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Fahdhienie F, Mudatsir M, Abidin TF, Nurjannah N. Risk factors of pulmonary tuberculosis in Indonesia: A case-control study in a high disease prevalence region. NARRA J 2024; 4:e943. [PMID: 39280301 PMCID: PMC11391971 DOI: 10.52225/narra.v4i2.943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 08/05/2024] [Indexed: 09/18/2024]
Abstract
Tuberculosis (TB) remains one of the most widespread infectious diseases in the world, with high mortality and morbidity rates, contributing to a significant disease burden, particularly in developing countries. The aim of this study was to determine the risk factors of TB among the population aged 17 years (late adolescent) and above in one of the high TB prevalence countries, Indonesia. A case-control study was conducted in Banda Aceh, Indonesia, involving newly diagnosed pulmonary TB patients who visited one of the eleven community health centers in Banda Aceh. The controls were individuals matched by age and sex who lived near the cases and had no TB infection. A total of 16 risk factors were assessed. Hierarchical multivariable logistic regression models were used to examine the association between the risk factors and the occurrence of TB. A total of 196 cases and 196 controls were included in the study. Multivariable logistic regression analysis identified 11 independent predictors for the occurrence of TB after controlling possible confounders. Patients who lived in houses with insufficient light exposure were 77 times more likely to develop TB compared to those living in houses with sufficient light exposure (adjusted odds ratio (AOR): 77.69; 95%CI: 27.09, 222.79). The study also showed that people who had close contact with TB patients (AOR: 25.39; 95%CI: 2.10, 306.52), had poor knowledge of TB (AOR: 24.2; 95%CI: 6.89, 85.17), had comorbidities (AOR: 4.49; 95%CI: 1.35, 14.89), insufficient food utilization (AOR: 3.41; 95%CI: 1.51, 7.71), negative preventive behavior (AOR: 3.39; 95%CI: 1.49, 7.72), low education level (AOR: 3.08; 95%CI: 1.26, 7.55), and insufficient housing humidity (AOR: 2.89; 95%CI: 1.18, 7.12) were associated with increased the odds of having TB. Being employed, having income above minimum wage, and having good nutritional intake were protective factors for developing TB. In conclusion, the determinants of TB among people aged 17 years and older are a clear indication of the need for TB prevention programs targeting not only individual risk factors but also environmental risk factors, particularly providing adequate housing conditions. This study provided useful information that might help to develop and adopt effective policies for TB control in Indonesia.
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Affiliation(s)
- Farrah Fahdhienie
- Doctoral Program in Medical Science, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
- Faculty of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia
| | - Mudatsir Mudatsir
- Department of Microbiology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Taufik F Abidin
- Department of Informatics, Faculty of Mathematics and Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
| | - Nurjannah Nurjannah
- Magister Program of Public Health, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia
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Shetty S, Pappachan JM, Fernandez CJ. Diabetes and tuberculosis: An emerging dual threat to healthcare. World J Diabetes 2024; 15:1409-1416. [PMID: 39099826 PMCID: PMC11292341 DOI: 10.4239/wjd.v15.i7.1409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/21/2024] [Accepted: 04/24/2024] [Indexed: 07/08/2024] Open
Abstract
Tuberculosis (TB) remains a huge global healthcare challenge even in the 21st century though the prevalence has dropped in developed countries in recent decades. Diabetes mellitus (DM) is an important risk factor for the development and perpetuation of TB owing to the immune dysfunction in patients with DM. The coexistence of both diseases in the same individual also aggravates disease severity, complications, and chance of treatment failure because of gross immune alterations posed by DM as well as TB. Various complex cellular and humoral immunological factors are involved in the dangerous interaction between TB and DM, some of which remain unknown even today. It is highly important to identify the risk factors for TB in patients with DM, and vice versa, to ensure early diagnosis and management to prevent complications from this ominous coexistence. In their research study published in the recent issue of the World Journal of Diabetes, Shi et al elaborate on the factors associated with the development of TB in a large cohort of DM patients from China. More such research output from different regions of the world is expected to improve our knowledge to fight the health devastation posed by TB in patients with diabetes.
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Affiliation(s)
- Sahana Shetty
- Department of Endocrinology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India
| | - Joseph M Pappachan
- Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
| | - Cornelius James Fernandez
- Department of Endocrinology & Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston PE21 9QS, United Kingdom
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Greenwald MA, Edwards N, Eastlund DT, Gurevich I, Ho APZ, Khalife G, Lin-Torre J, Thompson HW, Wilkins RM, Alrabaa SF. The American Association of Tissue Banks tissue donor screening for Mycobacterium tuberculosis-Recommended criteria and literature review. Transpl Infect Dis 2024:e14294. [PMID: 38852068 DOI: 10.1111/tid.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 06/10/2024]
Abstract
After two multistate outbreaks of allograft tissue-transmitted tuberculosis (TB) due to viable bone, evidence-based donor screening criteria were developed to decrease the risk of transmission to recipients. Exclusionary criteria, commentary, and references supporting the criteria are provided, based on literature search and expert opinion. Both exposure and reactivation risk factors were considered, either for absolute exclusion or for exclusion in combination with multiple risk factors. A criteria subset was devised for tissues containing viable cells. Risk factors for consideration included exposure (e.g., geographic birth and residence, travel, homelessness, incarceration, healthcare, and workplace) and reactivation (e.g., kidney disease, liver disease, history of transplantation, immunosuppressive medications, and age). Additional donor considerations include the possibility of sepsis and chronic illness. Donor screening criteria represent minimal criteria for exclusion and do not completely exclude all possible donor TB risks. Additional measures to reduce transmission risk, such as donor and product testing, are discussed but not included in the recommendations. Careful donor evaluation is critical to tissue safety.
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Affiliation(s)
- Melissa A Greenwald
- American Association of Tissue Banks, McLean, Virginia, USA
- Uniformed Services University, Bethesda, Maryland, USA
- Donor Alliance, Denver, Colorado, USA
| | | | | | | | | | - Ghada Khalife
- Solvita, Dayton, Ohio, USA
- Wright State University, Dayton, Ohio, USA
| | - Janet Lin-Torre
- MTF Biologics, Edison, New Jersey, USA
- Department of Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | | | | | - Sally F Alrabaa
- University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
- LifeLink Tissue Bank, Tampa, Florida, USA
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Chauhan A, Parmar M, Dash GC, Chauhan S, Sahoo KC, Samantaray K, Sharma J, Mahapatra P, Pati S. Health literacy and tuberculosis control: systematic review and meta-analysis. Bull World Health Organ 2024; 102:421-431. [PMID: 38812804 PMCID: PMC11132163 DOI: 10.2471/blt.23.290396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/24/2023] [Accepted: 02/23/2024] [Indexed: 05/31/2024] Open
Abstract
Objective To identify literature on health literacy levels and examine its association with tuberculosis treatment adherence and treatment outcomes. Methods Two authors independently searched Pubmed®, Embase, CINAHL, PsycINFO, Scopus, LILACS, Global Health Medicus and ScienceDirect for articles reporting on health literacy levels and tuberculosis that were published between January 2000 and September 2023. We defined limited health literacy as a person's inability to understand, process, and make decisions from information obtained concerning their own health. Methodological quality and the risk of bias was assessed using the JBI critical appraisal tools. We used a random effects model to assess the pooled proportion of limited health literacy, the association between health literacy and treatment adherence, and the relationship between health literacy and tuberculosis-related knowledge. Findings Among 5813 records reviewed, 22 studies met the inclusion criteria. The meta-analysis revealed that 51.2% (95% confidence interval, CI: 48.0-54.3) of tuberculosis patients exhibit limited health literacy. Based on four studies, patients with lower health literacy levels were less likely to adhere to tuberculosis treatment regimens (pooled odds ratio: 1.95; 95% CI: 1.37-2.78). Three studies showed a significant relationship between low health literacy and inadequate knowledge about tuberculosis (pooled correlation coefficient: 0.79; 95% CI: 0.32-0.94). Conclusion Health literacy is associated with tuberculosis treatment adherence and care quality. Lower health literacy might hamper patients' ability to follow treatment protocols. Improving health literacy is crucial for enhancing treatment outcomes and is a key strategy in the fight against tuberculosis.
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Affiliation(s)
| | - Malik Parmar
- Country Office for India, World Health Organization, New Delhi, India
| | - Girish C Dash
- Indian Council of Medical Research, Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha751023, India
| | - Sandeep Chauhan
- WHO National Tuberculosis Elimination Programme Technical Support Network, New Delhi, India
| | - Krushna C Sahoo
- Indian Council of Medical Research, Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha751023, India
| | - Kajal Samantaray
- Indian Council of Medical Research, Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha751023, India
| | - Jessica Sharma
- Indian Council of Medical Research, Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha751023, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, India
| | - Sanghamitra Pati
- Indian Council of Medical Research, Regional Medical Research Centre, Chandrasekharpur, Bhubaneswar, Odisha751023, India
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Al-Bari MAA, Peake N, Eid N. Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges. World J Diabetes 2024; 15:853-866. [PMID: 38766427 PMCID: PMC11099355 DOI: 10.4239/wjd.v15.i5.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/08/2024] [Accepted: 03/21/2024] [Indexed: 05/10/2024] Open
Abstract
Tuberculosis (TB) remains a leading cause of death among infectious diseases, particularly in poor countries. Viral infections, multidrug-resistant and ex-tensively drug-resistant TB strains, as well as the coexistence of chronic illnesses such as diabetes mellitus (DM) greatly aggravate TB morbidity and mortality. DM [particularly type 2 DM (T2DM)] and TB have converged making their control even more challenging. Two contemporary global epidemics, TB-DM behaves like a syndemic, a synergistic confluence of two highly prevalent diseases. T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment. Since a bidirectional relationship exists between TB and DM, it is necessary to concurrently treat both, and promote recommendations for the joint management of both diseases. There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure, and reinfection. In addition, autophagy may play a role in these comorbidities. Therefore, the TB-DM comorbidities present several health challenges, requiring a focus on multidisciplinary collaboration and integrated strategies, to effectively deal with this double burden. To effectively manage the comorbidity, further screening in affected countries, more suitable drugs, and better treatment strategies are required.
