Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Evaluating the success rates and effectiveness of surgical and orthodontic interventions for impacted canines: a systematic review of surgical and orthodontic interventions and a case series

OBJECTIVES

The goal is to gather more information on orthodontic traction of impacted canines in the arch or their extraction.

METHODS

We focused our search on English-language papers published between January 1, 2004, and July 24, 2024 in PubMed, Scopus, and Web of Science that were relevant to our topic. The search strategy employed the Boolean terms "impacted" AND "canine". In addition to the overview, this article discusses a number of clinical instances involving canine disinclusion.

RESULTS

The study analyzed 2748 papers from databases like Web of Science, PubMed, and Scopus, resulting in 1455 articles after eliminating duplicates. After examining titles and abstracts, 897 entries were removed. The remaining 558 papers were confirmed, with 543 items removed due to being off-topic. The study includes a qualitative analysis of the 15 final articles.

CONCLUSIONS

This article concludes that both extraction and orthodontic traction are effective treatments for impacted canines, with the choice depending on patient-specific factors. Advances in surgical techniques and imaging technologies have improved outcomes, while a multidisciplinary, patient-centered approach remains essential. Future research should focus on refining treatment selection criteria and integrating genetic and technological advancements.

Improving diagnostics and surveillance of malaria among displaced people in Africa

African communities that have been forced to leave their homes experience a considerably greater susceptibility to malaria as a result of densely populated living conditions, restricted availability of healthcare, and environmental influences. Internally displaced individuals frequently live in large settlements with restricted availability to drinking water, essential sanitation, and medical services, intensifying the spread of malaria. As a result, the occurrence of malaria is significantly more common among refugees and internally displaced individuals compared to those who are not displaced. This leads to greater rates of illness and death, especially among young people. Insufficient monitoring worsens the condition, leading to delayed identification and medical intervention, and contributing to a higher incidence of severe malaria and deaths. Furthermore, these communities are faced with economic consequences that contribute to the continuation of poverty and the worsening of socio-economic inequalities. Furthermore, the psychological impact of malaria, which is marked by feelings of anxiety and uncertainty, is particularly severe in vulnerable populations such as displaced children and pregnant women, aggravating the overall burden. Hence, addressing malaria in displaced populations in Africa requires comprehensive and well-coordinated strategies. Advanced diagnostic and surveillance technologies are essential for promptly identifying and treating malaria, providing chances to monitor and control its spread effectively. Collaboration among healthcare, policy, and humanitarian sectors is crucial for implementing comprehensive solutions that incorporate enhanced diagnostics, surveillance, and socio-psychological support. Active involvement of the community, usage of Community Health Workers, and regular collection of surveillance data are crucial in increasing awareness, directing control efforts, and tackling the specific difficulties encountered by displaced groups. Moreover, the implementation of environmental management, the incorporation of health services, and the utilization of adaptable healthcare interventions are essential for reducing the effects of malaria. To mitigate the impact of malaria and improve health outcomes among displaced populations in Africa, it is crucial to focus on these specific areas.

Factors associated with malaria in pregnancy among women attending ANC clinics in selected districts of the Ashanti Region, Ghana

BACKGROUND

Malaria is a disease deeply rooted in poverty. Malaria in pregnant women leads to severe complications, including low birth weight and neonatal mortality, which can adversely affect both mother and child. This study aimed to identify the factors associated with malaria in pregnancy among women attending antenatal care (ANC) clinics in three districts of the Ashanti Region, Ghana.

METHODS

A cross-sectional study was conducted among 1215 pregnant women selected through multi-stage sampling. Data were collected using structured questionnaires and analysed using descriptive and inferential statistics, including regression analysis.

RESULTS

The self-reported prevalence of at least one episode of malaria was 76.7% (95% CI [74.1-79.3%]). Age, education, marital status, income, and religion were significantly associated with the prevalence of malaria among pregnant women, with a p-value < 0.001. Pregnant women aged 17-25 years were 10.26 times more likely to have malaria compared to other age groups (aOR = 10.26, 95% CI [4.52-11.05], p = 0.000). Women with no formal education had higher odds of malaria, being 15.10 times more likely to have malaria compared to those with tertiary education (aOR = 15.10, 95% CI [7.32-16.78], p = 0.002). Women not using insecticide-treated bed nets (ITNs) were 20 times more likely to have malaria compared to those who used ITNs (aOR = 20.0, 95% CI [7.04-21.03], p = 0.000).

CONCLUSION

Age, education, marital status, income, religion and insecticide-treated bed net (ITN) use significantly influence malaria prevalence in pregnancy. To achieve SDG 3 (Good Health and Well-being), particularly Target 3.1 (reducing maternal mortality) and Target 3.3 (ending malaria), the Ghana Health Service and Ministry of Health should prioritize expanding ITN distribution, educational campaigns, and targeted support for vulnerable groups to reduce malaria prevalence during pregnancy and improve maternal health outcomes.

Changes in The Trends of Tuberculosis-related Indicators in Hamadan Province Using the Join Point Regression Approach From 2011 to 2022

BACKGROUND

This study was conducted to investigate the trend of some tuberculosis (TB) indices and identify existing gaps in addressing this important public health issue in Hamadan province over a long time period. Study Design: A registry-based cross-sectional study.

METHODS

In this study, we examined the trend of 10 TB indicators separately in males and females, including the incidence rates of smear-positive pulmonary TB (SPPT), extra-pulmonary TB (EPT), and smear-negative pulmonary TB (SNPT), co-infection with AIDS, relapse rate, smear conversion rate two months after treatment initiation, TB mortality rate, diagnosis rate of pulmonary TB with a smear grade of 3+, treatment success rate, and TB diagnosis rate by the private sector in Hamadan province during 2011-2022. The trend analysis of TB was conducted using Joinpoint regression model, and the annual percentage change (APC) and the average annual percentage change (AAPC) were calculated.

RESULTS

A total of 481 females and 554 males were eligible for analysis. The incidence of SPPT in females showed a decreasing trend (AAPC: -7.72; 95% CI: -15.63, -1.10; P=0.008). The rates of EPT and treatment success showed a significant downward trend in both genders. In contrast, the recurrence rate among females exhibited a notable upward trend during the specified time period (AAPC: 18.45; 95% CI: 3.23, 46.47; P=0.0002).

CONCLUSION

The findings of this study suggest that the epidemiological profile of TB has exhibited a relatively favorable trend in some of the examined indicators since 2011, with declines observed in both SPPT and EPT.

Sexual Violence, Genital Cytokines, and Colposcopy Findings: A Cross-Sectional Study of Women Engaged in Sex Work in Mombasa, Kenya

BACKGROUND

Sexual violence (SV) increases human immunodeficiency virus (HIV) susceptibility in a sustained manner. This study evaluated genital cytokines and colposcopy findings in women reporting both recent and more remote SV.

METHODS

A cross-sectional study of HIV-1 negative Kenyan women who engage in sex work was performed. Cervicovaginal fluid was collected by menstrual cup and cytokines (IFNγ, TNFα, IL-1β, IL-6, IL-10, MIP-1α, MIP-1β, and CXCL10) measured using chemiluminescence. Cervical injury was assessed by colposcopy. Associations between recent (≤30 days prior), more remote (>30 days prior), and no (reference category) SV exposure and cytokine concentrations were evaluated using linear regression.

RESULTS

Among 282 participants, 25 (8.9%) reported recent SV and 123 (43.6%) reported more remote SV. Only two cytokines (IL-10 and CXCL10) were associated with the 3-category SV variable in bivariable modeling at the prespecified cutoff ( P < 0.2) and carried forward. In multivariable analyses, more remote SV (β = 0.72; 95% confidence interval [CI], 0.06-1.38; P = 0.03), but not recent SV (β = 0.20; 95% CI, -0.99 to 1.39; P = 0.74) was associated with cervicovaginal IL-10 compared with no SV. Recent (β = 0.36; 95% CI, -0.94 to 1.67; P = 0.58) and more remote (β = 0.51; 95% CI, -0.21 to 1.24; P = 0.16) SV were not associated with CXCL10 compared with no SV. Cervical epithelial friability (χ 2 = 1.3, P = 0.51), erythema (χ 2 = 2.9, P = 0.24), vascular disruption (χ 2 = 1.4; P = 0.50), epithelial disruption (χ 2 = 2.6, P = 0.27), or any colposcopy finding (χ 2 = 1.2, P = 0.54) were not associated with SV category by χ 2 test.

CONCLUSIONS

The mechanism linking SV to sustained increases in HIV susceptibility may not be related to persistent genital inflammation or injury.

Efficacy and Possible Mechanism(s) of Action of Gallium Tetraphenylporphyrin Nanoparticles against HIV-TB Coinfection in an In Vitro Granuloma Structure Model

Coinfection of Mycobacterium tuberculosis (Mtb) and human immunodeficiency virus-1 (HIV) is a significant public health concern. Treatment is challenging due to prolonged duration of therapy and drug interactions between antiretroviral therapy (ART) and anti-TB drugs. Noniron gallium meso-tetraphenyl porphyrin (GaTP), a heme mimetic, has shown broad antimicrobial activity. Here, we investigated the efficacy of nanoparticle encapsulating GaTP (GaNP) for the treatment of HIV and Mtb coinfection or single infection in in vitro granuloma structures. GaNP significantly reduced viable Mtb within primary human in vitro granuloma structures infected with Mtb H37Rv-lux and significantly reduced levels of HIV in CD4+ T cells infected with the virus axenically. Similarly, GaNP exhibited significant antimicrobial activity against HIV/Mtb-coinfected granuloma structures created in vitro, which contain the primary immune cells seen in human TB granulomas, including CD4+ T cells and macrophages, as assessed by a luciferase assay for Mtb and p24 ELISA for HIV detection. Furthermore, mechanistic studies revealed that GaTP increases the level of reactive oxygen species and inhibits catalase in Mtb. A significant increase in Mtb nitrate reductase activity was also observed when Mtb was incubated with GaTP and sodium nitrate. Overall, increased oxidative stress and nitrite levels induced by GaTP are consistent with the possibility that GaTP inhibits Mtb aerobic respiration, which leads to incomplete O2 reduction and a shift to respiration using exogenous NO3. These cumulative data continue to support the potential for developing the noniron heme analog GaTP and its nanoparticle GaNP as new therapeutic approaches for the treatment of HIV/Mtb coinfection.

