Tuberculous Research Articles

Possibilities of Adding Pulmonary Surfactant to Comprehensive Therapy of Patients with Respiratory Tuberculosis: Results of a Prospective Comparative Study

The objective: to assess effectiveness and safety of the surfactant as part of comprehensive anti-tuberculosis therapy in pulmonary tuberculosis patients depending on the drug resistance pattern and HIV status.Subjects and Methods. 184 patients with pulmonary tuberculosis were enrolled in the study, of them 130 (70.7%) were men and 54 (29.3%) were women. All patients were randomized into Main Group (MG) and Control Group (CG). Surfactant therapy was added to comprehensive anti-tuberculosis therapy of the patients from Main Group. Additionally, each group was divided into subgroups based on HIV status.Results. The addition of surfactant therapy to comprehensive anti-tuberculosis therapy increases effectiveness of treatment improving such parameters as sputum conversion and cavity healing regardless of drug susceptibility pattern including patients with concomitant HIV infection. At the same time, the agent used for surfactant therapy demonstrated good tolerability.

Chemotherapy Options in New Patients with Drug Susceptible Tuberculosis and Concurrent HIV Infection

The objective: to compare effectiveness and safety of isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate with the drug of isonicotinic acid hydrazide group in the complex therapy of patients with drug susceptible tuberculosis and HIV infection.Subjects and Methods. In 2020-2021, 40 patients with HIV infection and drug susceptible respiratory tuberculosis with a positive sputum test were examined in Moscow Regional Clinical TB Dispensary as a part of the post-registration observational study. The subjects were randomized into two groups – Main Group (MG) and Comparison Group (CG). Isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate was administered to the patients from MG as a part of regimen 1 of chemotherapy (instead of isoniazid). The effectiveness and safety of the investigational drug and comparator were evaluated. The primary effectiveness criteria included resolution of clinical symptoms of intoxication and sputum conversion. The secondary effectiveness criterion was positive X-ray changes. The safety criterion was the absence of adverse reactions.Results. During the study period, no adverse reactions were registered when isonicotinoylhydrazine-O,N' iron (II) sulfate dehydrate was used, as well as isoniazid. Good tolerability was noted as well as high compliance to treatment by patients. Thus, both in terms of effectiveness and safety, isonicotinoylhydrazine-O,N' iron (II) sulfate dihydrate is comparable to isoniazid as part of anti-tuberculosis chemotherapy for patients with drug susceptible tuberculosis and concurrent HIV infection.

Genitourinary tuberculosis: the poorly studied subtype

Genitourinary tuberculosis: the poorly studied subtype

Assessing the Risk of Tuberculosis Relapse Development during the Period of Stabilization of the COVID-19 Epidemic

The objective: to evaluate risk factors for tuberculosis relapse development during stabilization of the COVID-19 situation.Subjects and Methods. 165 patients over 18 years of age were enrolled in the observational comparative study, those patients were followed up due to respiratory tuberculosis relapses in 2021-2023. Risk factors for early and late relapses that occurred during the pandemic (2021-2022) and post-pandemic (2023) periods were analyzed. They included age, gender, accommodation, social status, imprisonment, smoking, alcohol and substances abuse, comorbidities, clinical forms of tuberculosis, presence of cavities, bacterial excretion, and drug resistance of Mycobacterium tuberculosis.Results. The data obtained confirmed the assumption that the COVID-19 pandemic had led to changes in social and medical-biological risk factors for tuberculosis relapse.

Use of Dispersible Fixed-Dose Combinations in Chemotherapy of Drug Susceptible Tuberculosis: Results of the Observational Study

The objective: to assess effectiveness, safety and pharmacoeconomic feasibility of using a dispersible fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg) in patients with respiratory tuberculosis and preserved susceptibility of Mycobacterium tuberculosis (MTB) to anti-tuberculosis drugs.Subjects and Methods. A post-registration observational study was conducted to assess treatment effectiveness of pulmonary tuberculosis in 60 adult patients with drug susceptible tuberculosis. In Main Group, patients received the fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg), while in Control Group, patients were treated with the regimen consisting of single anti-tuberculosis drugs.Results. Sputum conversion rate made 76.7% by the end of the intensive phase (60 doses) when replacing isoniazid, rifampicin and pyrazinamide with the dispersible fixed-dose combination, while with the standard choice of drugs, it was 66.7%. The incidence of adverse reactions was 7-fold lower when using the investigational drug which contributed to a high level of adherence and high effectiveness of therapy. Pharmacoeconomic analysis convincingly demonstrated advantages and economic benefits of the dispersible fixed-dose combination (isoniazid 150 mg, rifampicin 150 mg, pyrazinamide 375 mg), which was more costly than the combination of single drugs.

