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Jennings K, Lembani M, Hesseling AC, Mbula N, Mohr-Holland E, Mudaly V, Smith M, Osman M, Meehan SA. A decline in tuberculosis diagnosis, treatment initiation and success during the COVID-19 pandemic, using routine health data in Cape Town, South Africa. PLoS One 2024; 19:e0310383. [PMID: 39259735 PMCID: PMC11389921 DOI: 10.1371/journal.pone.0310383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/28/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) negatively impacted tuberculosis (TB) programs which were already struggling to meet End-TB targets globally. We aimed to quantify and compare diagnosis, treatment initiation, treatment success, and losses along this TB care cascade for drug-susceptible TB in Cape Town, South Africa, prior to and during COVID-19. METHODS This observational study used routine TB data within two predefined cohorts: pre-COVID-19 (1 October 2018-30 September 2019) and during-COVID-19 (1 April 2020-31 March 2021). The numbers of people diagnosed, treated for TB and successfully treated were received from the Western Cape Provincial Health Data Centre. Pre and post treatment loss to follow up and cascade success rates (proportion of individuals diagnosed with an outcome of treatment success) were calculated and compared across cohorts, disaggregated by sex, age, HIV status, TB treatment history and mode of diagnosis. RESULTS There were 27,481 and 19,800 individuals diagnosed with drug-susceptible TB in the pre- and during-COVID-19 cohorts respectively, a relative reduction of 28% (95% CI [27.4% - 28.5%]). Initial loss to follow up increased from 13.4% to 15.2% (p<0.001), while post treatment loss increased from 25.2% to 26.1% (p < 0.033). The overall cascade success rate dropped by 2.1%, from 64.8% to 62.7% (p< 0.001). Pre- and during-COVID-19 cascade success rates were negatively associated with living with HIV and having recurrent TB. CONCLUSIONS An already poorly performing TB program in Cape Town was negatively impacted by the COVID-19 pandemic. There was a substantial reduction in the number of individuals diagnosed with drug-susceptible. Increases in pre-and post-treatment losses resulted in a decline in TB cascade success rates. Strengthened implementation of TB recovery plans is vital, as health services now face an even greater gap between achievements and targets and will need to become more resilient to possible future public health disruptions.
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Affiliation(s)
- Karen Jennings
- City of Cape Town Health Department, Specialised Health, HIV/STI/TB Unit, Cape Town, South Africa
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Martina Lembani
- School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Anneke C Hesseling
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nyameka Mbula
- Department of Health and Wellness, Provincial Government of the Western Cape, Cape Town, South Africa
| | - Erika Mohr-Holland
- City of Cape Town Health Department, Specialised Health, Epidemiology Unit, Cape Town, South Africa
| | - Vanessa Mudaly
- Department of Health and Wellness, Provincial Government of the Western Cape, Cape Town, South Africa
| | - Mariette Smith
- Department of Health and Wellness, Provincial Government of the Western Cape, Cape Town, South Africa
- Department of Public Health and Facility Medicine, University of Cape Town, Cape Town, South Africa
| | - Muhammad Osman
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Human Sciences, Faculty of Education, Health and Human Sciences, University of Greenwich, London, United Kingdom
| | - Sue-Ann Meehan
- Department of Paediatrics and Child Health, Desmond Tutu TB Centre, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Singh K, Hussain T, Gupta B, Pati S. A Comparative Investigation on Cytokine Expression in Pulmonary Tuberculosis and Comorbidity with Type 2 Diabetes Mellitus. Int J Mycobacteriol 2024; 13:165-170. [PMID: 38916387 DOI: 10.4103/ijmy.ijmy_40_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/26/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Mycobacterium tuberculosis (Mtb) is the causative agent of tuberculosis (TB), with a high global prevalence and mortality rate. To control the gruesome pathogen, a deep understanding of pathophysiology and host-pathogen interaction is essential for early diagnosis and novel drug development. Cytokines play a crucial role in infection and susceptibility, and their expressions could serve as potential biomarkers to enhance our understanding of Mtb pathophysiology for improved therapeutic approaches. This cross-sectional study investigates the levels of four important T-cell immune-mediated cytokines: interleukins (IL-6 and IL-10), interferon-gamma (IFN-γ), and tumor necrosis factor-alpha in 80 cohort samples, with 20 people in each group. METHODS Following proper ethics and patient consent, we collected blood samples and isolated serum from all four groups: TB, type 2 diabetes mellitus (T2DM), type 2 diabetes-TB comorbidity (T2DM + TB), and a healthy individual as a control group (C). Furthermore, cytokine expression was measured in individual serum samples through the enzyme-linked immunosorbent assay method using commercial kits (Diaclone, French). Statistical significance was observed by analyzing triplicate data using t-tests and the one-way ANOVA method with GraphPad Prism 10. RESULTS The results showed that all four cytokine levels were higher (P ≤ 0.0001) than the control, especially IL-6, IL-10, and IFN-γ, which were found to be upregulated in T2DM + TB samples (P ≤ 0.0001) than individual TB or T2DM samples. CONCLUSION The high levels of cytokines in comorbidity cases raise the risk of insulin resistance and the severity of TB infection. These levels of expression could be used to keep track of the Mtb infection status or severity, aid in early diagnosis as a possible biomarker, and suggest possible treatment plans.
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Affiliation(s)
- Khusbu Singh
- ICMR-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha, India
- KIIT School of Biotechnology, Kalinga Institute of Industrial Technology Deemed to be University, Bhubaneswar, Odisha, India
| | - Tahziba Hussain
- ICMR-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha, India
| | - Bhawna Gupta
- KIIT School of Biotechnology, Kalinga Institute of Industrial Technology Deemed to be University, Bhubaneswar, Odisha, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha, India
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Shewade HD, Frederick A, Kalyanasundaram M, Chadwick J, Kiruthika G, Rajasekar TD, Gayathri K, Vijayaprabha R, Sabarinathan R, Shivakumar SVBY, Jeyashree K, Bhavani PK, Aarthi S, Suma KV, Pathinathan DP, Parthasarathy R, Nivetha MB, Thampi JG, Chidambaram D, Bhatnagar T, Lokesh S, Devika S, Laux TS, Viswanathan S, Sridhar R, Krishnamoorthy K, Sakthivel M, Karunakaran S, Rajkumar S, Ramachandran M, Kanagaraj KD, Kaleeswari M, Durai VP, Saravanan R, Sugantha A, Khan SZHM, Sangeetha P, Vasudevan R, Nedunchezhian R, Sankari M, Jeevanandam N, Ganapathy S, Rajasekaran V, Mathavi T, Rajaprakash AR, Murali L, Pugal U, Sundaralingam K, Savithri S, Vellasamy S, Dheenadayal D, Ashok P, Jayasree K, Sudhakar R, Rajan KP, Tharageshwari N, Chokkalingam D, Anandrajkumar SM, Selvavinayagam TS, Padmapriyadarsini C, Ramachandran R, Murhekar MV. --Eleven tips for operational researchers working with health programmes: our experience based on implementing differentiated tuberculosis care in south India. Glob Health Action 2023; 16:2161231. [PMID: 36621943 PMCID: PMC9833404 DOI: 10.1080/16549716.2022.2161231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Due to the workload and lack of a critical mass of trained operational researchers within their ranks, health systems and programmes may not be able to dedicate sufficient time to conducting operational research (OR). Hence, they may need the technical support of operational researchers from research/academic organisations. Additionally, there is a knowledge gap regarding implementing differentiated tuberculosis (TB) care in programme settings. In this 'how we did it' paper, we share our experience of implementing a differentiated TB care model along with an inbuilt OR component in Tamil Nadu, a southern state in India. This was a health system initiative through a collaboration of the State TB cell with the Indian Council of Medical Research institutes and the World Health Organisation country office in India. The learnings are in the form of eleven tips: four broad principles (OR on priority areas and make it a health system initiative, implement simple and holistic ideas, embed OR within routine programme settings, aim for long-term engagement), four related to strategic planning (big team of investigators, joint leadership, decentralised decision-making, working in advance) and three about implementation planning (conducting pilots, smart use of e-tools and operational research publications at frequent intervals). These may act as a guide for other Indian states, high TB burden countries that want to implement differentiated care, and for operational researchers in providing technical assistance for strengthening implementation and conducting OR in health systems and programmes (TB or other health programmes). Following these tips may increase the chances of i) an enriching engagement, ii) policy/practice change, and iii) sustainable implementation.