Amin HI, Ma ZF, Majeed A, Malakan Rad E, Malhotra HS, Malhotra K, Malik AA, Malik I, Mallhi TH, Mansournia MA, Marasini BP, Martinez-Guerra BA, Martins-Melo FRR, Martorell M, Marzo RR, Mathur N, McKowen ALW, Meles HN, Melese EB, Memish ZA, Mendoza W, Menezes RG, Meretoja TJ, Mestrovic T, Meylakhs P, Mhlanga L, Michalek IM, Micheletti Gomide Nogueira de Sá AC, Minervini G, Minh LHN, Moazen B, Mohamed NS, Mohammad-Alizadeh-Charandabi S, Mohammadian-Hafshejani A, Mohammed H, Mohammed S, Mohammed M, Mokdad AH, Monasta L, Moni MA, Montazeri F, Moradi M, Moradi Y, Motappa R, Mougin V, Mubarik S, Mukoro GD, Mulita F, Munjal K, Munkhsaikhan Y, Murlimanju B, Musaigwa F, Mustafa G, Muthupandian S, Nagarajan AJ, Naghavi P, Naik G, Nainu F, Najafi MS, Nargus S, Navaratna SNK, Naveed M, Nayak VC, Nayak BP, Nduaguba SO, Negesse CT, Nematollahi MH, Nguefack-Tsague G, Nguyen DH, Nguyen HQ, Nguyen VT, Niazi RK, Nigatu YT, Nikravangolsefid N, Niranjan V, Nnaji CA, Noor STA, Not applicable N, Noubiap JJ, Nri-Ezedi CA, Nugen F, Nutor JJ, Nzoputam CI, Nzoputam OJ, Obamiro KO, Odetokun IA, Oghenetega OB, Oguntade AS, Okeke SR, Okekunle AP, Okonji OC, Olagunju AT, Olakunde BO, Olalusi OV, Olatubi MI, Olorukooba AA, Olufadewa II, Omar Bali A, Onwujekwe OE, Opejin A, Ordak M, Orish VN, Ortiz-Brizuela E, Osuagwu UL, Ouyahia A, P A MP, Padubidri JR, Palladino C, Pandey A, Panos LD, Paredes JL, Parija PP, Parikh RR, Pashaei A, Pasovic M, Patel SK, Pathan AR, Patil S, Pawar S, Pepito VCF, Peprah EK, Peprah P, Pereira M, Perna S, Petcu IR, Pham HT, Pillay JD, Poluru R, Postma MJ, Pourtaheri N, Pradhan J, Prakash P, Prakasham TNN, Prates EJS, Pribadi DRA, Priscilla T, Puvvula J, Qattea I, Qazi AS, Radhakrishnan RA, Rafferty Q, Rafique I, Rahim F, Rahimi-Movaghar A, Rahimi-Movaghar V, Rahman M, Rahmani AM, Rahmani S, Rahmanian N, Rahmanian M, Rahmanian V, Rajaa S, Ramadan MM, Ramadan H, Ramasamy SK, Ramesh PS, Rana K, Ranabhat CL, Rao M, Rao SJ, Rashidi MM, Rathish D, Rauniyar SK, Rawaf S, Redwan EMM, Reiner Jr. RC, Rezaeian M, Rodriguez JAB, Root KT, Ross AG, Rotimi K, Roy N, Rwegerera GM, Sabet CJ, Saddik BA, Saeb MR, Saeed U, Saeedi P, Safi SZZ, Sagar R, Saheb Sharif-Askari F, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Saif Z, Sajid MR, Salam N, Salami AA, Saleh MA, Salehi L, Samadi Kafil H, Samy AM, Sanjeev RK, Santric-Milicevic MM, Saravanan A, Sartorius B, Sathyanarayan A, Satpathy M, Sawhney M, Sedighi M, Semagn BE, Senapati S, Sethi Y, Seylani A, Shah PA, Shahid S, Shaikh MA, Shamekh A, Shamshirgaran MA, Shamsi A, Shanawaz M, Shannawaz M, Sharifan A, Sharifi-Rad J, Shastry S, Shenoy RR, Shetty PK, Shetty M, Shetty PH, Shiferaw D, Shirkoohi R, Shittu A, Shrestha S, Sibhat MM, Siddig EE, Siedner MJ, Singh JA, Singh P, Singh S, Singh H, Sinto R, Skryabina AA, Smith AE, Sobia F, Sokhan A, Solanki S, Solanki R, Sorensen RJD, Sulaiman SK, Szarpak L, T Y SS, Tabish M, Tadakamadla SK, Taheri Abkenar Y, Taiba J, Talaat IM, Tampa M, Tamuzi JL, Tan KK, Tanwar M, Tarkang EE, Taveira N, Teklay G, Tesfaye BT, Teye-Kwadjo E, Thakur R, Thangaraju P, Thapa R, Thapar R, Thienemann F, Thomas J, Tovani-Palone MR, Tran TH, Tran MTN, Tsai AC, Tsegay GM, Tumurkhuu M, Udoh A, Ullah I, Ullah A, Umair M, Umar M, Unnikrishnan B, Vahdati S, Vaithinathan AG, Varthya SB, Vasankari TJ, Verras GI, Villafañe JH, Vo AT, Vos T, Walde MT, Wamai RG, Wang Y, Waqas M, Ward P, Wassie GT, Weintraub RG, Weldetinsaa HL, Weldu GA, Westerman R, Wickramasinghe ND, Woldekidan MA, Wong YJ, Worku NK, Wu Z, Wu X, Yaghoubi S, Yesera GE, Yezli S, Yi S, Yiğit A, Yin D, Yismaw Y, Yon DK, Yonemoto N, Zakham F, Zhang H, Zhang J, Zhao H, Zhu B, Zhuang Q, Zhumagaliuly A, Zielińska M, Zihao L, Zikarg YT, Zoladl M, Zumla A, Zyoud SH, Zheng P, Aravkin AY, Imai-Eaton JW, Naghavi M, Schumacher AE, Hay SI, Murray CJL, Kyu H. Global, regional, and national burden of HIV/AIDS, 1990-2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021

BACKGROUND

As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally.

METHODS

We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990-2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990-2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load <1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period.

FINDINGS

Global new HIV infections decreased by 21·9% (95% UI 13·1-28·8) between 2010 and 2021, from 2·11 million (2·02-2·25) in 2010 to 1·65 million (1·48-1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7-44·5), from 1·19 million (1·07-1·37) in 2010 to 718 000 (669 000-785 000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0-42·4) in 2021, an increase from 29·5 million (28·1-31·0) in 2010. The lifetime probability of HIV acquisition remains highest in the sub-Saharan Africa super-region, where it declined from its 1995 peak of 21·8% (20·1-24·2) to 8·7% (7·5-10·7) in 2021. Four of the seven GBD super-regions had a lifetime probability of less than 1% in 2021. In 2021, sub-Saharan Africa had the highest PUV of 999·9 (857·4-1154·2) per 100 000 population, but this was a 64·5% (58·8-69·4) reduction in PUV from 2003 to 2021. In the same period, PUV increased in central Europe, eastern Europe, and central Asia by 116·1% (8·0-218·2). Our forecasts predict a continued global decline in HIV incidence and mortality, with the number of people living with HIV peaking at 44·4 million (40·7-49·8) by 2039, followed by a gradual decrease. In 2025, we projected 1·43 million (1·29-1·59) new HIV infections and 615 000 (567 000-680 000) HIV-related deaths, suggesting that the interim 2025 targets for reducing these figures are unlikely to be achieved. Furthermore, our forecasted results indicate that few countries will meet the 2030 target for reducing HIV incidence and HIV-related deaths by 90% from 2010 levels.

INTERPRETATION

Our forecasts indicate that continuation of current levels of HIV control are not likely to attain ambitious incidence and mortality reduction targets by 2030, and more than 40 million people globally will continue to require lifelong ART for decades into the future. The global community will need to show sustained and substantive efforts to make the progress needed to reach and sustain the end of AIDS as a public threat.

FUNDING

The Bill & Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases.

Management of tuberculosis patients and the role of forensic medicine in COVID-19 pandemic

Tuberculosis and Coronaviral disease-19 had a global impact in 2020 and still predominating, both infectious diseases similar to the lethal pandemics spread in one route, likely airborne transmission, the infected person could spread to healthy people. However, tuberculosis slightly varies from COVID-19. Though the primordial disease of the tuberculosis epidemic has had a vast impact on this society, besides the COVID-19 pandemic with other co-morbidities, conditions faced numerous complications. This review exemplified the impact of two lethal diseases in changing patient care, diagnostic issues, and forensic sciences roles. The diagnosis of tuberculosis with a massive concern due to standard testing methods, leading to inaccuracy, sensitivity, and prolonged time consumption. In addition, unavailability of testing kits, equipment failure, over-crowd in hospitals and fewer healthcare workers, a prolonged testing period, and finally, anxiety about COVID-19. Also, the contribution of forensic sciences in the autopsy of the exact cause of infectious diseases is crucial. Likewise, during this pandemic, there has been a drastic reduction in tuberculosis incidence in high-burden countries and a synergistic effect of both diseases. So, this review summarized the overall burden of tuberculosis management during COVID-19 and followed the guidelines of various nations' healthcare authorities to mitigate the consequences of tuberculosis diagnosis and prognosis during the pandemic.

Mortality and comorbidities in a Nationwide cohort of HIV-infected adults: comparison to a matched non-HIV adults' cohort, France, 2006-18

BACKGROUND

Human immunodeficiency virus (HIV) remains a significant cause of morbidity and mortality worldwide. The aim of this study was to describe the mortality rate and associated comorbidities in a nationwide population-based cohort of persons living with HIV (PLWHIV) and to compare it with mortality in an age and gender-matched cohort of non-HIV individuals in France.

METHODS

Using data from the French national health data system, we identified and included 173 712 PLWHIV (66.5% men) and 173 712 non-HIV participants (66.5% men) matched for age and gender. PLHIV were identified based on ICD-10 HIV diagnoses, HIV-specific laboratory tests, and/or prescriptions for antiretroviral therapy specific to HIV. Hazard ratios (HRs) of mortality were assessed using multiple Cox regression models.