Infection risk with JAK inhibitors in dermatoses: a meta-analysis.

Evolving evidence suggests that Janus Kinase Inhibitors (JAKi) may predispose to certain infections, including tuberculosis and human herpes viruses. This review aimed to compare the infection risk in patients on a systemic JAKi for a dermatologic indication to a placebo. A systematic review was carried out from inception to June 2023, using the EMBASE, Medline, SCOPUS, and Cochrane Library of Registered Trials databases. Eligible studies included placebo-controlled randomized trials that investigated the incidence of infection in patients with a dermatologic indication. Primary outcomes included the most commonly reported infections pertaining to serious and opportunistic infections, upper respiratory tract infections, nasopharyngitis, herpes simplex, varicella zoster, tuberculosis, neutropenia, and lymphopenia. A meta-analysis of incidence ratios was conducted to determine odds ratios (OR), with a 95% confidence interval (CI) analysis. The meta-analysis found no increased risk of serious (OR: 0.92, 95% CI: 0.61-1.43, P = 0.74) or opportunistic infections (OR: 0.65, 95% CI: 0.32-1.31, P = 0.23). The incidence of varicella-zoster infections was significantly higher in the JAKi cohort (OR: 1.72, 95% CI: 1.08-2.72, P = 0.022). From 25 studies, there was no overall increased risk of herpes simplex infections (OR: 1.43, 95% CI: 0.93-2.23, P = 0.102) to placebo; however, a significantly higher risk in those with atopic dermatitis to alopecia areata was demonstrated (OR: 1.73, 95% CI: 1.13-2.69, P = 0.013). The results of this analysis do not suggest an increased risk of serious and opportunistic infections in those on JAKi compared to placebo. However, they support an increased risk of varicella-zoster infections and a higher risk of herpes simplex infections in those with atopic dermatitis to alopecia areata. The results of this report support these agents' short-term safety but signal that vigilance should be practiced in patients at risk for serious or recurrent herpes virus infections.

Contribution of QuantiFERON TB gold in tube to the diagnosis of tuberculous pleurisy: a monocentric prospective study

Introduction The diagnosis of tuberculous (TB) pleurisy remains difficult because of its paucibacillary character. Several authors have studied the usefulness of interferon gamma release assays in the early diagnosis of TB pleurisy, whereas these tests are designed for the detection of latent TB infection. Our objective is to study the performance and clinical relevance of QuantiFERON TB Gold in Tube (QFT-GIT) in the diagnosis of TB pleurisy in Algeria. Patients and methods QFT-GIT was tested in vitro in serum and pleural fluid on a prospective recruitment of 158 immunocompetent patients with pleural effusion. Results Of the 158 cases of pleurisy identified, 84 (53.84%) were TB, diagnosed and proven by conventional methods, and 72 (46.15%) were non-TB, of whom 67 (93%) were confirmed of neoplastic origin, five (7%) secondary to a systemic disease and two of nonspecific inflammatory origin. Our results showed a high pleural sensitivity of QFT-GIT (97.62%) compared to serum sensitivity (80.95%). In contrast, serum specificity (83.78%) was higher than pleural specificity (72.97%). When we used the optimal values from the receiver operation characteristics curve analysis, the area under the curve of interferon-gamma produced by the QFT-GIT test was significantly higher in the pleural fluid than in the blood. Area under the curve of TB antigen interferon-gamma response was 92, 18 [95% confidence interval (CI)=87.56–96.79], nil tube was 95.71% (95% CI=92.43–99), and mitogen tube was 65.34 (95% CI=57.71–72.98). Conclusion QFT-GIT in pleural fluid appears in our study as a useful test for the diagnosis of TB pleurisy, but its diagnostic accuracy needs to be validated in further large-scale research.

