1
|
Yang J, Kim SH, Sim JK, Gu S, Seok JW, Bae DH, Cho JY, Lee KM, Choe KH, Lee H, Yang B, Min KH. Tuberculosis survivors and the risk of cardiovascular disease: analysis using a nationwide survey in Korea. Front Cardiovasc Med 2024; 11:1364337. [PMID: 39185138 PMCID: PMC11341360 DOI: 10.3389/fcvm.2024.1364337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024] Open
Abstract
Background Although the association between tuberculosis (TB) and cardiovascular disease (CVD) has been reported in several studies and is explained by mechanisms related to chronic inflammation, few studies have comprehensively evaluated the association between TB and CVD in Korea. Methods Using the Korea National Health and Nutrition Survey, we classified individuals according to the presence or absence of previous pulmonary TB was defined as the formal reading of a chest radiograph or a previous diagnosis of pulmonary TB by a physician. Using multivariable logistic regression analyses, we evaluated the association between the 10-year atherosclerotic cardiovascular disorder (ASCVD) risk and TB exposure, as well as the 10-year ASCVD risk according to epidemiological characteristics. Results Among the 69,331 participants, 4% (n = 3,101) had post-TB survivor group. Comparing the 10-year ASCVD risk between the post-TB survivor and control groups, the post-TB survivor group had an increased 10-year ASCVD risk in the high-risk group (40.46% vs. 24.00%, P < 0.001). Compared to the control group, the intermediate- and high-risk groups had also significantly increased 10-year ASCVD risks (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.04-1.23 and OR 1.69, 95% CI 1.59-1.78, respectively) in the post-TB survivor group. In the association of CVD among post-TB survivors according to epidemiologic characteristics, age [adjusted OR (aOR) 1.10, 95% CI 1.07-1.12], current smoking (aOR 2.63, 95% CI 1.34-5.14), a high family income (aOR 2.48, 95% CI 1.33-4.62), diabetes mellitus (aOR 1.97, 95% CI 1.23-3.14), and depression (aOR 2.06, 95% CI 1.03-4.10) were associated with CVD in the post-TB survivor group. Conclusions Our study findings suggest a higher 10-year ASCVD risk among TB survivors than healthy participants. This warrants long-term cardiovascular monitoring and management of the post-TB population.
Collapse
Affiliation(s)
- Jiyoul Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sun-Hyung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jae Kyeom Sim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seonhye Gu
- Department of Epidemiology and Health Informatics, Korea University, Seoul, Republic of Korea
| | - Jeong Won Seok
- Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Dae-Hwan Bae
- Department of Cardiology, Chungbuk National University College of Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jun Yeun Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Ki Man Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kang Hyeon Choe
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Hyun Lee
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bumhee Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
2
|
de Oliveira Bonfim FF, Villar LM, Croda J, Pereira JG, Guimarães ACS, da Silva SR, Maymone Gonçalves CC, Leonardo LFT, de Rezende Romeira GR, Cesar GA, Weis-Torres S, de Oliveira Landgraf de Castro V, Horta MA, Simionatto S, Motta-Castro ARC, de Paula VS. High silent prevalence of human herpesvirus 1 (HSV-1) infection affecting the indigenous reservation of the municipality of Dourados, Central-West Brazil. BMC Infect Dis 2024; 24:700. [PMID: 39020287 PMCID: PMC11253429 DOI: 10.1186/s12879-024-09497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/12/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND The indigenous population located in the central region of Brazil, is the second largest in terms of population size in the country. The Indigenous Reserve of Dourados has risk factors that increase the vulnerability of the indigenous population to infectious diseases, especially Human alphaherpesvirus (HSV-1), a neglected disease with high prevalence in priority populations in developing countries. The virus can also cause many more severe diseases, including widespread neonatal infections, herpetic keratitis, and herpes encephalitis, which can be fatal if left untreated. We estimated the prevalence of anti-HSV-1 antibodies and correlated it with the demographic and behavioral characteristics of the Indigenous population of the Jaguapirú and Bororó villages (Dourados, Mato Grosso do Sul (MS), Brazil). METHODS Our approach was cross-sectional. From March 2017 to November 2018. Using anti-HSV-1 (Gg1) IgM and anti-HSV-1 (gG1) IgG Euroimmun and the detection and quantification of HSV-1 viral load in plasma samples, through real-time PCR. The maps were constructed using QGIS and the statistical analyses using R Studio software. RESULTS A total of 1138 individuals (> 18 years old) were enrolled. The prevalence of anti-HSV-1 IgM and IgG were 20% and 97.5%, respectively. The prevalence of anti-HSV-1 antibodies for IgG was higher in both sexes. Anti-HSV-1 IgM antibodies were present in 17.1%, 21.2%, 12.5%, and 22% of the participants with urinary problems, genital wounds, genital warts, and urethral discharge, respectively. Real-time PCR was used for confirmatory testing; HSV-1 DNA was detected in 25.6% (54/211) of anti-HSV1 IgM-positive samples. Viral loads ranged from 5.99E + 02 to 3.36E + 13. CONCLUSIONS The seroprevalence of HSV-1 IgM and detection of HSV-1 DNA in the Indigenous population confirmed high silent prevalence. Furthermore, the seroprevalence of HSV-1 in the Indigenous population was higher than that reported in the general adult Brazilian population. Various socioeconomic factors, drug use, and health and sexual behaviors could contribute to the facilitation of HSV-1 transmission in the Indigenous population. Our results may help develop culturally appropriate intervention programs that eliminate health access barriers and improve the implementation of public health policies aimed at promoting information regarding the prevention, treatment, and control of HSV-1 infection in Brazilian Indigenous populations.
Collapse
Grants
- 001 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 001 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 001 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 001 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 001 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior , Brasil
- 440245/2018-4 Conselho Nacional de Desenvolvimento Científico e Tecnológico
- 440245/2018-4 Conselho Nacional de Desenvolvimento Científico e Tecnológico
- 440245/2018-4 Conselho Nacional de Desenvolvimento Científico e Tecnológico
- 440245/2018-4 Conselho Nacional de Desenvolvimento Científico e Tecnológico
- 440245/2018-4 Conselho Nacional de Desenvolvimento Científico e Tecnológico
- 440245/2018-4 Conselho Nacional de Desenvolvimento Científico e Tecnológico
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- 041/2017 Fundação de Apoio ao Desenvolvimento do Ensino, Ciência e Tecnologia do Estado de Mato Grosso do Sul
- Fundação Oswaldo Cruz , Brasil
- Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro
- Secretaria do Estado de Saúde of Mato Grosso do Sul
Collapse
Affiliation(s)
| | - Livia Melo Villar
- Viral Hepatitis Laboratory, Oswaldo Cruz Foundation, Rio de Janeiro, 21040360, Brazil
| | - Julio Croda
- Department of Epidemiology of Microbial Diseases, Universidade Federal de Mato Grosso do Sul-UFMS, Campo Grande, Mato Grosso do Sul, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz, Campo Grande, Mato Grosso do Sul, Brazil
| | - Jéssica Gonçalves Pereira
- Molecular Virology and Parasitology Laboratory, Oswaldo Cruz Foundation, Rio de Janeiro, 21040360, Brazil
| | | | | | - Crhistinne Cavalheiro Maymone Gonçalves
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA
- State Department of Health of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, 79031350, Brazil
| | | | - Grazielli Rocha de Rezende Romeira
- Center for Biological and Health Sciences, Blood Center Sector, Federal University of Mato Grosso do Sul, Campo Grande, Grosso do Sul, 79070900, Brazil
| | - Gabriela Alves Cesar
- Center for Biological and Health Sciences, Blood Center Sector, Federal University of Mato Grosso do Sul, Campo Grande, Grosso do Sul, 79070900, Brazil
| | - Sabrina Weis-Torres
- Center for Biological and Health Sciences, Blood Center Sector, Federal University of Mato Grosso do Sul, Campo Grande, Grosso do Sul, 79070900, Brazil
| | | | - Marco Aurélio Horta
- Oswaldo Cruz Foundation, Biosafety Level 3 Facility (BSL-3), Rio de Janeiro, 21040360, Brazil
| | - Simone Simionatto
- Health Sciences Research Laboratory, Federal University of Grande Dourados (UFGD), Dourados, Mato Grosso do Sul, Brazil
| | - Ana Rita Coimbra Motta-Castro
- Center for Biological and Health Sciences, Blood Center Sector, Federal University of Mato Grosso do Sul, Campo Grande, Grosso do Sul, 79070900, Brazil
- State Department of Health of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, 79031350, Brazil
| | - Vanessa Salete de Paula
- Molecular Virology and Parasitology Laboratory, Oswaldo Cruz Foundation, Rio de Janeiro, 21040360, Brazil.