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Affiliation(s)
- Hemant Deepak Shewade
- ICMR – National Institute of Epidemiology, Chennai, India,CONTACT Hemant Deepak Shewade ; Department of Health Research, Government of India, ICMR-National Institute of Epidemiology, R-127, Second Main Road, TNHB, Ayapakkam, Chennai600077, India
| | | | | | | | - G. Kiruthika
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | - K. Gayathri
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | | | | | | | - P. K. Bhavani
- ICMR – National Institute for Research in Tuberculosis, Chennai, India
| | - S. Aarthi
- State TB Cell, Government of Tamil Nadu, Chennai, India
| | - K. V. Suma
- The WHO Country Office for India, New Delhi, India
| | | | | | | | | | | | | | - S. Lokesh
- ICMR – National Institute of Epidemiology, Chennai, India
| | | | | | - Stalin Viswanathan
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - R. Sridhar
- Government Hospital of Thoracic Medicine, Tambaram, India
| | - K. Krishnamoorthy
- Department of Respiratory Medicine, Tirunelveli Medical College Hospital, Tirunelveli, India
| | - M. Sakthivel
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Karunakaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Rajkumar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Ramachandran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. D. Kanagaraj
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Kaleeswari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. P. Durai
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Saravanan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. Sugantha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - P. Sangeetha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Vasudevan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Nedunchezhian
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Sankari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - N. Jeevanandam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Ganapathy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. Rajasekaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - T. Mathavi
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. R. Rajaprakash
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - Lakshmi Murali
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - U. Pugal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Sundaralingam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Savithri
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Vellasamy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - D. Dheenadayal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - P. Ashok
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Jayasree
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Sudhakar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. P. Rajan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | | | | | - T. S. Selvavinayagam
- Directorate of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, India
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Ajin KA, Arun Kumar S, Singh M, Akshatha HS, Bhagyalalitha M, Pujar KG, Sumana MN, Chandrashekar VM, Bidye D, Pujar GV. Novel Antitubercular Agents: Design, Synthesis, Molecular Dynamic and Biological Studies of Pyrazole - 1,2,4-Triazole Conjugates. Chem Biodivers 2023; 20:e202300971. [PMID: 37882429 DOI: 10.1002/cbdv.202300971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/27/2023]
Abstract
Mycobacterium tuberculosis (Mtb) has numerous cell wall and non-cell wall mediated receptors for drug action, of which cell wall mediated targets were found to be more promising because of their pivotal role in bacterial protection and survival. Herein, we reported the design and synthesis of a series of pyrazole-linked triazoles based on the reported structural features of promising drug candidates that target DprE1 receptors through a Structure-based drug design (SBDD) approach (6a-6j and 7a-7j). The synthesized compounds were evaluated for their in-vitro antitubercular activity against virulent strains of Mtb H37Rv. In-silico studies revealed that most compounds exhibit binding interactions with crucial amino acids like Lys418, Tyr314, Tyr60, and Asp386 at DprE1. Furthermore, the protein-ligand (7j) shows appreciable stability compared to innate protein in a 100 ns molecular dynamic simulation study. In-vitro MAB assay revealed that 14 compounds exhibit significant antitubercular activity with minimum inhibitory concentration (MIC) of the 3.15-4.87 μM of the 20 compounds tested. An in-vitro cytotoxicity study on normal cell lines (MCF10) revealed safe compounds (IC50 values:341.85 to 726.08 μM). Hence, the present study opens the development of new pyrazole-linked triazoles as probable DprE1 inhibitors.
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Affiliation(s)
- K A Ajin
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, Karnataka, Indi
| | - Sethu Arun Kumar
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, Karnataka, Indi
| | - Manisha Singh
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, Karnataka, Indi
| | - H S Akshatha
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, Karnataka, Indi
| | - Meduri Bhagyalalitha
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, Karnataka, Indi
| | - Karthik G Pujar
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, Karnataka, Indi
| | - M N Sumana
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, India
| | - V M Chandrashekar
- Department of Pharmacology, HSK College of Pharmacy, 587101, Bagalkot, India
| | - Durgesh Bidye
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, Karnataka, Indi
| | - Gurubasavaraj Veeranna Pujar
- Department of Pharmaceutical Chemistry, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Sri Shivarathreeshwara Nagara, Mysuru, 570015, Karnataka, Indi
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Liu E, Kakodkar P, Pan H, Zhou A, Toyota P, Persad AR, Marciniuk K, Wang C, Auer RN, Sanche S, Vitali A, Radic J. Pediatric intracranial tuberculoma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 6:CASE23236. [PMID: 37539871 PMCID: PMC10555599 DOI: 10.3171/case23236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis. Intracranial tuberculoma is a rare complication of extrapulmonary tuberculosis due to hematogenous spread to subpial and subependymal regions. Intracranial tuberculoma can occur with or without meningitis. OBSERVATIONS A 3-year-old male who had recently emigrated from Sudan presented to the emergency department with right-sided seizures lasting 30 minutes, which were aborted with levetiracetam and midazolam. Head computed tomography revealed a multilobulated left supratentorial mass with solid and cystic components and measuring 8.0 × 4.8 × 6.5 cm. The patient had successful resection of the mass, which was positive for M. tuberculosis. He was started on rifampin, isoniazid, pyrazinamide, ethambutol, and fluoroquinolone and was discharged home in stable condition. LESSONS A literature review on pediatric intracranial tuberculoma was performed, which included 48 studies (n = 49). The mean age was 8.8 ± 5.4 years with a slight female predilection (59%). Predominant solitary tuberculomas (63%) were preferentially managed with both resection and antituberculosis therapy (ATT), whereas multifocal tuberculomas were preferentially managed with ATT. Intracranial tuberculoma is a rare but treatable cause of space-occupying lesions in children. Clinicians should maintain a high level of suspicion in patients from endemic regions and involve the infectious disease service early.
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Affiliation(s)
| | | | - Henry Pan
- Pathology and Laboratory Medicine, and
| | | | | | | | | | | | | | - Stephen Sanche
- Infectious Disease, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Burusie A, Enquesilassie F, Salazar-Austin N, Addissie A. Epidemiology of childhood tuberculosis and predictors of death among children on tuberculosis treatment in central Ethiopia: an extended Cox model challenged survival analysis. BMC Public Health 2023; 23:1287. [PMID: 37403013 DOI: 10.1186/s12889-023-16183-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/23/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Childhood tuberculosis (TB) was poorly studied in Ethiopia. This study aimed to describe the epidemiology of childhood TB and identify predictors of death among children on TB treatment. METHODS This is a retrospective cohort study of children aged 16 and younger who were treated for TB between 2014 and 2022. Data were extracted from TB registers of 32 healthcare facilities in central Ethiopia. Phone interview was also conducted to measure variables without a space and not recorded in the registers. Frequency tables and a graph were used to describe the epidemiology of childhood TB. To perform survival analysis, we used a Cox proportional hazards model, which was then challenged with an extended Cox model. RESULTS We enrolled 640 children with TB, 80 (12.5%) of whom were under the age of two. Five hundred and fifty-seven (87.0%) of the enrolled children had not had known household TB contact. Thirty-six (5.6%) children died while being treated for TB. Nine (25%) of those who died were under the age of two. HIV infection (aHR = 4.2; 95% CI = 1.9-9.3), under nutrition (aHR = 4.2; 95% CI = 2.2-10.48), being under 10 years old (aHR = 4.1; 95% CI = 1.7-9.7), and relapsed TB (aHR = 3.7; 95% CI = 1.1-13.1) were all independent predictors of death. Children who were found to be still undernourished two months after starting TB treatment also had a higher risk of death (aHR = 5.64, 95% CI = 2.42-13.14) than normally nourished children. CONCLUSIONS The majority of children had no known pulmonary TB household contact implying that they contracted TB from the community. The death rate among children on TB treatment was unacceptably high, with children under the age of two being disproportionately impacted. HIV infection, baseline as well as persistent under nutrition, age < 10 years, and relapsed TB all increased the risk of death in children undergoing TB treatment.
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Affiliation(s)
- Abay Burusie
- Department of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia.