Diagnosis of pleural tuberculosis in the era of thoracoscopic surgery

Background Before thoracoscopic surgery, diagnosing tuberculous (TB) pleurisy was a medical challenge. Thoracoscopy is the most accurate but expensive method for TB pleurisy diagnosis. TB is common in low-income countries, where financial limitations prevent the use of thoracoscopy, motivating the search for a cheaper alternative. Patients and methods A prospective study was done from January 2019 to January 2023 to evaluate diagnostic methods for patients with exudative pleural effusions (PE) of unknown etiologies. The demographic, radiological, procedural, and histological data of exudative PE patients were analyzed. All patients were examined for adenosine deaminase (ADA) and lymphocyte/neutrophil ratio in pleural fluid. Ultrasound-guided Abrams needle biopsy and video-assisted thoracoscopic surgery pleural biopsies were obtained, and histopathological results were assessed. Results Of 250 patients with PE, 161 (64%) had TB PE, 72 (28.8%) had malignant PE, and 17 (6.8%) had idiopathic PE. Sensitivity of ADA (≥40 U/l) was 88%, lymphocyte/neutrophil ratio (≥0.75) was 86.1%, and their overall sensitivity was 91%. They had 93.2, 86.3, and 100% specificity, respectively. For ultrasound-guided Abrams needle biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 66, 46.5, and 78.4%, respectively. All were 100% specific. For thoracoscopic biopsy, the sensitivity of histopathology, culture, and combined histopathology/culture was 100, 86.6, and 100%, respectively. All were 100% specific. The assay sensitivity of pleural fluid and tissue Xpert Mycobacterium tuberculosis/rifampin resistance was 12.5 and 49.7%, respectively. Both were 100% specific. Combining ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and an ultrasound-guided Abrams needle biopsy yielded 92.4% sensitivity and 100% specificity. Conclusion Combining pleural fluid ADA more than or equal to 40 U/l, lymphocyte/neutrophil ratio more than or equal to 0.75, and ultrasound-guided Abrams needle biopsy can accurately detect TB PE in high-TB populations. It may be an affordable alternative to thoracoscopy in countries with limited resources.

Significance of Juvenile Idiopathic Arthritis in Pediatric-Phthisiatric Practice (Review)

Juvenile idiopathic arthritis (JIA) is a heterogeneous group that includes all forms of childhood chronic arthritis (joint inflammation lasting more than 6 weeks) of unknown cause in children under 16 years of age. JIA is the most common rheumatic disease in childhood (with an annual incidence from 1.6 to 23.0 new cases per 100,000 adolescents) and is characterized by an often hidden onset and a chronic relapsing course after diagnosis. Tuberculosis plays a special role among opportunistic infectious diseases in JIA, because rheumatic diseases are associated with an increase in the overall risk of developing tuberculosis. Children's phthisiologists often deal with the differential diagnosis difficulty of tubercular lesions of the joints with JIA, and first of all, with oligoarthritis. Clinical symptoms in JIA can be very diverse, and some characteristics of arthritis, not necessarily significant in JIA diagnosis, may have multiple etiologies that need to be carefully differentiated. It was detected during review that JIA is of urgent importance in children’s phthisiatric practice due to various reasons: oligoarthritis in JIA has similar clinical manifestations as in tuberculosis arthritis, which significantly complicates differential diagnosis and delays timely treatment of a correctly diagnosed disease; there is a high frequency of diagnosis of latent tuberculosis infection (LTBI) in JIA, which requires the appointment of preventive treatment to reduce the risk of LTBI progression to an active form of tuberculosis; patients with JIA receiving tumor necrosis factor blockers and/or methotrexate have a higher risk of tuberculosis activation, which is a serious problem in the treatment plan, and require constant monitoring for the possible development of tuberculosis. Therefore, in all pediatric patients with JIA, mandatory diagnostic screening (combination of tuberculin skin test methods with QuantiFERON®-TB Gold In-Tube, taking into account the high frequency of false-negative result of the tuberculin skin test due to immunosuppression caused by JIA) for timely detection of LTBI, and with a positive result of preventive antimycobacterial treatment, which will prevent the development of an active form of tuberculosis.Therefore, all pediatric patients with JIA should undergo mandatory diagnostic screening (combination of tuberculin skin test methods with QuantiFERON®-TB Gold In-Tube, considering the high frequency of false-negative result of tuberculin skin test due to immunosuppression caused by JIA) for timely detection of LTBI. When there is a positive result of the screening tests, it is necessary to carry out prophylactic antimycobacterial treatment, which will prevent the development of an active form of tuberculosis.