RESULTS

During the 13 years of follow-up (2006-18), we observed 20 018 deaths among PLWHIV compared with 6262 deaths among non-HIV participants (11.52% vs. 3.60%, P < 0.001). The over-mortality of PLWHIV was expressed by univariable HR = 2.135 (2.072-2.199), which remained significant after adjustment for region, Complementary Universal Health Insurance and AME, with multivariable HR = 2.182 (2.118-2.248). The results remained significant after adjusting for comorbidities, including infectious diseases [HR = 1.587 (1.538-1.638)]. Notably, PLWHIV were more importantly associated with mortality in women [HR = 2.966 (2.767-3.180)], compared in men [HR = 1.961 (1.898-2.027)].

CONCLUSION

Although the life expectancy of PLWHIV has globally increased, the causes of death should be prioritized in prevention policies and care management. Gender-specific policies should be highlighted, as we observed a higher impact of HIV mortality in women.

My tuberculosis epidemiology journey: Implications for TB program interventions, activities and strategy

Key learnings from some landmark studies that the author has been associated with and their implications on program strategies are highlighted. Learnings from prevalence surveys provide justification for active TB Case finding (ACF), role of Chest X-ray screening, justification of the elderly as a key vulnerable population and suggest re-think of the methods of sub-national certification for progress towards tuberculosis free status. Risk of infection studies suggest 14 million people acquiring new tuberculous infection each year in India suggesting a re-think on the targets for TB elimination. Justification is given for 'TB deaths averted' as a parameter for monitoring program impact, reviving risk of infection surveys using CyTB and higher emphasis on careful analysis of routine surveillance data for monitoring epidemiological trends rather than oft-repeated surveys. The modelling outputs suggest higher focus on reducing transmission of infection in urban and reducing treatment delay in rural areas and the need to scale up active case finding and TB preventive treatment in order to achieve End TB targets. Case finding studies justify upfront molecular diagnostics, need to confirm a single sputum result by another specimen or radiology during ACF and futility of X-ray based diagnosis during ACF. High rates of recurrence with intermittent treatment regimen providing evidence in favor of daily regimen, role of family centric approach to nutritional supplementation to prevent TB mortality and reduce TB incidence among household contacts are highlighted besides the need to address high proportion of families suffering catastrophic expenses during pre-treatment period.

Tuberculosis case fatality is higher in male than female patients in Europe: a systematic review and meta-analysis

PURPOSE

Epidemiological TB data indicate differences in infection prevalence, progression rates, and clinical disease incidence between sexes. In contrast, evidence on sex-specific differential (post) TB case fatality in Europe has not been synthesized systematically.

METHODS

We searched electronic databases and grey literature up to December 2020 for studies reporting sex-stratified TB death data for Europe. The JBI critical appraisal tools served for bias risk assessment and subgroup analyses for studying heterogeneity. Random-effects models meta-analyses enabled estimating pooled relative risks of sex-associated TB fatality. Considering associations of comorbidities and risk factors on fatality differences, we applied relative risk meta-regression.

RESULTS

Based on 17,400 records screened, 117 studies entered quantitative analyses. Seventy-five studies providing absolute participant data with moderate quality and limited sex stratification reported 33 to 235,000 TB cases and 7 to 27,108 deaths. The pooled male-to-female TB fatality risk ratio was 1.4 [1.3-1.5]. Heterogeneity was high between studies and subgroups. Study time, concurrent comorbidities (e.g., HIV, diabetes, cancers), and mean participant ages showed no effect modification. We identified higher male TB fatality in studies with higher homelessness (coefficient 3.18, 95% CI [-0.59 to 6.94], p-value 0.10) and lower migrants proportion (coefficient - 0.24, 95% CI [- 0.5 to 0.04], p-value 0.09).

CONCLUSION

We found 30-50% higher TB case fatality for males in Europe. Except for homelessness, migration, and a trend for some comorbidities, assessing effect modification could not reduce our meta-analysis' high heterogeneity. Public health authorities should take heed of this higher risk of dying in male patients' treatment services.

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

PURPOSE

Considering the dynamic influence of environmental, social, economic, and political factors in the emergence and growth of the BRICS countries (Brazil, Russia, India, China, and South Africa) over the years and pre-existing differences, the adverse effects of air pollution on the health and well-being of the people have remained major areas of academic inquiry and policy interventions. The present study examines the global trend of deaths and Disability Adjusted Life Years (DALYs) attributable to air pollution with particular reference to the BRICS countries for the period 1990 to 2019.

METHODS

This study has used the global burden of disease estimates by using different rounds of the Global Burden of Disease (GBD) study report published by the Institute of Health Metrics Evaluation. This study has calculated the cause of death and DALYs due to environmental risk factors (i.e. Air pollution). Data analysis has been done by using the standard formula for the calculation of death (mortality) rate and DALYs rate. Similarly, we calculated the age and gender-wise death and DALYs rate by using the appropriate numerator and denominator.

RESULTS

The study discovered a significant shift in disease patterns over this period, as communicable diseases like respiratory infections and tuberculosis were replaced by non-communicable diseases such as ischemic heart disease (17.2 million), chronic obstructive pulmonary disease (14.59 million), and stroke (17.02 million) as the primary causes of air pollution-related deaths in 2019 at the global level. Additionally, the study identified a worrying increase in deaths linked to neonatal disorders and respiratory infections caused by ambient particulate matter pollution in South Africa, India, and Brazil. The impact of air pollution on public health is evident across different age groups and genders, with people aged 50-69 years, those aged 70 and above, and children under 5 years being more vulnerable. Furthermore, the male population is disproportionately affected by communicable and noncommunicable diseases caused by air pollution.

CONCLUSION

The study highlights the need for policymakers to implement evidence-based interventions to tackle this global health problem. The interventions should aim to reduce the emerging crisis of non-communicable diseases related to air pollution, particularly among vulnerable age groups and the male population, ultimately improving public health outcomes.

Unveiling the promise: Exosomes as game-changers in anti-infective therapy

Extracellular vesicles (EVs)-based intercellular communication (through exosomes, microvesicles, and apoptotic bodies) is conserved across all kingdoms of life. In recent years, exosomes have gained much attention for targeted pharmaceutical administration due to their unique features, nanoscale size, and capacity to significantly contribute to cellular communication. As drug delivery vehicles, exosomes have several advantages over alternative nanoparticulate drug delivery technologies. A key advantage lies in their comparable makeup to the body's cells, which makes them non-immunogenic. However, exosomes vesicles face several challenges, including a lack of an effective and standard production technique, decreased drug loading capacity, limited characterization techniques, and underdeveloped isolation and purification procedures. Exosomes are well known for their long-term safety and natural ability to transport intercellular nucleic acids and medicinal compounds across the blood-brain-barrier (BBB). Therefore, in addition to revealing new insights into exosomes' distinctiveness, the growing availability of new analytical tools may drive the development of next-generation synthetic systems. Herein, light is shed on exosomes as drug delivery vehicles in anti-infective therapy by reviewing the literature on primary articles published between 2002 and 2023. Additionally, the benefits and limitations of employing exosomes as vehicles for therapeutic drug delivery are also discussed.

Comprehensive insights into herbal P-glycoprotein inhibitors and nanoformulations for improving anti-retroviral therapy efficacy

The worldwide HIV cases were 39.0 million (33.1-45.7 million) in 2022. Due to genetic variations, HIV-1 is more easily transmitted than HIV-2 and favours CD4 + T cells and macrophages, producing AIDS. Conventional HIV drug therapy has many drawbacks, including adherence issues leading to resistance, side effects that lower life quality, drug interactions, high costs limiting global access, inability to eliminate viral reservoirs, chronicity requiring lifelong treatment, emerging toxicities, and a focus on managing infections. Conventional dosage forms have bioavailability issues due to intestinal P-glycoprotein (P-gp) efflux, which can reduce anti-retroviral drug efficacy and lead to resistance. Use of phyto-constituents with P-gp regulating actions has great benefits for semi-synthetic modification to create formulations with greater bioavailability and reduced toxicity, which improves drug effectiveness. Lipid-based nanocarriers, solid lipid nanoparticles, nanostructured lipid carriers, polymer-based nanocarriers, and inorganic nanoparticles may inhibit P-gp efflux. Employing potent P-gp inhibitors within nanocarriers as a Trojan horse approach can enhance the intracellular accumulation of anti-retroviral drugs (ARDs), which are substrates for efflux transporters. This technique increases oral bioavailability and offers lower-dose options, boosting HIV patient compliance and lowering costs. Molecular docking of the inhibitor with P-gp may anticipate optimum binding and function, allowing drug efflux to be minimised.

Association between indoor residual spraying and the malaria burden in Zambia and factors associated with IRS refusals: a case-control study in Vubwi District

BACKGROUND

Indoor residual spraying (IRS) has been implemented to prevent malaria in Zambia for several decades, but its effectiveness has not been evaluated long term and in Vubwi District yet. This study aimed to assess the association between IRS and the malaria burden in Zambia and Vubwi District and to explore the factors associated with refusing IRS.

METHODS

A retrospective study was used to analyze the association between IRS and malaria incidence in Zambia in 2001-2020 and in Vubwi District in 2014-2020 by Spearman correlation analysis. A case-control study was used to explore the factors associated with IRS refusals by households in Vubwi District in 2021. A logistic regression model was performed to identify factors associated with IRS refusals.

RESULTS

The malaria incidence reached its peak (391/1000) in 2001 and dropped to the lowest (154/1000) in 2019. The annual percentage change in 2001-2003, 2003-2008, 2008-2014, 2014-2018 and 2018-2020 was - 6.54%, - 13.24%, 5.04%, - 10.28% and 18.61%, respectively. A significantly negative correlation between the percentage of population protected by the IRS against the total population in Zambia (coverage) and the average malaria incidence in the whole population was observed in 2005-2020 (r = - 0.685, P = 0.003) and 2005-2019 (r = - 0.818, P < 0.001). Among 264 participants (59 in the refuser group and 205 in the acceptor group), participants with specific occupations (self-employed: OR 0.089, 95% CI 0.022-0.364; gold panning: OR 0.113, 95% CI 0.022-0.574; housewives: OR 0.129, 95% CI 0.026-0.628 and farmers: OR 0.135, 95% CI 0.030-0.608 compared to employees) and no malaria case among household members (OR 0.167; 95% CI 0.071-0.394) had a lower risk of refusing IRS implementation, while those with a secondary education level (OR 3.690, 95% CI 1.245-10.989) had a higher risk of refusing IRS implementation compared to those who had never been to school.

CONCLUSIONS

Increasing coverage with IRS was associated with decreasing incidence of malaria in Zambia, though this was not observed in Vubwi District, possibly because of the special geographical location of Vubwi District. Interpersonal communication and targeted health education should be implemented at full scale to ensure household awareness and gain community trust.