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Fikre Enquesilassie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nicole Salazar-Austin
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adamu Addissie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Omokhua-Uyi AG, Madikizela B, Aro AO, Abdalla MA, Van Staden J, McGaw LJ. Flavonoids of Chromolaena odorata (L.) R.M.King & H.Rob. as potential leads for treatment against tuberculosis. SOUTH AFRICAN JOURNAL OF BOTANY : OFFICIAL JOURNAL OF THE SOUTH AFRICAN ASSOCIATION OF BOTANISTS = SUID-AFRIKAANSE TYDSKRIF VIR PLANTKUNDE : AMPTELIKE TYDSKRIF VAN DIE SUID-AFRIKAANSE GENOOTSKAP VAN PLANTKUNDIGES 2023; 158:158-165. [PMID: 37206481 PMCID: PMC10182713 DOI: 10.1016/j.sajb.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 05/21/2023]
Abstract
Tuberculosis (TB) is currently rated as the 13th leading cause of mortality and the second leading cause of death after COVID-19, and above AIDS. Existing challenges relating to the development of multidrug-resistant strains and dangerous side effects of currently used drugs add impetus to the search for additional TB treatments. Hence, interest has grown in the use of medicinal plants as a source of bioactive preparations with efficacy against TB-causing organisms, and also with the ability to ameliorate the negative effects of TB drugs. This study aimed to evaluate the antimycobacterial and hepatoprotective potentials of extracts and isolated flavonoid compounds from invasive Chromolaena odorata. Test organisms used were pathogenic Mycobacterium bovis and M. tuberculosis H37RV, and the fast-growing M. aurum, M. fortuitum and M. smegmatis. The selectivity index (SI) values of the test substances were determined through cytotoxicity assays to promote these extracts and compounds as leads for the development of effective and safe anti-tubercular drugs. The antimycobacterial activity was evaluated using a serial microdilution method, and the SI was calculated from the 50% lethal concentrations calculated from cytotoxicity tests. Hepatoprotective activity was determined using HepG2 liver cells treated with rifampicin as a toxin. The extracts and compounds had a range of antimycobacterial activity with minimum inhibitory concentration (MIC) values ranging from 0.031 to 2.5 mg/mL. Two flavonoid compounds, 5,7,4'-trimethoxy flavanone and 5‑hydroxy-3,7,4'-trimethoxyflavone showed promising antimycobacterial potential, and minimal toxicity was observed, as most SI values were higher than 1. The flavonoid compound 5,7,4'-trimethoxy flavanone had the highest SI (6.452), which was against M. tuberculosis H37RV. The HepG2 cells were reduced to 65% due to toxicity by rifampicin, however, the flavonoid compounds were able to improve cell viability to between 81 and 89% at different concentrations tested. Results obtained indicate that C. odorata may serve as a lead for the development of safe and effective antimycobacterial and hepatoprotective drugs.
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Affiliation(s)
- A G Omokhua-Uyi
- Phytomedicine Programme, Department of Paraclinical Sciences, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3201, South Africa
| | - B Madikizela
- Phytomedicine Programme, Department of Paraclinical Sciences, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
| | - A O Aro
- Phytomedicine Programme, Department of Paraclinical Sciences, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
| | - M A Abdalla
- Phytomedicine Programme, Department of Paraclinical Sciences, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
| | - J Van Staden
- Research Centre for Plant Growth and Development, School of Life Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville 3201, South Africa
| | - L J McGaw
- Phytomedicine Programme, Department of Paraclinical Sciences, University of Pretoria, Private Bag X04, Onderstepoort 0110, South Africa
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Cattaneo P, Mulongo CM, Morino G, De Vita MV, Paone G, Scarlata S, Kinyita S, Odhiambo H, Mazzi C, Gobbi F, Buonfrate D. Burden of Pulmonary Rifampicin-Resistant Tuberculosis in Kajiado, Kenya: An Observational Study. Microorganisms 2023; 11:1280. [PMID: 37317254 DOI: 10.3390/microorganisms11051280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Rifampicin resistance (RR) is a major challenge in the clinical management of tuberculosis (TB), but data on its prevalence are still sparse in many countries. Our study aimed at estimating the prevalence of RR-TB in Kajiado County, Kenya. Secondary objectives were to estimate the incidence of pulmonary TB in adults and the rate of HIV-TB coinfection. METHODS We conducted an observational study in the context of the ATI-TB Project, carried out in Kajiado. The project was based on an active-case-finding campaign implemented with the aid of village chiefs, traditional healers and community health volunteers. Diagnosis relied on Xpert MTB/RIF, including a mobile machine that could be used to cover areas where testing would otherwise be difficult. RESULTS In sum, 3840 adults were screened for active TB during the campaign. RR cases among all TB diagnoses were 4.6%. The annual incidence of pulmonary TB among adults was 521 cases per 100,000 population. The rate of HIV coinfection was 22.2% among pulmonary TB diagnoses. CONCLUSION The prevalence of RR-TB was four times that what could be inferred from official notifications in Kajiado, and higher than overall prevalence in Kenya. In addition, our estimate of incidence of pulmonary TB in adults in Kajiado significantly differed from cases notified in the same area. In contrast, the rate of HIV coinfection was in line with national and regional data. TB diagnostic capability must be strengthened in Kajiado to improve patients' management and public health interventions.
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Affiliation(s)
- Paolo Cattaneo
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | | | - Gianfranco Morino
- World Friends Amici del Mondo Onlus, Ruaraka Uhai Neema Hospital, off Thika Highway, Nairobi P.O. Box 39433-00623, Kenya
| | - Maria Vittoria De Vita
- World Friends Amici del Mondo Onlus, Ruaraka Uhai Neema Hospital, off Thika Highway, Nairobi P.O. Box 39433-00623, Kenya
| | - Gabriele Paone
- World Friends Amici del Mondo Onlus, Ruaraka Uhai Neema Hospital, off Thika Highway, Nairobi P.O. Box 39433-00623, Kenya
| | - Simone Scarlata
- Unit of Internal Medicine, Respiratory Pathophysiology and Thoracic Endoscopy, Fondazione Policlinico Universitario Campus Bio Medico, 00128 Rome, Italy
| | | | | | - Cristina Mazzi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Federico Gobbi
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
| | - Dora Buonfrate
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, 37024 Verona, Italy
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9
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Biswas B, Kumar Misra T, Ray D, Majumder T, Kanti Bandyopadhyay T, Kumar Bhowmick T. Current Therapeutic Delivery Approaches Using Nanocarriers for the Treatment of Tuberculosis Disease. Int J Pharm 2023; 640:123018. [PMID: 37149113 DOI: 10.1016/j.ijpharm.2023.123018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/04/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023]
Abstract
Tuberculosis is a major health issue globally and a leading cause of death due to the infective microorganism Mycobacterium tuberculosis. Treatment of drug resistance tuberculosis requires longer treatment with multiple daily doses of drugs. Unfortunately, these drugs are often associated with poor patient compliance. In this situation, a need has been felt for the less toxic, shorter, and more effective treatment of the infected tuberculosis patients. Current research to develop novel anti-tubercular drugs shows hope for better management of the disease. Research on drug targeting and precise delivery of the old anti-tubercular drugs with the help of nanotechnology is promising for effective treatment. This review has discussed the status currently available treatments for tuberculosis patients infected with Mycobacterium alone or in comorbid conditions like diabetes, HIV and cancer. This review also highlighted the challenges in the current treatment and research on the novel anti-tubercular drugs to prevent multi-drug-resistant tuberculosis. It presents the research highlights on the targeted delivery of anti-tubercular drugs using different nanocarriers for preventing multi-drug resistant tuberculosis. Report has shown the importance and development of the research on nanocarriers mediated anti-tubercular delivery of the drugs to overcome the current challenges in tuberculosis treatment.
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Affiliation(s)
- Bhabatush Biswas
- Department of Bioengineering, National Institute of Technology Agartala, West Tripura - 799046, India
| | - Tarun Kumar Misra
- Department of Chemistry, National Institute of Technology Agartala, West Tripura - 799046, India
| | - Debasish Ray
- Agartala Govt. Medical College, Agartala, 799006, Tripura - 799006, India
| | - Tapan Majumder
- Agartala Govt. Medical College, Agartala, 799006, Tripura - 799006, India
| | - Tarun Kanti Bandyopadhyay
- Department of Bioengineering, National Institute of Technology Agartala, West Tripura - 799046, India
| | - Tridib Kumar Bhowmick
- Department of Bioengineering, National Institute of Technology Agartala, West Tripura - 799046, India.
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10
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Shewade HD, Frederick A, Kiruthika G, Kalyanasundaram M, Chadwick J, Rajasekar TD, Gayathri K, Vijayaprabha R, Sabarinathan R, Kathiresan J, Bhavani P, Aarthi S, Suma K, Pathinathan DP, Parthasarathy R, Nivetha MB, Thampi JG, Chidambaram D, Bhatnagar T, Lokesh S, Devika S, Laux TS, Viswanathan S, Sridhar R, Krishnamoorthy K, Sakthivel M, Karunakaran S, Rajkumar S, Ramachandran M, Kanagaraj K, Kaleeswari M, Durai V, Saravanan R, Sugantha A, Khan SZHM, Sangeetha P, Vasudevan R, Nedunchezhian R, Sankari M, Jeevanandam N, Ganapathy S, Rajasekaran V, Mathavi T, Rajaprakash A, Murali L, Pugal U, Sundaralingam K, Savithri S, Vellasamy S, Dheenadayal D, Ashok P, Jayasree K, Sudhakar R, Rajan K, Tharageshwari N, Chokkalingam D, Anandrajkumar S, Selvavinayagam T, Padmapriyadarshini C, Ramachandran R, Murhekar MV. The First Differentiated TB Care Model From India: Delays and Predictors of Losses in the Care Cascade. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e2200505. [PMID: 37116929 PMCID: PMC10141439 DOI: 10.9745/ghsp-d-22-00505] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023]
Abstract
To reduce TB deaths in resource-limited settings, a differentiated care strategy can be used to triage patients with high risk of severe illness (i.e., those with very severe undernutrition, respiratory insufficiency, or inability to stand without support) at diagnosis and refer them for comprehensive assessment and inpatient care. Globally, there are few examples of implementing this type of strategy in routine program settings. Beginning in April 2022, the Indian state of Tamil Nadu implemented a differentiated care strategy called Tamil Nadu-Kasanoi Erappila Thittam (TN-KET) for all adults aged 15 years and older with drug-susceptible TB notified by public facilities. Before evaluating the impact on TB deaths, we sought to understand the retention and delays in the care cascade as well as predictors of losses. During April-June 2022, 14,961 TB patients were notified and 11,599 (78%) were triaged. Of those triaged, 1,509 (13%) were at high risk of severe illness; of these, 1,128 (75%) were comprehensively assessed at a nodal inpatient care facility. Of 993 confirmed as severely ill, 909 (92%) were admitted, with 8% unfavorable admission outcomes (4% deaths). Median admission duration was 4 days. From diagnosis, the median delay in triaging and admission of severely ill patients was 1 day each. Likelihood of triaging decreased for people with extrapulmonary TB, those diagnosed in high-notification districts or teaching hospitals, and those transferred out of district. Predictors of not being comprehensively assessed included: aged 25-34 years, able to stand without support, and diagnosis at a primary or secondary-level facility. Inability to stand without support was a predictor of unfavorable admission outcomes. To conclude, the first quarter of implementation suggests that TN-KET was feasible to implement but could be improved by addressing predictors of losses in the care cascade and increasing admission duration.
