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Chen YL, Xie YQ, Wei MY, Xu DM. Clinical effects of detailed nursing management interventions on medication adherence and disease perception in patients with drug-resistant tuberculosis. World J Clin Cases 2024; 12:4191-4198. [PMID: 39015906 PMCID: PMC11235556 DOI: 10.12998/wjcc.v12.i20.4191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Tuberculosis (TB) is a chronic respiratory infectious disease that considerably jeopardizes human health, and there is no effective vaccine suitable for its prevention in the entire population. AIM To investigate the promotion of medication adherence and disease cognition in patients with drug-resistant (DR-)TB using detailed nursing management. METHODS In total, 114 patients with DR-TB who were diagnosed and treated at our hospital between January 2019 and January 2023 were included in this study. Patients in the control group (n = 57) were managed with conventional nursing care, while those in the observation group (n = 57) were managed with detailed nursing care. Medication adherence, disease awareness scores, medication safety, and nursing satisfaction were compared between the two groups after the intervention. RESULTS The post-intervention medication compliance rate was 91.23% in the observation group and 75.44% in the control group, with the former being 15.79% higher than the latter (P < 0.05). There was no statistically significant difference in the disease awareness scores between the two groups before the intervention; the disease awareness scores of the observation group were significantly higher than those of the control group after the intervention (P < 0.05). The incidence of gastrointestinal reactions, joint swelling and pain, hearing loss, electrolyte disorders, and liver and kidney function abnormalities were lower in the observation group than those in the control group. The total nursing satisfaction of the observation group was higher than that of the control group (P < 0.05). CONCLUSION Implementation of detailed nursing management for patients with DR-TB can effectively improve medication adherence, enhance awareness of the disease, ensure safety of medication, and improve satisfaction with nursing care.
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Affiliation(s)
- Yan-Li Chen
- Nursing Department, The First People’s Hospital of Tianmen in Hubei Province, Tianmen 431700, Hubei Province, China
| | - Ya-Qin Xie
- Nursing Department, The First People’s Hospital of Tianmen in Hubei Province, Tianmen 431700, Hubei Province, China
| | - Ming-Yue Wei
- Infectious Disease Department, The First People’s Hospital of Tianmen in Hubei Province, Tianmen 431700, Hubei Province, China
| | - Dong-Mei Xu
- Nursing Department, The First People’s Hospital of Tianmen in Hubei Province, Tianmen 431700, Hubei Province, China
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Dekhil N, Mardassi H. Delineating the evolutionary pathway to multidrug-resistant outbreaks of a Mycobacterium tuberculosis L4.1.2.1/Haarlem sublineage. Int J Infect Dis 2024; 144:107077. [PMID: 38697608 DOI: 10.1016/j.ijid.2024.107077] [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: 02/20/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVES We sought to capture the evolutionary itinerary of the Mycobacterium tuberculosis L4.1.2.1/Haarlem sublineage in northern Tunisia, where it caused a major multidrug-resistant (MDR) tuberculosis outbreak in a context strictly negative for HIV infection. METHODS We combined whole genome sequencing and Bayesian approaches using a representative collection of drug-susceptible and drug-resistant L4.1.2.1/Haarlem clinical strains (n = 121) recovered from the outbreak region over 16 years. RESULTS In the absence of drug resistance, the L4.1.2.1/Haarlem sublineage showed a propensity for rapid transmission as witnessed by the high clustering (44.6%) and recent transmission rates (25%), as well as the reduced mean distance between genome pairs. The entire pool of L4.1.2.1/Haarlem MDR strains was found to be linked to either the aforementioned major outbreak (68 individuals, 2001-2016) or to a minor, newly uncovered outbreak (six cases, 2001-2011). Strikingly, the two outbreaks descended independently from a common ancestor that can be dated back to 1886. CONCLUSIONS Our data point to the intrinsic propensity for rapid transmission of the M. tuberculosis L4.1.2.1/Haarlem sublineage in northern Tunisia, linking the overall MDR tuberculosis epidemic to a single ancestor. These findings bring out the important role of the bacillus' genetic background in the emergence of successful MDR M. tuberculosis clones.