Prevalence of metabolic syndrome among people living with human immunodeficiency virus in sub-Saharan Africa: a systematic review and meta-analysis

Metabolic syndrome (MetS) poses a significant clinical challenge for individuals living with HIV (PLHIV). In sub-Saharan Africa (SSA), this condition is becoming a growing concern, owing to lifestyle changes and an increasingly aging population. Several SSA countries have reported on the prevalence of MetS. However, these estimates may be outdated because numerous recent studies have updated MetS prevalence among PLHIV in these countries. Moreover, prior research has focused on various study designs to report the pooled prevalence, which is a methodological limitation. Therefore, this systematic review and meta-analysis aimed to determine the pooled estimates of MetS in PLHIV in SSA by addressing these gaps. We systematically searched Google Scholar, Science Direct, Scopus, Web of Sciences, EMBASE, and PubMed/Medline for the prevalence of MetS and its subcomponents among people with HIV in sub-Saharan Africa. The estimated pooled prevalence was presented using a forest plot. Egger's and Begg's rank regression tests were used to assess evidence of publication bias. Twenty-five studies fulfilled the inclusion criteria after review of the updated PRISMA guidelines. The pooled prevalence of MetS was 21.01% [95% CI: (16.50, 25.51)] and 23.42% [95% CI: (19.16, 27.08)] to the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) and International Diabetes Federation (IDF) criteria, respectively. Low levels of high-density lipoprotein cholesterol (Low HDL) at 47.25% [95% CI: 34.17, 60.33)] were the highest reported individual subcomponent, followed by abdominal obesity at 38.44% [95% CI: (28.81, 48.88)]. The prevalence of MetS is high in sub-Saharan Africa. Low HDL levels and increased waist circumference/abdominal obesity were the most prevalent components of MetS. Therefore, early screening for MetS components and lifestyle modifications is required. Policymakers should develop strategies to prevent MetS before an epidemic occurs.PROSPERO: CRD42023445294.

Infectious Diseases of the Brain and Spine: Fungal Diseases

Advances in treatments of autoimmune diseases, acquired immunodeficiency syndrome, organ transplantation, and the use of long-term devices have increased the rates of atypical infections due to prolonged immune suppression. There is a significant overlap in imaging findings of various fungal infections affecting the central nervous system (CNS), often mimicking those seen in neoplastic and noninfectious inflammatory conditions. Nonetheless, there are imaging characteristics that can aid in distinguishing certain atypical infections. Hence, familiarity with a wide range of infectious agents is an important part of diagnostic neuroradiology. In this article, an in-depth review of fungal diseases of the CNS is provided.

High-sensitivity C-reactive protein among people living with HIV on highly active antiretroviral therapy: a systemic review and meta-analysis

The pathological consequences of inflammation persist in people living with the human immunodeficiency virus (PLWH), regardless of the positive outcomes of highly active antiretroviral therapy (HAART). The current systematic review and meta-analysis aims to understand and explore the levels of high-sensitivity C-reactive protein (hs-CRP) and other cardiovascular disease (CVD)-risk factors including lipid profiles among PLWH on HAART. Major electronic databases including PubMed, Scopus, and Web of Science were searched to retrieve relevant global literature reporting on hs-CRP levels in PLWH on HAART. A total of twenty-two studies with an average participant age of 40 years were eligible for this systematic review and meta-analysis. Majority of the included studies were from Africa (n = 11), the United States (n = 6), and Europe (n = 5). Our systemic review showed that most studies reported increased levels of hs-CRP among PLWH on HAART when compared to controls (PLWH not on HAART or those without HIV), especially in studies from Africa. This was supported by a meta-analysis showing significantly elevated levels of hs-CRP in PLWH on HAART when compared to PLWH not on HAART (standardised mean difference [SMD] = 0.56; 95% CI = 0.10‑1.01, z = 2.41; p = 0.02) or those without HIV (SMD = 1.19; 95% CI = 0.76‑1.63, z = 5.35; p < 0.001). Where lipid profiles, as a major predictor for CVD risk, were also impaired in PLWH on HAART when compared to PLWH not on HAART and HIV-negative participants. In conclusion, elevated levels of hs-CRP and lipid levels are prevalent in PLWH on HAART, this may increase the risk of CVD complications, especially for those people living in Africa. However, more evidence in larger population studies is required to confirm these outcomes and unveil any possible clinical implications of HAART-induced modulation of hs-CRP levels in PLWH.

Global prevalence, burden and trend in HIV and drug-susceptible tuberculosis co-infection from 1990 to 2019 and prediction to 2040

Objectives

The purpose of this study is to describe the current situation and forecast the trends of co-infection between the human immunodeficiency virus (HIV) and drug-susceptible tuberculosis (DS-TB) in different countries, across various age groups and genders.

Methods

We obtained data on the number of cases, age-standardized incidence rate, age-standardized prevalence rate, age-standardized rate of disability-adjusted life years (DALYs), and age-standardized death rate from the Global Burden of Disease (GBD) 2019 database. These data were used to describe the distribution and burden of co-infection between the human immunodeficiency virus (HIV) and DS-TB in different regions, genders, and age groups. We employed joinpoint regression analysis to analyze the temporal trends from 1990 to 2019. Additionally, an age-period-cohort model was established to forecast the future trends of co-infection up to 2040.

Results

The prevalence and burden of co-infection varied across different age groups and genders. The territories with the higher disease burden were distributed in some Asian and African countries. In terms of temporal trends, the age-standardized incidence rate and age-standardized prevalence rate of HIV and DS-TB co-infection exhibited an overall increasing trend from 1990 to 2019, and the prediction indicated a slow downward trend from 2019 to 2040.

Conclusions

The co-infection of HIV and DS-TB posed a grave threat to public health and economic development. What's more, there existed a significant disparity between the actual state of co-infection and the desired goals for prevention and control.

Discrimination Based on Personal Responsibility: Luck Egalitarianism and Healthcare Priority Setting

Luck egalitarianism is a responsibility-sensitive theory of distributive justice. Its application to health and healthcare is controversial. This article addresses a novel critique of luck egalitarianism, namely, that it wrongfully discriminates against those responsible for their health disadvantage when allocating scarce healthcare resources. The philosophical literature about discrimination offers two primary reasons for what makes discrimination wrong (when it is): harm and disrespect. These two approaches are employed to analyze whether luck egalitarian healthcare prioritization should be considered wrongful discrimination. Regarding harm, it is very plausible to consider the policies harmful but much less reasonable to consider those responsible for their health disadvantages a socially salient group. Drawing on the disrespect literature, where social salience is typically not required for something to be discrimination, the policies are a form of discrimination. They are, however, not disrespectful. The upshot of this first assessment of the discrimination objection to luck egalitarianism in health is, thus, that it fails.

Exosomes: Friends or Foes in Microbial Infections?

The use of new approaches is necessary to address the global issue of infections caused by drug-resistant pathogens. Antimicrobial photodynamic therapy (aPDT) is a promising approach that reduces the emergence of drug resistance, and no resistance has been reported thus far. APDT involves using a photosensitizer (PS), a light source, and oxygen. The mechanism of aPDT is that a specific wavelength of light is directed at the PS in the presence of oxygen, which activates the PS and generates reactive oxygen species (ROS), consequently causing damage to microbial cells. However, due to the PS's poor stability, low solubility in water, and limited bioavailability, it is necessary to employ drug delivery platforms to enhance the effectiveness of PS in photodynamic therapy (PDT). Exosomes are considered a desirable carrier for PS due to their specific characteristics, such as low immunogenicity, innate stability, and high ability to penetrate cells, making them a promising platform for drug delivery. Additionally, exosomes also possess antimicrobial properties, although in some cases, they may enhance microbial pathogenicity. As there are limited studies on the use of exosomes for drug delivery in microbial infections, this review aims to present significant points that can provide accurate insights.

Management Practices and Quality of Care: Evidence from the Private Health Care Sector in Tanzania

We measure the adoption of management practices in over 220 private for-profit and non-profit health facilities in 64 districts across Tanzania and link these data to process quality-of-care metrics, assessed using undercover standardised patients and clinical observations. We find that better managed health facilities are more likely to provide correct treatment in accordance with national treatment guidelines, adhere to a checklist of essential questions and examinations, and comply with infection prevention and control practices. Moving from the 10th to the 90th percentile in the management practice score is associated with a 48% increase in correct treatment. We then leverage a large-scale field experiment of an internationally recognised management support intervention in which health facilities are assessed against comprehensive standards, given an individually tailored quality improvement plan and supported through training and mentoring visits. We find zero to small effects on management scores, suggesting that improving management practices in this setting may be challenging.

China's hidden role in malaria control and elimination in Africa

BACKGROUND

Insufficient funding is hindering the achievement of malaria elimination targets in Africa, despite the pressing need for increased investment in malaria control. While Western donors attribute their inaction to financial constraints, the global health community has limited knowledge of China's expanding role in malaria prevention. This knowledge gap arises from the fact that China does not consistently report its foreign development assistance activities to established aid transparency initiatives. Our work focuses on identifying Chinese-funded malaria control projects throughout Africa and linking them to official data on malaria prevalence. By doing so, we aim to shed light on China's contributions to malaria control efforts, analysing their investments and assessing their impact. This would provide valuable insights into the development of effective financing mechanisms for future malaria control in Africa.

METHODS

Our research used AidData' s recently released Global Chinese Development Finance Dataset V.2.0 providing comprehensive coverage of all official sector Chinese development financing across Africa, from which we identify 224 Chinese-funded malaria projects in Sub-Saharan Africa (SSA) committed between 2002 and 2017. We conducted an analysis of the spending patterns by year, country and regions within Africa and compared it with data on population-adjusted malaria prevalence, sourced from the Malaria Atlas Project.

RESULTS

Chinese-financed malaria projects Africa mainly focused on three areas: the provision of medical supplies (72.32%), the construction of basic health infrastructure (17.86%) and the deployment of anti-malaria experts (3.57%). Moreover, nearly 39% of the initiatives were concentrated in just four countries: the Democratic Republic of Congo, Central African Republic, Uganda and Liberia. Additionally, China's development financing amount showed a weak negative correlation (-0.2393) with population-weighted malaria prevalence. We concluded that the extent and direction of China's support are not adequately tailored to address malaria challenges in different countries.