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Affiliation(s)
- Hemant Deepak Shewade
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - G. Kiruthika
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - Joshua Chadwick
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - T. Daniel Rajasekar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - K. Gayathri
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - R. Vijayaprabha
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - R. Sabarinathan
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - Jeyashree Kathiresan
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - P.K. Bhavani
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | - S. Aarthi
- State TB Cell, Government of Tamil Nadu, Chennai, India
| | - K.V. Suma
- World Health Organization Country Office for India, New Delhi, India
| | | | | | | | - Jerome G. Thampi
- World Health Organization Country Office for India, New Delhi, India
| | | | - Tarun Bhatnagar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | - S. Lokesh
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | | | - Stalin Viswanathan
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R. Sridhar
- Government Hospital of Thoracic Medicine, Tambaram, India
| | | | - M. Sakthivel
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Karunakaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Rajkumar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Ramachandran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K.D. Kanagaraj
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Kaleeswari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V.P. Durai
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Saravanan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A. Sugantha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - P. Sangeetha
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Vasudevan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Nedunchezhian
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - M. Sankari
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - N. Jeevanandam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Ganapathy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - V. Rajasekaran
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - T. Mathavi
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - A.R. Rajaprakash
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - Lakshmi Murali
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - U. Pugal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Sundaralingam
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Savithri
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - S. Vellasamy
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - D. Dheenadayal
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - P. Ashok
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K. Jayasree
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - R. Sudhakar
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | - K.P. Rajan
- Directorate of Medical and Rural Health Services, Government of Tamil Nadu, Chennai, India
| | | | - D. Chokkalingam
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
| | | | - T.S. Selvavinayagam
- Directorate of Public Health and Preventive Medicine, Government of Tamil Nadu, Chennai, India
| | - C. Padmapriyadarshini
- Indian Council of Medical Research, National Institute for Research in Tuberculosis, Chennai, India
| | | | - Manoj V. Murhekar
- Indian Council of Medical Research, National Institute of Epidemiology, Chennai, India
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11
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Varshney K, Patel H, Kamal S. Trends in Tuberculosis Mortality Across India: Improvements Despite the COVID-19 Pandemic. Cureus 2023; 15:e38313. [PMID: 37261163 PMCID: PMC10226868 DOI: 10.7759/cureus.38313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has had significant health implications across the globe. India is a country that has faced a double burden of COVID-19 and tuberculosis (TB) since 2020. There is a need to understand the impacts of COVID-19 on tuberculosis control programs in India. Therefore, our study aimed to determine the changes in TB mortality across India between 2019 and 2021. METHODS In our study, we described trends in TB and COVID-19 cases reported across India. Next, we compared death totals for TB between 2019, 2020, and 2021 in India at the national and state level. We considered total TB deaths, as well as deaths by TB for tribal populations, and for those living with human immunodeficiency virus (HIV). Percent changes were calculated. RESULTS In 2020, compared to 2019, there was a 15.4% decrease in TB death totals, with 28 out of India's 36 states showing a decrease during this time period. While total deaths increased in 2021 compared to 2020, decreases did occur in 2021 compared to 2019. Deaths by TB for individuals living with HIV decreased by 16.0% across India. At a national level, there was a notable rise in TB deaths among tribal populations, though this was not universal across states. CONCLUSION While the majority of the world has seen an increase in new TB cases and TB deaths annually since the start of the COVID-19 pandemic, there have instead been decreases in India during this time period. More research is required to understand the factors that have led to this decrease in TB deaths. Furthermore, additional allocation of resources is required to better support vulnerable populations in states where TB death totals have increased, especially among tribal populations.
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Affiliation(s)
| | - Hinal Patel
- School of Medicine, Deakin University, Waurn Ponds, AUS
| | - Shahed Kamal
- Internal Medicine, Northern Hospital Epping, Epping, AUS
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12
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Sanghavi KN, Kapadiya KM, Sriram D, Kumari J. Regioselective Pd-Catalyzed Suzuki–Miyaura Borylation Reaction for the Dimerization Product of 6-Bromoimidazo[1,2-a]pyridine-2-carboxylate: Mechanistic Pathway, Cytotoxic and Tubercular Studies. Synlett 2023. [DOI: 10.1055/s-0042-1751404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AbstractIn the pharmaceutical industry, boronic acid and esters play an important role in API-based synthesis. The most efficient way of preparing various active agents is palladium-catalyzed Suzuki–Miyaura borylation reactions. Herein, we report the formation of dimerization product [6,6′-biimidazo[1,2-a]pyridine]-2,2′-dicarboxamide derivatives 7a–j from 6-bromoimidazo[1,2-a]pyridine-2-carboxylate by employing the same conditions. A regioselective borylation of ethyl 6-bromoimidazo[1,2-a]pyridine-2-carboxylate (3) was examined for the formation of ethyl 6-(4,4,5,5-tetramethyl-1,3,2-dioxaborolan-2-yl)imidazo[1,2-a]pyridine-2-carboxylate (4a) but it was found to be directed towards the dimerization product 5. The nitrogen-rich system was incorporated into potential anti-cancer and anti-TB agents through acid amine coupling reactions between acid 6 and various amines (dialkyl/cyclic sec./tert.) to form the final adducts 7. Five derived scaffolds were identified as moderately active in TB activity against the H37Rv strain, while two compounds were found to be particularly potent in NCI-60 anti-cancer screening in nine cancer panels.
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Affiliation(s)
| | | | - Dharmarajan Sriram
- Department of Pharmacy, Birla Institute of Technology and Science-Pilani
| | - Jyothi Kumari
- Department of Pharmacy, Birla Institute of Technology and Science-Pilani
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13
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Romano M, Squeglia F, Kramarska E, Barra G, Choi HG, Kim HJ, Ruggiero A, Berisio R. A Structural View at Vaccine Development against M. tuberculosis. Cells 2023; 12:317. [PMID: 36672252 PMCID: PMC9857197 DOI: 10.3390/cells12020317] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Tuberculosis (TB) is still the leading global cause of death from an infectious bacterial agent. Limiting tuberculosis epidemic spread is therefore an urgent global public health priority. As stated by the WHO, to stop the spread of the disease we need a new vaccine, with better coverage than the current Mycobacterium bovis BCG vaccine. This vaccine was first used in 1921 and, since then, there are still no new licensed tuberculosis vaccines. However, there is extremely active research in the field, with a steep acceleration in the past decades, due to the advance of technologies and more rational vaccine design strategies. This review aims to gather latest updates in vaccine development in the various clinical phases and to underline the contribution of Structural Vaccinology (SV) to the development of safer and effective antigens. In particular, SV and the development of vaccine adjuvants is making the use of subunit vaccines, which are the safest albeit the less antigenic ones, an achievable goal. Indeed, subunit vaccines overcome safety concerns but need to be rationally re-engineered to enhance their immunostimulating effects. The larger availability of antigen structural information as well as a better understanding of the complex host immune response to TB infection is a strong premise for a further acceleration of TB vaccine development.