Tuberculosis in Human Bones from 4000 Years Ago, Iran.

Tuberculosis is caused by a bacterium called Mycobacterium tuberculosis, which is a contagious and infectious disease; in the first stage, it destroys the lungs and in the next stage other body organs, such as the spine and long bones. This disease is transmitted through an infected person and due to the weakness of the immune system, the infection intensifies. Tuberculosis has two stages: low activity and high activity. In this article, we have discussed the signs of tuberculosis destruction with high intensity on the bones of prehistory human remains. The examples of our research are related to human remains from the ancient cemetery of 4000 years ago from Sagezabad region of Qazvin Province of Iran. That period of history coincides with the Iron Age 2 and 3 in the region. People inside the Sagezabad cemetery were very near to early urban (the late rural) society. By matching the form of bone destruction with international atlases for tuberculosis, we have reached a satisfactory result in this article. Due to the strong penetration of the infection into the bones, destruction in the remains was high, so it has simplified the diagnosis for us. We found tuberculosis among the bones. This common ancient disease existed even among Neanderthals.

Antimicrobial Activity of Senna didymobotrya and Thunbergia alata Plant Extracts Against Selected Bacterial Clinical Isolates from Kericho Referral Hospital in Kenya

Bacterial infections are distributed worldwide and cause deadly infectious bacterial diseases such as skin, soft tissue and respiratory tract infections, meningitis, and tuberculosis. Bacterial infections are very common and can be easily acquired since bacteria are ubiquitous. It has challenged modern healthcare providers; conventional drugs are costly and have side effects. Therefore, alternative remedies that are easily available, affordable, and effective are needed. This study was carried out to determine the antimicrobial activity of Senna didymobotrya and Thunbergia alata crude plant extracts against Staphylococcus aureus, Streptococcus pyogenes and pseudomonas aeruginosa common in Kericho County. Plant leaves of the two plants were sourced from two sites (Bomet and Kabianga), dried, milled into powder and solvent extracted using hexane, dichloromethane: methanol ratio (1:1) and methanol. Phytochemicals present in each plant extract were evaluated using standard laboratory procedures. Antimicrobial sensitivity testing, Minimum Inhibitory Concentrations (MICs) and Minimum Bactericidal Concentration (MBC) were determined. Discs impregnated with standard antibacterial drugs were used as positive control. Leaves of T. alata and Senna didymobotrya collected from Bomet contained 7.41% and 10.4% while those from Kabianga contained 8.07% and 17.71% of extracts respectively, suggesting that site conditions do not influence the percentage of extracts. Leave extracts of S. didymobotrya and T. alata were found to be rich in alkaloids, flavonoids, terpenoids, glycosides and tannins irrespective of plant collection site, solvent of extraction. S. didymobotrya and T. alata plant extracts significantly inhibited growth of the exposed microbes in the following order: S. aureus, ≥S. pyogenes and≥ P. aeruginosa bacteria in comparison with commercial antibiotics (penicillin, chloromphenical, and erythromycin). The MIC values of the isolates ranged from 20×10-3 mg/ml to 4.8 ×10-3 mg/ml. However, bacterial inhibition by plant extracts showed re-growth of S. pyogenes after 36 hours, suggesting bacteriostatic nature. These results suggest that S. didymobotrya and T. alata leaves contain significant amounts of alkaloids, flavonoids, terpenoids, glycosides and tannins hence can be used as traditional medicine to manage S. aureus, S. pyogenes and P. aeruginosa bacteria found on human skin

Spectrum of diseases and injuries presentation among patients visiting Emergency Department at Janaki Medical College Teaching Hospital