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Affiliation(s)
- Naira Dekhil
- Unit of Typing & Genetics of Mycobacteria, Laboratory of Molecular Microbiology, Vaccinology, and Biotechnology Development, Institut Pasteur de Tunis, Université de Tunis El Manar, Tunis, Tunisia
| | - Helmi Mardassi
- Unit of Typing & Genetics of Mycobacteria, Laboratory of Molecular Microbiology, Vaccinology, and Biotechnology Development, Institut Pasteur de Tunis, Université de Tunis El Manar, Tunis, Tunisia.
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Zhao J, Cao X, Li Y, Li Y, Ma T, Liu F, Ruan H. Analysis of clinical characteristics of different types of lung function impaiement in TDL patients. BMC Pulm Med 2024; 24:292. [PMID: 38914991 PMCID: PMC11194949 DOI: 10.1186/s12890-024-03115-5] [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: 01/11/2024] [Accepted: 06/19/2024] [Indexed: 06/26/2024] Open
Abstract
AIM The clinical characteristics associated with pulmonary function decline in patients with Tuberculosis-destroyed lung (TDL) remain uncertain. We categorize them based on the pattern of pulmonary function impairment, distinguishing between restrictive spirometric pattern (RSP) and obstructive spirometric pattern (OSP). We aim to compare the severity of these patterns with the clinical characteristics of TDL patients and analyze their correlation. METHOD We conducted a retrospective analysis on the clinical data of TDL patients who underwent consecutive pulmonary function tests (PFT) from November 2002 to February 2023. We used the lower limit formula for normal values based on the 2012 Global Lung Function Initiative. We compared the clinical characteristics of RSP patients with those of OSP patients. The characteristics of RSP patients were analyzed using the tertiles of forced vital capacity percentage predicted (FVC% pred) decline based on PFT measurements, and the characteristics of OSP patients were analyzed using the tertiles of forced expiratory volume in 1 s percentage predicted (FEV1% pred) decline. RESULT Among the RSP patients, those in the Tertile1 group (with lower FVC% pred) were more likely to have a higher of body mass index (BMI), spinal deformities, and C-reactive protein (CRP) compared to the other two groups (P for trend < 0.001, 0.027, and 0.013, respectively). Among OSP patients, those in the Tertile1 group (with lower FEV1% pred) showed an increasing trend in cough symptoms and contralateral lung infection compared to the Tertile 2-3 group (P for trend 0.036 and 0.009, respectively). CONCLUSION For TDL patients, we observed that Patients with high BMI, a higher proportion of spinal scoliosis, and abnormal elevation of CRP levels were more likely to have reduced FVC. Patients with decreased FEV1% pred have more frequent cough symptoms and a higher proportion of lung infections on the affected side.
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Affiliation(s)
- Jing Zhao
- Department of anesthesia, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, P. R. China
| | - Xiaoman Cao
- Department of anesthesia, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, P. R. China
| | - YunSong Li
- Department of Thoracic Surgery, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, P. R. China
| | - Yang Li
- Department of General, Changchun Infectious Disease Hospital, Changchun city, Jilin, P. R. China
| | - Teng Ma
- Department of Cellular and Molecular Biology, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, P. R. China.
- , No 9, Bei guan Street, Tong Zhou District, Beijing, 101149, P. R. China.
| | - Fangchao Liu
- Department of Science and Technology, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, P. R. China.
| | - Hongyun Ruan
- Department of Cellular and Molecular Biology, Beijing Chest Hospital, Beijing Tuberculosis and Thoracic Tumor Research Institute, Capital Medical University, Beijing, P. R. China.