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Affiliation(s)
- Maria Romano
- Institute of Biostructures and Bioimaging, IBB, CNR, 80131 Naples, Italy
- Department of Pharmacy, University of Naples “Federico II”, 80131 Naples, Italy
| | - Flavia Squeglia
- Institute of Biostructures and Bioimaging, IBB, CNR, 80131 Naples, Italy
| | - Eliza Kramarska
- Institute of Biostructures and Bioimaging, IBB, CNR, 80131 Naples, Italy
| | - Giovanni Barra
- Institute of Biostructures and Bioimaging, IBB, CNR, 80131 Naples, Italy
| | - Han-Gyu Choi
- Department of Microbiology, and Medical Science, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Hwa-Jung Kim
- Department of Microbiology, and Medical Science, College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Alessia Ruggiero
- Institute of Biostructures and Bioimaging, IBB, CNR, 80131 Naples, Italy
| | - Rita Berisio
- Institute of Biostructures and Bioimaging, IBB, CNR, 80131 Naples, Italy
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14
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Kumar NP, Nancy A, Viswanathan V, Sivakumar S, Thiruvengadam K, Ahamed SF, Hissar S, Kornfeld H, Babu S. Chitinase and indoleamine 2, 3-dioxygenase are prognostic biomarkers for unfavorable treatment outcomes in pulmonary tuberculosis. Front Immunol 2023; 14:1093640. [PMID: 36814914 PMCID: PMC9939892 DOI: 10.3389/fimmu.2023.1093640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/17/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction Chitinase, Indoleamine 2,3-dioxygenesae-1 (IDO-1) and heme oxygenase-1 (HO-1) are candidate diagnostic biomarkers for tuberculosis (TB). Whether these immune markers could also serve as predictive biomarkers of unfavorable treatment outcomes in pulmonary TB (PTB) is not known. Methods A cohort of newly diagnosed, sputum culture-positive adults with drug-sensitive PTB were recruited. Plasma chitinase protein, IDO protein and HO-1 levels measured before treatment initiation were compared between 68 cases with unfavorable outcomes (treatment failure, death, or recurrence) and 108 control individuals who had recurrence-free cure. Results Plasma chitinase and IDO protein levels but not HO-1 levels were lower in cases compared to controls. The low chitinase and IDO protein levels were associated with increased risk of unfavourable outcomes in unadjusted and adjusted analyses. Receiver operating characteristic analysis revealed that chitinase and IDO proteins exhibited high sensitivity and specificity in differentiating cases vs controls as well as in differentiating treatment failure vs controls and recurrence vs controls, respectively. Classification and regression trees (CART) were used to determine threshold values for these two immune markers. Discussion Our study revealed a plasma chitinase and IDO protein signature that may be used as a tool for predicting adverse treatment outcomes in PTB.
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Affiliation(s)
- Nathella Pavan Kumar
- Department of Immunology, National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR), Chennai, India
| | - Arul Nancy
- International Center for Excellence in Research, National Institutes of Health, National Institute for Research in Tuberculosis (NIRT), International Center for Excellence in Research, Chennai, India
| | - Vijay Viswanathan
- Diabetology, Prof. M. Viswanathan Diabetes Research Center, Chennai, India
| | - Shanmugam Sivakumar
- Department of Bacteriology, National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR), Chennai, India
| | - Kannan Thiruvengadam
- Epidemiology Statistics, National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR), Chennai, India
| | - Shaik Fayaz Ahamed
- International Center for Excellence in Research, National Institutes of Health, National Institute for Research in Tuberculosis (NIRT), International Center for Excellence in Research, Chennai, India
| | - Syed Hissar
- Clinical Research, National Institute for Research in Tuberculosis, Indian Council of Medical Research (ICMR), Chennai, India
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Subash Babu
- International Center for Excellence in Research, National Institutes of Health, National Institute for Research in Tuberculosis (NIRT), International Center for Excellence in Research, Chennai, India.,Laboratory of Parasitic Diseases (LPD), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States
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15
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Patel BH, Shewade HD, Davara KB, Mehta KG, Modi BV, Vyas MJ, Murthy HJD, Vanitha B, Kumar AMV. Screening adults with tuberculosis for severe illness at notification: programme experience from Gujarat, India. Trans R Soc Trop Med Hyg 2022; 116:1172-1180. [PMID: 35758410 DOI: 10.1093/trstmh/trac060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/23/2022] [Accepted: 06/03/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND National tuberculosis (TB) programmes in high-burden countries do not systematically assess severity at diagnosis followed by referral for inpatient care. Due to limited capacity, comprehensive assessment of all TB patients is not practical. In three districts of Gujarat (West India) in June 2021, we determined the feasibility of screening for severe illness by paramedical staff of public facilities and the burden of 'high risk for severe illness' at notification among adults (≥15 y of age) with TB. METHODS In this cross-sectional study, the screening criteria for high risk for severe illness was the presence of any one of the following: body mass index (BMI) ≤14.0 kg/m2, BMI ≤16.0 kg/m2 with bilateral leg swelling, respiratory rate >24/min, oxygen saturation <94% or inability to stand without support. We summarized the feasibility indicators and burden using proportion (95% confidence interval [CI]) and median, as applicable. RESULTS Of 626 notified adults, 87% were screened. The median time interval for screening was 3 d from notification and all indicators were collected in 97% of patients. The burden of high risk for severe illness was high, at 41.6% (95% CI 37.5 to 45.8). CONCLUSIONS High burden and feasibility (high coverage, acceptable time interval and minimal missing data) makes a strong case for routine screening of severe illness.
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Affiliation(s)
| | - Hemant Deepak Shewade
- Division of Health System Research, ICMR - National Institute of Epidemiology, Chennai, India600077
| | | | | | - Bhavesh Vitthalbhai Modi
- Community and Family Medicine Department, All India Institute of Medical Sciences, Rajkot, Gujarat, India360006
| | | | | | | | - Ajay M V Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France75006.,Operational Research Unit, The Union South-East Asia Office, New Delhi, India110016.,Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India575018
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16
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Bert-Dulanto A, Alarcón-Braga EA, Castillo-Soto A, Escalante-Kanashiro R. Predicting mortality in pulmonary tuberculosis: A systematic review of prognostic models. Indian J Tuberc 2022; 69:432-440. [PMID: 36460372 DOI: 10.1016/j.ijtb.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 10/11/2021] [Indexed: 06/17/2023]
Abstract
BACKGROUND Pulmonary tuberculosis is a highly prevalent disease in low-income countries; clinical prediction tools allow healthcare personnel to catalog patients with a higher risk of death in order to prioritize medical attention. METHODOLOGY We conducted a literature search on prognostic models aimed to predict mortality in patients diagnosed with pulmonary tuberculosis. We included prospective and retrospective studies where prognostic models predicting mortality were either developed or validated in patients diagnosed with pulmonary tuberculosis. Three reviewers independently assessed the quality of the included studies using the PROBAST tool (Prediction model study Risk of Bias Assessment Tool). A narrative review of the characteristics of each model was conducted. RESULTS Six articles (n = 3553 patients) containing six prediction models were included in the review. Most studies (5 out of 6) were retrospective cohorts, only one study was a prospective case-control study. All the studies had a high risk of bias according to the PROBAST tool in the overall assessment. Regarding the applicability of the prediction models, three studies had a low concern of applicability, two high concern and one unclear concern. Five studies developed new prediction rules. In general, the presented models had a good discriminatory ability, with areas under the curve fluctuating between 0.65 up to 0.91. CONCLUSION None of the prognostic models included in the review accurately predict mortality in patients with pulmonary tuberculosis, due to great heterogeneity in the population and a high risk of bias.
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Affiliation(s)
- Aimée Bert-Dulanto
- Peruvian University of Applied Sciences, Lima - Perú, Av Alameda San Marcos 11, Chorrillos 15067, Lima, Peru
| | - Esteban A Alarcón-Braga
- Peruvian University of Applied Sciences, Lima - Perú, Av Alameda San Marcos 11, Chorrillos 15067, Lima, Peru.
| | - Ana Castillo-Soto
- Peruvian University of Applied Sciences, Lima - Perú, Av Alameda San Marcos 11, Chorrillos 15067, Lima, Peru
| | - Raffo Escalante-Kanashiro
- Peruvian University of Applied Sciences, Lima - Perú, Av Alameda San Marcos 11, Chorrillos 15067, Lima, Peru; Intensive Care Unit, Instituto Nacional de Salud Del Niño, Av. Brasil 600, Breña 15083, Lima, Peru
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Shewade HD, Nagaraja SB, Vanitha B, Murthy HJD, Bhargava M, Singarajipura A, Shastri SG, Patel BH, Davara K, Reddy RC, Kumar AMV, Bhargava A. Screening for Severe Illness at Diagnosis Has the Potential to Prevent Early TB Deaths: Programmatic Experience From Karnataka, India. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00736. [PMID: 36041840 PMCID: PMC9426979 DOI: 10.9745/ghsp-d-21-00736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 06/03/2022] [Indexed: 11/20/2022]
Abstract
Despite TB being a potentially fatal disease, severity is not systematically assessed at the start of drug-susceptible TB treatment. We document our experience screening people for severe illness at diagnosis/notification in program settings and the potential impact on reducing early TB deaths. Due to the coronavirus disease (COVID-19) pandemic and its associated response, TB deaths increased for the first time in a decade. In any potentially fatal illness, an assessment of severity is essential. This is not systematically done for adults with TB, mostly due to a lack of policy and/or limited availability of diagnostic and clinical capacity. We developed a screening tool using simple and easily measurable indicators that can be used by paramedical TB program staff to quickly identify people with severe illness. During October–November 2020 in Karnataka, India, the paramedical program staff from 16 districts screened people with TB (aged ≥15 years) notified by public facilities for “high risk of severe illness,” which was defined as the presence of any of the following indicators: (1) body mass index (BMI) ≤14.0 kg/m2; (2) BMI ≤16.0 kg/m2 with bilateral leg swelling; (3) respiratory rate >24/minute; (4) oxygen saturation <94%; (5) inability to stand without support. In this cohort study, we determined the incidence of program-recorded early deaths (within 2 months) and its association with high risk of severe illness. Of 3,010 people with TB, 1,529 (50.8%) were screened at diagnosis/notification, of whom 537 (35.1%) had a high risk of severe illness. There were 195 (6.5%, 95% CI=5.7, 7.4) early deaths: 59 (30.2%) within a week and 100 (51.3%) within 2 weeks of treatment initiation. The incidence of early deaths was significantly higher among those with high risk of severe illness (8.9%) at diagnosis compared to those without (3.8%) [adjusted relative risk: 2.36 (95% confidence interval=1.57, 3.55)]. To conclude, early deaths were especially high during the first 2 weeks and strongly associated with a high risk of severe illness at diagnosis/notification. Screening for severe illness should be explored as a potential strategy to end TB deaths.