Background & Objectives: The Global Burden of Disease study is a systemic effort to quantify the comparative magnitude of the health loss due to diseases, injuries and risk factors by age, sex and geographies in specific point of time. Five out of ten causes of disease burden in 2017 in Nepal are Non-Communicable Disease (NCDs), ischemic heart disease (IHD), Chronic Obstructive Pulmonary Disease (COPD), Lower Respiratory Tract Infection (LRTI) and Tuberculosis (TB). We aimed to find out the demographic, clinical presentation and outcome of Emergency patients at Janaki Medical College Teaching Hospital (JMCTH) Emergency department. Materials and Methods: A descriptive observational study of patients visiting ED at Janaki Medical College, Ramdaiya, Bhawadi, Dhanusha. Distinctiveness of adult patients who entered the emergency department (ED) in a hospital in Nepal were prospectively recorded in the local emergency registry from 2023-04-15 to 2023-07-18. Post-ED mortality, patient households were followed-up by telephone interviews at 90 days. Patients were diagnosed, treated and admitted in different wards for further evaluation and treatment. Data were collected, analyzed, interpreted, using SPSS version 20. Results: The majority of patients were male (55.58%) predominantly from Dhanusha (79.4%). Common symptoms included musculoskeletal pain (16.5%), abdominal pain (13.3%), and fever (9.9%). The most common diseases were acute pain abdomen (21.26%) and hypertension (11.06%), Abrasions (35%) and cut injuries (13.59%) were the most frequent injuries. Most of the patients were admitted to the observation ward (52.9%). Conclusion: Most patients attending emergency department were young males from Dhanusha, primarily of Terai Madheshi and other castes. The results emphasize the necessity of better emergency care services and public health initiatives in Janakpurdham, as well as the critical role of emergency departments which provides services in wide range of acute and chronic diseases.

Challenges in Managing Newly Diagnosed Granulomatosis With Polyangiitis and Concurrent Respiratory Infections: A Retrospective Case Series.

Granulomatosis with polyangiitis (GPA), formerly termed Wegener's granulomatosis, is an autoimmune disease marked by necrotizing granulomatous inflammation and vasculitis affecting small-sized vessels. It commonly impacts the renal and respiratory systems. This retrospective case series sampling conductedin a tertiary care hospital between May 2023 and April 2024 examined six newly diagnosed GPA patients who wereproteinase 3 cytoplasmic-antinuclear cytoplasmic antibody (PR3 c-ANCA) positive and had concurrent respiratory infections. None of them had any prior immunosuppressive conditions.The age range was 18-47 years with a mean of 35.0 (standard deviation: 11.83). All the patients had pneumonia (N=6, 100%). Out of all, five hadbacterial pneumonia (N=5, 83.3%) and one had tuberculous pneumonia (N=1, 16.7%). A high levelof PR3 c-ANCA (>150 RU/mL) was noted in four patients (N=4, 66.7%).Common symptoms included dry cough (N=5, 83.3%), loss of weight and appetite(N=2, 33.3%), and fever (N=2, 33.3%). Three patients had otitis mediaand/or nasal polyposis (N=3, 50%). Two patients (N=2, 33.3%) with life-threatening organ dysfunction were given concurrent antibiotics and steroids; the antibiotics were later modified based on culture and sensitivity results. One of these patients received antituberculosis therapy as Mycobacterium tuberculosis (MTB) was detected after 27 days of incubation in mycobacterial growth indicator tube broth. The remaining four patients (N=4, 66.7%)receivedantibiotics initially for 5-7 days until clinical resolution of pneumonia. Ultimately, they all showed clinical and radiological resolution (N=6, 100%) within 3-6 months of treatment. The patients exhibited constitutional symptoms such as fever and weight loss; lower airway disease symptoms including dry cough and hemoptysis; nasal and ear disease symptoms like epistaxis, ear pain, and ear discharge; and a renal disease symptom, hematuria.Computed tomography of the thorax revealed bilateral consolidations, most of which were cavitating. Bronchoalveolar lavagecultures grew Escherichia coli, Burkholderia cepacia, Pseudomonas aeruginosa, Klebsiella pneumoniae, and MTB, whereas pus swab cultures from otitis media grew Pseudomonas aeruginosa, Staphylococcus aureus,and coagulase-negative staphylococci. This study highlights the therapeutic challenges of GPA complicated by concurrent infections. Patients exhibited typical GPA signs, confirmed by PR3 c-ANCA levels. Concurrent infections require cautious antibiotic treatment before starting immunosuppressive therapy, except in life-threatening organ dysfunction. A unique case presented with both tuberculosis and GPA. Tailored treatment regimens combining antibiotics and immunosuppressives, including corticosteroids, methotrexate, and rituximab, resulted in clinical and radiological improvement in all the patients within 3-6 months. The addition of co-trimoxazole reduced the incidence of non-severe GPA relapses. Tailored treatment plans addressing both infectious and autoimmune aspects are essential for optimal care in GPA complicated by concurrent infections. This study highlights the need for a multidisciplinary approachinvolving pulmonologist, rheumatologist, microbiologist, and pathologistin the diagnosis and treatment of GPA, emphasizing the importance of individualized treatment plans tailored to the specific clinical scenario.