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Quiroz-Aldave JE, Durand-Vásquez MDC, Gamarra-Osorio ER, Concepción-Urteaga LA, Pecho-Silva S, Rodríguez-Hidalgo LA, Concepción-Zavaleta MJ. Drug-induced hypothyroidism in tuberculosis. Expert Rev Endocrinol Metab 2024; 19:199-206. [PMID: 38258451 DOI: 10.1080/17446651.2024.2307525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Adverse reactions to tuberculosis treatment can impact patient adherence and prognosis. Hypothyroidism is a frequent adverse reaction caused using ethionamide, prothionamide, and para-aminosalicylic acid and is often underdiagnosed. AREAS COVERED We searched Scielo, Scopus, and EMBASE databases, including 67 articles. Antitubercular drug-induced hypothyroidism has a prevalence of 17%. It occurs after 2 to 3 months of treatment and resolves within 4 to 6 weeks after discontinuation. It is postulated to result from the inhibition of thyroperoxidase function, blocking thyroid hormone synthesis. Symptoms are nonspecific, necessitating individualized thyroid-stimulating hormone measurement for detection. Specific guidelines for management are lacking, but initiation of treatment with levothyroxine, as is customary for primary hypothyroidism, is recommended. Discontinuation of antitubercular drugs is discouraged, as it may lead to unfavorable consequences. EXPERT OPINION Antitubercular drug-induced hypothyroidism is more common than previously thought, affecting one in six MDR-TB patients. Despite diagnostic and treatment recommendations, implementation is hindered in low-income countries due to the lack of certified laboratories. New drugs for tuberculosis treatment may affect thyroid function, requiring vigilant monitoring for complications, including hypothyroidism.
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Affiliation(s)
- Juan Eduardo Quiroz-Aldave
- Division of Non-communicable diseases, Endocrinology research line, Hospital de Apoyo Chepén, Chepén, Perú
| | | | | | | | - Samuel Pecho-Silva
- Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Perú
- Division of Pneumology, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
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Dahl VN, Butova T, Rosenthal A, Grinev A, Gabrielian A, Vashakidze S, Shubladze N, Toxanbayeva B, Chingissova L, Crudu V, Chesov D, Kalmambetova G, Saparova G, Wejse CM, Butov D. Drug-Resistant Tuberculosis, Georgia, Kazakhstan, Kyrgyzstan, Moldova, and Ukraine, 2017-2022. Emerg Infect Dis 2024; 30:831-833. [PMID: 38526186 PMCID: PMC10977852 DOI: 10.3201/eid3004.231732] [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] [Indexed: 03/26/2024] Open
Abstract
In 2021, the World Health Organization recommended new extensively drug-resistant (XDR) and pre-XDR tuberculosis (TB) definitions. In a recent cohort of TB patients in Eastern Europe, we show that XDR TB as currently defined is associated with exceptionally poor treatment outcomes, considerably worse than for the former definition (31% vs. 54% treatment success).
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Liang S, Xu X, Yang Z, Du Q, Zhou L, Shao J, Guo J, Ying B, Li W, Wang C. Deep learning for precise diagnosis and subtype triage of drug-resistant tuberculosis on chest computed tomography. MedComm (Beijing) 2024; 5:e487. [PMID: 38469547 PMCID: PMC10925488 DOI: 10.1002/mco2.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 03/13/2024] Open
Abstract
Deep learning, transforming input data into target prediction through intricate network structures, has inspired novel exploration in automated diagnosis based on medical images. The distinct morphological characteristics of chest abnormalities between drug-resistant tuberculosis (DR-TB) and drug-sensitive tuberculosis (DS-TB) on chest computed tomography (CT) are of potential value in differential diagnosis, which is challenging in the clinic. Hence, based on 1176 chest CT volumes from the equal number of patients with tuberculosis (TB), we presented a Deep learning-based system for TB drug resistance identification and subtype classification (DeepTB), which could automatically diagnose DR-TB and classify crucial subtypes, including rifampicin-resistant tuberculosis, multidrug-resistant tuberculosis, and extensively drug-resistant tuberculosis. Moreover, chest lesions were manually annotated to endow the model with robust power to assist radiologists in image interpretation and the Circos revealed the relationship between chest abnormalities and specific types of DR-TB. Finally, DeepTB achieved an area under the curve (AUC) up to 0.930 for thoracic abnormality detection and 0.943 for DR-TB diagnosis. Notably, the system demonstrated instructive value in DR-TB subtype classification with AUCs ranging from 0.880 to 0.928. Meanwhile, class activation maps were generated to express a human-understandable visual concept. Together, showing a prominent performance, DeepTB would be impactful in clinical decision-making for DR-TB.