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Affiliation(s)
| | | | | | | | - Madhavi Bhargava
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
| | - Anil Singarajipura
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Suresh G Shastri
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | | | - Kajal Davara
- Community Medicine Department, GMERS Medical College, Vadodara, India
| | - Ramesh Chandra Reddy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Ajay M V Kumar
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
| | - Anurag Bhargava
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru, India
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18
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Ruggiero A, Choi HG, Barra G, Squeglia F, Back YW, Kim HJ, Berisio R. Structure based design of effective HtpG-derived vaccine antigens against M. tuberculosis. Front Mol Biosci 2022; 9:964645. [PMID: 36032688 PMCID: PMC9403545 DOI: 10.3389/fmolb.2022.964645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Abstract
Vaccine development against Tuberculosis is a strong need, given the low efficacy of the sole vaccine hitherto used, the Bacillus Calmette–Guérin (BCG) vaccine. The chaperone-like protein HtpGMtb of M. tuberculosis is a large dimeric and multi-domain protein with promising antigenic properties. We here used biophysical and biochemical studies to improve our understanding of the structural basis of HtpGMtb functional role and immunogenicity, a precious information to engineer improved antigens. We showed that HtpGMtb is a dimeric nucleotide-binding protein and identified the dimerisation interface on the C-terminal domain of the protein. We also showed that the most immunoreactive regions of the molecule are located on the C-terminal and middle domains of the protein, whereas no role is played by the catalytic N-terminal domain in the elicitation of the immune response. Based on these observations, we experimentally validated our predictions in mice, using a plethora of immunological assays. As an outcome, we designed vaccine antigens with enhanced biophysical properties and ease of production, albeit conserved or enhanced antigenic properties. Our results prove the efficacy of structural vaccinology approaches in improving our understanding of the structural basis of immunogenicity, a precious information to engineer more stable, homogeneous, efficiently produced, and effective vaccine antigens.
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Affiliation(s)
- Alessia Ruggiero
- Institute of Biostructures and Bioimaging, IBB, CNR, Napoli, Italy
| | - Han-Gyu Choi
- Department of Microbiology and Medical Science, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Giovanni Barra
- Institute of Biostructures and Bioimaging, IBB, CNR, Napoli, Italy
| | - Flavia Squeglia
- Institute of Biostructures and Bioimaging, IBB, CNR, Napoli, Italy
| | - Young Woo Back
- Department of Microbiology and Medical Science, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Hwa-Jung Kim
- Department of Microbiology and Medical Science, College of Medicine, Chungnam National University, Daejeon, South Korea
- *Correspondence: Hwa-Jung Kim, ; Rita Berisio,
| | - Rita Berisio
- Institute of Biostructures and Bioimaging, IBB, CNR, Napoli, Italy
- *Correspondence: Hwa-Jung Kim, ; Rita Berisio,
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19
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Damara I, Ariane A, Winston K. Predisposing Factors of Tuberculosis Infection in Systemic Lupus Erythematosus Patients: A Single-Center Case-Control Study. Cureus 2022; 14:e26410. [PMID: 35915698 PMCID: PMC9337775 DOI: 10.7759/cureus.26410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Indonesia has the second-highest tuberculosis cases in the world, according to the global WHO tuberculosis report, amounting to approximately 10% of the world's tuberculosis cases. Systemic lupus erythematosus (SLE) patients are at an increased risk for tuberculosis infection. This research aims to analyze the association between corticosteroid pulse dose, corticosteroid cumulative dose, SLE disease duration, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and lupus nephritis status with the development of tuberculosis in SLE patients. Methods: This research was a matched case-control study to identify risk factors of tuberculosis infection in SLE patients. Data were taken from medical records of Cipto Mangunkusumo National General Hospital, a national tertiary hospital. Inclusion criteria were patients who meet the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) 2012 criteria of SLE in the period of 2012-2016 or patients who meet the SLICC 2012 SLE criteria and developed tuberculosis between 2012 and 2016. Statistical analyses used were bivariate analysis and correlation analysis. All statistical analyses were conducted using SPSS software (IBM Corp., Armonk, NY). All statistical analyses were defined as statistically significant when the p-value was less than 0.05. Results: A total of 48 SLE patients were included from medical records consisting of 24 SLE patients with tuberculosis infection and controls of 24 SLE patients without tuberculosis infection. In this study, it was observed that the presence of lupus nephritis (p = 0.001), administration of pulse corticosteroids (p = 0.048), high corticosteroid cumulative dose (p = 0.001), and high SLEDAI score (p = 0.003) were associated with tuberculosis infection. Correlation analysis showed that all of these variables had a weak positive correlation with tuberculosis infection in SLE patients. Conclusion: SLE patients with lupus nephritis, administration of pulse corticosteroids, high cumulative corticosteroid dose, and high SLEDAI score have a higher risk of tuberculosis infection. Clinicians and patients should be aware of these risk factors in SLE patients to prevent tuberculosis infection. Corticosteroid pulse dose should be avoided in SLE patients and if it is needed, tuberculosis prophylaxis may be considered.
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20
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Sallam YM, Gasim R, Kloub MN, Qassem NM. Isolated tuberculosis liver abscess in an immunocompetent patient. Clin Case Rep 2021; 9:e05049. [PMID: 34786194 PMCID: PMC8577243 DOI: 10.1002/ccr3.5049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/04/2021] [Indexed: 11/07/2022] Open
Abstract
Isolated TLA is an extremely rare condition, but should always be considered in a patient presented with liver abscess, especially from an endemic area. Diagnosis depends on histological identification, with treatment being quadruple therapy.
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Affiliation(s)
- Yazan M. Sallam
- Internal Medicine DepartmentHamad Medical CorporationDohaQatar
| | - Ramsey Gasim
- Internal Medicine DepartmentHamad Medical CorporationDohaQatar
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21
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Zimmer AJ, Klinton JS, Oga-Omenka C, Heitkamp P, Nawina Nyirenda C, Furin J, Pai M. Tuberculosis in times of COVID-19. J Epidemiol Community Health 2021; 76:310-316. [PMID: 34535539 PMCID: PMC8453591 DOI: 10.1136/jech-2021-217529] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 12/25/2022]
Abstract
The COVID-19 pandemic has caused widespread disruptions to tuberculosis (TB) care and service delivery in 2020, setting back progress in the fight against TB by several years. As newer COVID-19 variants continue to devastate many low and middle-income countries in 2021, the extent of this setback is likely to increase. Despite these challenges, the TB community can draw on the comprehensive approaches used to manage COVID-19 to help restore progress and mitigate the impact of COVID-19 on TB. Our team developed the ‘Swiss Cheese Model for Ending TB’ to illustrate that it is only through multisectoral collaborations that address the personal, societal and health system layers of care that we will end TB. In this paper, we examine how COVID-19 has impacted the different layers of TB care presented in the model and explore how we can leverage some of the lessons and outcomes of the COVID-19 pandemic to strengthen the global TB response.