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Affiliation(s)
| | - Nicholas Peake
- Biosciences and Chemistry and Biomolecular Research Centre, Sheffield Hallam University, Sheffield S1 1WB, United Kingdom
| | - Nabil Eid
- Department of Anatomy, Division of Human Biology, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
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López-González JA, Martínez-Soto JM, Avila-Cervantes C, Mata-Pineda AL, Álvarez-Hernández G, Álvarez-Meza JB, Bolado-Martínez E, Candia-Plata MDC. Evaluation of Systemic Inflammation Before and After Standard Anti-tuberculosis Treatment in Patients With Active Pulmonary Tuberculosis and Diabetes Mellitus. Cureus 2024; 16:e55391. [PMID: 38562330 PMCID: PMC10984244 DOI: 10.7759/cureus.55391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Diabetes mellitus (DM) is a common comorbidity of active pulmonary tuberculosis (APTB) that increases the risk of treatment failure during anti-tuberculosis chemotherapy. Evaluating systemic inflammatory response could help determine differences in response to treatment between APTB patients and those with APTB and DM. Methodology To explore changes in systemic inflammation, measured by a set of inflammatory mediators in subjects with APTB and TBDM before and after six months of anti-tuberculosis chemotherapy, 30 APTB and nine TBDM subjects underwent cytokine testing, including interleukin (IL)-6, IL-8, IL-10, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and transforming growth factor-beta 1 (TGF-β1) by enzyme-linked immunosorbent assay, C-reactive protein by nephelometry, and sialic acid by colorimetric assay at baseline and following six months of standard anti-tuberculosis treatment. Sputum smear microscopy or molecular biology (Xpert MTB/RIF) was used for diagnosis, and sputum smear microscopy was performed monthly during the treatment of the patient with pulmonary tuberculosis to evaluate his evolution. Principal component analysis examined changes in the inflammatory status. Results Both groups showed negative sputum smear microscopy in the sixth month after starting anti-tuberculosis chemotherapy. TGF-β1 was found to be significantly higher in subjects with TBDM before treatment compared to APTB patients (p<0.001), and systemic inflammation continued only in TBDM subjects after treatment (accumulation and persistence of inflammatory mediators like IL-6, IL-8, IL-10, IFN-γ, TNF-α, TGF-β1, C-reactive protein, and sialic acid in blood). On the other hand, the mediators IFN-γ, C-reactive protein, and total sialic acid were found to be most influential in distinguishing pre- and post-treatment inflammatory response in subjects with APTB without DM. Conclusions Inflammatory mediators analyzed in combination, including IFN-γ, CRP, and total sialic acid, may be useful in evaluating the systemic inflammatory response in subjects with APTB and TBDM before and after anti-tuberculosis treatment. Determining these mediators revealed persistent systemic inflammation in TBDM subjects after six months of standard tuberculosis treatment, despite negative sputum smear microscopy results and good glycemic control. This suggests a need for inflammation-modulating therapies during tuberculosis control. Finally, monitoring sputum smear microscopy results alongside the determination of proposed inflammatory mediators (IFN-γ, CRP, and total sialic acid) are effective in evaluating the response to anti-tuberculosis treatment in APTB subjects without DM, warranting further investigation.
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Sama LF, Sadjeu S, Tchouangueu TF, Dabou S, Kuh GF, Ngouateu OB, Noubom M. Diabetes Mellitus and HIV Infection among Newly Diagnosed Pulmonary Tuberculosis Patients in the North West Region of Cameroon: A Cross-Sectional Study. Int J Clin Pract 2023; 2023:5998727. [PMID: 38045656 PMCID: PMC10691891 DOI: 10.1155/2023/5998727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/21/2023] [Accepted: 09/07/2023] [Indexed: 12/05/2023] Open
Abstract
Objective To determine the prevalence rate of HIV and diabetes among tuberculosis (TB) patients and also the comorbidity rate. Design Cross-sectional study. Setting. This study was carried out at the Tuberculosis Reference Laboratory, Regional Hospital Bamenda, North West Region of Cameroon, from January 2017 to December 2019. Participants. 1115 cases of pulmonary tuberculosis aged ≥14 years (mean 42.5 ± 15.28 years). Methods Sputum samples collected were acid-fast stained and examined macroscopically as well as inoculated for culture. A chest X-ray was performed for further confirmation of TB diagnosis. After the TB diagnosis was done, fasting blood glucose, 2 h-PG test, HbA1c, and biochemical enzymatic tests were performed for the diagnosis of diabetes. Rapid strip test and enzyme-linked immunosorbent assay were used to diagnose HIV infection. Interventions. No intervention was done during the period of study. Outcome Measures. The prevalence of TB/HIV and TB/HIV/DM, signs and symptoms, imaging results, and bacteriology status among TB/HIV, TB/HIV/DM coinfected, and comorbidity cases. Results Of 1115 participants, 38.57% had TB/HIV, and 5.83% had TB/HIV/DM. Among TB/HIV/DM cases, 20.39% had a cough for more than 2 weeks [p < 0.0001; OR (95%CI): 4.866 (3.170-7.404)], and 35.71% had a fever for at least 2 weeks [p < 0.0001; OR (95%CI): 7.824 (5.336-11.36)]. The majority of TB/HIV/DM patients (77.42%) had chest pain for at least 2 weeks [p < 0.0001; OR (95%CI): 114.3 (59.78-207.1)]. 7.41%, 14.18%, and 9.09% of TB/HIV/DM, respectively, had chest abnormality, positive smear, and positive culture (p = 0.018). Significant differences were observed between signs and symptoms, imaging results, bacteriology, treatment history for TB cases and those with HIV and/or DM, and those without HIV and/or DM coinfection and comorbidity. Conclusion This study reports a high prevalence of DM comorbidity and HIV coinfection among active TB patients in the North West Region of Cameroon as well as TB/HIV/DM comorbidity.
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Affiliation(s)
- Leonard Fonkeng Sama
- Department of Biochemistry, University of Dschang, P.O. Box 67, Dschang, Cameroon
| | - Sidoine Sadjeu
- Gulf of Guinea University Institute, Institute of Applied Science, Douala, Cameroon
| | - Thibau Flaurant Tchouangueu
- Department of Microbiology, Haematology and Immunology, Faculty of Health and Pharmaceutical Science, P.O. Box 96, University of Dschang, Dschang, Cameroon
| | - Solange Dabou
- Department of Biochemistry, University of Dschang, P.O. Box 67, Dschang, Cameroon
| | - Georges Ful Kuh
- Department of Biochemistry, University of Dschang, P.O. Box 67, Dschang, Cameroon
| | - Omer Bebe Ngouateu
- University of Yaoundé I, Faculty of Science, Department of Animal Biology and Physiology, P.O. Box 812, Yaoundé, Cameroon
| | - Michel Noubom
- Department of Microbiology, Haematology and Immunology, Faculty of Health and Pharmaceutical Science, P.O. Box 96, University of Dschang, Dschang, Cameroon
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Bisht MK, Dahiya P, Ghosh S, Mukhopadhyay S. The cause-effect relation of tuberculosis on incidence of diabetes mellitus. Front Cell Infect Microbiol 2023; 13:1134036. [PMID: 37434784 PMCID: PMC10330781 DOI: 10.3389/fcimb.2023.1134036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/25/2023] [Indexed: 07/13/2023] Open
Abstract
Tuberculosis (TB) is one of the oldest human diseases and is one of the major causes of mortality and morbidity across the Globe. Mycobacterium tuberculosis (Mtb), the causal agent of TB is one of the most successful pathogens known to mankind. Malnutrition, smoking, co-infection with other pathogens like human immunodeficiency virus (HIV), or conditions like diabetes further aggravate the tuberculosis pathogenesis. The association between type 2 diabetes mellitus (DM) and tuberculosis is well known and the immune-metabolic changes during diabetes are known to cause increased susceptibility to tuberculosis. Many epidemiological studies suggest the occurrence of hyperglycemia during active TB leading to impaired glucose tolerance and insulin resistance. However, the mechanisms underlying these effects is not well understood. In this review, we have described possible causal factors like inflammation, host metabolic changes triggered by tuberculosis that could contribute to the development of insulin resistance and type 2 diabetes. We have also discussed therapeutic management of type 2 diabetes during TB, which may help in designing future strategies to cope with TB-DM cases.