| |
Collapse
|
3
|
Singh N, Koegelenberg CFN. Smoking cessation for hospitalised inpatients: Butt where do we begin? Afr J Thorac Crit Care Med 2024; 30:e2379. [PMID: 39171158 PMCID: PMC11334889 DOI: 10.7196/ajtccm.2024.v30i2.2379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Affiliation(s)
- Nevadna Singh
- Division of Pulmonology, Department of Medicine, Faculty of
Medicine and Health Sciences, Stellenbosch University and Tygerberg
Hospital, Cape Town, South Africa
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Faculty of
Medicine and Health Sciences, Stellenbosch University and Tygerberg
Hospital, Cape Town, South Africa
| |
Collapse
|
4
|
Soin G, Kok J, Allie A, Bhawoodien Q, Dheda K, Geragotellis A, Mulisa K, Sibi A, Tarwa T, Leone F, van Zyl-Smit RN. The need for smoking cessation counselling and nicotine withdrawal therapy for hospitalised patients: A smoking point prevalence study at Groote Schuur Hospital, Cape Town, South Africa. Afr J Thorac Crit Care Med 2024; 30:e1360. [PMID: 39171153 PMCID: PMC11334896 DOI: 10.7196/ajtccm.2024.v30i2.1360] [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: 08/04/2023] [Accepted: 03/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background South Africa has high tobacco-attributable mortality and a smoking prevalence of 32.5% in males and 25.6% in females. There are limited data on smoking prevalence and desire to quit in hospitalised patients, who have limited access to smoking cessation services. Objectives To determine smoking prevalence and the extent of nicotine withdrawal symptoms, using a hospital-wide inpatient survey. Methods A 1-day point prevalence survey was conducted at Groote Schuur Hospital, Cape Town. All wards except the haematology isolation, active labour and psychiatry lock-up wards were evaluated. Smoking status, withdrawal symptoms and desire to quit were established. Results Smoking status was confirmed in 85.8% of inpatients (n=501/584), of whom 31.9% (n=160) were current smokers; 43.5% (n=101/232) of male and 21.9% (n=59/269) of female inpatients were smokers. Documentation and confirmation of smoking status was highest in the maternity wards (100%) and lowest in the surgical wards (79.6%) and intensive care units (70.0%). Smoking prevalence ranged from 47.6% in male surgical patients to 15.2% in maternity patients. Of the smokers, 54.5% reported being motivated to quit, with a median (interquartile range) Fagerström test for nicotine dependence score of 4 (2 - 6), and 31.4% reported moderate to severe cravings to smoke, highest in the surgical wards. Conclusion Smoking prevalence was higher in hospitalised patients than in the local general population. Many inpatients were not interested in quitting; however, a third had significant nicotine withdrawal symptoms. All inpatients who are active smokers should be identified and given universal brief smoking cessation advice. Patients with severe withdrawal symptoms should be allowed to smoke outside, and nicotine withdrawal pharmacotherapy should be provided to those who are bedbound or express a desire to stop smoking during the current admission. Study synopsis What the study adds. A single data point prevalence study of active smokers at Groote Schuur Hospital, Cape Town, was conducted. The prevalence of smoking was higher in the hospitalised patients than in the general community, but not all smokers were identified by the clinicians. Although symptoms of nicotine withdrawal were severe in some patients, motivation to quit smoking was not related to the degree of withdrawal being experienced. Many patients were not motivated to quit smoking.Implications of the findings. Better identification of inpatient smokers is required, and all should be given smoking cessation advice. Withdrawal symptoms can be severe in some patients, and those who are not interested in stopping smoking should allowed to smoke outside or be provided with nicotine withdrawal pharmacotherapy while in hospital. Those who are willing to quit should be supported as well as possible, including provision of nicotine replacement therapy or varenicline, and followed up after discharge as best practice.
Collapse
Affiliation(s)
- G Soin
- Division of Pulmonology and UCT Lung Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa
| | - J Kok
- Faculty of Health Sciences, University of Cape Town, South Africa
| | - A Allie
- Faculty of Health Sciences, University of Cape Town, South Africa
| | - Q Bhawoodien
- Faculty of Health Sciences, University of Cape Town, South Africa
| | - K Dheda
- Faculty of Health Sciences, University of Cape Town, South Africa
| | - A Geragotellis
- Faculty of Health Sciences, University of Cape Town, South Africa
| | - K Mulisa
- Faculty of Health Sciences, University of Cape Town, South Africa
| | - A Sibi
- Faculty of Health Sciences, University of Cape Town, South Africa
| | - T Tarwa
- Faculty of Health Sciences, University of Cape Town, South Africa
- Molecular Mycobacteriology Research Unit, Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University
of Cape Town, South Africa
| | - F Leone
- Division of Pulmonology, University of Pennsylvania, USA
| | - R N van Zyl-Smit
- Division of Pulmonology and UCT Lung Institute, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa
| |
Collapse
|
5
|
Faust L, Caceres-Cardenas G, Martinez L, Huddart S, Vidal JR, Corilloclla-Torres R, Ayllon MC, Benedetti A, Pai M, Ugarte-Gil C. Tuberculosis case notifications and outcomes in Peruvian prisons prior to and during the COVID-19 pandemic: a national-level interrupted time series analysis. LANCET REGIONAL HEALTH. AMERICAS 2024; 33:100723. [PMID: 38800646 PMCID: PMC11117008 DOI: 10.1016/j.lana.2024.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 05/29/2024]
Abstract
Background The COVID-19 pandemic has significantly disrupted tuberculosis (TB) programs, making it urgent to focus TB elimination efforts on key populations. People experiencing incarceration are at high risk for TB, however, how COVID-19-related disruptions have impacted incarcerated populations with TB is unknown. Methods Using Peruvian National TB Program data from Jan 2018 to Dec 2021, an interrupted time series of drug-susceptible (DS) TB case notifications pre- and during COVID-19 was conducted (cut-off date: COVID-19 emergency declaration in Peru, 16 March 2020). The effect of TB care occurring pre-vs. during COVID-19 on TB treatment success in the incarcerated and non-incarcerated populations was explored using logistic regression. Findings DS-TB cases notified in prisons from Jan 2018 to Dec 2021 (n = 10,134) represented 10% of all cases notified in the country (n = 101,507). In the first week of COVID-19, DS-TB case notifications dropped by 61.2% (95% CI: 59.9-62.7%) in the non-incarcerated population and 17.7% (95% CI: 17.5-17.9%) among the incarcerated population. TB treatment success was significantly lower in people receiving TB care entirely during the COVID-19 pandemic vs. before COVID-19 in the non-incarcerated population (OR: 0.81, 95% CI: 0.78-0.85), but not statistically significantly lower in the incarcerated population (OR: 0.88, 95% CI: 0.76-1.01). Incarceration status was not found to modify the effect of COVID-19 period on TB treatment outcomes (OR: 1.07, 95% CI: 0.92-1.25), although treatment success was higher in the incarcerated population (OR [incarcerated vs. not incarcerated, pre-COVID]: 1.52, 95% CI: 1.39-1.67). Interpretation Both incarcerated and non-incarcerated populations experienced a large drop in DS-TB case notifications (although higher in the non-incarcerated population). Lower TB treatment success among those receiving care during COVID-19 indicates significant TB service disruptions in the overall population. The finding that incarceration at time of diagnosis was associated with treatment success is plausible in Peru given increased screening and stricter treatment monitoring in prisons. Funding Canadian Institutes of Health Research (Funding Reference Number: 179418) .
Collapse
Affiliation(s)
- Lena Faust
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- McGill International TB Centre, McGill University, Montréal, Canada
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Sophie Huddart
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco, San Francisco, USA
- UCSF Center for Tuberculosis, University of California San Francisco, San Francisco, USA
| | - Julia Rios Vidal
- Dirección De Control y Prevención de la Tuberculosis (DPCT), Ministerio de Salud, Lima, Perú
| | | | | | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
- McGill International TB Centre, McGill University, Montréal, Canada
| | - César Ugarte-Gil
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Perú
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| |
Collapse
|
6
|
Audley G, Raubenheimer P, Symons G, Mendelson M, Meintjes G, Ntusi NAB, Wasserman S, Dlamini S, Dheda K, van Zyl-Smit R, Calligaro G. High-flow nasal oxygen in resource-constrained, non-intensive, high-care wards for COVID-19 acute hypoxaemic respiratory failure: Comparing outcomes of the first v. third waves at a tertiary centre in South Africa. Afr J Thorac Crit Care Med 2024; 30:e1151. [PMID: 38756391 PMCID: PMC11094705 DOI: 10.7196/ajtccm.2024.v30i1.1151] [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: 06/05/2023] [Accepted: 01/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background High-flow nasal oxygen (HFNO) is an accepted treatment for severe COVID-19-related acute hypoxaemic respiratory failure (AHRF). Objectives To determine whether treatment outcomes at Groote Schuur Hospital, Cape Town, South Africa, during the third COVID-19 wave would be affected by increased institutional experience and capacity for HNFO and more restrictive admission criteria for respiratory high-care wards and intensive care units. Methods We included consecutive patients with COVID-19-related AHRF treated with HFNO during the first and third COVID-19 waves. The primary endpoint was comparison of HFNO failure (composite of the need for intubation or death while on HFNO) between waves. Results A total of 744 patients were included: 343 in the first COVID-19 wave and 401 in the third. Patients treated with HFNO in the first wave were older (median (interquartile range) age 53 (46 - 61) years v. 47 (40 - 56) years; p<0.001), and had higher prevalences of diabetes (46.9% v. 36.9%; p=0.006), hypertension (51.0% v. 35.2%; p<0.001), obesity (33.5% v. 26.2%; p=0.029) and HIV infection (12.5% v. 5.5%; p<0.001). The partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2 /FiO2 ) ratio at HFNO initiation and the ratio of oxygen saturation/FiO2 to respiratory rate within 6 hours (ROX-6 score) after HFNO commencement were lower in the first wave compared with the third (median 57.9 (47.3 - 74.3) mmHg v. 64.3 (51.2 - 79.0) mmHg; p=0.005 and 3.19 (2.37 - 3.77) v. 3.43 (2.93 - 4.00); p<0.001, respectively). The likelihood of HFNO failure (57.1% v. 59.6%; p=0.498) and mortality (46.9% v. 52.1%; p=0.159) did not differ significantly between the first and third waves. Conclusion Despite differences in patient characteristics, circulating viral variant and institutional experience with HFNO, treatment outcomes were very similar in the first and third COVID-19 waves. We conclude that once AHRF is established in COVID-19 pneumonia, the comorbidity profile and HFNO provider experience do not appear to affect outcome. Study synopsis What the study adds. This study adds to the body of evidence demonstrating the utility of high-flow nasal oxygen (HFNO) in avoiding invasive mechanical ventilation (IMV) in patients with severe COVID-19 hypoxaemic respiratory failure, and shows that this utility remained consistent across different waves of the COVID-19 pandemic.Implications of the study. In resource-constrained settings, HFNO is a feasible non-invasive alternative to IMV and can be employed with favourable and consistent outcomes outside traditional critical care wards. It also confirms that the degree of gas exchange abnormality, and not pre-existing patient-related factors, circulating wave variant or provider experience, is the main predictor of HFNO failure.
