1
|
Regan M, Li Y, Swartwood NA, Barham T, Asay GRB, Cohen T, Hill AN, Horsburgh CR, Khan A, Marks SM, Myles RL, Salomon JA, Self JL, Menzies NA. Racial and ethnic disparities in diagnosis and treatment outcomes among US-born people diagnosed with tuberculosis, 2003-19: an analysis of national surveillance data. Lancet Public Health 2024; 9:e47-e56. [PMID: 38176842 DOI: 10.1016/s2468-2667(23)00276-1] [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: 07/14/2023] [Revised: 10/21/2023] [Accepted: 11/01/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Persistent racial and ethnic disparities in tuberculosis incidence exist in the USA, however, less is known about disparities along the tuberculosis continuum of care. This study aimed to describe how race and ethnicity are associated with tuberculosis diagnosis and treatment outcomes. METHODS In this analysis of national surveillance data, we extracted data from the US National Tuberculosis Surveillance System on US-born patients with tuberculosis during 2003-19. To estimate the association between race and ethnicity and tuberculosis diagnosis (diagnosis after death, cavitation, and sputum smear positivity) and treatment outcomes (treatment for more than 12 months, treatment discontinuation, and death during treatment), we fitted log-binomial regression models adjusting for calendar year, sex, age category, and regional division. Race and ethnicity were defined based on US Census Bureau classification as White, Black, Hispanic, Asian, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, and people of other ethnicities. We quantified racial and ethnic disparities as adjusted relative risks (aRRs) using non-Hispanic White people as the reference group. We also calculated the Index of Disparity as a summary measure that quantifies the dispersion in a given outcome across all racial and ethnic groups, relative to the population mean. We estimated time trends in each outcome to evaluate whether disparities were closing or widening. FINDINGS From 2003 to 2019, there were 72 809 US-born individuals diagnosed with tuberculosis disease of whom 72 369 (35·7% women and 64·3% men) could be included in analyses. We observed an overall higher risk of any adverse outcome (defined as diagnosis after death, treatment discontinuation, or death during treatment) for non-Hispanic Black people (aRR 1·27, 95% CI 1·22-1·32), Hispanic people (1·20, 1·14-1·27), and American Indian or Alaska Native people (1·24, 1·12-1·37), relative to non-Hispanic White people. The Index of Disparity for this summary outcome remained unchanged over the study period. INTERPRETATION This study, based on national surveillance data, indicates racial and ethnic disparaties among US-born tuberculosis patients along the tuberculosis continuum of care. Initiatives are needed to reduce diagnostic delays and improve treatment outcomes for US-born racially marginalised people in the USA. FUNDING US Centers for Disease Control and Prevention.
Collapse
Affiliation(s)
- Mathilda Regan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Yunfei Li
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Nicole A Swartwood
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Terrika Barham
- Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Garrett R Beeler Asay
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Ted Cohen
- Yale School of Public Health, New Haven, CT, USA
| | - Andrew N Hill
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - C Robert Horsburgh
- Departments of Epidemiology, Biostatistics, Global Health, and Medicine, Boston University Schools of Public Health and Medicine, Boston, MA, USA
| | - Awal Khan
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Suzanne M Marks
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Ranell L Myles
- Office of Health Equity, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Joshua A Salomon
- Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Julie L Self
- Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB prevention, US Centers for Disease Control and Prevention, Atlanta, GE, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Busatto C, Bierhals DV, Vianna JS, da Silva PEA, Possuelo LG, Ramis IB. Epidemiology and control strategies for tuberculosis in countries with the largest prison populations. Rev Soc Bras Med Trop 2022; 55:e00602022. [PMID: 36417620 PMCID: PMC9757719 DOI: 10.1590/0037-8682-0060-2022] [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: 11/22/2022] Open
Abstract
Tuberculosis (TB) is a serious infectious disease, and its control is considered a challenge, especially among vulnerable populations such as prisoners. The occurrence of TB in prisons is an alarming public health problem in many countries. This integrative review aims to describe the epidemiology of TB and control strategies for this disease in countries with the largest prison populations. Studies have shown that it is essential to know the prevalence of TB in prisons of each country. This is because it can serve as an indication of the need for action in prisons to reduce TB rates, including improving the structure of prison environments, rapidly and accurately diagnosing new cases, identifying drug-resistant strains, and implementing effective and directly observed treatment for TB.