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Affiliation(s)
- Manoj Kumar Bisht
- Laboratory of Molecular Cell Biology, Centre for DNA Fingerprinting and Diagnostics (CDFD), Hyderabad, India
- Regional Centre for Biotechnology, Faridabad, India
| | - Priyanka Dahiya
- Laboratory of Molecular Cell Biology, Centre for DNA Fingerprinting and Diagnostics (CDFD), Hyderabad, India
- Regional Centre for Biotechnology, Faridabad, India
| | - Sudip Ghosh
- Molecular Biology Unit, Indian Council of Medical Research (ICMR)-National Institute of Nutrition, Jamai Osmania PO, Hyderabad, India
| | - Sangita Mukhopadhyay
- Laboratory of Molecular Cell Biology, Centre for DNA Fingerprinting and Diagnostics (CDFD), Hyderabad, India
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Grzywa R, Łupicka-Słowik A, Sieńczyk M. IgYs: on her majesty's secret service. Front Immunol 2023; 14:1199427. [PMID: 37377972 PMCID: PMC10291628 DOI: 10.3389/fimmu.2023.1199427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
There has been an increasing interest in using Immunoglobulin Y (IgY) antibodies as an alternative to "classical" antimicrobials. Unlike traditional antibiotics, they can be utilized on a continual basis without leading to the development of resistance. The veterinary IgY antibody market is growing because of the demand for minimal antibiotic use in animal production. IgY antibodies are not as strong as antibiotics for treating infections, but they work well as preventative agents and are natural, nontoxic, and easy to produce. They can be administered orally and are well tolerated, even by young animals. Unlike antibiotics, oral IgY supplements support the microbiome that plays a vital role in maintaining overall health, including immune system function. IgY formulations can be delivered as egg yolk powder and do not require extensive purification. Lipids in IgY supplements improve antibody stability in the digestive tract. Given this, using IgY antibodies as an alternative to antimicrobials has garnered interest. In this review, we will examine their antibacterial potential.
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Solanki HM, Ranpariya PN, Chudasama RK. Health Status and Treatment Outcome of Tuberculosis with Diabetes Mellitus Cases, Rajkot City, Gujarat - A Longitudinal Study. Indian J Community Med 2023; 48:75-81. [PMID: 37082395 PMCID: PMC10112767 DOI: 10.4103/ijcm.ijcm_171_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 10/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background India, with the highest number of tuberculosis (TB) cases in the world, is also facing epidemic growth in diabetes mellitus (DM). TB is curable while DM is a metabolic and incurable disease that if not controlled will affect the health status of a person. This study was conducted to assess the health status and treatment outcome of TB with DM cases. Materials and Methods We selected a total of 64 newly registered pulmonary TB (PTB) with DM cases from five tuberculosis units (TUs) in Rajkot city from October 2019 to December 2020. At the end of treatment, 64 cases were analyzed for treatment outcome and 56 cases (5 deaths; 3 lost to follow-up) were followed up to observe progression in health status. The information was collected in pretested proforma by interview. Results There was a significant improvement in TB symptoms (cough, weight loss, weakness, anorexia, evening rise of temperature, dyspnea, chest pain, hemoptysis), DM symptoms (frequent urination, excessive thirst and hunger, tingling and numbness), symptoms of mental health (fatigue, sleep disturbance, negative emotions, socially inactive), and adverse drug reactions (ADRs) on consecutive visits (McNemar's test, P < 0.001) and at the end of treatment (Cochran's Q test, P < 0.001). Improvement of nutritional status was also found statistically significant on consecutive visits (Wilcoxon test, P < 0.001) and at the end of treatment (Friedman's test, P < 0.001). The cure rate was 82.8% and 4.7% of cases had completed treatment. Conclusion At the end of treatment, there was a significant improvement in health status and treatment outcome; also good cure rate was reported among cases.
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Affiliation(s)
- Harsha M. Solanki
- Department of Community Medicine, P D U Government Medical College, Rajkot, Gujarat, India
| | - Pooja N. Ranpariya
- Department of Community Medicine, P D U Government Medical College, Rajkot, Gujarat, India
| | - Rajesh K. Chudasama
- Department of Community Medicine, P D U Government Medical College, Rajkot, Gujarat, India
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Klein BY, Greenblatt CL, Gofrit ON, Bercovier H. Bacillus Calmette-Guérin in Immuno-Regulation of Alzheimer's Disease. Front Aging Neurosci 2022; 14:861956. [PMID: 35832066 PMCID: PMC9271739 DOI: 10.3389/fnagi.2022.861956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022] Open
Abstract
Bacillus Calmette-Guérin is frequently the treatment of choice of superficial bladder cancer. Exposing the urinary bladder of elderly patients with bladder cancer to the BCG vaccine reduced the risk of Alzheimer's disease (AD) substantially. Vaccines against other infectious microorganisms by other vaccination methods showed a similar but a lesser effect. This suggests that immune effects on AD are antigenically non-specific, likely being a metabolic result of immune system activation, similar to that shown for Juvenile diabetes. In this mini review we point to the benefit of BCG vaccine. We then briefly highlight the pathological involvement of the immune system in the AD both, in the peripheral and the central (brain) compartments. Given the uncertain prophylactic mechanism of the BCG effect against AD we propose to take advantage of the therapeutically planned bladder exposure to BCG. Based on pathological aggregation of wrongly cleaved amyloid precursor protein (APP) resistant to the unfolded protein response (UPR) which results in amyloid beta plaques we predict that BCG may impact the UPR signaling cascade. In addition pathways of innate immunity training concerned with energy metabolism, predict capability of activated immune cells to substitute deranged astrocytes that fail to support neuronal energy metabolism. This mini review points to ways through which immune cells can mediate between BCG vaccination and AD to support the wellness of the central nervous system.
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Affiliation(s)
- Benjamin Y. Klein
- Department of Microbiology and Molecular Genetics, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Charles L. Greenblatt
- Department of Microbiology and Molecular Genetics, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ofer N. Gofrit
- Department of Urology, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hervé Bercovier
- Department of Microbiology and Molecular Genetics, The Hebrew University of Jerusalem, Jerusalem, Israel
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12
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Ren Y, Ren H, Tian Q, Li X, Liu Y. The relationship between computed tomography appearance of pulmonary tuberculosis and blood glucose levels in 763 diabetes mellitus patients with pulmonary tuberculosis: a comparative study. Endocrine 2022; 76:584-592. [PMID: 35332512 PMCID: PMC9156482 DOI: 10.1007/s12020-022-03033-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/02/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Glucose tolerance is often impaired in pulmonary tuberculosis (TB) patients. We aimed to explore the relationship between computed tomography (CT) findings of TB and blood glucose levels in diabetes mellitus (DM) patients. METHODS 763 diabetes mellitus patients with pulmonary tuberculosis (DMTB) from March 2015 to March 2018 were selected and their clinical data were retrospectively evaluated. CT appearance of DMTB was reviewed and compared according to blood glucose levels and CT scores. TB scores were calculated according to the combination of typical and atypical CT appearance. The relationship between blood glucose levels and CT scores was analyzed via Pearson correlation coefficient. RESULTS TB lesions mainly occurred in the left lung and the lower lobes in the DMTB patients. Nodules and cavities are the main typical complications in these DMTB patients, and especially the number and size of cavities predominantly contribute to CT scan scores. The size of cavities (diameters (cm), median (95% CI of median)) was 0.72 (0.66-0.77), 1.20 (1.09-1.28), and 3.45 (2.92-3.94) from the low-, middle- and high-CT-score groups, respectively. The patients with high CT scores had a higher level of fasting plasma glucose (mean 13.48 mM, 95% CI of median 12.56-14.44 mM) than the patients in the low-CT-score (mean 8.73 mM, 95% CI of median 8.49-9.36 mM) and middle-CT-score groups (mean 10.16 mM, 95% CI of median 9.89-10.49 mM) (P < 0.0001). CT scores have a consistent relationship with the levels of blood glucose (rho = 0.60, P < 0.0001). CONCLUSIONS CT appearance stands for the severity of tuberculosis and is closely associated with blood glucose levels in diabetic TB patients.