Collapse
Affiliation(s)
- G Audley
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
| | - P Raubenheimer
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
| | - G Symons
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa
| | - G Meintjes
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town,
South Africa
| | - N A B Ntusi
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town,
South Africa
- South African Medical Research Council/University of Cape Town Extramural Research Unit on the Intersection of Noncommunicable Diseases
and Infectious Diseases, University of Cape Town, South Africa
| | - S Wasserman
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa
| | - S Dlamini
- Division of General Internal Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur
Hospital, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote
Schuur Hospital, Cape Town, South Africa
| | - K Dheda
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- South African Medical Research Council/University of Cape Town Extramural Research Unit on the Intersection of Noncommunicable Diseases
and Infectious Diseases, University of Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town,
South Africa; South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, South Africa
| | - R van Zyl-Smit
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
| | - G Calligaro
- Division of Pulmonology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute, University of Cape Town,
South Africa; South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, South Africa
| |
Collapse
|
7
|
Katoto PDMC, Bihehe D, Brand A, Mushi R, Kusinza A, Alwood BW, van Zyl-Smit RN, Tamuzi JL, Sam-Agudu NA, Yotebieng M, Metcalfe J, Theron G, Godri Pollitt KJ, Lesosky M, Vanoirbeek J, Mortimer K, Nawrot T, Nemery B, Nachega JB. Household air pollution and risk of pulmonary tuberculosis in HIV-Infected adults. Environ Health 2024; 23:6. [PMID: 38233832 PMCID: PMC10792790 DOI: 10.1186/s12940-023-01044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND In low- and middle-income countries countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection. METHODS We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB. RESULTS We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/week were more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]. CONCLUSION Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.
Collapse
Affiliation(s)
- Patrick D M C Katoto
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa.
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo.
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Dieudonné Bihehe
- Department of Internal Medicine, Université Evangélique en Afrique, Bukavu, DR, Congo
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Raymond Mushi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Aline Kusinza
- Department of Medicine, Division of Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Brian W Alwood
- Department of Medicine, Division of Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacques L Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - John Metcalfe
- Division of Pulmonary and Critical Care Medicine, Trauma Center, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Grant Theron
- South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, USA
| | - Maia Lesosky
- Division of epidemiology and Biostatistics, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Tim Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre of Environmental Health, University of Hasselt, Hasselt, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jean B Nachega
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA.
- Department of Medicine, Center for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Department of Epidemiology and Center for Global Health, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto St., Room A522 Crabtree Hall, Pittsburgh, 15260, PA, USA.
| |
Collapse
|
8
|
Vidyasagaran AL, Readshaw A, Boeckmann M, Jarde A, Siddiqui F, Marshall AM, Akram J, Golub JE, Siddiqi K, Dogar O. Is Tobacco Use Associated With Risk of Recurrence and Mortality Among People With TB?: A Systematic Review and Meta-Analysis. Chest 2024; 165:22-47. [PMID: 37652295 PMCID: PMC10790178 DOI: 10.1016/j.chest.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/20/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Associations between tobacco use and poor TB treatment outcomes are well documented. However, for important outcomes such as TB recurrence or relapse and mortality during treatment, as well as for associations with smokeless tobacco (ST), the evidence is not summarized systematically. RESEARCH QUESTION Is tobacco use associated with risk of poor treatment outcomes among people with TB? STUDY DESIGN AND METHODS The MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health Literature databases were searched on November 22, 2021. Epidemiologic studies reporting associations between tobacco use and at least one TB treatment outcome were eligible. Independent double-screening, extractions, and quality assessments were undertaken. Random effects meta-analyses were conducted for the two primary review outcomes (TB recurrence or relapse and mortality during treatment), and heterogeneity was explored using subgroups. Other outcomes were synthesized narratively. RESULTS Our searches identified 1,249 records, of which 28 were included in the meta-analyses. Based on 15 studies, higher risk of TB recurrence or relapse was found with ever using tobacco vs never using tobacco (risk ratio [RR], 1.78; 95% CI, 1.31-2.43; I2 = 85%), current tobacco use vs no tobacco use (RR, 1.95; 95% CI, 1.59-2.40; I2 = 72%), and former tobacco use vs never using tobacco (RR, 1.84; 95% CI, 1.21-2.80; I2 = 4%); heterogeneity arose from differences in study quality, design, and participant characteristics. Thirty-eight studies were identified for mortality, of which 13 reported mortality during treatment. Ever tobacco use (RR, 1.55; 95% CI, 1.32-1.81; I2 = 0%) and current tobacco use (RR, 1.51; 95% CI, 1.09-2.10; I2 = 87%) significantly increased the likelihood of mortality during treatment among people with TB compared with never using tobacco and not currently using tobacco, respectively; heterogeneity was explained largely by differences in study design. Almost all studies in the meta-analyses scored high or moderate on quality assessments. Narrative synthesis showed that tobacco use was a risk factor for other unfavorable TB treatment outcomes, as previously documented. Evidence on ST was limited, but identified studies suggested an increased risk for poor outcomes with its use compared with not using it. INTERPRETATION Tobacco use significantly increases the risk of TB recurrence or relapse and mortality during treatment among people with TB, highlighting the need to address tobacco use to improve TB outcomes. TRIAL REGISTRY PROSPERO; No.: CRD42017060821; URL: https://www.crd.york.ac.uk/prospero/.
Collapse
Affiliation(s)
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, England; Yorkshire and North Lincolnshire Area Team, Natural England
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Alexander Jarde
- Université de Paris, Centre d'Épidémiologie Clinique, Hôpital Hôtel-Dieu, and Cochrane France, Paris, France
| | - Faraz Siddiqui
- Department of Health Sciences, University of York, York, England
| | - Anna-Marie Marshall
- Department of Health Sciences, University of York, York, England; Research Fellow in Public Health and lecturer in Public Health and Psychology, Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, England
| | - Janita Akram
- Hull York Medical School, University of York, York, England
| | - Jonathan E Golub
- Center for Tuberculosis Research, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, England; Hull York Medical School, University of York, York, England
| | - Omara Dogar
- Department of Health Sciences, University of York, York, England; Usher Institute, The University of Edinburgh, Edinburgh, Scotland.
| |
Collapse
|
9
|
Bhikoo R, Allwood BW, Irusen EM, Koegelenberg CFN. Lung Cancer Presents at a Younger Age and Is Less Likely to be Curable in People Living with HIV. Respiration 2023; 103:47-50. [PMID: 37879317 DOI: 10.1159/000534464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/30/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Globally, lung cancer remains the leading cause of malignancy-related death in men and women. There is increasing evidence that the risk for lung cancer in people living with human immunodeficiency virus (PLHIV) is higher than that of the general population. Given the high burden of PLHIV and lung cancer in Southern Africa, we aimed to compare the characteristics of PLHIV and HIV-negative lung cancer patients with regards to demographics, cell type, performance status, and tumour stage at presentation. METHODS All patients who presented to a large tertiary hospital over a 7-year period with a confirmed tissue diagnosis of primary lung cancer were included in a prospective registry. The patient demographics, HIV status, as well as the patients' performance status according to the Eastern Cooperative Oncology Group (ECOG) were documented. RESULTS The cohort consisted of 1,805 patients (mean age 60.0 years) of which 1,129 were male. In total, 133 were PLHIV and 1,292 were confirmed HIV-negative, while the remaining were categorised as HIV-unknown. PLHIV with lung cancer were found to be younger than the HIV-negative group (mean [±SD] 54.6 [9.3] versus 60.3 [10.1], p < 0.001). Notably, not a single PLHIV was diagnosed with resectable non-small cell lung cancer (NSCLC), and only 7 of 133 (6.5%) had potentially curable disease NSCLC (up to stage IIIB) compared to 240 of 1292 HIV-negative patients (27.7%, p < 0.001). CONCLUSION PLHIV with lung cancer were diagnosed at a significantly younger age and were significantly less likely to have curable NSCLC at presentation.