Collapse
Affiliation(s)
- Caroline Busatto
- Universidade Federal do Rio Grande, Programa de Pós-Graduação em Ciências da Saúde, Rio Grande, RS, Brasil
| | - Dienefer Venske Bierhals
- Universidade Federal do Rio Grande, Programa de Pós-Graduação em Ciências da Saúde, Rio Grande, RS, Brasil
| | - Julia Silveira Vianna
- Universidade Federal do Rio Grande, Programa de Pós-Graduação em Ciências da Saúde, Rio Grande, RS, Brasil
| | | | - Lia Gonçalves Possuelo
- Universidade de Santa Cruz do Sul, Programa de Pós-Graduação em Promoção da Saúde, Santa Cruz do Sul, RS, Brasil
| | - Ivy Bastos Ramis
- Universidade Federal do Rio Grande, Programa de Pós-Graduação em Ciências da Saúde, Rio Grande, RS, Brasil
| |
Collapse
|
3
|
Synthesis and activity of BNF15 against drug-resistant Mycobacterium tuberculosis. Future Med Chem 2020; 13:251-267. [PMID: 33295787 DOI: 10.4155/fmc-2019-0154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: Tuberculosis is the leading cause of mortality among infectious diseases worldwide. Finding a new competent anti tubercular therapy is essential. Materials & methods: We screened thousands of compounds and evaluated their efficacy against Mycobacterium tuberculosis. Results: Initially, 2-nitronaphtho[2,3-b]benzofuran-6,11-dione was active against M. tuberculosis. Next, among 15 newly synthesized derivatives, BNF15 showed promising effect against all drug-sensitive and drug-resistant M. tuberculosis (MIC: 0.02-0.78 μg/ml). BNF15 effectively killed intracellular M. tuberculosis and nontuberculous mycobacteria. BNF15 exhibited a prolonged post antibiotic effect superior to isoniazid, streptomycin, and ethambutol and synergistic interaction with rifampicin. In acute oral toxicity test, BNF15 did not show toxic effect at a concentration up to 2000 mg/kg. Conclusion: These results highlight the perspective of BNF15 to treat drug-resistant M. tuberculosis.
Collapse
|
4
|
Teo AKJ, Tan RKJ, Smyth C, Soltan V, Eng S, Ork C, Sok N, Tuot S, Hsu LY, Yi S. Characterizing and Measuring Tuberculosis Stigma in the Community: A Mixed-Methods Study in Cambodia. Open Forum Infect Dis 2020; 7:ofaa422. [PMID: 33134412 PMCID: PMC7585330 DOI: 10.1093/ofid/ofaa422] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/15/2020] [Indexed: 01/19/2023] Open
Abstract
Background Stigma is a significant barrier to healthcare and a factor that drives the global burden of tuberculosis (TB). However, there is a scarcity of information on TB stigma in developing countries. We aimed to characterize, measure, and explore the determinants of TB stigma among people with TB in Cambodia. Methods We conducted a mixed-methods study between February and August 2019 using a triangulation convergent design—a cross-sectional survey (n = 730) and nested in-depth interviews (n = 31) among people with TB. Quantitative data were analyzed using descriptive statistics and generalized linear regression models. Qualitative transcripts were thematically analyzed. Results A total of 56% and 51% of participants experienced self-stigma and perceived stigma by the community, respectively. We found rural dwellers, knowledge of how TB is transmitted, and knowledge that anybody can get TB were associated with higher levels of self-stigma and perceived stigma by the community. Higher scores on knowledge of TB symptoms were inversely associated with both self-stigma and community stigma. Thematic analyses revealed accounts of experienced stigma, acts of intentional distancing and hiding TB diagnosis from others, and feelings of embarrassment and shame. Conclusions Tuberculosis stigma was prevalent, suggesting a need for the incorporation of stigma-reduction strategies in the national TB responses. These strategies should be contextualized and developed through community engagement. Future research should continue to measure the levels and dimensions of TB stigma among people with TB through behavioral surveillance using standardized tools.
Collapse
Affiliation(s)
- Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | - Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore
| | | | | | - Sothearith Eng
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Chetra Ork
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Ngovlyly Sok
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore.,KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, California, USA.,School of Public Health, National Institute of Public Health, Phnom Penh, Cambodia
| |
Collapse
|
5
|
Kersten JF, Wobbe-Ribinski S, Diel R, Nienhaus A, Schablon A. Influence of age, sex and hospitalisation on the administration of tuberculosis medication: an evaluation of routine data from a German health insurer. ERJ Open Res 2020; 6:00369-2019. [PMID: 32743006 PMCID: PMC7383052 DOI: 10.1183/23120541.00369-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/06/2020] [Indexed: 11/05/2022] Open
Abstract
Background So far, there is no reliable information on the drugs actually taken by tuberculosis patients. With billing data from a large German health insurance company, valid data from practice will be used for analysis. The objective here is to use the claims data of a health insurer to gain an insight into the prescriptions issued to patients with tuberculosis in Germany. Methods The study design encompasses a longitudinal, analytical observational study of selected insurance holders. Descriptive analyses of the outpatient drug supply of pulmonary tuberculosis patients are determined for 6 payroll years. We have studied whether different doses of tuberculosis medication are associated with age, sex, inpatient status and comorbidity. Quantile regression is used as a method to identify subgroups or characteristic dosages. Results The number of defined daily doses prescribed per patient varies among insurance holders and encompasses widely differing timeframes. Higher doses are observed with increasing age, as well as in patients with tuberculosis-related hospitalisations. The sex of the patient has no identifiable effect on the prescribed doses for any of the first-line tuberculosis drugs. Comorbidity partially has a significant impact on the duration and intensity of tuberculosis drug prescriptions.
