 2b). IDO activity was increased among TB participants with high CRP, which persisted even after successful therapy in participants with high and low CRP levels (Figure 3). Fig 1a: CRP was evaluated on TB participants and their asymptomatic, healthy household contacts. The median CRP of the healthy contacts was <2 mg/L, whereas the median CRP for TB participants at baseline was 21 and decreased to 8 at the end of successful therapy (EOT). Previous studies have demonstrated that CRP levels >3 mg/L are associated with increased CVD risk . 62% (111/186) of TB participants have CRP levels >3 mg//L at the end of TB therapy. Fig 1b: All TB participants living with HIV (PLWH) are started on ART, with >90% having a viral load <1000 at end of therapy (EOT). At EOT, TB participants without HIV do not have lower CRP levels compared to PLWHIV, preliminarily suggesting HIV is not driving the persistent inflammation. Fig2a: The Trolox antioxidant capacity was evaluated on TB Participants with High CRP >3mg/L (n:36) vs Low CRP <3mg/L (n:32) and Healthy Controls (n:32). Conclusion This study shows that a substantial proportion of TB participants exhibit persistent inflammation and IDO activity even after ATT. Among TB participants who do not normalize inflammation at the end of successful therapy, there is also persistent LP and decreased redox capacity. This suggests that there is a bidirectional malignant relationship between LP and redox capacity. Potentially, this suggests that mitigating lipid peroxidation may help decrease post-TB inflammation. Fig2b: Oxidized LDL was measured in TB individuals with High levels of CRP High CRP >3mg/L (n:16) vs Low CRP <3mg/L (n:16) and Healthy Controls (n:4) Fig3 Plasma Kynurenine to Tryptophan ratio was evaluated in TB individuals with persistent augmented levels of CRP (n:19) at baseline and Heathy Controls. At the end of Therapy the KYN:TRYP was evaluated in TB individuals with high (n:22) and Low CRP levels (n:17) Disclosures All Authors: No reported disclosures

Hubungan Jumlah Monosit Dan Nilai Laju Endap Darah (LED) Terhadap Lama Pengobatan Pasien Tuberculosis

Tuberculosis (TBC) is a bacterial infection caused by Mycobacterium tuberculosis. The duration of TBC treatment is routinely 6 months; otherwise, resistance will develop. TBC can increase leukocytes, including monocytosis as an inflammatory response and an elevated ESR. The aim of this study was to determine the relationship between the number of monocytes and the ESR value on the duration of tuberculosis treatment in patients at the Respira Lung Hospital, Yogyakarta City. The study was conducted in June and July 2023 at the Respira Pulmonary Hospital in Yogyakarta City. The study sample was 32 tuberculosis patients and blood was drawn to determine the monocyte number and ESR value. The results showed that the average number of monocytes was 7% (normal), the ESR value was 41.59 mm/hour (high) with the average duration of tuberculosis treatment for respondents was 3 months. Spearman test obtained Sig p<0.05. This study concluded that there is a correlation between the number of monocytes and the ESR value on the duration of TB treatment in patients at the Respira Lung Hospital in Yogyakarta City, with the direction of the relationship reversed.

Health Education In Increasing Self-Efficacy In The Treatment Of Tuberculosis Patients At Tamalanrea Makassar Health Center

Tuberculosis is an infectious disease caused by the bacterium Mycobacterium tuberculosis which spreads through the air (Airborne disease).symptoms of cough with phlegm for 2 weeks or more.Disease prevalenceTB (Tuberculosis)as many as 845,000 with a death rate reaching 98,000 cases, treatment coverage is only 67%, several factors cause unhealthy housing, education and non-compliance with treatment inutritional indicators, immune levels, greatly influence the quality of life of tuberculosis sufferers so that there is a need to increase self-efficacy in managing the disease,with education about the infectious disease tuberculosis The research method used was pre-experimental with a one group pre-test and post-test design with a sample size of 36 people. The instrument we used was a pre- and post-questionnaire and provided intervention in the form of health education. The results of the research showed that after health education was carried out, the Negative Ranks data showed that respondents' scores from pre-post 3 respondents experienced a decrease in self-efficacy regarding tuberculosis treatment after health education, while the positive ranks data showed that 12 respondents' scores from pre-post experienced an increase. Self-efficacy towards tuberculosis treatment after health education, and the tie data shows that 21 respondents got a fixed score from pre-post after health education. The results of the Wilcoxon statistical test obtained a p value = (0.020) <α (0.05), and so The alternative hypothesis (Ha) is accepted. The conclusion is that there is an influence of health education on increasing self-efficacy in the treatment of tuberculosis sufferers at the Tamalanrea Makassar Community Health Center