Collapse
Affiliation(s)
- Raisa Bhikoo
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Elvis M Irusen
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| |
Collapse
|
10
|
Katoto PDMC, Bihehe D, Brand A, Mushi R, Kusinza A, Alwood BW, van Zyl-Smit RN, Tamuzi JL, Sam-Agudu NA, Yotebieng M, Metcalfe J, Theron G, Godri Pollitt KJ, Lesosky M, Vanoirbeek J, Mortimer K, Nawrot T, Nemery B, Nachega JB. Household Air Pollution and Risk of Pulmonary Tuberculosis in HIV-Infected Adults. RESEARCH SQUARE 2023:rs.3.rs-3410503. [PMID: 37886487 PMCID: PMC10602081 DOI: 10.21203/rs.3.rs-3410503/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background In developing countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection. Methods We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB. Results We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/weekwere more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]. Conclusion Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Metcalfe
- Zuckerberg San Francisco General Hospital, University of California
| | - Grant Theron
- NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Romanowski K, Law MR, Karim ME, Campbell JR, Hossain MB, Gilbert M, Cook VJ, Johnston JC. Healthcare Utilization After Respiratory Tuberculosis: A Controlled Interrupted Time Series Analysis. Clin Infect Dis 2023; 77:883-891. [PMID: 37158618 PMCID: PMC10506780 DOI: 10.1093/cid/ciad290] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/02/2023] [Accepted: 05/05/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Despite data suggesting elevated morbidity and mortality among people who have survived tuberculosis disease, the impact of respiratory tuberculosis on healthcare utilization in the years following diagnosis and treatment remains unclear. METHODS Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals treated for respiratory tuberculosis between 1990 and 2019. We matched each person with up to four people without a tuberculosis diagnosis from the same source cohort using propensity score matching. Then, using a controlled interrupted time series analysis, we measured outpatient physician encounters and inpatient hospital admissions in the 5 years following respiratory tuberculosis diagnosis and treatment. RESULTS We matched 1216 individuals treated for respiratory tuberculosis to 4864 non-tuberculosis controls. Immediately following the tuberculosis diagnostic and treatment period, the monthly rate of outpatient encounters in the tuberculosis group was 34.0% (95% confidence interval [CI]: 30.7%, 37.2%) higher than expected, and this trend was sustained for the duration of the post-tuberculosis period. The excess utilization represented an additional 12.2 (95% CI: 10.6, 14.9) outpatient encounters per person over the post-tuberculosis period, with respiratory morbidity a large contributor to the excess healthcare utilization. Results were similar for hospital admissions, with an additional 0.4 (95% CI: .3, .5) hospital admissions per person over the post-tuberculosis period. CONCLUSIONS Respiratory tuberculosis appears to have long-term impacts on healthcare utilization beyond treatment. These findings underscore the need for screening, assessment, and treatment of post-tuberculosis sequelae, as it may provide an opportunity to improve health and reduce resource use.
Collapse
Affiliation(s)
- Kamila Romanowski
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Jonathon R Campbell
- Respiratory Epidemiology and Clinical Research Unit, Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
- Departments of Medicine & Global and Public Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Md Belal Hossain
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Gilbert
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Victoria J Cook
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - James C Johnston
- Provincial Tuberculosis Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- McGill International TB Centre, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
12
|
Maritz ER, Montepiedra G, Mitchell CD, Madhi SA, Bobat R, Violari A, Hesseling AC, Cotton MF. Predictors of TB disease in HIV-exposed children from Southern Africa. Int J Tuberc Lung Dis 2023; 27:619-625. [PMID: 37491747 PMCID: PMC10365557 DOI: 10.5588/ijtld.22.0439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/07/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND: P1041 was a randomised, placebo-controlled isoniazid prophylaxis trial in South Africa. We studied predictors for TB in HIV-exposed children participating in the P1041 trial.METHODS: We included data from entry until Week 108. Predictors considered were type of housing, overcrowding, age, sex, ethnicity, tobacco exposure, weight-for-age percentile Z-score (WAZ), CD4%, viral load (VL), antiretroviral therapy (ART) and number of household smokers.RESULTS: Of 543 HIV-positive (HIV+) and 808 HIV-exposed uninfected (HEU) infants at entry, median age was 96 days (interquartile range: 92-105). Of 1,351 caregivers, 125 (9%) had a smoking history, and 62/1,351 reported current smoking. In 594/1,351 (44%) households, there was at least one smoker. Smoking caregivers consumed 1-5 cigarettes daily. In the HIV+ cohort, significant baseline TB predictors after adjusting covariates were as follows: WAZ (adjusted hazard ratio [aHR] 0.76, P = 0.002) and log10 HIV RNA copies/ml (aHR 1.50, P = 0.009). Higher CD4% (aHR 0.88, P = 0.002) and ART (aHR 0.50, P = 0.006) were protective. In the HEU cohort, smoking exposure was associated with reduced TB-free survival on univariate analysis, but not after adjustment in the multivariate model.CONCLUSION: Low WAZ and high VL were strong predictors of TB disease or death. Rising CD4 percentage and being on ART were protective in the HIV+ cohort.
Collapse
Affiliation(s)
- E R Maritz
- Family Center for Research with Ubuntu, Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa
| | - G Montepiedra
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA
| | - C D Mitchell
- Leonard M Miller School of Medicine Miami, University of Miami, FL, USA
| | - S A Madhi
- Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg
| | - R Bobat
- Department of Paediatrics, University of KwaZulu-Natal, Durban
| | - A Violari
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg
| | - A C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa
| | - M F Cotton
- Family Center for Research with Ubuntu, Department of Paediatrics & Child Health, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
13
|
Chidumwa G, Olivier S, Ngubane H, Zulu T, Sewpaul R, Kruse G, Rigotti NA, Siedner MJ, Reddy KP, Wong EB. Tobacco smoking and prevalence of communicable and non-communicable diseases in rural South Africa: A cross-sectional study. RESEARCH SQUARE 2023:rs.3.rs-2730894. [PMID: 37066285 PMCID: PMC10104274 DOI: 10.21203/rs.3.rs-2730894/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background South Africa is facing a convergence of communicable diseases (CDs) and non-communicable diseases (NCDs). The contribution of tobacco use to the burden of these conditions is unknown. Methods We analyzed the associations between current tobacco smoking and four important CDs and NCDs in Vukuzazi, a cross-sectional study of individuals aged 15 years and older conducted between 2018-2020 in a demographic surveillance area in KwaZulu-Natal, South Africa. Data on HIV, active tuberculosis (TB), hypertension and diabetes mellitus were collected via direct measurement from participants. Results Of 18,024 participants (68% female, median age 37 years [interquartile rage 23-56 years]), 1,301 (7.2%) reported current smoking. Prevalence of HIV infection was similarly high among people who currently smoked (34.6%) and people who had never smoked (33.9%). However, among people living with HIV (PLWH), there was a higher prevalence of detectable viremia in people reporting current smoking compared to people who reported never smoking (28.8% vs. 16.6%; p-value < 0.001). Active TB was more prevalent in people who currently smoked than in people who never smoked (3.1% vs 1.3%, p < 0.001). In contrast, the prevalence of hypertension and diabetes mellitus were lower in people reporting current smoking than in people reporting never smoking (17.1% vs 26.0% (p < 0.001), and 2.5% vs 10.2% (p < 0.001), respectively). In sex-stratified multivariable analyses that were adjusted for potential confounding factors (including body mass index for the NCDs), the magnitude of differences in CD prevalence between people who currently smoked and people who never smoked decreased, whereas the lower prevalence of NCDs among people reporting current smoking persisted. Conclusions In rural South Africa, smoking is associated with higher rates of active TB, and people with HIV who smoke have worse disease control. In contrast, hypertension and diabetes mellitus are less common in those who smoke. Interventions to screen for TB among those who smoke and to address smoking among people with HIV may be particularly impactful.