CONCLUSION

With China's increasing engagement in global health, it is anticipated that malaria control will continue to be a prominent priority on its development assistance agenda. This is attributed to China's vast expertise in malaria elimination, coupled with its substantial contribution as a major producer of malaria diagnostics and treatments.

A novel approach to estimate the impact of health workforce investments on health outcomes through increased coverage of HIV, TB and malaria services

BACKGROUND

Globally, HIV, TB and malaria account for an estimated three million deaths annually. The Global Fund partnered with the World Health Organization to assist countries with health workforce planning in these areas through the development of an integrated health workforce investment impact tool. Our study illustrates the development of a user-friendly tool (with two MS Excel calculator subcomponents) that computes associations between human resources for health (HRH) investment inputs and reduced morbidity and mortality from HIV, TB, and malaria via increased coverage of effective treatment services.

METHODS

We retrieved from the peer-reviewed literature quantitative estimates of the relation among HRH inputs and HRH employment and productivity. We converted these values to additional full-time-equivalent doctors, nurses and midwives (DNMs). We used log-linear regression to estimate the relation between DNMs and treatment service coverage outcomes for HIV, TB, and malaria. We then retrieved treatment effectiveness parameters from the literature to calculate lives saved due to expanded treatment coverage for HIV, TB, and malaria. After integrating these estimates into the tool, we piloted it in four countries.

RESULTS

In most countries with a considerable burden of HIV, TB, and malaria, the health workforce investments include a mix of pre-service education, full remuneration of new hires, various forms of incentives and in-service training. These investments were associated with elevated HIV, TB and malaria treatment service coverage and additional lives saved. The country case studies we developed in addition, indicate the feasibility and utility of the tool for a variety of international and local actors interested in HRH planning.

CONCLUSIONS

The modelled estimates developed for illustrative purposes and tested through country case studies suggest that HRH investments result in lives saved across HIV, TB, and malaria. Furthermore, findings show that attainment of high targets of specific treatment coverage indicators would require a substantially greater health workforce than what is currently available in most LMICs. The open access tool can assist with future HRH planning efforts, particularly in LMICs.

The burden of tuberculosis among adolescents and young adults in five Asian countries from 1990 to 2019

BACKGROUND

Previous studies have shown that the risk of tuberculosis (TB) increases dramatically during adolescence. The objective of this article was to analyze the burdens and trends of TB incidence and mortality rates in Asian adolescents and young adults.

METHODS

Time series ecological study of TB incidence and mortality rates of adolescents and young adults aged 10-24 years from 1990 to 2019, using data extracted from the Global Burden of Disease website for 5 Asian countries. The annual percentage change was calculated by joinpoint regression analysis to estimate the trends in the age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR).

RESULTS

The highest ASIR per 100,000 person-years in 2019 was in Mongolia [74 (95% uncertainty interval (UI), 51 to 105)], while the lowest was in Japan [4 (95% UI, 2 to 6)]. The highest ASDR per 100,000 person-years was in Mongolia [2 (95% UI, 1 to 3)], while the lowest was in Japan [0.009 (95% UI, 0.008 to 0.010)]. As the absolute number of cases and deaths decreased from 1990 to 2019, the ASIRs and ASDRs in all five countries also decreased.

CONCLUSIONS

Our finding revealed that although all five countries in Asia experienced descending TB incidence and mortality trend in past three decades, the trends were especially significant in developed countries and varied across geographic regions. This study may be crucial in helping policymakers make decisions and allocate appropriate resources to adolescent TB control strategies.

Favourable outcomes in RR-TB patients using BPaL and other WHO-recommended second-line anti-TB drugs

SETTING: According to reports in South Africa, treatment failure rates for rifampicin-resistant TB (RR-TB) are significant and below the WHO target of ≥70%. HIV infection and the use of highly active antiretroviral therapy (HAART) influence how patients receiving anti-TB drugs respond to therapy. In the treatment of RR-TB, more recent medications, including bedaquiline, pretomanid and linezolid (BPaL), have shown promising results.OBJECTIVE: To assess treatment outcomes in RR-TB patients using BPaL and other second-line anti-TB drugs as recommended by the WHO in the South African population.DESIGN: The databases Medline, PubMed, Google Scholar and Embase were searched for studies between 2015 and 2022, which investigated BPaL outcomes in South Africa.RESULTS: Of the 27,259 participants, 21% were on bedaquiline, 1% were taking pretomanid and 9% were taking linezolid as part of their background regimen. About 68% of the patients were HIV-positive, with 59% of them taking HAART.CONCLUSION: Overall, 66% of patients taking BPaL drugs as part of their background regimen had favourable treatment outcomes. Additionally, patients with RR-TB who were HIV-positive and taking HAART while receiving BPaL drugs as part of a background regimen had improved treatment outcomes.

The association between the CD4/CD8 ratio and surgical site infection risk among HIV-positive adults: insights from a China hospital

Purpose

It is well known that the CD4/CD8 ratio is a special immune-inflammation marker. We aimed to explore the relationship between the CD4/CD8 ratio and the risk of surgical site infections (SSI) among human immunodeficiency virus (HIV)-positive adults undergoing orthopedic surgery.

Methods

We collected and analyzed data from 216 HIV-positive patients diagnosed with fractures at the department of orthopedics, Beijing Ditan Hospital between 2011 and 2019. The demographic, surgical, and hematological data for all patients were collected in this retrospective cohort study. We explored the risk factors for SSI using univariate and multivariate logistic regression analysis. Then, the clinical correlation between the CD4 count, CD4/CD8 ratio, and SSI was studied using multivariate logistic regression models after adjusting for potential confounders. Furthermore, the association between the CD4/CD8 ratio and SSI was evaluated on a continuous scale with restricted cubic spline (RCS) curves based on logistic regression models.

Results

A total of 23 (10.65%) patients developed SSI during the perioperative period. Patients with hepatopathy (OR=6.10, 95%CI=1.46-28.9), HIV viral load (OR=8.68, 95%CI=1.42-70.2; OR=19.4, 95%CI=3.09-179), operation time (OR=7.84, 95%CI=1.35-77.9), and CD4 count (OR=0.05, 95%CI=0.01-0.23) were risk factors for SSI (P-value < 0.05). Our study demonstrated that a linear relationship between CD4 count and surgical site infection risk. In other words, patients with lower CD4 counts had a higher risk of developing SSI. Furthermore, the relationship between CD4/CD8 ratio and SSI risk was non-linear, inverse 'S' shaped. The risk of SSI increased substantially when the ratio was below 0.913; above 0.913, the risk of SSI was almost unchanged. And there is a 'threshold-saturation' effect between them.

Conclusion

Our research shows the CD4/CD8 ratio could be a useful predictor and immune-inflammation marker of the risk of SSI in HIV-positive fracture patients. These results, from a Chinese hospital, support the beneficial role of immune reconstitution in HIV-positive patients prior to orthopedic surgery.

Prevalence of Tuberculosis among People Who Use Drugs in Iran: A Systematic Review and Meta-analysis

Background

Drug use, especially injecting drug use, is associated with a higher risk of tuberculosis (TB). This study aimed to systematically review the prevalence of TB among people who use drugs (PWUD) in Iran.

Methods

A systematic search was conducted in international and national databases. All studies that provided data on the prevalence of TB among PWUD based on screening tests and diagnosis from 1990 up to August 2019 were assessed. Meta-analysis was performed on the prevalence of active TB among people who inject drugs (PWID).

Findings

Overall, nine studies were included. The studies were carried out from 1994 to 2012 in seven out of the 31 provinces of Iran. Seven studies provided data on the prevalence of TB diagnosis among 1087 PWID. The pooled prevalence of TB diagnosis was 10.1% (95% CI: 4.5, 15.8) in studies carried out in hospitals and 0.54% (95% CI: 0.04, 1.04) in other settings.

Conclusion

The present review suggests an approximately 40 times higher prevalence of TB among PWID compared to the general population. However, most of the included studies were conducted on a subpopulation of drug users, and caution should be exercised when generalizing the findings.

Characterizing the Development of Research Landscapes in Substance Use and HIV/AIDS During 1990 to 2021

Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions.

Point of care ultrasound findings in critically ill SARS-COV2 patients in an HIV endemic, resourced constrained setting

Objectives

To describe the incidence of venous thromboembolism (VTE) in mechanically ventilated COVID-19 patients in an HIV endemic, resourced constrained setting. To describe the incidence of VTE in relation to HIV status and anticoagulant therapy, and to evaluate VTE-associated cardio-respiratory changes. To establish the contribution of HIV, anticoagulation therapy and other risk factors to mortality.

Design

Prospective descriptive study.

Setting

Single-center tertiary teaching hospital.

Participants

One hundred and one consecutively admitted critically ill adult patients with COVID-19 acute respiratory distress syndrome.

Interventions

Point of care ultrasound (POCUS) assessment of the lower limbs and the cardio-respiratory system was performed on intensive care unit (ICU) admission and repeated if clinically indicated.

Measurements and main results

DVT was diagnosed by POCUS, whilst pulmonary embolism was diagnosed using a combination of clinical criteria and POCUS (echocardiography and chest wall ultrasound). VTE was diagnosed in 16/101 (16%) patients, despite 14/16 (88%) receiving prior therapeutic dosage of low molecular weight heparin. Clinically significant PE was diagnosed in 5/16 (31%) with 11/16 (69%) having DVT only. The majority of VTE patients, 12/16 (75%), demised 16/101 (16%) patients had HIV co-infection, and 4/16 (25%) with HIV had VTE. Valvular abnormalities were the most common cardiac abnormality with marked tricuspid regurgitation detected in 51/101 (51%). The absence of right atrial enlargement had a 93% negative predictive value for the absence of VTE. Univariate analysis did not demonstrate statistically significant individual risk factors for mortality.

Conclusions

Mechanically ventilated COVID- 19 patients at ICU admission had a low incidence of VTE (16%). Therapeutic dose anticoagulation did not reduce mortality compared to prophylactic dosage. In contrast to findings from other studies, no individual risk factor contributed significantly to mortality, likely due to small sample size. POCUS is an ideal screening tool to aid in the assessment of critically ill patients.

From research to a political commitment to strengthen access to surgical, obstetric, and anesthesia care in Africa by 2030

Objective

This study aimed to engage African leaders and key stakeholders to commit themselves toward the strengthening of surgical, obstetric, and anesthesia care systems by 2030 in Africa.