Tobacco smoking-attributable mortality in Kenya, 2012-2021.

Tobacco smoking poses a significant risk for various diseases, including cardiovascular diseases, chronic respiratory diseases, and cancers. In Kenya, tobacco-related deaths contribute substantially to non-communicable disease mortality. This study aims to quantify the mortality attributed to tobacco smoking in Kenya from 2012 to 2021. Employing a prevalence-based analysis model, the study utilized population attributable fraction (PAF) to estimate age-specific smoke attributable mortality (SAM) rates for individuals aged ≥35 years. Causes of death associated with tobacco use, including cancers, cardiovascular diseases, respiratory diseases, tuberculosis, and diabetes, were analyzed based on age, sex, and death records between 2012 and 2021. Over the study period, 60228 deaths were attributed to tobacco-related diseases, with an annual increase observed until 2016 and subsequent fluctuations. Respiratory diseases, diabetes mellitus, malignant cancers, tuberculosis, and cardiovascular diseases collectively accounted for 16.5% of deaths among individuals aged ≥35 years. Notable contributors were pneumonia and influenza (respiratory diseases), esophageal cancer (cancers), and cerebrovascular diseases (cardiovascular diseases). Of the observed deaths, 16.5% were attributed to smoking, with respiratory diseases (40.5%), malignant cancers (31.4%), tuberculosis (13%), cardiovascular diseases (8.9%), and diabetes mellitus (6.1%) contributing. Pneumonia and influenza, esophageal cancer, chronic airway obstruction, and tuberculosis were primary causes, comprising 70% of all SAM. Tobacco-related mortality is a significant public health concern in Kenya. Efforts should focus on preventing tobacco use and managing associated disease burdens. Smoking cessation initiatives and comprehensive tobacco control measures are imperative to mitigate the impact on population health.

Challenging urological reconstruction in post-tuberculosis contracted bladder and renal complications: A rare case report

Genitourinary Tuberculosis (GUTB) represents a manifestation of extrapulmonary tuberculosis associated with significant urinary tract complications, such as contracted bladder and renal insufficiency. This report delineates a rare instance of GUTB culminating in considerable urological impairment, necessitating complex reconstructive procedures.

Analysis of epidemiological characteristics of extrapulmonary tuberculosis from South-Central China.