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Affiliation(s)
- Alexandra Jaye Zimmer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,McGill International TB Centre, Montreal, Quebec, Canada
| | - Joel Shyam Klinton
- McGill International TB Centre, Montreal, Quebec, Canada.,TB PPM Learning Network, Montreal, Quebec, Canada
| | - Charity Oga-Omenka
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,McGill International TB Centre, Montreal, Quebec, Canada
| | - Petra Heitkamp
- McGill International TB Centre, Montreal, Quebec, Canada.,TB PPM Learning Network, Montreal, Quebec, Canada
| | | | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada .,McGill International TB Centre, Montreal, Quebec, Canada
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22
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Avoi R, Liaw YC. Tuberculosis Death Epidemiology and Its Associated Risk Factors in Sabah, Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9740. [PMID: 34574665 PMCID: PMC8470141 DOI: 10.3390/ijerph18189740] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/28/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
Tuberculosis (TB) is a leading killer from a single infectious agent globally. In 2019, Malaysia's TB incidence rate was 92 per 100,000 population, and the TB mortality rate was estimated at 4 cases per 100,000 population per year. However, the state of Sabah had a higher burden of TB with a notification rate of 128 per 100,000 population and a TB case fatality rate of 8% compared to the national figure. This study aims to provide a comprehensive report on TB deaths epidemiology and its associated factors at a sub-national level. This nested case-control study used Sabah State Health Department TB surveillance data from the Malaysia national case-based TB registry (MyTB) between 2014 and 2018. Cases were defined as all-cause TB deaths that occurred before anti-TB treatment completion from the time of TB diagnosis. Controls were randomly selected from TB patients who completed anti-TB treatment. The TB mortality rate had increased significantly from 9.0/100,000 population in 2014 to 11.4/100,000 population in 2018. The majority of TB deaths occurred in the first two months of treatment. TB-related deaths were primarily due to advanced disease or disseminated TB, whereas non-TB-related deaths were primarily due to existing comorbidities. Many important independent risk factors for TB deaths were identified which are useful to address the increasing TB mortality rate.
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Affiliation(s)
- Richard Avoi
- Department of Community and Family Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu 88400, Malaysia
| | - Yau Chun Liaw
- TB/Leprosy Unit, Sabah State Health Department, Ministry of Health, Putrajaya 62590, Malaysia
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23
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Gichuki J, Mategula D. Characterisation of tuberculosis mortality in informal settlements in Nairobi, Kenya: analysis of data between 2002 and 2016. BMC Infect Dis 2021; 21:718. [PMID: 34332534 PMCID: PMC8325236 DOI: 10.1186/s12879-021-06464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) remains one of the key public health problems in Africa. Due to multifaceted challenges, its burden is poorly described in informal settlements. We describe tuberculosis mortality in two informal settlements in Nairobi, Kenya. METHODS This is a secondary analysis of 2002-2016 verbal autopsy data from informal settlements in the Nairobi Urban Health Demographic Surveillance System (NUHDSS). A descriptive analysis of deaths assigned as caused by TB was done. Pearson chi-square tests were used to determine differences between socio-demographic factors. Logistic regression was carried out to examine the risk of death from TB within the characteristics. RESULTS There were 6218 deaths in the NUHDSS within the period of analysis, of which 930 (14.96%) were deaths from TB. The average number of TB deaths per year was 62(SD 23.9). There was a reduction in TB deaths from 21.2% in 2005 to 1.7% in 2016. Males had 1.39 higher odds of dying from TB than females (AOR 1.39; 95% CI 1.18-1.64; p-value < 0.001). Compared to those aged 30-39 years, the ≥50-year-olds had a 42% lower chance of dying from TB (AOR 0.57; 95% CI 0.47-0.73; p-value < 0.001). Those dying at home had 1.39 odds of dying from TB as compared to those who died in a health facility(AOR 1.93; 95% CI 1.17-1.64; p value< 0.001). CONCLUSION There was a reduction in TB deaths over the study period. Males had the highest risk of death. There is a need to strengthen TB surveillance and access to TB diagnosis and treatment within informal settlements to enhance early diagnosis and treatment.
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Affiliation(s)
- Judy Gichuki
- Nairobi City County Government, Health Services Department, P.O. Box 34349, Nairobi, 00100, Kenya.
| | - Donnie Mategula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O Box 30096, Blantyre, Malawi
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24
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Shewade HD, Nagaraja SB, Murthy HJD, Vanitha B, Bhargava M, Singarajipura A, Shastri SG, Reddy RC, Kumar AMV, Bhargava A. Screening People with Tuberculosis for High Risk of Severe Illness at Notification: Programmatic Experience from Karnataka, India. Trop Med Infect Dis 2021; 6:tropicalmed6020102. [PMID: 34203984 PMCID: PMC8293347 DOI: 10.3390/tropicalmed6020102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/05/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022] Open
Abstract
Due to limited availability of diagnostics and capacity, people with tuberculosis do not always undergo systematic assessment for severe illness (requiring inpatient care). In Karnataka (south India), para-medical programme staff used a screening tool to identify people at 'high risk of severe illness', defined using indicators of very severe undernutrition, abnormal vital signs and poor performance status (any one): (i) body mass index (BMI) ≤ 14.0 kg/m2 (ii) BMI ≤ 16.0 kg/m2 with bilateral leg swelling (iii) respiratory rate > 24/min (iv) oxygen saturation < 94% (v) inability to stand without support. Of 3020 adults notified from public facilities (15 October to 30 November 2020) in 16 districts, 1531 (51%) were screened (district-wise range: 13-90%) and of them, 538 (35%) were classified as 'high risk of severe illness'. Short median delays in screening from notification (five days), and all five indicators being collected for 88% of patients, suggests the feasibility of using this tool in programme settings. However, districts with poor screening coverage require further attention. To end tuberculosis deaths, screening should be followed by referral to higher facilities for comprehensive clinical evaluation, to assess the need for inpatient care. Future studies should assess the validity (especially sensitivity in picking severely ill patients) of this screening tool.
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Affiliation(s)
- Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), 75006 Paris, France;
- The Union South-East Asia Office, New Delhi 110016, India
- Correspondence:
| | | | | | - Basavarajachar Vanitha
- Bowring and Lady Curzon Medical College and Research Institute, Bengaluru 560001, India;
| | - Madhavi Bhargava
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru 575018, India; (M.B.); (A.B.)
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
| | - Anil Singarajipura
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru 560023, India; (A.S.); (S.G.S.); (R.C.R.)
| | - Suresh G. Shastri
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru 560023, India; (A.S.); (S.G.S.); (R.C.R.)
| | - Ramesh Chandra Reddy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru 560023, India; (A.S.); (S.G.S.); (R.C.R.)
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), 75006 Paris, France;
- The Union South-East Asia Office, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
| | - Anurag Bhargava
- Centre for Nutrition Studies, Yenepoya (Deemed to be University), Mangaluru 575018, India; (M.B.); (A.B.)
- Yenepoya Medical College, Yenepoya (Deemed to be University), Mangaluru 575018, India
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25
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Sun Y, Luo H. Effect of systematic nursing on patients with dysfunctional uterine bleeding and rehabilitation. Am J Transl Res 2021; 13:5691-5696. [PMID: 34150178 PMCID: PMC8205831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/25/2021] [Indexed: 06/12/2023]
Abstract
Purpose: To study the effect of systematic nursing on patients with dysfunctional uterine bleeding and rehabilitation. Methods: 98 patients who were treated in our hospital for dysfunctional uterine bleeding from May 2017 to May 2019 were selected, and were divided into a control group (n=49, conventional nursing) and an observation group (n=49, systematic nursing) according to the random number table method. The curative effect, uterine bleeding time, normalization time of biochemical index recovery, psychologic status, quality of life, and nursing satisfaction of the two groups were compared. Results: The efficacy rate of the observation group (93.88%) was higher than the control group (77.55%); the observation group had less uterine bleeding time and activated partial thromboplastin time (APTT) in comparison with the control group (P<0.05). There was no significant difference in self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores between the two groups before intervention (P>0.05); after intervention, the SAS and SDS scores of both groups decreased, with the observation group being more significant (P<0.05. The quality of life score and nursing satisfaction rate of the observation group were higher (P<0.05). Conclusion: Systematic nursing can improve the curative effect of patients with dysfunctional uterine bleeding, accelerate the rehabilitation process, relieve negative emotions, and improve the quality of life and nursing satisfaction.
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Affiliation(s)
- Yan Sun
- Department of Gynecology, The First People’s Hospital of LianyungangLianyungang, China
| | - Haiyan Luo
- Department of Neoursurgery, The First People’s Hospital of LianyungangLianyungang, China
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26
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Wondmieneh A, Gedefaw G, Getie A, Demis A. Prevalence of undernutrition among adult tuberculosis patients in Ethiopia: A systematic review and meta-analysis. J Clin Tuberc Other Mycobact Dis 2021; 22:100211. [PMID: 33458257 PMCID: PMC7797563 DOI: 10.1016/j.jctube.2020.100211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Undernutrition and tuberculosis are the major public health problems of people living in middle and low-income countries. Even though single studies have been reported from different areas of Ethiopia, there is no national-level study that estimates the overall burden of undernutrition among tuberculosis patients. Therefore, this study aimed to estimate the overall magnitude of undernutrition among adult tuberculosis patients in Ethiopia. METHODS We searched out records from databases such as PubMed/MEDLINE, HINARI, EMBASE, Scopus, Google Scholar, and African journals and the online Ethiopian University repositories for published and unpublished articles. The data were extracted using a standardized data extraction format. Meta-analysis was computed using STATA version 11 software. The Cochrane Q-test and I2 with its corresponding p-value were used to assess the heterogeneity of the study. The presence of publication bias was evaluated using Egger's test and presented with funnel plots. The random-effects meta-analysis model was computed to estimate the pooled prevalence of undernutrition among adult tuberculosis patients. RESULTS A total of Twelve observational studies with 4963 study participants were included in this systematic review and meta-analysis. The pooled prevalence of undernutrition among tuberculosis patients in Ethiopia was 50.8% (95% CI 43.97, 57.63). The results of subgroup analysis showed that the highest prevalence of undernutrition among TB patients was observed from studies done in the Amhara region (65.63%). In this meta-analysis, the pooled prevalence of undernutrition among TB-HIV co-infected patients was 45.45% (95%CI 21.85, 56.07). CONCLUSION The prevalence of undernutrition among TB patients in Ethiopia was noticeably high. The result of this study showed that undernutrition is more severe in the Amhara regional state. Additionally, TB-HIV co-infected patients are highly affected by undernutrition. Therefore, the Ministry of Health in collaboration with clinicians should give special attention to provide nutritional care and support for TB patients as part of regular care. Moreover, special nutritional support should be designed for TB-HIV co-infected patients.