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Affiliation(s)
- Yan Ren
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China.
| | - Hongmei Ren
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China
| | - Qian Tian
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China
| | - Xue Li
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China
| | - Yuxi Liu
- Tuberculosis Ward 9, Shenyang Tenth People's Hospital, Shenyang, 110044, China
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Antonio-Arques V, Franch-Nadal J, Moreno-Martinez A, Real J, Orcau À, Mauricio D, Mata-Cases M, Julve J, Navas Mendez E, Puig Treserra R, Barrot de la Puente J, Millet JP, Del Val García JL, Vlacho B, Caylà JA. Subjects With Diabetes Mellitus Are at Increased Risk for Developing Tuberculosis: A Cohort Study in an Inner-City District of Barcelona (Spain). Front Public Health 2022; 10:789952. [PMID: 35677764 PMCID: PMC9168433 DOI: 10.3389/fpubh.2022.789952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis is the leading cause of mortality from lung infectious disease worldwide in recent years, and its incidence has re-emerged in large cities in low-incidence countries due to migration and socioeconomic deprivation causes. Diabetes mellitus and tuberculosis are syndemic diseases, with diabetes being considered a risk factor for developing tuberculosis. Objective To investigate whether diabetic patients were at increased risk of tuberculosis living in an inner-district of a large city of northeastern Spain. Methods Observational matched retrospective cohort study based on clinical records from the population of the lowest socioeconomic status in Barcelona (Ciutat Vella district). A cohort including patients with type 1 and type 2 diabetes mellitus in 2007 and new cases until 2016 (8004 subjects), matched 1:1 by sex and age with a non-diabetic cohort. Follow-up period was until December 31st 2018. We evaluated the risk of developing tuberculosis in diabetic patients compared to non-diabetic patients during the follow up period. We used time-to-event analysis to estimate the incidence of tuberculosis, and competing risks regression by clusters and conditional Cox regression models to calculate the hazard ratio (HR) and its 95% confidence intervals (CI). Results Among the 16,008 included subjects, the median follow-up was 8.7 years. The mean age was 57.7 years; 61.2% men and 38.8% women in both groups. The incidence of tuberculosis was 69.9 per 100,000 person-years in diabetic patients, and 40.9 per 100,000 person-years in non-diabetic patients (HR = 1.90; CI: 1.18-3.07). After adjustment for the country of origin, chronic kidney disease, number of medical appointments, BMI, alcoholism and smoking, the risk remained higher in diabetic patients (1.66: CI 0.99-2.77). Additionally, subjects from Hindustan or with a history of alcohol abuse also showed a higher risk of developing tuberculosis (HR = 3.51; CI:1.87-6.57, and HR = 2.73; CI:1.22-6.12 respectively). Conclusion People with diabetes mellitus were at higher risk of developing tuberculosis in a large cohort recruited in an inner-city district with a high incidence for this outcome, and low socioeconomic conditions and high proportion of migrants. This risk was higher among Hindustan born and alcohol abusers.
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Affiliation(s)
- Violeta Antonio-Arques
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Bordeta Magòria, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Raval Sud, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Antonio Moreno-Martinez
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Jordi Real
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Àngels Orcau
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Didac Mauricio
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Endocrinology and Nutrition, Hospital Universitari de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, University of Vic—Central University of Catalonia, Barcelona, Spain
| | - Manel Mata-Cases
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Primary Health Care Center La Mina, Gerència d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Josep Julve
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Biochemistry, Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Elena Navas Mendez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Rai Puig Treserra
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Joan Barrot de la Puente
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Primary Health Care Center Doctor Jordi Nadal, Gerència d'Atenció Primària Girona Ciutat, Institut Catala de la Salut, Salt, Spain
| | - Joan Pau Millet
- CIBER of Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Epidemiology Service, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jose Luis Del Val García
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Unitat d'Avaluació, Sistemes d'informació i Qualitat, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain
| | - Bogdan Vlacho
- DAP-Cat Group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Joan A. Caylà
- Foundation of the Tuberculosis Research Unit of Barcelona, Barcelona, Spain
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Jiang W, Trimawartinah, Rahman FM, Wibowo A, Sanjaya A, Silitonga PII, Tang S, Long Q. The co-management of tuberculosis-diabetes co-morbidities in Indonesia under the National Tuberculosis Control Program: results from a cross-sectional study from 2017 to 2019. BMC Public Health 2022; 22:689. [PMID: 35395745 PMCID: PMC8990273 DOI: 10.1186/s12889-022-13017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Indonesia suffers from a high burden of tuberculosis (TB) and diabetes (DM). The government initiated national TB-DM co-management activities under the National TB Control Program in 2017. This study investigates the detection and treatment outcomes of TB-DM in Jakarta after implementing these activities, and identifies the main factors associated with these outcomes. Methods A cross-sectional study was conducted using TB registry data in two districts of Jakarta, East Jakarta (low-income) and South Jakarta (high-income). A 5-step cascade analysis was used: diagnosed TB patients; TB patients tested for DM; diagnosed TB-DM patients; and patients received and completed TB treatment/cured. We conducted descriptive analyses to understand the characteristics of TB and TB-DM patients, and used a two-level mixed-effect logistic regression to explore factors associated with having a DM test and completing TB treatment/being cured. Results Over the study period (2017–2019) 50.8% of the new pulmonary TB patients aged over 15 were tested for DM. The percentage increased from 41.7% in 2017–2018 to 60.1% in 2019. Of the TB patients tested for DM, 20.8% were diagnosed with DM. Over 90% of the detected TB-DM patients received standard TB treatment, 86.3% of whom completed treatment/were cured. Patients in East Jakarta were more likely to be tested for DM and to complete standard TB treatment/be cured than patients in South Jakarta (P < 0.001). Bacteriologically positive TB patients were more likely to be tested for DM (OR = 1.37, 95% CIs 1.17,1.60). Patients diagnosed in sub-district level healthcare centers had a higher likelihood of being tested for DM than those in government and private hospitals (P < 0.05). Receiving DM treatment was associated with a higher likelihood of completing TB treatment/being cured (OR = 1.82, 95% CIs 1.20, 2.77). Conclusions TB-DM case detection significantly improved in 2019 after introducing TB-DM co-management activities in Jakarta, while gaps in TB-DM co-management existed between bacteriologically positive and clinically diagnosed TB patients, and across different types of health facilities. Collaboration between TB and DM departments should be strengthened, and more resources need to be mobilized to further improve the co-management of TB-DM in Indonesia.
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Affiliation(s)
- Weixi Jiang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China
| | - Trimawartinah
- Department of Public Health, University of Muhammadiyah Prof DR Hamka, South Jakarta, Indonesia
| | - Fauziah Mauly Rahman
- Global Health Initiative Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Adik Wibowo
- Global Health Initiative Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | - Adhi Sanjaya
- Global Health Initiative Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | | | - Shenglan Tang
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.,SingHealth Duke-NUS Global Health Institute, Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, No. 8 Duke Avenue, Kunshan, 215316, Jiangsu, China.
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15
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Arini M, Sugiyo D, Permana I. Challenges, opportunities, and potential roles of the private primary care providers in tuberculosis and diabetes mellitus collaborative care and control: a qualitative study. BMC Health Serv Res 2022; 22:215. [PMID: 35177037 PMCID: PMC8851698 DOI: 10.1186/s12913-022-07612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction The comorbidity of tuberculosis and diabetes mellitus (TB-DM) is a looming global co-epidemic problem. Despite the Indonesian Government’s ongoing effort to impose regulation for collaborative TB-DM management, the involvement of private primary care providers (PPCs) has not been considered before the COVID-19 pandemic. This study aimed to capture the PPCs’ existing practices and explore their challenges, opportunities, and potential roles in the collaborative TB-DM services and control. Methods A descriptive qualitative research design was used to collect data. Two Focus Group Discussions (FGDs) were conducted with 13 healthcare workers (HCWs) from different private clinics and eight private/solo general practitioners (GPs) from Yogyakarta City, Indonesia. We triangulated these data with data from FGDs of HCWs community health centers (CHCs) and in-depth interviews of three regional health regulators, five hospitals staff members, and a representative of national health insurance. The discussions were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Results PPCs have not been initiated into the implementation of the collaborative TB-DM programme. The themes identified in this study were health system-related barriers, knowledge and perception of HCWs, lack of implementation of bi-directional screening, and needs of multisector role. The potential roles identified for PPCs include involvement in health promotion, bi-directional screening, patient referral, and data reporting according to the TB-DM programme indicators. However, more thorough improvement of PPCs’ capacity and logistic supplies are needed to provide comprehensive TB treatment. Conclusion Although PPCs’ involvement in implementing collaborative TB-DM services has yet to be considered, their potential role should not be neglected. Therefore, it is essential to increase their involvement by enhancing their capacity and improving the Public-Private Mix. PPCs’ engagement should be initiated and maintained to ensure the sustainability of the programme.
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Affiliation(s)
- Merita Arini
- Department of Family Medicine and Public Health; and Master of Hospital Administration, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia. .,Department of Public Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences; and Muhammadiyah Steps, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia.