Collapse
Affiliation(s)
| | | | | | - Thando Zulu
- Africa Health Research Institute, KwaZulu-Natal
| | | | | | | | | | | | | |
Collapse
|
14
|
Bonfim FFDO, Villar LM, Croda J, Silva SRD, Gonçalves CCM, de Castro VDOL, de Rezende Romeira GR, Cesar GA, Dos Santos Weis-Torres SM, Horta MA, Simionatto S, Motta-Castro ARC, de Paula VS. Epidemiological Survey of Human Alphaherpesvirus 2 (HSV-2) Infection in Indigenous People of Dourados Municipality, Central Brazil. Trop Med Infect Dis 2023; 8:tropicalmed8040197. [PMID: 37104324 PMCID: PMC10143357 DOI: 10.3390/tropicalmed8040197] [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: 10/27/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 04/28/2023] Open
Abstract
Sexually transmitted Human alphaherpesvirus 2 (HSV-2) causes genital ulcers, especially among sexually active adolescents and adults. We estimated the exact prevalence of anti-HSV-2 antibodies and correlated it with the demographic and behavioral aspects of the Indigenous population of the Jaguapirú and Bororó villages (Dourados, Mato Grosso do Sul (MS), Brazil). In total, 1360 individuals (>18 years old) were administered serologic tests. The prevalence of anti-HSV-2 IgM was 12.9%, that of anti-HSV-2 IgG was 57.2%, and 8.5% cases tested positive for both HSV-2 IgM and IgG. The prevalence of anti-HSV-2 antibodies was higher in females (59.5%) compared to males (49%), with an OR of 0.64 (0.49-0.83). Anti-HSV-2 antibodies were found in 14.2%, 12.3%, 15.4%, and 14.5% of participants with urinary problems, genital wounds, genital warts, and urethral discharge, respectively. In summary, the seroprevalence of HSV-2 in the Indigenous population was five times higher than that reported in the general adult Brazilian population. Educational level, income level, smoking, condom use, incarceration, illicit drug abuse, the sharing of used needles and syringes without adequate disinfection, homosexual relationships, prostitution, the sexual practices among drug users, and avoidance of contraceptive methods could contribute to the facilitation of HSV-2 transmission in the Indigenous population. Our results may help develop culturally appropriate intervention programs that eliminate health-access barriers and improve the implementation of public health policies aimed at promoting information regarding and preventing, treating, and controlling HSV-2 infection in Brazilian Indigenous populations.
Collapse
Affiliation(s)
| | - Livia Melo Villar
- Viral Hepatitis Laboratory, Oswaldo Cruz Foundation, Rio de Janeiro 21040360, Brazil
| | - Julio Croda
- Brazilian Society of Tropical Medicine, Campo Grande 79070900, Brazil
| | | | - Crhistinne Cavalheiro Maymone Gonçalves
- Center for Biological and Health Sciences, Blood Center Sector, Federal University of Mato Grosso do Sul, Campo Grande 79070900, Brazil
- State Department of Health of Mato Grosso do Sul, Campo Grande 79031350, Brazil
| | | | | | - Gabriela Alves Cesar
- Center for Biological and Health Sciences, Blood Center Sector, Federal University of Mato Grosso do Sul, Campo Grande 79070900, Brazil
| | | | - Marco Aurélio Horta
- Biosafety Level 3 Platform (NB3), Oswaldo Cruz Foundation, Rio de Janeiro 21040360, Brazil
| | - Simone Simionatto
- College of Biological and Environmental Sciences, Federal University of Grande Dourados, Dourados 79070900, Brazil
| | - Ana Rita Coimbra Motta-Castro
- Center for Biological and Health Sciences, Blood Center Sector, Federal University of Mato Grosso do Sul, Campo Grande 79070900, Brazil
- Center for Health and Biological Sciences, Oswaldo Cruz Foundation, Rio de Janeiro 79070900, Brazil
| | | |
Collapse
|
15
|
Thoker ZA, Madan K, Mittal S, Tiwari P, Shah TH, Mohan A, Hadda V, Guleria R. Clinical Profile and Quality of Life of Patients With Post-pulmonary Tuberculosis Sequelae Presenting to a Tertiary Care Hospital. Cureus 2023; 15:e36354. [PMID: 37082491 PMCID: PMC10112386 DOI: 10.7759/cureus.36354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/21/2023] Open
Abstract
Background and objective There is a dearth of studies on the clinical presentation of patients with post-pulmonary tuberculosis (PTB) sequelae and its impact on their quality of life (QoL). In light of this, we conducted this study to analyze the clinical profile and QoL in patients with post-PTB sequelae. Methods Patients with a history of treated PTB and evidence of radiological damage were enrolled prospectively from November 2018 till June 2020 to study their clinical profile and QoL as per the eligibility criteria. A detailed clinical history was taken along with posteroanterior-view chest X-rays and CT scans of the thorax with bronchial angiography in patients with hemoptysis. QoL was assessed using the Hindi version of St. George's Respiratory Questionnaire (SGRQ) for which permission was obtained from the St. George's University of London. SGRQ scores were calculated using score calculation algorithms (Microsoft Excel-based) and missing data imputation as recommended by its developer. Results A total of 174 patients were included in the analysis. The analyzed population was relatively younger (mean age: 44.27 years) with BMIs leaning toward the lower side of normal (median: 19.6 kg/m²); the majority of the patients were males (59%) and non-smokers (77%). PTB had been diagnosed clinico-radiologically in the majority (68%) of patients with non-compliance to antitubercular treatment (ATT) being reported by only 9% of patients. Multiple courses of ATT were received by about one-third of patients, mainly on a clinico-radiologic basis. Systemic hypertension (HTN) (11%) and diabetes mellitus (DM) (9%) were the most common comorbidities. The most common symptom complex found was cough, expectoration, and dyspnea (n=102, 59%). At least one incidence of massive hemoptysis was reported by 20% of patients. Bronchial artery embolization (BAE) was performed for moderate to massive hemoptysis in 26% of patients with a success rate of >90%. One-fifth of the study participants required hospitalization for exacerbation of respiratory symptoms with more than half of these (59%) requiring ventilatory support. Health-related QoL was significantly impaired as reflected by a median SGRQ total score of 45.53. The most affected domain of QoL was the activity domain (mean score: 45.47). Females had worse QoL as compared to males (p=0.0062), and so did underweight patients (p=0.048). The prolonged duration of the illness also significantly impaired the QoL (p<0.001, r=0.313). Conclusion The sequelae of PTB are under-recognized even among physicians and are frequently misdiagnosed as active PTB. The QoL is more severely affected due to residual damage. This study highlights the clinical profile of this patient population and underscores the need to recognize post-PTB sequelae as a separate entity. An important remedy to mitigate its long-term consequences is its inclusion and recognition in national and international TB guidelines to facilitate its early identification and promote further research to address its evidence-based management.
Collapse
|
16
|
Purushothama J, Badiger S, Olickal JJ, Kunkulol R, Kumar N, D’Souza N. Effectiveness of Nicotine Replacement Therapy on Smoking Cessation and Reduction Among Pulmonary Tuberculosis Patients - A Randomized Controlled Trial. Int J Prev Med 2023; 14:33. [PMID: 37351046 PMCID: PMC10284237 DOI: 10.4103/ijpvm.ijpvm_3_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 10/28/2022] [Indexed: 06/24/2023] Open
Abstract
Background’ India is ranked second in the world in terms of tobacco use and tops the list of eight high-burden countries that account for two-thirds of the new tuberculosis (TB) cases globally. As tobacco smoking among TB patients is associated with unsuccessful TB treatment outcomes, effective smoking cessation interventions for TB patients is essential to combat this double pandemic. Aim The study determined the effectiveness of nicotine replacement therapy (NRT) on smoking reduction and cessation among pulmonary TB patients. Settings and Design The study included 300 pulmonary TB patients undergoing antitubercular treatment in government health care centers of Dakshina Kannada district in southern India. Materials and Methods The participants in this two-armed, single-blinded, placebo-controlled, block-randomized trial were divided equally (n = 150) for experimental arm (brief advice + NRT) and control arm (brief advice + placebo). The total duration of treatment and follow-up was 6 months. Unadjusted relative risk (URR) and adjusted relative risk (ARR) were calculated for treatment outcomes at 95% confidence interval (CI). Generalized linear regression analysis was performed upon variables with P value less than 0.2. Results After 6 months of intervention including follow up, there was a significant reduction in self-reported smoking (ARR = 1.08, 95% CI 1.01-1.17, P = 0.03) in the experimental arm compared with the control arm. Biochemically verified smoking abstinence was not significantly different between the two arms (ARR = 1.01, 95% CI 0.72-1.38, P = 0.97). Conclusion The study showed statistically significant effectiveness of NRT for self-reported smoking reduction.