Methods

From research to a political commitment, a baseline assessment was performed to foster the identification of the gaps in surgical care as a first step of an inclusive process. The preliminary findings were discussed during the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by 2030 in Africa. The conclusions served to draft the Dakar Declaration and its Regional Action Plan 2022-2030 to improve access to surgical care by 2030 in Africa, endorsed by Heads of State.

Results

The International Symposium was composed of two meetings that gathered (i) 85 scientific experts and (ii) 28 ministers of health or representatives from 28 sub-Saharan African countries. The 28 African countries represent (i) 51% of the continent's total population, (ii) 68% of the 47 African countries of the WHO Africa Region, (iii) 58% of all African Union countries, and (vi) 79% (3,371) of the WHO Africa Region's total (4,271) health districts. The International Symposium and the Heads of State Summit successfully produced the Dakar Declaration on access to equitable, affordable, and quality Surgical, Obstetric, and Anesthesia Care by 2030 in Africa and its Regional Actions Plan 2022-2030 which prioritizes 12 urgent actions needed to be implemented, six strategic priorities, 16 key indicators, and an annual dashboard to monitor progress.

Conclusion

The Dakar Declaration and its Regional Action Plan 2022-2030 are a commitment to establish quality and sustainable surgical, obstetric, and anesthesia care in each African country within the ambitious framework of "The Africa we want" Agenda 2063.

Long-term trends of HIV/AIDS incidence in India: an application of joinpoint and age-period-cohort analyses: a gendered perspective

Background

Monitoring the transmission patterns of human immunodeficiency virus (HIV) in a population is fundamental for identifying the key population and designing prevention interventions. In the present study, we aimed to estimate the gender disparities in HIV incidence and the age, period, and cohort effects on the incidence of HIV in India for identifying the predictors that might have led to changes in the last three decades.

Data and methods

This study utilizes data from the Global Burden of Disease Study for the period 1990-2019. The joinpoint regression analysis was employed to identify the magnitude of the changes in age-standardized incidence rates (ASIRs) of HIV. The average annual percentage changes in the incidence were computed, and the age-period-cohort analysis was performed.

Results

A decreasing trend in the overall estimates of age-standardized HIV incidence rates were observed in the period 1990-2019. The joinpoint regression analysis showed that the age-standardized incidence significantly declined from its peak in 1997 to 2019 (38.0 and 27.6 among males and females per 100,000 in 1997 to 5.4 and 4.6, respectively, in 2019). The APC was estimated to be 2.12 among males and 1.24 among females for the period 1990-2019. In recent years, although the gender gap in HIV incidence has reduced, females were observed to bear a proportionately higher burden of HIV incidence. Age effect showed a decline in HIV incidence by 91.1 and 70.1% among males and females aged between 15-19 years and 75-79 years. During the entire period from 1990-1994 to 2015-2019, the RR of HIV incidence decreased by 36.2 and 33.7% among males and females, respectively.

Conclusion

India is experiencing a decline in new HIV infections in recent years. However, the decline is steeper for males than for females. Findings highlight the necessity of providing older women and young women at risk with effective HIV prevention. This study emphasizes the need for large-scale HIV primary prevention efforts for teenage girls and young women.

Geographical evolutionary pathway of global tuberculosis incidence trends

BACKGROUNDS

Tuberculosis (TB) remains a serious public health and human development problem, especially in developing countries. Despite the effectiveness of directly observed therapy, short course programs in reducing transmission and progression of TB, poverty reduction and socioeconomic development remain crucial factors in decreasing TB incidence. However, the geographical pathway on the planet is not yet clear.

OBJECTIVES

This study was to reconstruct the geographical evolutionary process of TB in 173 countries and territories from 2010 to 2019 to analyze the socioeconomic determinants that impact the global TB epidemic. In addition, the TB incidence in 2030 was predicted.

METHODS

This study analyses TB incidence data from 173 countries and territories between 2010 and 2019. The Geotree model would be used to reconstruct the geographical evolutionary process of TB, which provides a simplified schema for geo-visualizing the trajectories of TB incidence and their socioeconomic drivers. Additionally, to estimate the future TB incidence in 2030, a multilevel model was utilized in conjunction with the hierarchical nature of the Geotree based on a stratified heterogeneity analysis.

RESULTS

Global TB incidence was found to be associated with the country type and development stages. Between 2010 and 2019, the average TB incidence rate in 173 countries and territories was -27.48%, with marked spatially stratified heterogeneity by country type and development stage. Low-income and lower-middle-income countries were most vulnerable to TB. Upper-middle-income countries experienced a faster decline in TB incidence than high-income countries, and TB incidence generally decreased as the development stage increased, except for the lower-middle development stage in 2019.The highest average rate of decline in TB incidence was observed in the upper-middle development stage of high-income countries, with a reduction of 45.24%. Meanwhile, 37 high-income countries in the high development stage demonstrated an average rate of change of -13.93%. Socioeconomic determinants, including gross domestic product per capita, urbanization rate, and sociodemographic index, were found to inhibit TB incidence. Based on current trends, the predicted average global TB incidence in 2030 is 91.581 per 100,000 population.

CONCLUSIONS

The trajectories of the global TB incidence have been reconstructed to formulate targeted public health responses. To eliminate TB, countries at similar development stage can draw on the experiences of countries at higher development stages that are tailored to their unique characteristics. By learning from successful TB control strategies, countries can take strategic steps toward eradicating TB and improving public health outcomes.

Design, Synthesis, and Antiviral Activities of New Benzotriazole-Based Derivatives

Several human diseases are caused by enteroviruses and are currently clinically untreatable, pushing the research to identify new antivirals. A notable number of benzo[d][1,2,3]triazol-1(2)-yl derivatives were designed, synthesized, and in vitro evaluated for cytotoxicity and antiviral activity against a wide spectrum of RNA positive- and negative-sense viruses. Five of them (11b, 18e, 41a, 43a, 99b) emerged for their selective antiviral activity against Coxsackievirus B5, a human enteroviruses member among the Picornaviridae family. The EC50 values ranged between 6 and 18.5 μM. Among all derivatives, compounds 18e and 43a were interestingly active against CVB5 and were selected to better define the safety profile on cell monolayers by transepithelial resistance test (TEER). Results indicated compound 18e as the hit compound to investigate the potential mechanism of action by apoptosis assay, virucidal activity test, and the time of addition assay. CVB5 is known to be cytotoxic by inducing apoptosis in infected cells; in this study, compound 18e was proved to protect cells from viral infection. Notably, cells were mostly protected when pre-treated with derivative 18e, which had, however, no virucidal activity. From the performed biological assays, compound 18e turned out to be non-cytotoxic as well as cell protective against CVB5 infection, with a mechanism of action ascribable to an interaction on the early phase of infection, by hijacking the viral attachment process.

Public health determinants of child malaria mortality: a surveillance study within Siaya County, Western Kenya

BACKGROUND

Malaria deaths among children have been declining worldwide during the last two decades. Despite preventive, epidemiologic and therapy-development work, mortality rate decline has stagnated in western Kenya resulting in persistently high child malaria morbidity and mortality. The aim of this study was to identify public health determinants influencing the high burden of malaria deaths among children in this region.

METHODS

A total of 221,929 children, 111,488 females and 110,441 males, under the age of 5 years were enrolled in the Kenya Medical Research Institute/Center for Disease Control Health and Demographic Surveillance System (KEMRI/CDC HDSS) study area in Siaya County during the period 2003-2013. Cause of death was determined by use of verbal autopsy. Age-specific mortality rates were computed, and cox proportional hazard regression was used to model time to malaria death controlling for the socio-demographic factors. A variety of demographic, social and epidemiologic factors were examined.

RESULTS

In total 8,696 (3.9%) children died during the study period. Malaria was the most prevalent cause of death and constituted 33.2% of all causes of death, followed by acute respiratory infections (26.7%) and HIV/AIDS related deaths (18.6%). There was a marked decrease in overall mortality rate from 2003 to 2013, except for a spike in the rates in 2008. The hazard of death differed between age groups with the youngest having the highest hazard of death HR 6.07 (95% CI 5.10-7.22). Overall, the risk attenuated with age and mortality risks were limited beyond 4 years of age. Longer distance to healthcare HR of 1.44 (95% CI 1.29-1.60), l ow maternal education HR 3.91 (95% CI 1.86-8.22), and low socioeconomic status HR 1.44 (95% CI 1.26-1.64) were all significantly associated with increased hazard of malaria death among children.

CONCLUSIONS

While child mortality due to malaria in the study area in Western Kenya, has been decreasing, a final step toward significant risk reduction is yet to be accomplished. This study highlights residual proximal determinants of risk which can further inform preventive actions.

Livelihood activities, human mobility, and risk of malaria infection in elimination settings: a case-control study

BACKGROUND

Livelihood activities and human movements participate in the epidemiology of vector-borne diseases and influence malaria risk in elimination settings. In Saudi Arabia, where malaria transmission intensity varies geographically, it is vital to understand the components driving transmission within specific areas. In addition, shared social, behavioural, and occupational characteristics within communities may provoke the risk of malaria infection. This study aims to understand the relationship between human mobility, livelihood activities, and the risk of malaria infection in the border region of Jazan to facilitate further strategic malaria interventions. In addition, the study will complement and reinforce the existing efforts to eliminate malaria on the Saudi and Yemen border by providing a deeper understanding of human movement and livelihood activities.

METHODS

An unmatched case-control study was conducted. A total of 261 participants were recruited for the study, including 81 cases of confirmed malaria through rapid diagnostic tests (RDTs) and microscopy and 180 controls in the Baish Governorate in Jazan Provinces, Saudi Arabia. Individuals who received malaria tests were interviewed regarding their livelihood activities and recent movement (travel history). A questionnaire was administered, and the data was captured electronically. STATA software version 16 was used to analyse the data. Bivariate and multivariate analyses were conducted to determine if engaging in agricultural activities such as farming and animal husbandry, recent travel history outside of the home village within the last 30 days and participating in spiritual gatherings were related to malaria infection status.

RESULTS

A logistical regression model was used to investigate components associated with malaria infection. After adjusting several confounding factors, individuals who reported travelling away from their home village in the last 30 days OR 11.5 (95% CI 4.43-29.9), and those who attended a seasonal night spiritual gathering OR 3.04 (95% CI 1.10-8.42), involved in animal husbandry OR 2.52 (95% CI 1.10-5.82), and identified as male OR 4.57 (95% CI 1.43-14.7), were more likely to test positive for malaria infection.