| | - Dianita Sugiyo
- Department of Public Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences; and Muhammadiyah Steps, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia.,Master of Nursing; and Center of Biotechnology and Halal Studies, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia
| | - Iman Permana
- Department of Family Medicine and Public Health; and Master of Hospital Administration, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia.,Department of Public Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences; and Muhammadiyah Steps, Universitas Muhammadiyah Yogyakarta, Jalan Brawijaya, Tamantirto, Kasihan, Bantul, 55183, Indonesia
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Katana GG, Ngari M, Maina T, Sanga D, Abdullahi OA. Tuberculosis poor treatment outcomes and its determinants in Kilifi County, Kenya: a retrospective cohort study from 2012 to 2019. Arch Public Health 2022; 80:48. [PMID: 35123570 PMCID: PMC8818215 DOI: 10.1186/s13690-022-00807-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background Tuberculosis (TB) is one of the leading causes of deaths in Africa, monitoring its treatment outcome is essential to evaluate treatment effectiveness. The study aimed to evaluate proportion of poor TB treatment outcomes (PTO) and its determinants during six-months of treatment at Kilifi County, Kenya. Methods We conducted a retrospective analysis of data from the TB surveillance system (TIBU) in Kilifi County, Kenya from 2012 to 2019. The outcome of interest was PTO (lost-to-follow-up (LTFU), death, transferred out, treatment failure, drug resistance) or successful treatment (cured or completed treatment). We performed time-stratified (at three months follow-up) survival regression analyses accounting for sub-county heterogeneity to determine factors associated with PTO. Results We included 14,706 TB patients, their median (IQR) age was 37
(28–50) years and 8,791 (60%) were males. A total of 13,389 (91%) were on first line anti-TB treatment (2RHZE/4RH), 4,242 (29%) were HIV infected and 192 (1.3%) had other underlying medical conditions. During 78,882 person-months of follow-up, 2,408 (16%) patients had PTO: 1,074 (7.3%) deaths, 776 (5.3%) LTFU, 415 (2.8%) transferred out, 103 (0.7%) treatment failure and 30 (0.2%) multidrug resistance. The proportion of poor outcome increased from 7.9% in 2012 peaking at 2018 (22.8%) and slightly declining to 20% in 2019 (trend test P = 0.03). Over two-thirds 1,734 (72%) poor outcomes occurred within first three months of follow-up. In the first three months of TB treatment, overweight ((aHR 0.85 (95%CI 0.73–0.98), HIV infected not on ARVS (aHR 1.72 (95% CI 1.28–2.30)) and year of starting treatment were associated with PTO. However, in the last three months of treatment, elderly age ≥50 years (aHR 1.26 (95%CI 1.02–1.55), a retreatment patient (aHR 1.57 (95%CI 1.28–1.93), HIV infected not on ARVs (aHR 2.56 (95%CI 1.39–4.72), other underlying medical conditions (aHR 2.24 (95%CI 1.41–3.54)) and year of starting treatment were positively associated with PTO while being a female (aHR 0.83 (95%CI 0.70–0.97)) was negatively associated with PTO. Conclusions Over two-thirds of poor outcomes occur in the first three months of TB treatment, therefore greater efforts are needed during this phase. Interventions targeting HIV infected and other underlying medical conditions, the elderly and retreated patients provide an opportunity to improve TB treatment outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00807-4.
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Yorke E, Boima V, Dey ID, Amissah-Arthur MB, Ganu V, Amaning-Kwarteng E, Tetteh J, Charles Mate-Kole C. Transient Impact of Dysglycemia on Sputum Conversion among Smear-Positive Tuberculosis Patients in a Tertiary Care Facility in Ghana. CLINICAL MEDICINE INSIGHTS-CIRCULATORY RESPIRATORY AND PULMONARY MEDICINE 2021; 15:11795484211039830. [PMID: 34566441 PMCID: PMC8458672 DOI: 10.1177/11795484211039830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/26/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients. METHODS We conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6 months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dysglycemia as well as sputum conversion. RESULTS A significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs 67%, P-value < .05) at 2 months but not at 6 months (87% vs 77%, P-value > .05). After controlling for age group and adjusting for other covariates, patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months, respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times increased odds and 89% less likely for sputum conversion, respectively. CONCLUSION A significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.
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Affiliation(s)
- Ernest Yorke
- University of Ghana, Accra, Greater Accra, Ghana
| | | | | | | | - Vincent Ganu
- Korle-Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | | | - John Tetteh
- University of Ghana, Accra, Greater Accra, Ghana.,Korle-Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - C Charles Mate-Kole
- University of Ghana, Accra, Greater Accra, Ghana.,Korle-Bu Teaching Hospital, Accra, Greater Accra, Ghana
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Namuganga AR, Chegou NN, Mayanja-Kizza H. Past and Present Approaches to Diagnosis of Active Pulmonary Tuberculosis. Front Med (Lausanne) 2021; 8:709793. [PMID: 34631731 PMCID: PMC8495065 DOI: 10.3389/fmed.2021.709793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/17/2021] [Indexed: 12/15/2022] Open
Abstract
Tuberculosis disease continues to contribute to the mortality burden globally. Due to the several shortcomings of the available diagnostic methods, tuberculosis disease continues to spread. The difficulty to obtain sputum among the very ill patients and the children also affects the quick diagnosis of tuberculosis disease. These challenges warrant investigating different sample types that can provide results in a short time. Highlighted in this review are the approved pulmonary tuberculosis diagnostic methods and ongoing research to improve its diagnosis. We used the PRISMA guidelines for systematic reviews to search for studies that met the selection criteria for this review. In this review we found out that enormous biosignature research is ongoing to identify host biomarkers that can be used as predictors of active PTB disease. On top of this, more research was also being done to improve already existing diagnostic tests. Host markers required more optimization for use in different settings given their varying sensitivity and specificity in PTB endemic and non-endemic settings.
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Affiliation(s)
- Anna Ritah Namuganga
- Uganda–Case Western Research Collaboration-Mulago, Kampala, Uganda
- Joint Clinical Research Centre, Kampala, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Novel N. Chegou
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Harriet Mayanja-Kizza
- Uganda–Case Western Research Collaboration-Mulago, Kampala, Uganda
- College of Health Sciences, Makerere University, Kampala, Uganda
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Yoo JE, Kim D, Han K, Rhee SY, Shin DW, Lee H. Diabetes Status and Association With Risk of Tuberculosis Among Korean Adults. JAMA Netw Open 2021; 4:e2126099. [PMID: 34546370 PMCID: PMC8456384 DOI: 10.1001/jamanetworkopen.2021.26099] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE The risk of tuberculosis (TB) associated with diabetes status, considering impaired fasting glucose or duration of diabetes, has not been well established. OBJECTIVE To evaluate the association of diabetes status with the development of TB in the general population. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from the Korean National Health Insurance System database. Adult participants without a history of TB who underwent a health screening in 2009 were included. Eligible participants were followed up for incident TB cases from 1 year after the day of health screening until December 31, 2018. Data analysis was performed from September 2019 to September 2020. EXPOSURES Five levels of diabetes status were evaluated: normal glucose, impaired fasting glucose (considered as without diabetes), new-onset diabetes, diabetes duration less than 5 years, and diabetes duration 5 years or longer (considered as having diabetes). MAIN OUTCOMES AND MEASURES Newly diagnosed TB. RESULTS Among 4 423 177 participants, the mean (SD) age was 46.5 (13.9) years, and there were 2 597 142 men (58.7%). A total of 26 458 participants (0.6%) received a diagnosis of TB within a median (interquartile range) of 8.3 (8.1-8.6) years of follow-up. An increased risk of TB was observed in participants with diabetes compared with those without diabetes (adjusted hazard ratio [aHR], 1.48; 95% CI, 1.42-1.53). Although participants with impaired fasting glucose did not show an increased risk of TB incidence (aHR, 0.97; 95% CI, 0.93-1.01), the risk of TB incidence increased with diabetes duration (new-onset diabetes, aHR, 1.32; 95% CI, 1.23-1.42; diabetes duration <5 years, aHR, 1.45; 95% CI, 1.36-1.54; diabetes duration ≥5 years, aHR, 1.57; 95% CI, 1.48-1.66). Among participants with new-onset diabetes, compared with those in the lowest decile (fasting plasma glucose [FPG] level ≥126 but <128 mg/dL), the risk of TB was significantly increased for those in the highest decile (FPG level ≥202 mg/dL, aHR, 1.79; 95% CI, 1.42-2.26). CONCLUSIONS AND RELEVANCE These findings suggest that longer diabetes duration is associated with development of TB, showing a dose-response association. Among participants with new-onset diabetes, incident TB was more common among those with FPG levels greater than or equal to 202 mg/dL.
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Affiliation(s)
- Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dahye Kim
- Department of Biostatistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Sang Youl Rhee
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Dong Wook Shin
- Supportive Care Center, Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
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Lesnic E, Malic A, Tafuni O. The impact of diabetes mellitus on the anti-tuberculosis treatment outcome: a series of cases from the Republic of Moldova. Med Pharm Rep 2021; 94:325-332. [PMID: 34430854 DOI: 10.15386/mpr-1974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/17/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background and aims The Republic of Moldova ranks among the European Region countries with the highest global incidence of tuberculosis. Almost 5% of the cases with pulmonary TB had been diagnosed with DM in 2017. The aim of this study was to assess the impact of diabetes mellitus on the anti-tuberculosis treatment effectiveness for the improvement of the disease outcome. Methods A retrospective, longitudinal and case-control study, which included a total number of 252 patients diagnosed with pulmonary tuberculosis and distributed into a study group of 93 patients diagnosed with diabetes mellitus and a control group of 159 patients without glycemic disorders was performed. The statistical analysis was performed using EpiInfo software. The statistical analysis of the differences between normally distributed continuous variables was tested with the Student T-test. Results Based on the collected data we established that the majority of the patients with glycemic disorders were diagnosed with the type 2 diabetes, associated with hyperglycemia and in half of them complications of diabetes were revealed. The age older 55 years and the low economical state were common characteristics of the diabetic patients. Tuberculosis was detected in every second diabetic patient through the radiological screening compared with the passive detection of most of the non-diabetic patients. The anti-tuberculosis treatment outcome was endangered by a higher rate of the adverse drug events in patients with diabetes, which contributed to death in 15%, lost to follow-up 7%, and therapeutic failure in 6%. Conclusions The anti-tuberculous treatment outcome in patients diagnosed with tuberculosis and diabetes mellitus was significantly diminished by glycemic disorders, history of the previous anti-tuberculous treatment and adverse drug reactions. Individualized therapeutic approach to tuberculosis could improve the treatment effectiveness.