Exploring Community Participation in Prevention and Care of Tuberculosis from Patients’, Healthcare Providers’ and Community Member’s Perspective, In Wolayta Zone, SNNPR, Ethiopia. A Qualitative Study

Background: In developing countries, tuberculosis (TB) continues to be the major cause of morbidity and mortality. To reduce the loss of lives and economical burden that TB poses up on citizens, early case detection and successful treatment of infected cases are very essential mainly with active community participation in prevention and care of TB. This study was aimed to explore community participation in prevention and care of TB in Wolayta Zone of SNNPR, Ethiopia. Method: Descriptive phenomenological research methodology was employed in the study. A total 24 participants were chosen using purposive sampling technique. Participants in the study were from various sections of society. Of these, 14 were TB patients on TB treatment and former TB patients who were recovered, 8 were health professionals and 2 were Key Informants which were selected from the community to provide key information. Data were gathered through focus groups and in-depth interviews. Using the Open Code and Colaizi 7 steps of descriptive phenomenological method data analysis was used. Interviews were audio recorded, verbatim transcribed, translated, and exhaustive description was written. Results: Community participation in prevention and care of TB in study area was high. Preventive participation and supportive participations were identified and these participations have their own goals in TB prevention and care. Preventive participation has focused on early case finding strategies like referring the suspect cases for TB diagnosis and contact tracing. Supportive participation has focused on treatment success such physical, economical, psychological and social supports which increase the patients adherence to treatment and as result increases treatment success rate. Conclusion. Our study revealed highto moderate community participation in tuberculosis prevention and care in the the study area. The finding is that the TB prevention and care strategy for eliminating TB will be operationally effective. In cumulative effect, the region might be able to meet the WHO's recommendations for the community TB prevention and care plan, which call for case notification of more than 70% and an 85% success rate for treatment and all seek to eliminating TB by 2030. Therefore, the study emphasizes the necessity for effective communication to be established between community and the health institutions. To further raise TB notification and treatment success rates, all feasible methods of utilizing community participation in TB care are advised.

Rifampicin induced acute thrombocytopenia with skin rashes: a case report

Rifampicin is an essential component of the treatment regimen for tuberculosis. Extensive clinical experience has shown that the drug has mild adverse effect, but on rare occasions, it can cause life threatening adverse reactions like thrombocytopenia. Blajchman et al first described rifampicin-induced thrombocytopenia in 1970. Since then, almost 40 cases have been documented in the literature and a recent review by Cooper and Ghanima included rifampicin in the group of not uncommon drugs that cause immune-mediated thrombocytopenia. Diagnosis of drug-induced immune thrombocytopenia is by identifying clinical symptoms and a careful evaluation of the suspected causative drug. The physician treating tuberculosis patients must be aware of this rare life-threatening complication, when we detected early, is completely reversible.

Clinical Utility of Contezolid-Containing Regimens in 25 Cases of Linezolid-Intolerable Tuberculosis Patients.