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Affiliation(s)
- Shufan Liang
- Department of Pulmonary and Critical Care MedicineState Key Laboratory of Respiratory Health and Multimorbidity, Targeted Tracer Research and Development Laboratory, Med‐X Center for Manufacturing, Frontiers Science Center for Disease‐related Molecular Network, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Xiuyuan Xu
- Machine Intelligence LaboratoryCollege of Computer ScienceSichuan UniversityChengduChina
| | - Zhe Yang
- Machine Intelligence LaboratoryCollege of Computer ScienceSichuan UniversityChengduChina
| | - Qiuyu Du
- Machine Intelligence LaboratoryCollege of Computer ScienceSichuan UniversityChengduChina
| | - Lingyu Zhou
- Machine Intelligence LaboratoryCollege of Computer ScienceSichuan UniversityChengduChina
| | - Jun Shao
- Department of Pulmonary and Critical Care MedicineState Key Laboratory of Respiratory Health and Multimorbidity, Targeted Tracer Research and Development Laboratory, Med‐X Center for Manufacturing, Frontiers Science Center for Disease‐related Molecular Network, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Jixiang Guo
- Machine Intelligence LaboratoryCollege of Computer ScienceSichuan UniversityChengduChina
| | - Binwu Ying
- Department of Laboratory MedicineWest China Hospital, Sichuan UniversityChengduChina
| | - Weimin Li
- Department of Pulmonary and Critical Care MedicineState Key Laboratory of Respiratory Health and Multimorbidity, Targeted Tracer Research and Development Laboratory, Med‐X Center for Manufacturing, Frontiers Science Center for Disease‐related Molecular Network, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
| | - Chengdi Wang
- Department of Pulmonary and Critical Care MedicineState Key Laboratory of Respiratory Health and Multimorbidity, Targeted Tracer Research and Development Laboratory, Med‐X Center for Manufacturing, Frontiers Science Center for Disease‐related Molecular Network, West China Hospital, West China School of Medicine, Sichuan UniversityChengduChina
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Chesov E, Chesov D, Reimann M, Dreyer V, Utpatel C, Gröschel MI, Ciobanu N, Crudu V, Lange C, Heyckendorf J, Merker M. Impact of Mycobacterium tuberculosis strain type on multidrug-resistant tuberculosis severity, Republic of Moldova. J Infect 2023; 87:588-591. [PMID: 37827458 DOI: 10.1016/j.jinf.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Elena Chesov
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Chiril Draganiuc Phthisiopneumology Institute, Chisinau, Republic of Moldova; Division of Clinical Infectious Disease, Research Center Borstel, Borstel, Germany
| | - Dumitru Chesov
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Chiril Draganiuc Phthisiopneumology Institute, Chisinau, Republic of Moldova; Division of Clinical Infectious Disease, Research Center Borstel, Borstel, Germany; German Center for Infection Research, Partner site Hamburg-Lübeck-Riems-Borstel, Borstel, Germany
| | - Maja Reimann
- Division of Clinical Infectious Disease, Research Center Borstel, Borstel, Germany; German Center for Infection Research, Partner site Hamburg-Lübeck-Riems-Borstel, Borstel, Germany; Respiratory Medicine & International Health, University of Lübeck, Germany
| | - Viola Dreyer
- German Center for Infection Research, Partner site Hamburg-Lübeck-Riems-Borstel, Borstel, Germany; Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
| | - Christian Utpatel
- German Center for Infection Research, Partner site Hamburg-Lübeck-Riems-Borstel, Borstel, Germany; Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany
| | - Matthias I Gröschel
- Department of Infectious Diseases and Respiratory Medicine, Charite ́ - Universitaetsmedizin Berlin, Berlin, Germany
| | - Nelly Ciobanu
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Chiril Draganiuc Phthisiopneumology Institute, Chisinau, Republic of Moldova
| | - Valeriu Crudu
- Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova; Chiril Draganiuc Phthisiopneumology Institute, Chisinau, Republic of Moldova
| | - Christoph Lange
- Division of Clinical Infectious Disease, Research Center Borstel, Borstel, Germany; German Center for Infection Research, Partner site Hamburg-Lübeck-Riems-Borstel, Borstel, Germany; Respiratory Medicine & International Health, University of Lübeck, Germany; Baylor College of Medicine and Texas Children´s Hospital, Houston, TX, USA
| | - Jan Heyckendorf
- Clinic for Internal Medicine I, University Clinic Schleswig-Holstein Campus Kiel, Germany
| | - Matthias Merker
- Evolution of the Resistome, Research Center Borstel, Borstel, Germany.
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