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Affiliation(s)
- Evelina Lesnic
- Department of Pneumophthisiology, Nicolae Testemiţanu State Medicine and Pharmacy University, Republic of Moldova
| | - Alina Malic
- Department of Pneumophthisiology, Nicolae Testemiţanu State Medicine and Pharmacy University, Republic of Moldova
| | - Ovidiu Tafuni
- Department of Pneumophthisiology, Nicolae Testemiţanu State Medicine and Pharmacy University, Republic of Moldova
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Li F, Liu C, Jiang M, Wu S. Application of responsibility-based nursing in patients with both DM and PTB. Am J Transl Res 2021; 13:5011-5018. [PMID: 34150086 PMCID: PMC8205722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 01/07/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the application value of responsibility-based nursing intervention in the nursing of patients with both diabetes mellitus (DM) and pulmonary tuberculosis (PTB). METHODS A total of 180 patients with both DM and PTB admitted to our hospital from April 2019 to April 2020 were enrolled as research objects, of which 86 patients were under routine nursing intervention as a regular group (Reg group) and other 94 patients were under responsibility-based nursing intervention as a responsibility group (Res group). The unhealthy emotion, treatment compliance, self-efficacy, self-care ability, and life quality of both groups were evaluated after nursing intervention, and they were compared in blood glucose level and PTB treatment outcome. RESULTS After intervention, the Res group got lower self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores than the Reg group (both P<0.05). The Res group also got higher scores of self-efficacy, self-care ability, and life quality, and showed significantly higher treatment compliance rate and nursing satisfaction than the Reg group after intervention (all P<0.05). Additionally, after intervention, the Res group got higher scores of life quality than the Reg group (all P<0.05). The levels of fasting blood glucose (FBG), 2 hour postprandial blood glucose (2h PG), and glycosylated hemoglobin (HbA1c) in the Res group were lower than those in the Reg group, and the cavity closure rate, sputum negative conversion rate, and focus absorption rate of the Res group were all significantly higher than those of the Reg group (all P<0.05). CONCLUSION Responsibility-based nursing intervention can improve the treatment compliance, self-management ability, self-efficacy, and life quality of patients with both DM and PTB.
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Affiliation(s)
- Fang Li
- Department of 3 Internal Medicine, Hunan Province Chest Hospital Changsha 410013, Hunan Province, China
| | - Chunxiang Liu
- Department of 3 Internal Medicine, Hunan Province Chest Hospital Changsha 410013, Hunan Province, China
| | - Mina Jiang
- Department of 3 Internal Medicine, Hunan Province Chest Hospital Changsha 410013, Hunan Province, China
| | - Shu Wu
- Department of 3 Internal Medicine, Hunan Province Chest Hospital Changsha 410013, Hunan Province, China
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Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: a syndemic complicated by COVID-19. Med Clin (Barc) 2021; 157:288-293. [PMID: 34049681 PMCID: PMC8101986 DOI: 10.1016/j.medcli.2021.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/16/2023]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
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Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, España
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, España.
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, España
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Adlar F, Anthony W. Spontaneous Pneumothorax as a Complication in Concomitant Diabetic Ketoacidosis and Pulmonary Tuberculosis: A Case Report. CASE REPORTS IN ACUTE MEDICINE 2021. [DOI: 10.1159/000513324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Secondary spontaneous pneumothorax (SSP) can occur as a complication of several underlying diseases such as pulmonary tuberculosis (TB) or, rarely, diabetic ketoacidosis (DKA). As diabetes mellitus (DM) is significantly prevalent in tuberculosis patients, it is possible to have both TB and DKA concurrently. However, there has not been any documentation of SSP as a complication in concomitant DKA and pulmonary TB. In this report, we described a 30-year-old female who presented to the emergency department with a chief complaint of shortness of breath that had intensified since a day before. She was diagnosed with pulmonary TB 1 week before and had started on her anti-tuberculosis drugs regimen. Prior history of DM was not known. Physical examination showed a slight decrease in consciousness, tachycardia, tachypnea, Kussmaul breathing, decreased lung sounds in the right hemithorax and hyperresonant on percussion. Laboratory results showed leukocytosis and hyperglycemia, ketones were positive on urinalysis and arterial blood gas analysis indicated metabolic acidosis. Chest X-ray revealed pneumothorax in the right hemithorax. She was diagnosed with pneumothorax of the right hemithorax, DKA, sepsis and pulmonary TB. Treatment involved prompt placement of chest tube drainage, fluid rehydration, intravenous insulin, antibiotic, sodium bicarbonate and anti-tuberculosis drugs. Her condition improved after 9 days of uneventful hospitalization. We discussed how concomitant presence of both DKA and pulmonary TB can increase the likelihood of developing secondary spontaneous pneumothorax.
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Araia ZZ, Mesfin AB, Mebrahtu AH, Tewelde AG, Osman R, Tuumzghi HA. Diabetes Mellitus and Its Associated Factors in Tuberculosis Patients in Maekel Region, Eritrea: Analytical Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:515-523. [PMID: 33568928 PMCID: PMC7869713 DOI: 10.2147/dmso.s293557] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Both diabetes mellitus (DM) and tuberculosis (TB) are among the leading causes of morbidity and mortality in Eritrea. TB-DM comorbidity is known to complicate TB care, control and prevention. However, systematically studied epidemiological data on TB-DM comorbidity and its associated risk factors are lacking in this country. OBJECTIVE This study aimed to assess the prevalence of DM and its associated factors among TB patients in the Maekel region, Eritrea. METHODS Analytical cross-sectional study was conducted in eleven TB diagnostic and treatment sites. Pretested data extraction tool was used to collect data from medical records. Prevalence data were analysed using frequencies, proportions and median. To determine DM risk factors, univariable and multivariable logistic regression analysis was done with 95% CI and p value < 0.05 considered significant. RESULTS Out of total eligible (1134) TB cases, DM prevalence was 9.88%. Age and BMI were identified as independent risk factors for DM among TB patients. Higher odds of DM were found among TB patients aged 45-54 (aOR: 4.85[1.39-16.94], p= 0.013) and those ≥55 (aOR: 6.99[2.12-23.04], p= 0.001). TB cases with normal BMI were two times more likely to have DM (aOR: 2.00[1.23-3.26], p= 0.005) compared to those underweight. CONCLUSION The prevalence of DM among TB cases observed in this study is high, a clarion call to scale up current efforts to integrate TB-DM services within routine care. Furthermore, age and BMI were identified as independent risk factors for DM in TB cases, pointing to the need to pay attention to age and BMI status when managing this co-morbidity.
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Affiliation(s)
- Zenawi Zeramariam Araia
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
- Correspondence: Zenawi Zeramariam Araia National TB and Leprosy Control Program, Communicable Diseases Control Division, Ministry of Health, Asmara, EritreaTel +291-1-122129 Email
| | | | - Amanuel Hadgu Mebrahtu
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
| | | | - Randa Osman
- Orrota College of Medicine and Health Sciences, Asmara, Eritrea
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Mily A, Sarker P, Taznin I, Hossain D, Haq MA, Kamal SMM, Agerberth B, Brighenti S, Raqib R. Slow radiological improvement and persistent low-grade inflammation after chemotherapy in tuberculosis patients with type 2 diabetes. BMC Infect Dis 2020; 20:933. [PMID: 33287713 PMCID: PMC7722325 DOI: 10.1186/s12879-020-05473-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background Diabetes mellitus type 2 (DM) may impede immune responses in tuberculosis (TB) and thus contribute to enhanced disease severity. In this study, we aimed to evaluate DM-mediated alterations in clinical, radiological and immunological outcomes in TB disease. Methods Newly diagnosed pulmonary TB patients with or without DM (TB n = 40; TB-DM n = 40) were recruited in Dhaka, Bangladesh. Clinical symptoms, sputum smear and culture conversion as well as chest radiography were assessed. Peripheral blood and sputum samples were collected at the time of diagnosis (baseline) and after 1, 2 and 6 months of standard anti-TB treatment. Blood samples were also obtained from healthy controls (n = 20). mRNA expression of inflammatory markers in blood and sputum samples were quantified using real-time PCR. Results The majority of TB-DM patients had poor glycemic control (HbA1c > 8%) and displayed elevated pulmonary pathology (P = 0.039) particularly in the middle (P < 0.004) and lower lung zones (P < 0.02) throughout the treatment period. However, reduction of clinical symptoms and time to sputum smear and culture conversion did not differ between the groups. Transcripts levels of the pro-inflammatory cytokines IL-1β (P = 0.003 at month-1 and P = 0.045 at month-2) and TNF-α (P = 0.005 at month-1) and the anti-inflammatory cytokine IL-10 (P = 0.005 at month-2) were higher in peripheral blood after anti-TB treatment in TB-DM compared to TB patients. Conversely in sputum, TB-DM patients had reduced CD4 (P < 0.009 at month-1) and IL-10 (P = 0.005 at month-1 and P = 0.006 at month-2) transcripts, whereas CD8 was elevated (P = 0.016 at month-2). At 1- and 2-month post-treatment, sputum IL-10 transcripts were inversely correlated with fasting blood glucose and HbA1c levels in all patients. Conclusion Insufficient up-regulation of IL-10 in the lung may fuel persistent local inflammation thereby promoting lung pathology in TB-DM patients with poorly controlled DM.