Linezolid is increasingly used in the treatment of multidrug-resistant (MDR) M. tuberculosis (TB) with good efficacy; however, its clinical use is limited by intolerable adverse events (AEs). This usually results in dose adjustment or even discontinuation. Contezolid is a new oxazolidinone antibiotic with in vitro antibacterial activity against MDR TB equivalent to linezolid, but its safety and efficacy in MDB TB treatment has not been established. We conducted a retrospective study on 25 TB patients who received both linezolid and contezolid in Beijing Chest Hospital from January 1, 2022, to January 31, 2023. All patients received linezolid-containing anti-TB regimen first and then switched to contezolid-containing regimens due to the intolerable linezolid-related AEs. Most (68%, 17/25) of the patients were diagnosed with RR-TB or MDR-TB. A total of 30 AEs were reported in these patients. About 26.7% (8/30) of the AEs were Grade 3 (severe) in severity. After switching to contezolid-containing anti-TB regimens for at least 1 month, the linezolid-related AEs were resolved or improved in 90% of the cases. Clinical improvement was observed in all patients after treatment with contezolid-containing regimen, with negative results of sputum culture and/or smear for M. tuberculosis in 84% of the patients. Contezolid can be the first choice instead of linezolid to combine with other anti-TB drugs if necessary. Well-designed clinical trials are required to further confirm the safety and efficacy of contezolid in the treatment of TB patients.

Influential factors of tuberculosis in mainland China based on MGWR model.

Tuberculosis (TB), as a respiratory infectious disease, has damaged public health globally for decades, and mainland China has always been an area with high incidence of TB. Since the outbreak of COVID-19, it has seriously occupied medical resources and affected medical treatment of TB patients. Therefore, the authenticity and reliability of TB data during this period have also been questioned by many researchers. In response to this situation, this paper excludes the data from 2019 to the present, and collects the data of TB incidence in mainland China and the data of 11 influencing factors from 2014 to 2018. Using spatial autocorrelation methods and multiscale geographically weighted regression (MGWR) model to study the temporal and spatial distribution of TB incidence in mainland China and the influence of selected influencing factors on TB incidence. The experimental results show that the distribution of TB patients in mainland China shows spatial aggregation and spatial heterogeneity during this period. And the R2 and the adjusted R2 of MGWR model are 0.932 and 0.910, which are significantly better than OLS model (0.466, 0.429) and GWR model (0.836, 0.797). The fitting accuracy indicators MAE, MSE and MAPE of MGWR model reached 5.802075, 110.865107 and 0.088215 respectively, which also show that the overall fitting effect is significantly better than OLS model (19.987574, 869.181549, 0.314281) and GWR model (10.508819, 267.176741, 0.169292). Therefore, this model is based on real and reliable TB data, which provides decision-making references for the prevention and control of TB in mainland China and other countries.

Effect of gaseous pollutant and greenness exposure on mortality during treatment of newly treated tuberculosis patients: a provincial population-based cohort study.

Previous studies addressing the impact of environmental factors on TB prognosis are scarce, with only some studies examining the effect of particulate pollutants on TB mortality. Moreover, few studies have evaluated the effects of multiple gaseous pollutants and greenness exposures on newly treated TB patients on a large population scale. Through the Centers for Disease Control and Prevention, data were collected from January 1, 2015 to December 31, 2020 for newly treated TB patients in Anhui Province, China. Data on gaseous pollutants sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone were collected through the National Earth System Science Data Center of China. Normalized vegetation index data were obtained through NASA. The Cox proportional risk model was also applied to calculate the hazard ratios of SO2, NO2, CO, O3, and NDVI with 95% confidence intervals for mortality among newly treated TB patients. Multifactorial Cox regression analysis showed that for every 0.10μg/m3 increase in SO2, the risk of death among newly treated TB patients increased by 13.2% (HR = 1.132, 95% CI: 1.045-1.1.225), for every 10μg/m3 increase in NO2, the risk of death among newly treated TB patients increased by 11.4%, and for each 0.1 mg/m3 increase in CO, the risk of death among newly treated TB patients increased by 5.8%. For each 0.1 increase in NDVI 250m-buffer and 500m-buffer, the risk of death among newly treated TB patients decreased by 8.5% and 6.4%, respectively. The effect of gaseous pollutants on mortality decreased progressively with elevated greenness exposure when greenness exposure was grouped from low to high. Gaseous pollutants are a risk factor during the treatment of newly treated TB patients and greenness exposure is a protective factor. Higher greenness exposure reduces the risk of death due to exposure to gaseous pollutants.