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Affiliation(s)
- Adam Wondmieneh
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
| | - Getnet Gedefaw
- Department of Midwifery, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
| | - Addisu Getie
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, P.O.Box: 400, Woldia, Ethiopia
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27
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Sileshi T, Tadesse E, Makonnen E, Aklillu E. The Impact of First-Line Anti-Tubercular Drugs' Pharmacokinetics on Treatment Outcome: A Systematic Review. Clin Pharmacol 2021; 13:1-12. [PMID: 33469389 PMCID: PMC7811439 DOI: 10.2147/cpaa.s289714] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tuberculosis remains the major public health problem besides tremendous efforts to combat it. Most tuberculosis patients are treated with a standard dose of first-line anti-TB drugs. The cure rate, however, varies from patient to patient. Various factors have been related to anti-TB treatment failure. In recent years, studies associating lower plasma concentrations of anti-TB drugs with poor treatment outcomes are emerging although the results are inconclusive. OBJECTIVE Investigate the impact of first-line anti-tubercular drugs pharmacokinetics on treatment outcome. METHODS A systematic search of Pubmed, EMBASE, Web of Science, and the Cochrane Library for articles published in the English language between January 2010 to June 2020 was conducted to identify eligible studies describing associations of first-line anti-tubercular drug pharmacokinetics with treatment outcomes. The primary outcomes considered were pharmacokinetics parameter results and its association with treatment outcome. RESULTS The search identified 1754 articles of which twelve articles; ten prospective observational studies and two controlled clinical trials fulfilled the eligibility criteria. The majority of the studies showed target concentrations for the first-line anti-tubercular drugs below the current standard range. Among the twelve studies, eleven studies assessed rifampicin pharmacokinetics of which eight reported association of drug concentration and treatment outcomes. Similarly, four out of eight and three out of seven reported drug concentration and treatment outcome association for isoniazid and pyrazinamide, respectively. Despite the low plasma concentration, a favorable treatment outcome was achieved for the bulk of the patients. Irrespective of the inconsistency, an increase in exposure to rifampicin improved the outcome, and lower rifampicin, isoniazid, and pyrazinamide concentration are associated with poor outcome. No data are available for ethambutol associating its pharmacokinetics with treatment outcomes. CONCLUSION The pharmacokinetics of first-line antitubercular drugs can influence treatment outcomes. Further controlled clinical studies are, however, required to establish these relationships.
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Affiliation(s)
- Tesemma Sileshi
- Ambo University, Department of Pharmacy, Ambo, Ethiopia
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | | | - Eyasu Makonnen
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Eleni Aklillu
- Karolinska Institutet, Department of Laboratory Medicine, Stockholm, Sweden
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28
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Bigio J, Sassi A, Temesgen Z, Pai M. Improving the quality of tuberculosis care in the post-pandemic world. J Clin Tuberc Other Mycobact Dis 2021; 23:100212. [PMID: 34095545 PMCID: PMC8167427 DOI: 10.1016/j.jctube.2021.100212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Jacob Bigio
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada.,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Angelina Sassi
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
| | - Zelalem Temesgen
- Mayo Clinic Center for Tuberculosis & Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Dept of Epidemiology & Biostatistics, 1020 Pine Ave West, Montreal, Quebec H3A 1A2, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec, Canada
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André SR, Nogueira LMV, Rodrigues ILA, Cunha TND, Palha PF, Santos CBD. Tuberculosis associated with the living conditions in an endemic municipality in the North of Brazil. Rev Lat Am Enfermagem 2020; 28:e3343. [PMID: 32876291 PMCID: PMC7458573 DOI: 10.1590/1518-8345.3223.3343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 04/29/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: to analyze the association between the occurrence of new tuberculosis cases and the Adapted Living Condition Index, and to describe the spatial distribution in an endemic municipality. Method: this is an analytical and ecological study that was developed from new cases in residents of an endemic municipality in the North Region of Brazil. The data were obtained from the Notifiable Diseases Information System and from the 2010 Demographic Census. The Adapted Living Conditions Index was obtained by factor analysis and its association with the occurrence of the disease was analyzed by means of the chi-square test. The type I error was set at 0.05. Kernel estimation was used to describe the density of tuberculosis in each census sector. Results: the incidence coefficient was 97.5/100,000 inhabitants. The data showed a statistically significant association between the number of cases and socioeconomic class, with the fact that belonging to the highest economic class reduces the chance of the disease occurring. The thematic maps showed that tuberculosis was distributed in a heterogeneous way with a concentration in the Southern region of the municipality. Conclusion: tuberculosis, associated with precarious living conditions, reinforces the importance of discussion on social determinants in the health-disease process to subsidize equitable health actions in risk areas, upon a context of vulnerability.
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Affiliation(s)
- Suzana Rosa André
- Departamento de Enfermagem Comunitária, Escola da Enfermagem Magalhães Barata, Universidade do Estado do Pará, Belém, PA, Brazil
| | - Laura Maria Vidal Nogueira
- Departamento de Enfermagem Comunitária, Escola da Enfermagem Magalhães Barata, Universidade do Estado do Pará, Belém, PA, Brazil
| | - Ivaneide Leal Ataíde Rodrigues
- Departamento de Enfermagem Comunitária, Escola da Enfermagem Magalhães Barata, Universidade do Estado do Pará, Belém, PA, Brazil
| | - Tarcísio Neves da Cunha
- Programa Nacional de Cooperação Acadêmica da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), MICROARS Consultoria e Projetos, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pedro Fredemir Palha
- PAHO/WHO Collaborating Centre at Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Claudia Benedita Dos Santos
- PAHO/WHO Collaborating Centre at Nursing Research Development, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Bhargava A, Shewade HD. The potential impact of the COVID-19 response related lockdown on TB incidence and mortality in India. Indian J Tuberc 2020; 67:S139-S146. [PMID: 33308660 PMCID: PMC7348601 DOI: 10.1016/j.ijtb.2020.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/25/2020] [Accepted: 07/03/2020] [Indexed: 11/24/2022]
Abstract
India has the highest burden of incident tuberculosis (TB) cases and deaths globally. TB is strongly associated with poverty and this risk is largely mediated by undernutrition in India. COVID-19 response related lockdown has resulted in an economic crisis which may double levels of poverty, has exacerbated food insecurity, and disrupted TB services. These developments may have serious implications for TB progression and transmission in India. The nutritional status of a population is a strong determinant of the TB incidence, and undernutrition in adults alone accounts for 32-44% of TB incidence in India. A systematic review has shown that a 14% increase in TB incidence can occur per one unit decrease in body mass index (BMI), across the BMI range of 18.5-30 kg/m2. We believe that one unit decrease in BMI (corresponding to a 2-3 kg weight loss) may result in the poor in India as a result of the lockdown and its aftermath. This may result in an increase in estimated (uncertainty interval) incident TB by 185 610 (180 230, 190 990) cases. A 59% reduction in TB case detection between end March and May 2020, may result in an estimated (uncertainty interval) additional 87 711 (59 998, 120 630) TB deaths [19.5% increase (14.5, 24.7)] in 2020. Disadvantaged social groups and those living in states with higher levels of poverty, under-nutrition,and migrant workers are at particular risk. We suggest enhanced rations including pulses through the public distribution system and direct cash transfers to the poor pending restoration of livelihoods. TB services should be resumed immediately with enhanced efforts at case detection including active case finding. To prevent deaths among TB detected within the national TB programme, systemic identification, referral and management of severe disease at notification should be considered.
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Affiliation(s)
- Anurag Bhargava
- Department of Medicine, Yenepoya Medical College, Yenepoya (Deemed to Be University), Mangaluru, 575018, India; Department of Medicine, McGill University, Montreal, H4A 3J1, Canada; Center for Nutrition Studies, Yenepoya (Deemed to Be University), Mangaluru, 575018, India
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