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Affiliation(s)
- Akhirunnesa Mily
- Center for Infectious Medicine (CIM), Department of Medicine Huddinge, ANA Futura, Karolinska Institutet, Stockholm, Sweden.,Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Protim Sarker
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Inin Taznin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Delwar Hossain
- Respiratory Medicine, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, Bangladesh
| | - Md Ahsanul Haq
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - S M Mostofa Kamal
- National Institute of the Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - Birgitta Agerberth
- Clinical Microbiology, Department of Laboratory Medicine (Labmed), ANA Futura, Karolinska Institutet, Stockholm, Sweden
| | - Susanna Brighenti
- Center for Infectious Medicine (CIM), Department of Medicine Huddinge, ANA Futura, Karolinska Institutet, Stockholm, Sweden
| | - Rubhana Raqib
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh.
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Jacob S, George LS, Joy A, Mathew MM, Vijayakumar K, Kumar A, Kunoor A. Prevalence of diabetes mellitus and HIV/AIDS among tuberculosis patients in Kerala. J Family Med Prim Care 2020; 9:6209-6212. [PMID: 33681065 PMCID: PMC7928115 DOI: 10.4103/jfmpc.jfmpc_1583_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/29/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION It is estimated that 10 million people fall ill with Tuberculosis (TB) every year worldwide. TB continues to be in the top 10 causes of death globally with India being the home to the world's largest number of TB patients. One of the major factors attributing to this is the presence of comorbidities such as Diabetes Mellitus and HIV/AIDS. AIM The aim of this study was to determine the prevalence of comorbidities such as Diabetes mellitus & HIV/AIDS among the newly diagnosed TB patients in Kerala in 2019 and also to determine the factors associated with it. MATERIALS AND METHODS A cross-sectional study was carried out using the secondary data from NIKSHAY portal. There were a total of 16,527 cases of pulmonary and extrapulmonary TB cases reported from 14 districts of Kerala from January to September 2019. Using a checklist, data regarding the age, gender, type of case, Type of patient, site of disease, drug resistance were collected separately for TB patients suffering from Diabetes mellitus and HIV/AIDS. The data was then entered into Excel sheet and was analyzed using SPSS version 23. RESULTS Out of the total 16,527 study population, most of the patients were elderly above the age of 60 years (28.6%). The prevalence of Diabetes mellitus (22.6%) was higher among TB patients when compared to HIV/AIDS (1.2%). Males in the age group between 50-59 years were found to be significantly associated with TB- Diabetes Mellitus comorbidities. Diabetes was significantly associated with Pulmonary TB patients, while HIV/AIDS was significantly associated with extrapulmonary TB. CONCLUSION Both Diabetes Mellitus and HIV/AIDS are comorbidities that have a strong impact on the diagnosis and management of Tuberculosis patients. Therefore, there is an urgent need to prevent these comorbidities from occurring along with the implementation of early diagnosis and appropriate management strategies. This study is of prime importance especially among Primary care Physicians who are treating TB patients on routine basis. They are particularly important in TB control since they are usually the first to meet a TB suspect, before diagnosis occurs. Both HIV/AIDS and Diabetes mellitus are immunocompromised conditions and these comorbidities can affect the treatment outcomes of TB. Primary care physicians are essential in detecting TB suspects and treating them, thus contribute significantly to reducing the burden of TB.
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Affiliation(s)
- Sherin Jacob
- Department of Community Medicine & Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Leyanna Susan George
- Department of Community Medicine & Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Aleena Joy
- Department of Community Medicine & Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Minu Maria Mathew
- Department of Community Medicine & Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - K. Vijayakumar
- Department of Community Medicine & Public Health, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Anil Kumar
- Department of Microbiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Akhilesh Kunoor
- Department of Pulmonary Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Barriers and facilitators to bidirectional screening of TB-DM in Ghana: Healthcare workers' perspectives. PLoS One 2020; 15:e0235914. [PMID: 32663233 PMCID: PMC7360027 DOI: 10.1371/journal.pone.0235914] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background The tuberculosis (TB) and diabetes mellitus (DM) co-epidemic continues to increase globally. Low-and middle-income countries bear the highest burden of co-epidemic, and Ghana is no exception. In 2011, the World Health Organisation (WHO) responded to this global challenge by launching a collaborative framework with a view to guide countries in implementing their DM and TB care, prevention and control plans. Subsequently, several countries, including Ghana, adopted this framework and began implementing bidirectional screening of TB and DM patients. Almost a decade later since the launch of the framework, the implementation of bidirectional screening in Ghana has not been subjected to empirical research. This study explored the barriers and facilitators to bidirectional screening through the lenses of the implementing healthcare workers. Methods This was an exploratory qualitative study conducted in three public health facilities offering both TB and DM services in Northern Ghana. In-depth interviews, document review and observations, were used to generate data. In total twenty-three healthcare workers (doctors, nurses, prescriber, health managers and TB task- shifting officers delivering care in TB and DM clinics) were interviewed, using semi-structured interview guides. The interview questions solicited information on the screening process, including knowledge of the collaborative framework, comorbidity, collaboration and workload. Results Six themes emerged from the analysis, of which two (Increase in staff capacity, and Institutionalisation of bidirectional screening) were facilitators, and four (Delays in screening, Fear and stigmatization of TB, Poor collaboration between TB and DM units, and Skewed funding for screening) were barriers. Conclusions The implementation of bidirectional screening at public health facilities in Ghana was evident in this study and increased staff capacity, funding and institutionalisation enhanced the policy implementation process. However, the screening of TB patients for DM is yet to be prioritised, and emphasis should be put on the design for cost-effective screening approaches for low- and middle-income countries.
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Suárez I, Fünger SM, Kröger S, Rademacher J, Fätkenheuer G, Rybniker J. The Diagnosis and Treatment of Tuberculosis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:729-735. [PMID: 31755407 DOI: 10.3238/arztebl.2019.0729] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 04/21/2019] [Accepted: 08/01/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Around 10 million people worldwide contract tuberculosis every year. According to the World Health Organization (WHO), approximately one-quarter of the world's population is latently infected with Mycobacterium tuberculosis. In Ger- many, the incidence of tuberculosis was in decline over several decades but rose in 2015 to 7.3 new cases per 100 000 persons. In 2018, a total of 5429 new cases were documented, corresponding to 6.5 new cases per 100 000 persons. METHODS This article is based on literature retrieved by a selective search in PubMed and on the authors' clinical experience. RESULTS Tuberculosis involves the lungs in almost 75% of patients but can generally involve any organ. In Germany, the majority of patients come from high-incidence countries. If a patient's differential diagnosis includes tuberculosis, the main tests for the detection of the pathogen in sputum and tissue samples are culture (the gold standard), microscopy, and nucleic acid amplification tests. Imaging studies are also used for diagnosis and follow-up. The standard treatment consists of a combination of isoniazid, rifampicin, ethambutol, and pyrazinamide, followed by a combination of isoniazid and rifampicin only. Liver damage is one of the more common adverse effects of this treatment, arising in 2.4% of patients. Multidrug-resistant tuberculosis, which is rare in Germany (around 100 cases per year), should be treated in special- ized centers. CONCLUSION Rapid diagnosis and targeted treatment are essential to prevent an unfavorable course of the disease as well as its transmission to other individuals. In patients presenting with unclear symptoms, tuberculosis should always be considered as a differential diagnosis. The diagnosis of latent tuberculosis and decision-making regarding its treatment are difficult because of the lack of specific biomarkers and of relevant data from clinical trials.