Evaluating the effectiveness of first-Line anti-tuberculosis in Al Dhafra Hospitals

Background: Tuberculosis (TB) continues to be a significant public health issue despite extensive efforts to control it. The standard treatment for TB involves the use of first-line anti-TB drugs administered at a standard dose. However, the effectiveness of this treatment can vary between individual patients, resulting in differing cure rates.
 Methodology: The objective of this retrospective study was to assess the effectiveness and safety of first-line generic anti-TB medications administered at Liwa Hospital in the Al Dhafra Region. Data was collected from the electronic medical records of 140 TB patients admitted to Liwa Hospital from January to December 2022. The study included patients with positive acid-fast bacillus (AFB) or polymerase chain reaction (PCR) test results, indicating active TB infection. Patients resistant to first-line anti-TB medications or with lung cancer were excluded. Data collected included demographic information, length of stay conversion time, hospital admission, prescribed medications, treatment duration, and treatment outcomes.
 Results: This study observed an average length of stay of 21 days for patients treated with first-line generic anti-TB medications at Liwa Hospital. Over 80% of the patients were discharged within 30 days of admission, indicating a positive response to the medications. Approximately 13% of the patients required a longer duration of treatment and were discharged between 30 and 60 days after admission. Only 5% of the patients had a prolonged stay of over 60 days, most of whom had co-morbidities or rifampicin resistance, but achieved AFB conversion within three months. The average conversion time for patients was 25 days, with over 92% achieving conversion within two months.
 Conclusion: This study demonstrated the efficacy and safety of first-line generic anti-TB medications in treating TB patients at Liwa Hospital. The majority of patients responded well to the medications, leading to discharge within 30 days.
 Keywords: Tuberculosis, Ethambutol, Pyrazinamide, Rifampicin, Isoniazid, First line drugs, Anti TB drugs

Risk factors for cardiotoxic adverse reactions in the treatment of tuberculosis patients with MDR and XDR of the pathogen

Risk factors for cardiotoxic adverse reactions in the treatment of tuberculosis patients with MDR and XDR of the pathogen

Risk factors and predictors of drug resistance in tuberculosis: A comprehensive analysis of cases in Chile (2014-2018)

Determine the risk factors associated with drug resistance and unsuccessful treatment of tuberculosis in Chile between 2014 and 2018. Analytical observational cross-sectional study including patients diagnosed with Tuberculosis (TB) who entered treatment during 2014-2018, contained in the national TB records. Demographic, clinical variables, and risk groups associated with drug resistance and unsuccessful treatment in TB patients were determined using logistic regression. Between 2014 and 2018, 13,1761 TB patients were reported in Chile, of whom 3.4% (n = 445) were drug-resistant. From this, 43.1% are rifampicin-resistant TB (RR-TB), multidrug-resistant (MDR-TB), and extensively drug-resistant (XDR-TB). The risk factors that generated the highest probability of drug resistance were relapse (OR: 4.27; CI95% 2.94; 6.20), foreigner (OR: 3.97; CI95% 2.86; 5.52), pulmonary TB (OR: 2.92; CI95% 1.71; 4.99) and HIV (OR: 1.97; CI: 95% 1.33; 2.90). Regarding the probability of unsuccessful treatment against TB, the highest probability were street situation (OR: 3.33; CI: 95% 2.45; 4.52), drug addiction (OR: 1.91; CI 95% 1.52; 2.41), foreigner (OR: 1.51; CI 95% 1.25; 1.83), drug resistance (OR: 2.81; CI 95% 1.87; 4.20), HIV (OR: 3.24; CI: 95% 2.61; 4.02), not belonging to an indigenous people (OR: 1.43; CI 95% 1.00; 2.06) alcoholism (OR: 1.25; CI 95% 1.01; 1.54), pulmonary TB (OR: 1.43; CI 95% 1.20; 1.70) and male sex (OR: 1.44; CI 95% 1.25; 1.65). The risk factors identified as relapse and coinfection with HIV as predictors of drug resistance highlight the complexity of disease management. Likewise, the presence of street situations, drug addiction, and alcoholism highlights the need for specific approaches to address tuberculosis in different population groups, suggesting the need for personalized strategies.

Classification and characterisation of extracellular vesicles-related tuberculosis subgroups and immune cell profiles.