This study aimed to investigate the epidemiological and drug resistance (DR) characteristics of extrapulmonary tuberculosis (EPTB) in South-Central China. EPTB inpatients who were culture-positive for Mycobacterium tuberculosis were retrospectively included in a study at a provincial TB hospital in Hunan, a province in South-Central China, from January 2013 to December 2021. Demographic, clinical, and drug susceptibility data were retrieved from TB treatment records. Descriptive statistical methods and a Chi-squared test were used to analyze the epidemiological and DR characteristics of EPTB patients. A logistic regression model was used to explore the risk factors of rifampicin-resistant/multidrug-resistant (RR/MDR)-EPTB. A total of 1,324 cases were included. The majority of EPTB patients were in the age range of 20-29 years, were predominantly men (male-to-female ratio: 2.03), and were farmers (65.63%). Most EPTB cases were found in 2013 and 2017 from 2013 to 2021. The most prevalent subtypes of EPTB were lymphatic TB (29.83%, 395/1,324), multiple EPTB (20.85%, 276/1,324), and musculoskeletal TB (14.65%, 194/1,324). Musculoskeletal TB and genitourinary TB predominantly presented as exclusive EPTB forms, while lymphatic TB and pharyngeal/laryngeal TB often co-occurred with pulmonary TB (PTB). Drug susceptibility testing results showed that total DR rates (resistance to any of RFP, isoniazid [INH], streptomycin [STR], and/or ethambutol [EMB]) and RR/MDR rates in EPTB were 25.23% and 12.39%, respectively. Musculoskeletal TB exhibited the highest rates of total DR (31.40%), INH resistance (28.90%), STR resistance (20.10%), EMB resistance (6.20%), MDR (13.90%), and poly-DR (6.70%). The multivariable logistic regression model showed that patients aged from 20 to 59 years (compared to those aged 10 years), workers (compared to retirees), and EPTB patients from the south and west of Hunan (compared to those from the east of Hunan) were at an increased risk of developing RR/MDR EPTB (all OR values > 1). Our study provided a detailed account of the epidemiological and DR characteristics of EPTB in Hunan province, China. The significant DR rates, particularly in musculoskeletal TB cases, highlight the need for timely diagnosis, effective drug susceptibility testing, and the development of more effective treatment regimens for EPTB, especially targeting musculoskeletal TB treatments.

Patterns and Influencing Factors of Organisms and Sensitivity in Sputum at Sylhet

Background: Respiratory tract infections, especially pneumonia and tuberculosis, remain significant public health problems in Bangladesh. This information alone is critical to manage local pathogen distributions, antibiotic susceptibility, and response plans. Objectives: To evaluate the frequency of bacterial pathogens in sputum samples, test their antibacterial sensitivity, and relate them to various demographic factors among patients in Sylhet, Bangladesh. Methods: This cross-sectional study was carried out in the Chest Disease Clinic, Sylhet from January to June 2024.Sputum samples were taken from 120 patients diagnosed with lower respiratory tract infections. Colony and bacterial identification was done microbiologically, and antibiotic susceptibility was determined by using the Kirby-Bauer disk diffusion method. Results: The cocci were the most prevalent, with gram-positive bacteria constituting 75% of all isolates: Staphylococcus aureus 29. Co-amoxiclav had the highest sensitivity of 23 percent, while the highest resistance was recorded for linezolid at 50 percent. Tobacco use was described in 79. Overall, there was a significant association between TB-positive status and the isolation of Klebsiella pneumoniae (p = 0.032). Most participants were of lower SES, and this was observed in 59.32% of the study’s participants. Conclusions: This research found that gram-positive organisms are the most frequent cause of respiratory infections in Sylhet, with S. aureus being the most dominant isolate. The high tobacco use and the link to S. aureus colonization indicate that interventions could and should be targeted. Concerning antibiotic susceptibility patterns, the need to exercise reasonable use of antibiotics and constant monitoring of antimicrobial resistance cannot be overemphasized. These findings may help the local clinicians, help set up empirical antibacterial therapy, and facilitate the design of some targeted health interventions. Scholars Middle East Publishers Browse Journals Payments Publication Ethics SUBMIT ARTICLE

Effects of air pollution on global health: evidence from the global burden of disease study in the BRICS countries.