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Affiliation(s)
- Isabelle Suárez
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Cologne; German Center for Infection Research, Cologne-Bonn, Partner Site Cologne; Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin; Department of Pneumonology, Hanover Medical School
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Hernandez AM, Jia P, Kim HY, Cuadros DF. Geographic Variation and Associated Covariates of Diabetes Prevalence in India. JAMA Netw Open 2020; 3:e203865. [PMID: 32356884 PMCID: PMC7195623 DOI: 10.1001/jamanetworkopen.2020.3865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Diabetes is a severe metabolic disorder affecting human health worldwide, with increasing prevalence in low- and middle-income countries. Gaps in knowledge regarding factors that lead to diabetes and its association with tuberculosis (TB) endemicity at the national scale still exist, mainly because of the lack of large-scale dual testing and appropriate evaluation methods. OBJECTIVES To identify locations in India where diabetes prevalence is concentrated, examine the association of diabetes with sociodemographic and behavioral covariates, and uncover where high regional TB endemicity overlaps with diabetes. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included 803 164 men aged 15 to 54 years and women aged 15 to 49 years who participated in the Demographic Health Survey (2015-2016), carried out by the India Ministry of Health and Family Welfare using a 2-stage clustered sampling, which included a diabetes estimation component. The survey was conducted from January 2015 to December 2016, and data analysis was conducted from July 2018 to January 2019. EXPOSURES Self-reported diabetes status. MAIN OUTCOMES AND MEASURES Self-reported diabetes status was used to estimate the association of covariates, including educational level, sex, age, religion, marital status, alcohol use, tobacco use, obesity status, and household socioeconomic level, with diabetes prevalence. Additionally, regional tuberculosis endemicity level, estimated using the India TB report for 2014 from the Revised National TB Program, was included to evaluate the national extent of the spatial overlap of diabetes and TB. RESULTS Among 803 164 sampled individuals (691 982 [86.2%] women; mean [SD] age, 30.09 [9.97] years), substantial geographic variation in diabetes prevalence in India was found, with a concentrated burden at the southern coastline (cluster 1, Andhra Pradesh and Telangana: prevalence, 3.01% [1864 of 61 948 individuals]; cluster 2, Tamil Nadup and Kerala: prevalence, 4.32% [3429 of 79 435 individuals]; cluster 3, east Orissa: prevalence, 2.81% [330 of 11 758 individuals]; cluster 4, Goa: prevalence, 4.43% [83 of 1883 individuals]). Having obesity and overweight (odds ratio [OR], 2.44; 95% CI, 2.18-2.73; P < .001; OR, 1.66; 95% CI, 1.52-1.82; P < .001, respectively), smoking tobacco (OR, 3.04; 95% CI, 1.66-5.56; P < .001), and consuming alcohol (OR, 2.01; 95% CI, 1.37-2.95; P < .001) were associated with increased odds of diabetes. Regional TB endemicity and diabetes spatial distributions showed that there is a lack of consistent geographical overlap between these 2 diseases (eg, TB cluster 4: 60 213 TB cases; 186.79 diabetes cases in 20 183.88 individuals; 0.93% diabetes prevalence; TB cluster 8: 47 381 TB cases; 180.53 diabetes cases in 22 449.18 individuals; 0.80% diabetes prevalence; TB cluster 9: 37 620 TB cases, 601.45 diabetes cases in 12 879.36 individuals; 4.67% diabetes prevalence). CONCLUSIONS AND RELEVANCE In this study, identifying spatial clusters of diabetes on the basis of a nationally representative survey suggests that India may face different levels of disease severity, and each region might need to implement control strategies that are more appropriate for its unique epidemiologic context.
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Affiliation(s)
- Andrés M. Hernandez
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, Ohio
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, Ohio
| | - Peng Jia
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong, China
- State Key Laboratory of Urban and Regional Ecology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, China
| | - Hae-Young Kim
- Africa Health Research Institute, Kwazulu-Natal, South Africa
- University of KwaZulu-Natal School of Nursing and Public Health, Kwazulu-Natal, South Africa
| | - Diego F. Cuadros
- Department of Geography and Geographic Information Science, University of Cincinnati, Cincinnati, Ohio
- Health Geography and Disease Modeling Laboratory, University of Cincinnati, Cincinnati, Ohio
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GADALLAH M, ABDELMONIEM W, FAWZY M, MOKHTAR A, MOHSEN A. Multicenter screening of diabetic patients for detecting new cases of tuberculosis: an approach to intensify the case detection rate of tuberculosis in developing countries with high prevalence of diabetes. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E343-E348. [PMID: 31967091 PMCID: PMC6953452 DOI: 10.15167/2421-4248/jpmh2019.60.4.883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 08/28/2019] [Indexed: 11/16/2022]
Abstract
Introduction Tuberculosis (TB) is a major public health problem in most of developing countries. Meanwhile, the prevalence of type 2 diabetes mellitus (DM) is also increasing rapidly. Objectives To describe the feasibility of implementing screening test for tuberculosis among diabetic patients and identifying factors associated with high detection rate. Methods Study Design: Multi-center cross-sectional study. This study was implemented in the governmental healthcare settings. To diagnose TB among diabetics, we used a symptom-based questionnaire that included the symptoms of suspected TB according to the guidelines of National Tuberculosis Program in Egypt. Results Among 4283 adult diabetics, 14 TB cases were diagnosed; 9 known TB cases and 5 newly detected cases. The number needed to detect one new case of TB was 855. Male diabetics and who those suffered from liver disease experienced a significantly higher prevalence of TB and a higher detection rate of new active cases. Conclusions Screening for TB among diabetics in routine governmental healthcare services was successfully implemented. Screening DM patients in countries with a high prevalence of DM will reveal a significant number of active TB cases, which will in turn improve the case detection rate of TB.
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Affiliation(s)
- M. GADALLAH
- Department of Community Medicine, Faculty of Medicine, Ain Shams University, Egypt
- Correspondence: Mohsen Gadallah, Department of Community Medicine, Faculty of Medicine, Ain Shams University, Ramsis Street, Abbassyia Square, Cairo-Egypt, 11566 - E-mail:
| | - W. ABDELMONIEM
- Ministry of Health and Population, Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - M. FAWZY
- Ministry of Health and Population, Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - A. MOKHTAR
- Ministry of Health and Population, Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - A. MOHSEN
- Department of Community Medicine, National Research Centre, Cairo, Egypt
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He L, Zhang G, Wei M, Zhao Y, Chen W, Peng Q, Meng G. Effect of Individualized Dietary Intervention on Oxidative Stress in Patients with Type 2 Diabetes Complicated by Tuberculosis in Xinjiang, China. Diabetes Ther 2019; 10:2095-2105. [PMID: 31538317 PMCID: PMC6848526 DOI: 10.1007/s13300-019-00691-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION This study aimed to examine the effect of individual dietary intervention on nutrition and oxidative stress of patients with type 2 diabetes mellitus (T2DM) complicated by pulmonary tuberculosis (PTB) in Xinjiang. METHODS A total of 164 patients with T2DM and PTB from January 2018 to December 2018 in the Chest Hospital of Xinjiang Uyghur Autonomous Region were included. According to the random number table method, the patients were divided into an experimental group (n = 82) and control group (n = 82). The original treatments of PTB and T2DM were maintained. The control group was treated with a self-controlled diet, while the experimental group was treated with an individual quantitative dietary intervention. All patients included in our study were closely followed up for 3 months and the serum levels of variables related to nutrition, oxidative stress, and blood glucose were measured to compare each patient's nutritional and oxidative stress after the intervention. Proportions of patients with sputum testing positive for bacteria before and after the intervention were also recorded and compared between the two groups. RESULTS There were no significant differences between the two groups with regard to age, sex, labor intensity, marital status, course and treatment of diabetes, and proportion of patients with sputum positive for bacteria before the intervention (P > 0.05). There were statistically significant differences between the two groups in variables to related nutrition and oxidative stress, especially SOD which was increased by 13.2% in the experimental group and 2.5% in the control group after intervention (P < 0.05). The proportion of patients with sputum positive for bacteria in the experimental group was significantly lower than that in the control group, and the difference was statistically significant (P < 0.05). CONCLUSION A combination of individual quantitative dietary interventions can improve the nutritional status of patients with T2DM-PTB and adjust the oxidative stress. This method provides a theoretical basis for a reasonable diet in patients with T2DM-PTB. TRIAL REGISTRATION ChiCTR900025477 (Retrospectively registered).
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Affiliation(s)
- Liyun He
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Guoming Zhang
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Meng Wei
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Yanjun Zhao
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Weixing Chen
- Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, 830000, Xinjiang, People's Republic of China
| | - Qiaojun Peng
- The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830000, Xinjiang, People's Republic of China.
| | - Guiyun Meng
- Chest Hospital of Xinjiang Uyghur Autonomous Region, Urumqi, 830000, Xinjiang, People's Republic of China.
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Jo EK, Silwal P, Yuk JM. AMPK-Targeted Effector Networks in Mycobacterial Infection. Front Microbiol 2019; 10:520. [PMID: 30930886 PMCID: PMC6429987 DOI: 10.3389/fmicb.2019.00520] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/28/2019] [Indexed: 12/22/2022] Open
Abstract
AMP-activated protein kinase (AMPK), a key metabolic regulator, plays an essential role in the maintenance of energy balance in response to stress. Tuberculosis (TB), primarily caused by the pathogen Mycobacterium tuberculosis (Mtb), remains one of the most important infectious diseases worldwide, characterized by both high incidence and mortality. Development of new preventive and therapeutic strategies against TB requires a profound understanding of the various host-pathogen interactions that occur during infection. Emerging data suggest that AMPK plays an essential regulatory role in host autophagy, mitochondrial biogenesis, metabolic reprogramming, fatty acid β-oxidation, and the control of pathologic inflammation in macrophages during Mtb infection. As described in this review, recent studies have begun to define the functional properties of AMPK modulators capable of restricting intracellular bacteria and promoting host defenses. Several host defense factors in the context of AMPK activation also participate in autophagic and non-autophagic pathways in a coordinated manner to enhance antimicrobial responses against Mtb infection. A better understanding of these AMPK-targeted effector networks offers significant potential for the development of novel therapeutics for human TB and other infectious diseases.
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Affiliation(s)
- Eun-Kyeong Jo
- Department of Microbiology, School of Medicine, Chungnam National University, Daejeon, South Korea
- Infection Control Convergence Research Center, School of Medicine, Chungnam National University, Daejeon, South Korea
- Department of Medical Science, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Prashanta Silwal
- Department of Microbiology, School of Medicine, Chungnam National University, Daejeon, South Korea
- Infection Control Convergence Research Center, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Jae-Min Yuk
- Infection Control Convergence Research Center, School of Medicine, Chungnam National University, Daejeon, South Korea
- Department of Medical Science, School of Medicine, Chungnam National University, Daejeon, South Korea
- Department of Infection Biology, School of Medicine, Chungnam National University, Daejeon, South Korea
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