Collapse
Affiliation(s)
- Jan F Kersten
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Roland Diel
- Dept of Occupational Medicine, Public Health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany.,Institute for Epidemiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Dept of Occupational Medicine, Public Health and Hazardous Substances, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
| | - Anja Schablon
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| |
Collapse
|
6
|
Tuberculosis among Health Workers-A Secondary Data Analysis of German Social Accident Insurance Data from 2002-2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051564. [PMID: 32121256 PMCID: PMC7084340 DOI: 10.3390/ijerph17051564] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/21/2020] [Accepted: 02/27/2020] [Indexed: 11/22/2022]
Abstract
Tuberculosis (TB) is the most common cause of fatal infections worldwide. Recent TB figures in Europe indicate that 30 people were infected with tuberculosis each hour in 2017. Healthcare workers are at particular risk of being infected through patient contact. TB is the second most common occupational infectious disease among German healthcare workers. Routine data from the German Social Accident Insurance were used to examine trends in occupational TB diseases. We analyzed annual cross-sectional data for the years 2002 to 2017. The data underwent descriptive analysis. A total of 4653 TB cases were recognized as occupational diseases (OD) in the period under study. In 2002, 60 TB cases were recognized as OD No. 3101, i.e., transmissions from person to person. Since 2013, the level has settled at around 500 recognized cases per year. This is around eight times the number of cases compared to 2002. The following three groups collectively accounted for the largest share of TB cases (88.5%): nurses (including geriatric nurses), other healthcare employees, and physicians. The upward trend in the number of TB cases recognized as occupational diseases is probably due to improvements in diagnostic tests used to diagnose TB infections. TB in health and welfare workers remains an important issue in the health and welfare sector in Germany, partly due to the long latency period between potential exposure to infectious patients or materials and the recognition of the latent tuberculosis infection (LTBI) or active TB as OD.
Collapse
|
7
|
Sharma BB, Singh S, Sharma KK, Suraj KP, Mahmood T, Samaria KU, Kant S, Singh N, Singh T, Singh A, Gupta R, Koul PA, Salvi S, Singh V. Methodology of Seasonal Waves of Respiratory Disorders survey conducted at respiratory outpatient clinics across India. Lung India 2020; 37:100-106. [PMID: 32108592 PMCID: PMC7065537 DOI: 10.4103/lungindia.lungindia_466_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Respiratory disorders are important contributors to disease burden across the world. The aim is to assess the proportionate burden of types of respiratory diseases and their seasonal patterns in India we are performing a field study. The present report describes methodological aspects of a respiratory disease point prevalence survey from India. Methods: A total of 4108 chest physicians were invited. Acceptance was received from 420 sites. Chest physicians were classified according to location of practice one as medical college, district government hospital, private hospital, and private clinics. Qualifications of practicing chest physicians were postgraduate in chest medicine, including Doctorate of Medicine (68.4%), diploma in chest medicine (22.1%), and Postgraduate in Medicine (9.5%). The study questionnaire was designed to record demographic data, comorbidities, risk factors, and respiratory conditions based on ICD-10. Results: A total of 366 sites provided baseline data, and the response rate of recruitment of the study sites was 8.9% in the baseline phase. However, government and private medical colleges, as well as government and private hospitals across India, were part of recruitment of respiratory patients for this survey. Conclusions: It is feasible to conduct a large multisite study to assess respiratory disease burden. Challenges include low response rate and logistic issues.