CONCLUSION

Human movement and livelihood activities, especially at nighttime, should be considered malaria risk factors in malaria elimination settings, mainly when the targeted area is limited to a confined borderland area.

Human Immunodeficiency Virus and Uveitis

Uveitis is one of the most common ocular complications in people living with the Human immunodeficiency virus (HIV) and can be classified into HIV-induced uveitis, co-infection related uveitis, immune recovery uveitis, and drug-induced uveitis. The introduction of antiretroviral therapy has considerably changed the incidence, diagnosis, and treatment of different types of HIV-related uveitis. Furthermore, the specific immune condition of patients infected with HIV makes diagnosing HIV-related uveitis difficult. Recent studies have focused on the growing prevalence of syphilis/tuberculosis co-infection in uveitis. Simultaneously, more studies have demonstrated that HIV can directly contribute to the incidence of uveitis. However, the detailed mechanism has not been studied. Immune recovery uveitis is diagnosed by exclusion, and recent studies have addressed the role of biomarkers in its diagnosis. This review highlights recent updates on HIV-related uveitis. Furthermore, it aims to draw the attention of infectious disease physicians and ophthalmologists to the ocular health of patients infected with HIV.

An insight to better understanding cross border malaria in Saudi Arabia

BACKGROUND

Border malaria is a major obstacle for the malaria elimination in Saudi Arabia. Today, the southern border of Saudi Arabia is a region where malaria cases are resurging, and malaria control is dwindling mainly due to the humanitarian crisis and the conflict in Yemen. This study analyses the current border malaria epidemiology along the southern border of Saudi Arabia from 2015 to 2018.

METHODS

All reported cases maintained by the malaria elimination centres in Aledabi and Baish, Jazan Province, Saudi Arabia, from 2015 to 2018 were analysed to examine the epidemiological changes over time. Pearson's Chi-Square test of differences was utilized to assess differences between the characteristics of imported and local causes and between border cases. A logistic regression model was used to predict imported status was related to living along side of the border area.

RESULTS

A total of 3210 malaria cases were reported in Baish and Aledabi malaria centres between 2015 and 2018, of which 170 were classified as local cases and 3040 were classified as imported cases. Reported malaria cases were mainly among males, within the imported cases 61.5% (1868/3039) were residents of the border areas.

CONCLUSIONS

Given the complexity of cross-border malaria, creating a malaria buffer zone that covers a certain margin from both sides of the border would allow for a joint force, cross-border malaria elimination programme. To initiate a malaria elimination activity and cases reported as belonging to this zone, rather than being pushed from one country to the other, would allow malaria elimination staff to work collaboratively with local borderland residents and other stakeholders to come up with innovative solutions to combat malaria and reach malaria-free borders.

The management correlation between metabolic index, cardiovascular health, and diabetes combined with cardiovascular disease

Background

Cardiovascular disease (CVD) has become a major cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Although there is also evidence that multifactorial interventions to control blood glucose, blood pressure, and lipid profiles can reduce macrovascular complications and mortality in patients with T2DM, the link between these risk factors has not been established.

Methods

On 10 December 2018, 1,920 people in four cities in Anhui Province were included. Latent category analysis (LCA) was used to explore the clustering mode of HRBs (health risk behaviors). The primary exposure was HRBs and exercise and diet interventions, and the primary outcome was CVD and other variables, including zMS, triglyceride-glucose index (TyG), TyG-WC (waist circumference), TyG-BMI, TG/HDL, and cardiovascular health (CVH). A multivariable logistic regression model was used to establish the relationship between HRBs, exercise, diet interventions, and CVD. Moderate analysis and mediation moderation analysis were employed by the PROCESS method to explore the relationship between these variables. Sensitivity analysis explored the robustness of the model.

Results

The mean age was 57.10 ± 10.0 years old. Overall, CVD affects approximately 19.9% of all persons with T2DM. Macrovascular complications of T2DM include coronary heart disease, myocardial infarction (MI), cardiac insufficiency, and cerebrovascular disease. Elderly age (χ 2 = 22.70), no occupation (χ 2 = 20.97), medium and high socioeconomic status (SES) (χ 2 = 19.92), higher level of TyG-WC (χ 2 = 6.60), and higher zMS (χ 2 = 7.59) were correlated with high CVD. Many metabolic indices have shown a connection with T2DM combined with CVD, and there was a dose-response relationship between HRB co-occurrence and clustering of HRBs and zMS; there was a dose-response relationship between multifactorial intervention and CVH. In the mediation moderation analysis, there was an association between HRB, gender, TyG, TyG-BMI, and CVD. From an intervention management perspective, exercise and no diet intervention were more significant with CVD; moreover, there was an association between intervention management, gender, zMS, TyG-WC, TyG-BMI, TG/HDL, and CVD. Finally, there was an association between sex, CVH, and CVD. Sensitivity analysis demonstrated that our results were robust.

Conclusions

CVD is one of the common complications in patients with type 2 diabetes, and its long-term outcome will have more or less impact on patients. Our findings suggest the potential benefits of scaling up multifactorial and multifaceted interventions to prevent CVD in patients with T2DM.

The relationship between sugar-sweetened beverages, sleep disorders, and diabesity

Background

Diabetes and obesity in adults are global issues. Obesity and type 2 diabetes mellitus (T2DM) are increasingly categorized under the umbrella term "diabesity." Health risk factors (HRFs), which include altering sleep habits and reducing sugar-sweetened beverages (SSBs) consumption, have emerged as relatively novel and crucial strategies for preventing and treating diabetes.

Objective

We aimed to explore: 1) whether SSBs could affect diabesity in China's community; 2) whether HRFs could moderate this relationship; and 3) whether a three-way interaction exists between HRFs, SSBs, and diabesity.

Methods

On December 10, 2018, we investigated diabetes complications in four cities in Anhui Province and obtained basic and lifestyle information using a detailed questionnaire. The primary exposure was SSBs and outcomes were body mass index (BMI) and waist circumference (WC), while glycated hemoglobin (HbA1c) and sleep patterns (including duration and disorders) were considered moderators.

Results

Overall, 1920 participants were enrolled, and those who did not complete the questionnaire were excluded. Finally, this study included 1765 participants, with a response rate of 92.0%. The mean age was (57.10 ± 10.0) years. Patients with lower educational levels were more likely to have a lower prevalence of WC (χ 2 = 2.73) and BMI (χ 2 = 3.47), and some HRFs were positively correlated with WC and BMI. Additionally, SSBs were significantly associated with BMI (β = 1.29) and WC (β = 2.97), and there was also differences based on sex, some HRFs, such as HbA1c, FBG and TG, showed higher levels in male participants, whereas TC level was higher in female participants. In the moderation analysis, sleep patterns were also associated with total cholesterol, triglyceride, and BMI. Furthermore, there were three-way interaction effects among HbA1c, sleep patterns, and SSBs on total cholesterol, triglyceride, BMI, and WC. Moreover, sensitivity analysis demonstrated that our results were robust.

Conclusion

SSBs positively correlated with patterns dose-dependently. Moreover, SSBs could also be associated with sleep patterns, and blood glucose levels were correlated with diabesity. A three-way interaction effect was discovered between SSBs, sleep patterns, blood glucose levels, and patterns. Therefore, understanding the diabesity caused by SSBs and other HRFs can help prevent its occurrence.

Tunable Strategy for the Asymmetric Synthesis of Sulfoglycolipids from Mycobacterium tuberculosis To Elucidate the Structure and Immunomodulatory Property Relationships

We developed a versatile asymmetric strategy to synthesize different classes of sulfoglycolipids (SGLs) from Mycobacterium tuberculosis. The strategy features the use of asymmetrically protected trehaloses, which were acquired from the glycosylation of TMS α-glucosyl acceptors with benzylidene-protected thioglucosyl donors. The positions of the protecting groups at the donors and acceptors can be fine-tuned to obtain different protecting-group patterns, which is crucial for regioselective acylation and sulfation. In addition, a chemoenzymatic strategy was established to prepare the polymethylated fatty acid building blocks. The strategy employs inexpensive lipase as a desymmetrization agent in the preparation of the starting substrate and readily available chiral oxazolidinone as a chirality-controlling agent in the construction of the polymethylated fatty acids. A subsequent investigation on the immunomodulatory properties of each class of SGLs showed how the structures of SGLs impact the host innate immunity response.

Tuberculosis burden in India and its control from 1990 to 2019: Evidence from global burden of disease study 2019

BACKGROUND

Tuberculosis is still a major public health problem in India. This study aims to assess trends in the burden of tuberculosis from 1990 to 2019 for tracking success of tuberculosis control programme in India.

METHODS

In this study, the 2019 global burden of disease study data were used to measure the incidence, prevalence, mortality, and disability-adjusted life years lost (DALY)rates of Tuberculosis during 1990-2019 for India and its states. Age and gender-specific rates were also analyzed for India. All rates were age-standardized and 95% uncertainty intervals (UIs) were computed.

RESULT

Overall incidence, prevalence, death and DALY of TB decreased in India from 1990 to 2019. Tuberculosis morbidity and mortality was higher in males as compared to females. Incidence of TB was low in children up to 14 years of age. Prevalence of TB was higher in females as compared to males till 29 years of age, whereas higher prevalence was reported in males as compared to females in adults aged 30 years and more. Death rate of TB was low in children and young adults up to 29 years of age.

CONCLUSION

This study shows that overall incidence, prevalence, death and DALY of tuberculosis decreased from 1990 to 2019 in India. The burden of TB was higher among males as compared to females during study period. TB affects all the age groups but deaths were higher in older age groups.

Understanding barriers to tuberculosis diagnosis and treatment completion in a low-resource setting: A mixed-methods study in the Kingdom of Lesotho

BACKGROUND

Lesotho is one of the 30 countries with the highest tuberculosis incidence rates in the world, estimated at 650 per 100,000 population. Tuberculosis case detection is extremely low, particularly with the rapid spread of COVID-19, dropping from an estimated 51% in 2020 to 33% in 2021. The aim of this study is to understand the barriers to tuberculosis diagnosis and treatment completion.

METHODS

We used a convergent mixed methods study design. We collected data on the number of clients reporting symptoms upon tuberculosis screening, their sputum test results, the number of clients diagnosed, and the number of clients who started treatment from one district hospital and one health center in Berea district, Lesotho. We conducted in-depth interviews and focus group discussions with 53 health workers and patients. We used a content analysis approach to analyze qualitative data and integrated quantitative and qualitative findings in a joint display.