Around the world, tuberculosis (TB) remains one of the most common causes of morbidity and mortality. The molecular mechanism of Mycobacterium tuberculosis (Mtb) infection is still unclear. Extracellular vesicles (EVs) play a key role in the onset and progression of many disease states and can serve as effective biomarkers or therapeutic targets for the identification and treatment of TB patients. We analysed the expression profile to better clarify the EVs characteristics of TB and explored potential diagnostic markers to distinguish TB from healthy control (HC). Twenty EVs-related differentially expressed genes (DEGs) were identified, and 17 EVs-related DEGs were up-regulated and three DEGs were down-regulated in TB samples, which were related to immune cells. Using machine learning, a nine EVs-related gene signature was identified and two EVs-related subclusters were defined. The single-cell RNA sequence (scRNA-seq) analysis further confirmed that these hub genes might play important roles in TB pathogenesis. The nine EVs-related hub genes had excellent diagnostic values and accurately estimated TB progression. TB's high-risk group had significantly enriched immune-related pathways, and there were substantial variations in immunity across different groups. Furthermore, five potential drugs were predicted for TB using CMap database. Based on the EVs-related gene signature, the TB risk model was established through a comprehensive analysis of different EV patterns, which can accurately predict TB. These genes could be used as novel biomarkers to distinguish TB from HC. These findings lay the foundation for further research and design of new therapeutic interventions aimed at treating this deadly infectious disease.

RESULTS OF LONG-TERM FOLLOW-UP OF PATIENTS WITH HIV/TUBERCULOSIS COINFECTION

The problem of combined HIV/tuberculosis infection is characterized by a broad social orientation, a serious risk factor for the development of the disease and a factor of death is the use of narcotic substances. The number of patients with HIV/tuberculosis co-infection in the Russian Federation remains high, the majority of cases of tuberculosis in patients with HIV infection are detected in the late stages of the disease, mainly when patients turn to the general treatment network. In recent years, the situation has been complicated by an increase in the proportion of cases of sexual transmission of HIV, the number of infected among young women is growing. The problem of drug resistance of Mycobacterium tuberculosis creates many difficulties in terms of diagnosis and treatment. The course of the tuberculosis process in HIV patients, due to pronounced immunosuppression, is often atypical, TB diagnosis is especially difficult at the stage of severe immunodeficiency, the tuberculosis process often proceeds in a generalized form. Treatment of comorbid patients is also a big problem due to the simultaneous administration of a large number of anti-tuberculosis drugs in addition to their lifelong HIV treatment, which leads to a decrease in adherence to treatment. The article presents data from an 11-year follow-up of a cohort of patients with HIV infection and tuberculosis. The clinical and anamnestic data, the experience of HIV infection, the timing and causes of deaths were evaluated. The patients were mainly young men (70%) with a high level of intravenous drug use (77.5%), high hepatitis C virus infection (55%), severe immunosuppression (60.1%), a significant proportion of MDR (43.8%), lack of adherence to antiretroviral therapy (58.8%). 51.25% of patients died during the follow-up period. Due to the high risks of death and other failures of tuberculosis treatment in patients with HIV/TB comorbidity, studies of the results of management of such patients in the long term remain a priority for all regions of the country. The problem of detecting tuberculosis in patients with HIV-infection remains urgent, which requires the interaction of both the phthisiological service and infectious disease specialists, narcologists and primary health care.

Leucocyte Counts and Derivatives as Inflammatory Indicators in Active Tuberculosis