Considering the dynamic influence of environmental, social, economic, and political factors in the emergence and growth of the BRICS countries (Brazil, Russia, India, China, and South Africa) over the years and pre-existing differences, the adverse effects of air pollution on the health and well-being of the people have remained major areas of academic inquiry and policy interventions. The present study examines the global trend of deaths and Disability Adjusted Life Years (DALYs) attributable to air pollution with particular reference to the BRICS countries for the period 1990 to 2019. This study has used the global burden of disease estimates by using different rounds of the Global Burden of Disease (GBD) study report published by the Institute of Health Metrics Evaluation. This study has calculated the cause of death and DALYs due to environmental risk factors (i.e. Air pollution). Data analysis has been done by using the standard formula for the calculation of death (mortality) rate and DALYs rate. Similarly, we calculated the age and gender-wise death and DALYs rate by using the appropriate numerator and denominator. The study discovered a significant shift in disease patterns over this period, as communicable diseases like respiratory infections and tuberculosis were replaced by non-communicable diseases such as ischemic heart disease (17.2 million), chronic obstructive pulmonary disease (14.59 million), and stroke (17.02 million) as the primary causes of air pollution-related deaths in 2019 at the global level. Additionally, the study identified a worrying increase in deaths linked to neonatal disorders and respiratory infections caused by ambient particulate matter pollution in South Africa, India, and Brazil. The impact of air pollution on public health is evident across different age groups and genders, with people aged 50-69 years, those aged 70 and above, and children under 5 years being more vulnerable. Furthermore, the male population is disproportionately affected by communicable and noncommunicable diseases caused by air pollution. The study highlights the need for policymakers to implement evidence-based interventions to tackle this global health problem. The interventions should aim to reduce the emerging crisis of non-communicable diseases related to air pollution, particularly among vulnerable age groups and the male population, ultimately improving public health outcomes.

Intestinal microbiota and tuberculosis: Insights from Mendelian randomization.

Respiratory tuberculosis (RTB), a global health concern affecting millions of people, has been observationally linked to the gut microbiota, but the depth and nature of this association remain elusive. Despite these findings, the underlying causal relationship is still uncertain. Consequently, we used the Mendelian randomization (MR) method to further investigate this potential causal connection. We sourced data on the gut microbiota from a comprehensive genome-wide association study (GWAS) conducted by the MiBioGen Consortium (7686 cases, and 115,893 controls). For RTB, we procured 2 distinct datasets, labeled the Fingen R9 TBC RESP and Fingen R9 AB1 RESP, from the Finnish Genetic Consortium. To decipher the potential relationship between the gut microbiota and RTB, we employed MR on both datasets. Our primary mode of analysis was the inverse variance weighting (IVW) method. To ensure robustness and mitigate potential confounders, we meticulously evaluated the heterogeneity and potential pleiotropy of the outcomes. In the TBC RESP (RTB1) dataset related to the gut microbiota, the IVW methodology revealed 7 microbial taxa that were significantly associated with RTB. In a parallel vein, the AB1 RESP (RTB2) dataset highlighted 4 microbial taxa with notable links. Notably, Lachnospiraceae UCG010 was consistently identified across both datasets. This correlation was especially evident in the data segments designated Fingen R9 TBC RESP (OR = 1.799, 95% CI = 1.243-2.604) and Finngen R9 AB1 RESP (OR = 2.131, 95% CI = 1.088-4.172). Our study identified a causal relationship between particular gut microbiota and RTB at the level of prediction based on genetics. This discovery sheds new light on the mechanisms of RTB development, which are mediated by the gut microbiota.

Clinical and Radiological Characteristics of Respiratory Tuberculosis Treatment Failures in Children and Adolescents and Timing of their Detection Depending on Examination Method

The objective: selection of optimal timing for chest CT to identify respiratory tuberculosis treatment failures in children and adolescents through clinical and radiological comparison.Subjects and Methods. A retrospective comparative study was conducted. Totally 70 patients aged from 2 to 17 years with various clinical forms of respiratory tuberculosis were examined. Retrospectively, patients were divided into 3 groups: Group 1 (35 people) – CT was performed before the treatment start and, as the first control, after 2-3 months of chemotherapy; Group 2 (17 people) had a CT before the chemotherapy start and after 2-3 months – plain X-ray (or in combination with linear tomography), CT control – after 6-9 months after the chemotherapy start; Group 3 (18 people) included patients who had only plain X-ray (or in combination with linear tomography) before and during chemotherapy, CT was first performed after treatment failureResults. In all groups, in more than 40% of cases, radiological changes were the only informative criterion of treatment failure. CT performed in the early stages was optimal for timely detection of treatment failure: before the chemotherapy start and in 2-3 months (Group 1). In patients of Groups 2 and 3, opportunities for timely correction of chemotherapy were missed due to inadequate assessment of pathological changes. CT performed after 6-9 months of treatment reliably revealed irreversible changes in 53% and 78% (Groups 2 and 3), respectively.