FINDINGS

During March-August, 2019, 218 clients at the hospital and 292 clients at the health center reported tuberculosis symptoms. The full diagnostic testing process was completed for 66% of clients at the hospital and 68% at the health center. Among clients who initiated tuberculosis treatment, 68% (61/90) at the hospital and 74% (32/43) at the health center completed treatment. The main barriers to testing and treatment completion were challenges at sample collection, lack of decentralized diagnostic services, and socioeconomic factors such as food insecurity and high patient movement to search for jobs.

CONCLUSIONS

Tuberculosis diagnosis could be improved through the effective decentralization of laboratory services at the health facility level, and treatment completion could be improved by providing food and other forms of social support to patients.

Validity and Reliability of the Human Immunodeficiency Virus-Related Stigma Questionnaire in Persian

Background: It was aimed to adapt a 12-item questionnaire into Persian among people living with human immunodeficiency virus (PLHIV) in Markazi province. Material and Methods: Content validity was evaluated based on the opinions of the relevant experts, and by calculating the scale-level content validity index (S-CVI) and the item-level content validity index (I-CVI). Reliability was assessed via test-retest, intraclass correlation coefficient (ICC), and Cronbach's alpha. Results: The obtained scores on clarity and relevancy (I-CVI) ranged from 0.9 to 1. The S-CVI also had an acceptable validity of 0.99. The Cronbach's alpha index of the whole questionnaire was 0.84 and ranged from 0.69 to 0.82 for subscales. The ICC in test-retest for all questionnaires was 0.88 and for subscales ranged from 0.77 to 0.88. Conclusion: The Persian version of the 12-item human immunodeficiency virus-related stigma questionnaire was found to be, in addition to being short and comprehensive, acceptable reliability and high validity to use in order to determine the stigma related to Persian-speaker PLHIV.

Transmissibility of tuberculosis among students and non-students: an occupational-specific mathematical modelling

BACKGROUND

Recently, despite the steady decline in the tuberculosis (TB) epidemic globally, school TB outbreaks have been frequently reported in China. This study aimed to quantify the transmissibility of Mycobacterium tuberculosis (MTB) among students and non-students using a mathematical model to determine characteristics of TB transmission.

METHODS

We constructed a dataset of reported TB cases from four regions (Jilin Province, Xiamen City, Chuxiong Prefecture, and Wuhan City) in China from 2005 to 2019. We classified the population and the reported cases under student and non-student groups, and developed two mathematical models [nonseasonal model (Model A) and seasonal model (Model B)] based on the natural history and transmission features of TB. The effective reproduction number (Reff) of TB between groups were calculated using the collected data.

RESULTS

During the study period, data on 456,423 TB cases were collected from four regions: students accounted for 6.1% of cases. The goodness-of-fit analysis showed that Model A had a better fitting effect (P < 0.001). The average Reff of TB estimated from Model A was 1.68 [interquartile range (IQR): 1.20-1.96] in Chuxiong Prefecture, 1.67 (IQR: 1.40-1.93) in Xiamen City, 1.75 (IQR: 1.37-2.02) in Jilin Province, and 1.79 (IQR: 1.56-2.02) in Wuhan City. The average Reff of TB in the non-student population was 23.30 times (1.65/0.07) higher than that in the student population.

CONCLUSIONS

The transmissibility of MTB remains high in the non-student population of the areas studied, which is still dominant in the spread of TB. TB transmissibility from the non-student-to-student-population had a strong influence on students. Specific interventions, such as TB screening, should be applied rigorously to control and to prevent TB transmission among students.

Protozoan co-infections and parasite influence on the efficacy of vaccines against bacterial and viral pathogens

A wide range of protozoan pathogens either transmitted by vectors (Plasmodium, Babesia, Leishmania and Trypanosoma), by contaminated food or water (Entamoeba and Giardia), or by sexual contact (Trichomonas) invade various organs in the body and cause prominent human diseases, such as malaria, babesiosis, leishmaniasis, trypanosomiasis, diarrhea, and trichomoniasis. Humans are frequently exposed to multiple pathogens simultaneously, or sequentially in the high-incidence regions to result in co-infections. Consequently, synergistic or antagonistic pathogenic effects could occur between microbes that also influences overall host responses and severity of diseases. The co-infecting organisms can also follow independent trajectory. In either case, co-infections change host and pathogen metabolic microenvironments, compromise the host immune status, and affect microbial pathogenicity to influence tissue colonization. Immunomodulation by protozoa often adversely affects cellular and humoral immune responses against co-infecting bacterial pathogens and promotes bacterial persistence, and result in more severe disease symptoms. Although co-infections by protozoa and viruses also occur in humans, extensive studies are not yet conducted probably because of limited animal model systems available that can be used for both groups of pathogens. Immunosuppressive effects of protozoan infections can also attenuate vaccines efficacy, weaken immunological memory development, and thus attenuate protection against co-infecting pathogens. Due to increasing occurrence of parasitic infections, roles of acute to chronic protozoan infection on immunological changes need extensive investigations to improve understanding of the mechanistic details of specific immune responses alteration. In fact, this phenomenon should be seriously considered as one cause of breakthrough infections after vaccination against both bacterial and viral pathogens, and for the emergence of drug-resistant bacterial strains. Such studies would facilitate development and implementation of effective vaccination and treatment regimens to prevent or significantly reduce breakthrough infections.

Research of childhood tuberculosis in suspected populations by molecular methods: A multicenter study in China

The research of childhood tuberculosis is inadequate in china. The cross-priming amplification (CPA) of specific DNA in clinical samples is increasingly adopted for the diagnosis of childhood tuberculosis. In this study, a multicenter research was performed to investigate the incidence and characteristics of childhood tuberculosis in suspected populations mainly by CPA method. 851 children suspected of tuberculosis were enrolled in seven centers across China. All samples were tested by a CPA method and 159 subjects were tested by Xpert MTB/RIF and liquid culture method in parallel to assess the reliability of the CPA method. A positive result in any one of the three methods provided a definitive diagnosis of Mycobacterium tuberculosis complex (MTBC) infection. The MTBC-positive rate was 9.5% (81/851) by the combined methods; 93.8% of the cases were detected by CPA technology (76/81). The rate of pulmonary infection was significantly higher than that of extrapulmonary infection (7.1%, 60/851 vs 2.5%, 21/851; P < 0.001). Scrofula was the predominant type of extrapulmonary tuberculosis. The MTBC positive rates in 12-18-year-old group (middle school), was 28.4% (23/81), higher than in those under-six-year-old (preschool; 39/525) and the 6~11-year-old (primary school; 18/235) groups combined (P < 0.001). The MTBC positive rate in patients with a clear history of tuberculosis exposure was significantly higher than in cases in which there was no history of tuberculosis contact(35.3%, 18/51 vs 7.8%, 61/782; P < 0.001). In conclusion, this multicenter investigation showed that pulmonary tuberculosis and extrapulmonary tuberculosis are not uncommon in children in China, with teenagers being particularly susceptible to infection. The incidence of pulmonary tuberculosis in children is higher than that of extrapulmonary tuberculosis. History of exposure to tuberculosis is a high risk factor for childhood tuberculosis.

Associations of hyponatremia and SIADH with increased mortality, young age and infection parameters in patients with tuberculosis

BACKGROUND AND OBJECTIVE

Hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) are associated with and can be caused by tuberculosis (TB) through meningitis by locally invading the hypothalamus, adrenal, or pituitary glands or possibly through ectopic ADH production. This study assessed the association of TB mortality with hyponatremia and SIADH in a large cohort of a university hospital in Austria.

METHODS

This retrospective study enrolled patients with hyponatremia and patients diagnosed with TB from 01/2001-11/2019 to assess the prevalence of TB in hyponatremia and TB morbidity and mortality in patients with and without hyponatremia. Sex, age, microbiological results, laboratory tests and comorbidities were analysed and used to calculate survival rates.

RESULTS

Of 107.532 patients with hyponatremia (0.07%) and 186 patients with TB (43%), 80 patients were diagnosed with both-hyponatremia and TB. Only three TB patients had SIADH, precluding further SIADH analysis. In hyponatremia, young age and high CRP levels showed significant associations with TB diagnosis (p<0.0001). Survival rates of patients diagnosed with TB with moderate to profound hyponatremia were significantly lower than those without hyponatremia (p = 0.002).

CONCLUSION

In this study of a large cohort from a tertiary care hospital in a non-endemic area of TB, 0.07% of patients presenting with hyponatremia, but especially younger patients and patients with high CRP values, were diagnosed with TB. Crucially, patients with moderate to profound hyponatremia had a significantly higher mortality rate and thus required increased medical care.

Acute Malaria in Malawian Children and Adults is Characterized by Thrombocytopenia That Normalizes in Convalescence

Background

Plasmodium falciparum malaria has been linked with significant perturbations of the peripheral cell-mediated immune system during acute phase. Some of these changes include lower than normal platelet counts. Although the exact mechanisms that drive thrombocytopenia in P. falciparum malaria are not fully known, a number of hypotheses have been proposed. We conducted two sets of studies with one aimed at determining platelet counts in Malawian children, and the other in adults during acute P. falciparum malaria and a month post treatment.

Materials and Methods

We recruited a total of 113 HIV-uninfected children with acute malaria [n=54 with uncomplicated malaria (UCM), n=30 with severe malarial anemia (SMA), n=29 presenting with cerebral malaria (CM)]. We also recruited 42 HIV-uninfected healthy controls. Out of the 113 participants with malaria, 73 (65%) [n=34 (63%) UCM, n=21 (70%) SMA and n=18 (62%) CM] were successfully followed-up one month after treatment. A 5mL peripheral blood sample was collected for platelet count using HMX Haematological Analyzer analysis both at baseline (acute malaria) and at follow-up a month later. Platelet counts were also determined in blood samples of 106 HIV-uninfected adults, 47 of whom presented with UCM and 29 with severe malaria (SM) and these counts were compared to those of 30 healthy controls. Of the malaria cases, platelet counts for 44 UCM and 21 SM were determined again during follow-up a month after treatment.

Results

In both children and adults, platelet counts were significantly lower during acute disease compared to the levels in the healthy controls with the lowest levels observed in CM (children) or SM (adults). These lower than normal levels increased close to normal levels a month post treatment.

Conclusion

P. falciparum malaria in Malawian children and adults was characterized by profound thrombocytopenia which recovered during convalescence.