Collapse
Affiliation(s)
- Jagannath Purushothama
- Department of Public Health, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | - Sanjeev Badiger
- Department of Community Medicine, A J Institute of Medical Sciences and Research Centre, Mangaluru, Karnataka India
| | - Jeby J. Olickal
- Department of Public Health, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | - Rahul Kunkulol
- Department of Pharmacology, Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Nanjesh Kumar
- Department of Community Medicine, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| | - Neevan D’Souza
- Department of Community Medicine, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangaluru, Karnataka, India
| |
Collapse
|
17
|
Kayongo A, Bartolomaeus TUP, Birkner T, Markó L, Löber U, Kigozi E, Atugonza C, Munana R, Mawanda D, Sekibira R, Uwimaana E, Alupo P, Kalyesubula R, Knauf F, Siddharthan T, Bagaya BS, Kateete DP, Joloba ML, Sewankambo NK, Jjingo D, Kirenga B, Checkley W, Forslund SK. Sputum Microbiome and Chronic Obstructive Pulmonary Disease in a Rural Ugandan Cohort of Well-Controlled HIV Infection. Microbiol Spectr 2023; 11:e0213921. [PMID: 36790203 PMCID: PMC10100697 DOI: 10.1128/spectrum.02139-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Sub-Saharan Africa has increased morbidity and mortality related to chronic obstructive pulmonary disease (COPD). COPD among people living with HIV (PLWH) has not been well studied in this region, where HIV/AIDS is endemic. Increasing evidence suggests that respiratory microbial composition plays a role in COPD severity. Therefore, we aimed to investigate microbiome patterns and associations among PLWH with COPD in Sub-Saharan Africa. We conducted a cross-sectional study of 200 adults stratified by HIV and COPD in rural Uganda. Induced sputum samples were collected as an easy-to-obtain proxy for the lower respiratory tract microbiota. We performed 16S rRNA gene sequencing and used PICRUSt2 (version 2.2.3) to infer the functional profiles of the microbial community. We used a statistical tool to detect changes in specific taxa that searches and adjusts for confounding factors such as antiretroviral therapy (ART), age, sex, and other participant characteristics. We could cluster the microbial community into three community types whose distribution was shown to be significantly impacted by HIV. Some genera, e.g., Veillonella, Actinomyces, Atopobium, and Filifactor, were significantly enriched in HIV-infected individuals, while the COPD status was significantly associated with Gammaproteobacteria and Selenomonas abundance. Furthermore, reduced bacterial richness and significant enrichment in Campylobacter were associated with HIV-COPD comorbidity. Functional prediction using PICRUSt2 revealed a significant depletion in glutamate degradation capacity pathways in HIV-positive patients. A comparison of our findings with an HIV cohort from the United Kingdom revealed significant differences in the sputum microbiome composition, irrespective of viral suppression. IMPORTANCE Even with ART available, HIV-infected individuals are at high risk of suffering comorbidities, as shown by the high prevalence of noninfectious lung diseases in the HIV population. Recent studies have suggested a role for the respiratory microbiota in driving chronic lung inflammation. The respiratory microbiota was significantly altered among PLWH, with disease persisting up to 3 years post-ART initiation and HIV suppression. The community structure and diversity of the sputum microbiota in COPD are associated with disease severity and clinical outcomes, both in stable COPD and during exacerbations. Therefore, a better understanding of the sputum microbiome among PLWH could improve COPD prognostic and risk stratification strategies. In this study, we observed that in a virologically suppressed HIV cohort in rural Uganda, we could show differences in sputum microbiota stratified by HIV and COPD, reduced bacterial richness, and significant enrichment in Campylobacter associated with HIV-COPD comorbidity.
Collapse
Affiliation(s)
- Alex Kayongo
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Theda Ulrike Patricia Bartolomaeus
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Till Birkner
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Lajos Markó
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Ulrike Löber
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Edgar Kigozi
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Carolyne Atugonza
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Richard Munana
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Denis Mawanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rogers Sekibira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Esther Uwimaana
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Patricia Alupo
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Kalyesubula
- African Community Center for Social Sustainability (ACCESS), Department of Research, Nakaseke, Uganda
- Makerere University, College of Health Sciences, Department of Medicine, Kampala, Uganda
| | - Felix Knauf
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Trishul Siddharthan
- University of Miami, School of Medicine, Division of pulmonary and critical care medicine, Miami, Florida, USA
| | - Bernard S. Bagaya
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - David P. Kateete
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Moses L. Joloba
- Makerere University, College of Health Sciences, Department of Immunology and Molecular Biology, Kampala, Uganda
| | - Nelson K. Sewankambo
- Makerere University, College of Health Sciences, Department of Medicine, Kampala, Uganda
| | - Daudi Jjingo
- Makerere University, College of Computing and Information Sciences, Department of Computer Science, Kampala, Uganda
- African Center of Excellence in Bioinformatics and Data Science, Infectious Diseases Institute, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
- Makerere University, College of Health Sciences, Department of Medicine, Kampala, Uganda
| | - William Checkley
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Sofia K. Forslund
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation of Charité - Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- European Molecular Biology Laboratory, Structural and Computational Biology Unit, Heidelberg, Germany
| |
Collapse
|
18
|
Wu C, Liu H, Lin Y, An R, Wang M, Zhong H, Yi H, Wang Q, Tan H, Chen L, Deng J, Chen M. Polymorphisms in PI3K/AKT genes and gene‑smoking interaction are associated with susceptibility to tuberculosis. Ann Hum Biol 2023; 50:472-479. [PMID: 38117222 DOI: 10.1080/03014460.2023.2288008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/26/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Phosphatidylinositol 3-kinase (PI3K) and protein kinase B (AKT) are involved in the clearance of Mycobacterium tuberculosis (MTB) by macrophages. AIM This study aimed to investigate the effects of polymorphisms in the PI3K/AKT genes and the gene-smoking interaction on susceptibility to TB. METHODS This case-control study used stratified sampling to randomly select 503 TB patients and 494 control subjects. Logistic regression analysis was used to determine the association between the polymorphisms and TB. Simultaneously, the marginal structure linear dominance model was used to estimate the gene-smoking interaction. RESULTS Genotypes GA (OR 1.562), AA (OR 2.282), and GA + AA (OR 1.650) at rs3730089 of the PI3KR1 gene were significantly associated with the risk to develop TB. Genotypes AG (OR 1.460), GG (OR 2.785), and AG + GG (OR 1.622) at rs1130233 of the AKT1 gene were significantly associated with the risk to develop TB. In addition, the relative excess risk of interaction (RERI) between rs3730089 and smoking was 0.9608 (95% CI: 0.5959, 1.3256, p < 0.05), which suggests a positive interaction. CONCLUSION We conclude that rs3730089 and rs1130233 are associated with susceptibility to TB, and there was positive interaction between rs3730089 and smoking on susceptibility to TB.
Collapse
Affiliation(s)
- Chunli Wu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Huixia Liu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Ying Lin
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Rongjing An
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Mian Wang
- Department of Epidemiology and Health Statistics, School of Public Health, University of South China, Hengyang, Hunan, China
| | - Hua Zhong
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hengzhong Yi
- Hunan Province Chest Hospital, Changsha, Hunan, China
| | - Qiaozhi Wang
- Hunan Province Chest Hospital, Changsha, Hunan, China
| | - Hongzhuan Tan
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Lizhang Chen
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Jing Deng
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Mengshi Chen
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| |
Collapse
|
19
|
Uddin MN, Emran TB. Prevention of Progression and Remission in Public Health Sectors: Bangladesh Perspectives. ATLANTIS HIGHLIGHTS IN CHEMISTRY AND PHARMACEUTICAL SCIENCES 2023:131-150. [DOI: 10.2991/978-94-6463-130-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
20
|
Rao Y, Cao W, Qu J, Zhang X, Wang J, Wang J, Li G, Li D, Pei Y, Xu W, Gai X, Sun Y. More severe lung lesions in smoker patients with active pulmonary tuberculosis were associated with peripheral NK cell subsets. Tuberculosis (Edinb) 2023; 138:102293. [PMID: 36549189 DOI: 10.1016/j.tube.2022.102293] [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: 09/13/2022] [Revised: 12/01/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Both pulmonary tuberculosis (PTB) and cigarette smoke (CS) exposure may lead to lung damage. The potential impact of CS exposure on tuberculosis-associated lung damage and the disturbance of immune cells and mediators involved, need to be further elucidated. METHODS We firstly evaluated the chest X-ray (CXR) scores of a retrospective cohort of male patients with active PTB, followed for 6 months, and compared the scores between smoker (≥10 pack-years) and non-smoker patients. In a cross-sectional study, we measured the peripheral blood NK cell subsets and plasma inflammatory cytokines in male smoker and non-smoker patients with active PTB before anti-tuberculosis therapy, and the proportions of NK cell subsets and the levels of cytokines were analyzed for correlation with the CXR scores. RESULTS In the retrospective cohort, male smoker patients with active PTB showed a higher CXR score, characterized by more cavitary lesions, enlarged lymph nodes and emphysema, as compared to non-smokers. The cross-sectional study revealed that the CXR score in smoker patients was correlated inversely with the percentages of blood CD107a+, NKP46+, and TIGIT+ NK cells. CONCLUSION In patients with active PTB, CS exposure was associated with more severe lung lesions, which were correlated with peripheral NK cell subsets.
Collapse
Affiliation(s)
- Yafei Rao
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Wenli Cao
- Beijing Geriatric Hospital, Beijing, China
| | - Jingge Qu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Xueyang Zhang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Jun Wang
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | | | - Gen Li
- Beijing Geriatric Hospital, Beijing, China
| | - Danyang Li
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Yuqiang Pei
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China
| | - Wei Xu
- Beijing Geriatric Hospital, Beijing, China
| | - Xiaoyan Gai
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China.
| | - Yongchang Sun
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing, China.
| |
Collapse
|
21
|
Tchakounte Youngui B, Tchounga BK, Graham SM, Bonnet M. Tuberculosis Infection in Children and Adolescents. Pathogens 2022; 11:pathogens11121512. [PMID: 36558846 PMCID: PMC9784659 DOI: 10.3390/pathogens11121512] [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: 11/15/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
The burden of tuberculosis (TB) in children and adolescents remains very significant. Several million children and adolescents are infected with TB each year worldwide following exposure to an infectious TB case and the risk of progression from TB infection to tuberculosis disease is higher in this group compared to adults. This review describes the risk factors for TB infection in children and adolescents. Following TB exposure, the risk of TB infection is determined by a combination of index case characteristics, contact features, and environmental determinants. We also present the recently recommended approaches to diagnose and treat TB infection as well as novel tests for infection. The tests for TB infection have limitations and diagnosis still relies on an indirect immunological assessment of cellular immune response to Mycobacterium tuberculosis antigens using immunodiagnostic testing. It is recommended that TB exposed children and adolescents and those living with HIV receive TB preventive treatment (TPT) to reduce the risk of progression to TB disease. Several TPT regimens of similar effectiveness and safety are now available and recommended by the World Health Organisation.