Collapse
Affiliation(s)
- Bharat Bhushan Sharma
- Department of Medicine, Division of Allergy and Pulmonary Medicine, SMS Medical College, Jaipur, Rajasthan, India
| | - Sheetu Singh
- Department of Chest and Tuberculosis, Institute of Respiratory Disease, SMS Medical College, Jaipur, Rajasthan, India
| | - Krishna Kumar Sharma
- Department of Pharmacology, Lal Bahadur Shastri College of Pharmacy, Jaipur, Affiliate to University of Rajastha, Rajasthan, India
| | - K P Suraj
- Department of Pulmonary Medicine, Institute of Chest Diseases, Government Medical College, Kozhikode, Kerala, India
| | - Tariq Mahmood
- Department of Pulmonary Medicine, MLN Medical College, Allahabad, Uttar Pradesh, India
| | | | - Surya Kant
- Department of Respiratory Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nishtha Singh
- Executive Director, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Tejraj Singh
- Department of Research Division, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Aradhna Singh
- Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
| | - Rajeev Gupta
- Department of Preventive Cardiology and Internal Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, Rajasthan, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, SKIMS, Srinagar, Jammu and Kashmir, India
| | - Sundeep Salvi
- Director, Chest Research Foundation, Pune, Maharashtra, India
| | | | -
- SWORD Study Group for the Indian Chest Society SWORD Survey Conducted by Department of Pulmonary Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
| |
Collapse
|
8
|
Hassan HM, Yousef BA, Guo H, Xiaoxin L, Zhang L, Jiang Z. Investigating the CYP2E1 Potential Role in the Mechanisms Behind INH/LPS-Induced Hepatotoxicity. Front Pharmacol 2018; 9:198. [PMID: 29563874 PMCID: PMC5850051 DOI: 10.3389/fphar.2018.00198] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/21/2018] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis (TB) is one of the oldest infectious diseases that affected humankind and remains one of the world's deadliest communicable diseases that could be considered as global emergency, but the discovery and development of isoniazid (INH) in the 1950s paved the way to an effective single and/or combined first-line anti-TB therapy. However, administration of INH induces severe hepatic toxicity in some patients. Previously, we establish a rat model of INH hepatotoxicity utilizing the inflammatory stress theory, in which bacterial lipopolysaccharide (LPS) potentially enhanced INH toxicity. These enhancing activities ranged between augmenting the inflammatory stress, oxidative stress, alteration of bile acid homeostasis, and CYP2E1 over-expression. Although pre-treatment with dexamethasone (DEX) helped overcome both inflammatory and oxidative stress which ended-up in alleviation of LPS augmenting effects, but still minor toxicities were being detected, alongside with CYP2E1 over expression. This finding positively indicated the corner-stone role played by CYP2E1 in the pathogenesis of INH/LPS-induced liver damage. Therefore, we examined whether INH/LPS co-treatment with CYP2E1 inhibitor diallyl sulfide (DAS) and DEX can protect against the INH/LPS-induced hepatotoxicity. Our results showed that pre-administration of both DAS and DEX caused significant reduction in serum TBA, TBil, and gamma-glutamyl transferase levels. Furthermore, the histopathological analysis showed that DAS and DEX could effectively reverse the liver lesions seen following INH/LPS treatment and protect against hepatic steatosis as indicated by absence of lipid accumulation. Pre-treatment with DAS alone could not completely block the CYP2E1 protein expression following INH/LPS treatment, as appeared in the immunoblotting and immunohistochemistry results. This is probably due to the fact that the combined enhancement activities of both INH and LPS on CYP2E1 protein expression levels might resist the blocking probabilities of DAS. In the meantime, addition of DEX to the DAS/INH/LPS combination caused a significant reduction in CYP2E1 protein expression as revealed by the immunoblotting and fading coloration in immunohistochemistry results. Thus, addition of DEX and DAS together caused strong protection against INH/LPS-induced hepatic damage. These findings reveal the potential therapeutic value of combining DAS and DEX with INH in TB management for reducing the potential risk and incidences of hepatotoxicity.
Collapse
Affiliation(s)
- Hozeifa M Hassan
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing, China.,Department of Pharmacology, Faculty of Pharmacy, University of Gezira, Wad Medani, Sudan
| | - Bashir A Yousef
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing, China.,Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Hongli Guo
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing, China
| | - Liu Xiaoxin
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing, China
| | - Luyong Zhang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing, China.,Jiangsu Center for Pharmacodynamics Research and Evaluation, China Pharmaceutical University, Nanjing, China.,Center for Drug Screening and Pharmacodynamics Evaluation, School of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhenzhou Jiang
- Jiangsu Key Laboratory of Drug Screening, China Pharmaceutical University, Nanjing, China.,Key Laboratory of Drug Quality Control and Pharmacovigilance (China Pharmaceutical University), Ministry of Education, Nanjing, China
| |
Collapse
|
9
|
Hashmi HJ, Javed H, Jamil N. Emerging epidemic of drug resistant tuberculosis in vulnerable populations of developing countries. Afr Health Sci 2017; 17:599-602. [PMID: 29062361 DOI: 10.4314/ahs.v17i2.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Hafiza Jawairia Hashmi
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Hasnain Javed
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| | - Nazia Jamil
- Department of Microbiology and Molecular Genetics, University of the Punjab, Lahore, Pakistan
| |
Collapse
|