Tuberculosis (TB) is a disease of public health concern in Nigeria as the country is listed among the 30 high TB burden countries in the world. It is caused by Mycobacterium tuberculosis, an airborne pathogen. Tuberculosis disease is a manifestation of an active state of the infection when host immune response has been overwhelmed. Leucocytes participate in immune response, and traditionally, the total and differential counts have been useful in offering general outlook on inflammation as well as immunodeficiency. Lately, leucocyte derivatives such as neutrophil-tolymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) have been reported as bettermarkers of inflammation in some disease conditions. This study assessed total and differential leucocyte counts together with the derivatives in active tuberculosis infection among 80 tuberculosis patients and equal number of matched controls. Total and differential leucocyte counts were determined using standard haematology autoanalyzer, while the ratios were mathematically derived. Data were analyzed and hypotheses tested using student’s t-test on statistical package for social sciences (SPSS) version 21. A p-value of ≤0.05 was considered as statistically significant. Neutrophil-lymphocyte ratio was significantly higher in TB patients,while lymphocyte-monocyte ratio was significantly lower in TB patients than the control. Furthermore, neutrophil-lymphocyte ratio was significantly higher, while the lymphocytemonocyte ratio was significantly lower in TB patients at diagnosis (n=26) in comparison withthose on treatment (n=54). There is derangement in leucocyte derivatives in association with tuberculosis. These derivatives improved significantly as anti-TB treatment progressed. Therefore, these variables could serve as useful indicators in the monitoring of treatment for TB patients.&nbsp

Synchronous video-supported treatment for tuberculosis in Cali, Colombia: An implementation study

ObjectiveTo describe the implementation and outcomes of synchronous video-supported treatment (VOT) as a telemedicine strategy for monitoring tuberculosis treatment in patients from Cali, Colombia. MethodsA quasi-experimental study was conducted in Cali, Colombia. Patients aged ≥ 18 years with newly diagnosed tuberculosis sensitive to first-line drugs were included. The intervention consisted of synchronous video calls to monitor the daily intake of drugs, remotely and in real-time using the WhatsApp mobile application. We described the demographic and clinical characteristics, supervision and treatment adherence process, adverse drug effects, perception of the strategies, and transportation costs. ResultsA total of 23 patients were enrolled in the study for synchronous VOT strategy. The adherence was 99.8% in the intensive phase (2HRZE) and 98.2% in the continuation phase (4HR). All patients completed the tuberculosis treatment, achieving 100% cure criteria for patients with pulmonary tuberculosis. Most adverse effects were reported during the first month of treatment (31.6%). Timesaving was the main advantage reported for the strategy. ConclusionsSynchronous VOT strategy was well tolerated and accepted by all patients, allowing an excellent level of adherence to tuberculosis treatment. Synchronous VOT is proposed as a viable alternative to directly observed therapy for tuberculosis in selected patients.

When should we be able to divert the cost of tuberculosis to other diseases?

Dear Editor, A country’s development and progress are based on its economy and gross domestic product (GDP). A recently published article in your journal introduces the past, present, and future of the Indian economy specifically related to healthcare. The author has nicely described the high burden of communicable and noncommunicable diseases. The authors have covered tuberculosis (TB) under communicable disease. We want to add some perspective to point out the status of TB burden on the Indian health economy.[1] Southeast Asian countries share more than 40% of the global TB burden and India is one of them. India belongs to the bracket of lower-middle-income countries.[2] Each and every single expenditure thing will have an effect on our country’s economy, either the share market or the healthcare system. As per recently published data, the Indian economy cost around $32 billion every year in TB-related fatalities.[1] TB is an old and infectious disease that makes a patient immunocompromised. TB patients have more chance to get other infectious diseases which makes patient’s life more troublesome in health and wealth both ways. The World Health Organization (WHO) and Government provide free testing and treatment for TB patients but this is not enough to control and eliminate the disease.[3] Majority of the patients belong to the lower and lower-middle-class family, which does not have the facility to get proper nutritious food; due to malnourishment, the patient does not get the treatment benefits that they need. Various studies revealed that several risk factors are responsible for the development of TB specifically drug-resistant TB and malnutrition, low body mass index, and low economy are few of them.[4] The Indian government is giving some amount to the patient to comply with treatment but that is not enough. To get benefits from the government, patients need to pass various documentary processes. Many patients stop the treatment in between due to these hectic procedures.[5] WHO and the government had the goal of END TB program to eradicate TB from India by the year 2025. Government and supportive people are on the right way but coronavirus disease 2019 (COVID-19) pandemic took us back foot.[6] TB not only is a fatal disease but also puts a lot of stress on the treasury. So, if TB is eliminated, a lot of funds can then be diverted to take care of other infectious diseases. So realistically, we can eliminate TB maybe by 2030. Out of all the programs mentioned, maybe TB is one entity, we can believe can be taken care of monetarily. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Oral anticoagulants and concurrent rifampin administration in tuberculosis patients with non-valvular atrial fibrillation