Collapse
Affiliation(s)
- Boris Tchakounte Youngui
- TransVIHMI, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), University of Montpellier, 34090 Montpellier, France
- Department of Public Health Evaluation and Research, Elizabeth Glaser Paediatric AIDS Foundation, Yaoundé 99322, Cameroon
- Correspondence:
| | - Boris Kevin Tchounga
- Department of Public Health Evaluation and Research, Elizabeth Glaser Paediatric AIDS Foundation, Yaoundé 99322, Cameroon
| | - Stephen M. Graham
- Department of Paediatrics and Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne 3052, Australia
| | - Maryline Bonnet
- TransVIHMI, Institut de Recherche pour le Développement (IRD), Institut National de la Santé et de la Recherche Médicale (INSERM), University of Montpellier, 34090 Montpellier, France
| |
Collapse
|
22
|
Velasco-Arnaiz E, Batllori M, Monsonís M, Valls A, Ríos-Barnes M, Simó-Nebot S, Gamell A, Fortuny C, Tebruegge M, Noguera-Julian A. Host, technical, and environmental factors affecting QuantiFERON-TB Gold In-Tube performance in children below 5 years of age. Sci Rep 2022; 12:19908. [PMID: 36402803 PMCID: PMC9675832 DOI: 10.1038/s41598-022-24433-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Abstract
Interferon-gamma release assays performance can be impaired by host-related, technical and environmental factors, but data in young children are limited. We performed a cross-sectional study of children < 5 years-of-age at risk of tuberculosis (TB), using QuantiFERON-TB Gold In-Tube (QFT-GIT) assays. The impact of the following was evaluated: (i) host-related [age; hematological parameters; erythrocyte sedimentation rate (ESR); C-reactive protein (CRP); and tobacco smoke exposure (TSE) based on serum cotinine concentrations], (ii) technical (pre-analytical delay) and (iii) environmental factors (annual season; monthly temperatures). Of 204 children, 35 (17.2%) were diagnosed with latent TB infection or TB disease. QFT-GIT results were indeterminate in 14 (6.9%) patients. In multivariate analysis, younger age and higher ESR were associated with lower positive control responses (beta: 0.247, p = 0.002 and - 0.204, p = 0.007, respectively), and increasing age was associated with lower rates of indeterminate QFT-GIT results [OR (95% CI) 0.948 (0.903-0.996) per month, p = 0.035]. In children with positive QFT-GIT results, average monthly temperatures correlated with antigen responses (r = 0.453, p = 0.020); also, antigen responses were lower in winter than in other seasons (p = 0.027). Serum cotinine concentrations determined in a subgroup of patients (n = 41) indicated TSE in 36 (88%), positive control responses being lower in children with TSE (p = 0.034). In children < 5 years-of-age, young age, elevated ESR, temperature, annual season and TSE can affect the performance of QFT-GIT assays.
Collapse
Affiliation(s)
- Eneritz Velasco-Arnaiz
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Marta Batllori
- grid.411160.30000 0001 0663 8628Laboratori de Bioquímica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Manuel Monsonís
- grid.411160.30000 0001 0663 8628Servei de Microbiologia. Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Valls
- grid.411160.30000 0001 0663 8628Laboratori de Bioquímica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María Ríos-Barnes
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Sílvia Simó-Nebot
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anna Gamell
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Clàudia Fortuny
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Marc Tebruegge
- grid.83440.3b0000000121901201Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Pediatrics, University of Melbourne, Parkville, Australia ,Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - Antoni Noguera-Julian
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain ,grid.411160.30000 0001 0663 8628Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain
| |
Collapse
|
23
|
Schaberg T, Brinkmann F, Feiterna-Sperling C, Geerdes-Fenge H, Hartmann P, Häcker B, Hauer B, Haas W, Heyckendorf J, Lange C, Maurer FP, Nienhaus A, Otto-Knapp R, Priwitzer M, Richter E, Salzer HJ, Schoch O, Schönfeld N, Stahlmann R, Bauer T. Tuberkulose im Erwachsenenalter. Pneumologie 2022; 76:727-819. [DOI: 10.1055/a-1934-8303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ZusammenfassungDie Tuberkulose ist in Deutschland eine seltene, überwiegend gut behandelbare Erkrankung. Weltweit ist sie eine der häufigsten Infektionserkrankungen mit ca. 10 Millionen Neuerkrankungen/Jahr. Auch bei einer niedrigen Inzidenz in Deutschland bleibt Tuberkulose insbesondere aufgrund der internationalen Entwicklungen und Migrationsbewegungen eine wichtige Differenzialdiagnose. In Deutschland besteht, aufgrund der niedrigen Prävalenz der Erkrankung und der damit verbundenen abnehmenden klinischen Erfahrung, ein Informationsbedarf zu allen Aspekten der Tuberkulose und ihrer Kontrolle. Diese Leitlinie umfasst die mikrobiologische Diagnostik, die Grundprinzipien der Standardtherapie, die Behandlung verschiedener Organmanifestationen, den Umgang mit typischen unerwünschten Arzneimittelwirkungen, die Besonderheiten in der Diagnostik und Therapie resistenter Tuberkulose sowie die Behandlung bei TB-HIV-Koinfektion. Sie geht darüber hinaus auf Versorgungsaspekte und gesetzliche Regelungen wie auch auf die Diagnosestellung und präventive Therapie einer latenten tuberkulösen Infektion ein. Es wird ausgeführt, wann es der Behandlung durch spezialisierte Zentren bedarf.Die Aktualisierung der S2k-Leitlinie „Tuberkulose im Erwachsenenalter“ soll allen in der Tuberkuloseversorgung Tätigen als Richtschnur für die Prävention, die Diagnose und die Therapie der Tuberkulose dienen und helfen, den heutigen Herausforderungen im Umgang mit Tuberkulose in Deutschland gewachsen zu sein.
Collapse
Affiliation(s)
- Tom Schaberg
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | - Folke Brinkmann
- Abteilung für pädiatrische Pneumologie/CF-Zentrum, Universitätskinderklinik der Ruhr-Universität Bochum, Bochum
| | - Cornelia Feiterna-Sperling
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin
| | | | - Pia Hartmann
- Labor Dr. Wisplinghoff Köln, Klinische Infektiologie, Köln
- Department für Klinische Infektiologie, St. Vinzenz-Hospital, Köln
| | - Brit Häcker
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | - Jan Heyckendorf
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Christoph Lange
- Klinische Infektiologie, Forschungszentrum Borstel
- Deutsches Zentrum für Infektionsforschung (DZIF), Standort Hamburg-Lübeck-Borstel-Riems
- Respiratory Medicine and International Health, Universität zu Lübeck, Lübeck
- Baylor College of Medicine and Texas Childrenʼs Hospital, Global TB Program, Houston, TX, USA
| | - Florian P. Maurer
- Nationales Referenzzentrum für Mykobakterien, Forschungszentrum Borstel, Borstel
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Albert Nienhaus
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg Eppendorf (UKE), Hamburg
| | - Ralf Otto-Knapp
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | | | | | | | | | | | - Ralf Stahlmann
- Institut für klinische Pharmakologie und Toxikologie, Charité Universitätsmedizin, Berlin
| | - Torsten Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| |
Collapse
|
24
|
Bay JG, Patsche CB, Svendsen NM, Gomes VF, Rudolf F, Wejse C. Tobacco smoking impact on tuberculosis treatment outcome: an observational study from West Africa. Int J Infect Dis 2022; 124 Suppl 1:S50-S55. [PMID: 35914683 DOI: 10.1016/j.ijid.2022.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Both tuberculosis (TB) and tobacco smoking are preventable health hazards. Few studies have examined the relationship between TB and tobacco smoking in an African setting, where the two health burdens collide heavily. This study aimed to describe the severity of TB disease and treatment outcomes among smokers with TB compared with nonsmokers with TB in Guinea-Bissau. METHODS We conducted a prospective follow-up study between 2003-2017 in Guinea-Bissau, enrolling adult patients with TB classified as nonsmokers or smokers. Disease severity was assessed using the Bandim TBscore. Multivariate logistic and Cox proportional hazard regressions were used to analyse treatment outcomes. RESULTS Of 1780 included patients, 385 were smokers who had smoked for a median 10 years (interquartile range [IQR] 5-20). No difference in disease severity at the time of diagnosis was observed. Smokers were not significantly more prone to a nonsuccessful treatment outcome, although a trend was seen (adjusted odds ratio [OR] 1.24, 95% confidence interval [CI] 0.91-1.70), and smokers tended to be more often lost to follow-up, but this also was not a significant finding (adjusted hazard ratio [HR] 2.09, 95% CI 0.89-4.94). CONCLUSION In a TB high-endemic setting with few tobacco smokers, smoking was not associated with disease severity or worse outcome, possibly because of socioeconomic confounders.