BackgroundEvidence and guidelines for Non-vitamin K antagonist oral anticoagulants (NOACs) use when prescribing concurrent rifampin for tuberculosis treatment in patients with non-valvular atrial fibrillation (NVAF) are limited.MethodsUsing the Korean National Health Insurance Service database from January 2009 to December 2018, we performed a population-based retrospective cohort study to assess the net adverse clinical events (NACE), a composite of ischemic stroke or systemic embolism and major bleeding, of NOACs compared with warfarin among NVAF patients taking concurrent rifampin administration for tuberculosis treatment. After a propensity matching score (PSM) analysis, Cox proportional hazards regression was performed in matched cohorts to investigate the clinical outcomes.ResultsOf the 735 consecutive patients selected, 465 (63.3%) received warfarin and 270 (36.7%) received NOACs. Among 254 pairs of patients after PSM, the crude incidence rate of NACE was 25.6 in NOAC group and 32.8 per 100 person-years in warfarin group. There was no significant difference between NOAC and warfarin use in NACE (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.48–1.14; P = 0.172). Major bleeding was the main driver of NACE, and NOAC use was associated with a statistically significantly lower risk of major bleeding than that with warfarin use (HR, 0.63; 95% CI, 0.40–1.00; P = 0.0499).ConclusionsIn our population-based study, there was no statically significant difference in the occurrence of NACE between NOAC and warfarin use. NOAC use may be associated with a lower risk of major bleeding than that with warfarin use.

Knowledge, Attitude, and Practices Among Healthcare Practitioners in the Context of Multidrug Resistance Tuberculosis: An Appraisal to Disease Elimination.

Tuberculosis (TB) remains one of the leading infectious causes of death worldwide, and India is among the countries with the highest TB burden. TB control is facing several roadblocks in our country with the rapid development of multidrug-resistant (MDR) as well as extensively drug-resistant TB (XDR) and as an after-effect of the global COVID-19 pandemic.With the target of TB elimination by 2025 (National Tuberculosis Elimination Program, NTEP), there is a need that treating physicians in our country be well aware of MDR-TB and be able to diagnose and treat it at an appropriate time. The present study is conducted to explore the knowledge levels, attitudes, and practices concerning MDR-TB amongst healthcare professionals working in different healthcare sectors. A total of 250 allopathic medical practitioners (Bachelor of Medicine and Bachelor of Surgery [MBBS], specialists, and superspecialists) working in any sector (private or government), who are directly involved in managing any form of TB patient and are willing to undertake the assessment, were included in this online questionnaire-based survey that was circulated using various social media platforms like WhatsApp, Facebook, Linked In, and Gmail. Responses to the questionnaires created in Google Forms were analyzed by capturing data in a Microsoft Excel® spreadsheet for further statistical analysis. The data were analyzed using multiple measures of dispersion and cross-tabulations. Among the 250 participants, most of the participants had encountered MDR-TB in their clinical practice, and the majority believe that MDR-TB is a rising problem. Although 88% of the participants did a GeneXpert assay before the start of anti-tubercular therapy (ATT), three-fourths of the participants knew that the assay detects the MTB genome and rifampicin resistance. MDR-TB was suspected in participants after no clinical improvement was observed after 3-6 weeks of a trial of ATT. Two-thirds of the participants knew that linezolid is currently being used as a second-line drug for the treatment of MDR- TB. The respondents in our survey mostly do not themselves treat MDR-TB and refer the patients to an MDR-TB center or a pulmonary medicine specialist. Healthcare practitioners (HCPs) with good knowledge levels can diagnose and treat TB patients appropriately, thus decreasing the rising MDR-TB problem, and they can educate patients and the general population about TB and the emerging MDR-TB situation. With the current level of knowledge about MDR-TB management, there is certainly an urgent need for educational and persuasive measures for the training of doctors in both the public and private sectors so as to achieve TB elimination by 2025.