Collapse
Affiliation(s)
- Julie Glerup Bay
- TB research unit, Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Cecilie Blenstrup Patsche
- TB research unit, Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
| | - Nicoline Marie Svendsen
- GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Frauke Rudolf
- TB research unit, Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Wejse
- TB research unit, Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; GloHAU, Centre for Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
25
|
Ahuja J. Opportunistic infections in elderly TB patients. Indian J Tuberc 2022; 69 Suppl 2:S259-S263. [PMID: 36400520 DOI: 10.1016/j.ijtb.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
Since ancient times, tuberculosis has been a lethal infectious illness. The elderly are particularly susceptible to various illnesses, including tuberculosis. Tuberculosis (TB) and people ageing weaken the immune system, thus increasing the risk of getting other co-infections. Most elderly TB cases are associated with the reactivation of dormant lesions, and these lesions have reactivated due to immunosenescence. Elderly patients have a greater mortality rate from tuberculosis and other co-infections. Active infection signs and symptoms are generally less severe in the elderly. The interaction of structural lung damage, prolonged inflammation, bacterial and fungal colonisation of the respiratory system, and mucociliary insufficiency causes recurrent infections. It is imperative to use all available tools to make a microbiological diagnosis in diagnostic challenges in atypical cases. The therapeutic management of older people presents a significant difficulty in identifying frailty to prevent loss of independence.
Collapse
Affiliation(s)
- Jatin Ahuja
- Infectious Diseases & Travel Health Specialist in Indraprastha Apollo Hospital, Delhi, India.
| |
Collapse
|
26
|
Goyal A, Ravindra K, Mor S. Occupational exposure to airborne pollen and associated health risks among gardeners: a perception-based survey. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:70084-70098. [PMID: 35583755 DOI: 10.1007/s11356-022-20595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Airborne pollen are considered a major trigger of respiratory diseases that causes morbidity and subsequently affects a person's quality of life (QOL). Outdoor workers, such as gardeners, florists, etc., are at greater risk of allergies due to continuous exposure to the high concentration of allergens. The current study aims to assess the associated health risks among gardeners due to occupational exposure to airborne pollen. A semi-structured questionnaire-based survey was conducted among gardeners (496) in Chandigarh, covering their socio-demographic status, occupational and environmental history, and respiratory and other health-related problems. Out of 496 respondents from 26 gardens in the city, 72.58% fall under the category of plantsman (mali), followed by 15.72% of grass cutters and 3.02% of headmali/supervisor. The majority of gardeners were males (95.76%) and a maximum number of respondents were in the age group of 29-38 years (27.41%). Among all, 4.2%, 3.6%, and 3.2% of respondents perceived the problem of shortness of breath and breathing problems. At the same time, 3.2% of respondents perceived that their breathing is never wholly satisfactory and surprisingly, all of them are plantsman (mali). Moreover, 18.9% of the respondents covered their faces with a cloth and only 0.5% of the respondents wore both spectacles and covered their faces with a cloth. Out of all respondents, 6.5% reported irritation in the eyes without wearing any personal protective device. The results show that a large proportion of gardeners are illiterate and unaware of occupational hazards and pollen allergies in their workplaces. Moreover, the regulatory authorities conduct no formal health awareness and training/education sessions to minimize the exposure and associate risk. The findings of the study will aid in a better understanding of the working conditions and health status of occupational gardeners, as well as the development of appropriate methods to improve their working conditions.
Collapse
Affiliation(s)
- Akshi Goyal
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India
| | - Khaiwal Ravindra
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Suman Mor
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India.
| |
Collapse
|
27
|
Diboun I, Cyprian FS, Anwardeen NR, Yassine HM, Elrayess MA, Rahmoon SM, Sayed SK, Schuchardt S, Khatib M, Bansal D, Farag EABA, Emara MM, Abdallah AM. Identification of Prognostic Metabolomic Biomarkers at the Interface of Mortality and Morbidity in Pre-Existing TB Cases Infected With SARS-CoV-2. Front Cell Infect Microbiol 2022; 12:929689. [PMID: 35937683 PMCID: PMC9354137 DOI: 10.3389/fcimb.2022.929689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection currently remains one of the biggest global challenges that can lead to acute respiratory distress syndrome (CARDS) in severe cases. In line with this, prior pulmonary tuberculosis (TB) is a risk factor for long-term respiratory impairment. Post-TB lung dysfunction often goes unrecognized, despite its relatively high prevalence and its association with reduced quality of life. In this study, we used a metabolomics analysis to identify potential biomarkers that aid in the prognosis of COVID-19 morbidity and mortality in post-TB infected patients. This analysis involved blood samples from 155 SARS-CoV-2 infected adults, of which 23 had a previous diagnosis of TB (post-TB), while 132 did not have a prior or current TB infection. Our analysis indicated that the vast majority (~92%) of post-TB individuals showed severe SARS-CoV-2 infection, required intensive oxygen support with a significantly high mortality rate (52.2%). Amongst individuals with severe COVID-19 symptoms, we report a significant decline in the levels of amino acids, notably the branched chains amino acids (BCAAs), more so in the post-TB cohort (FDR <= 0.05) in comparison to mild and asymptomatic cases. Indeed, we identified betaine and BCAAs as potential prognostic metabolic biomarkers of severity and mortality, respectively, in COVID-19 patients who have been exposed to TB. Moreover, we identified serum alanine as an important metabolite at the interface of severity and mortality. Hence, our data associated COVID-19 mortality and morbidity with a long-term metabolically driven consequence of TB infection. In summary, our study provides evidence for a higher mortality rate among COVID-19 infection patients who have history of prior TB infection diagnosis, which mandates validation in larger population cohorts.
Collapse
Affiliation(s)
- Ilhame Diboun
- Medical and Population Genomics Lab, Sidra Medicine, Doha, Qatar
| | - Farhan S. Cyprian
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | | | - Hadi M. Yassine
- Biomedical Research Center (BRC), QU Health, Qatar University, Doha, Qatar
| | | | - Samreen Mumtaz Rahmoon
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sarah Khaled Sayed
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Sven Schuchardt
- Fraunhofer Institute for Toxicology and Experimental Medicine (ITEM), Hannover, Germany
| | - Malkan Khatib
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Devendra Bansal
- Department of Public Health, Ministry of Public Health, Doha, Qatar
| | | | - Mohamed M. Emara
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Abdallah M. Abdallah, ; Mohamed M. Emara,
| | - Abdallah M. Abdallah
- Department of Basic Medical Sciences, College of Medicine, QU Health, Qatar University, Doha, Qatar
- *Correspondence: Abdallah M. Abdallah, ; Mohamed M. Emara,
| |
Collapse
|
28
|
Al-Shehari WA, Yin YA, Wang X, Wang Y, Sun H, Fu Y, Zhang F. Prevalence and surveillance of tuberculosis in Yemen from 2006 to 2018. Epidemiol Infect 2022; 150:e146. [PMID: 35856270 PMCID: PMC9354476 DOI: 10.1017/s0950268822001261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/02/2022] [Accepted: 07/05/2022] [Indexed: 12/14/2022] Open
Abstract
Tuberculosis is a major public health issue in Yemen, a country located at the southwestern tip of the Arabian Peninsula, while the situation of tuberculosis had been further exacerbated since the war started in 2015. The objective of this study is to investigate the incidence of tuberculosis in Yemen before the outbreak of COVID-19, from 2006 to 2018. During the 13-year period, 92 482 patients were enrolled in the TB programme records from the 22 governorates. Almost equal number of cases were diagnosed between males and females (a male to female ratio, 1.03:1). A notable rising incidence was observed in all age groups starting from 2011. The sharpest increase occurred in children under age 15, rising by 8.0-fold from 0.5 in the period 2006-2010 to 4.1 in the period 2011-2018. Paediatric TB accounted for 9.6% of all reported cases. In terms of the patient residence, incidence has more than doubled in Sana'a city, Sana'a Gov., Hajjah and Saadah. Concomitant diseases with tuberculosis included diabetes mellitus (14.0%), brucellosis (6.1%), hepatitis (6.0%), rheumatoid arthritis (4.3%), renal disorders (2.5%) and HIV infection (2.5%). Development of interventions to reduce tuberculosis incidence in children and concomitant communicable diseases is urgently needed.
Collapse
Affiliation(s)
- Wadee Abdullah Al-Shehari
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
- Department of Medical Microbiology, Faculty of Sciences, Ibb University, Ibb, Yemen
| | - Yi-An Yin
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Xinyang Wang
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Ying Wang
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Haobo Sun
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Yingmei Fu
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
| | - Fengmin Zhang
- Department of Microbiology, Basic Medical Sciences College, Harbin Medical University, Harbin 150086, China
- Wu Lien-Teh Institute, Harbin Medical University, Harbin 150086, China
| |
Collapse
|
29
|
Lung cancer in people living with HIV: a different kettle of fish? Afr J Thorac Crit Care Med 2022; 28:10.7196/AJTCCM.2022.v28i2.245. [PMID: 35919920 PMCID: PMC9339138 DOI: 10.7196/ajtccm.2022.v28i2.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
|
30
|
Parascandola M, Neta G, Bloch M, Gopal S. Colliding Epidemics: Research Gaps and Implementation Science Opportunities for Tobacco Use and HIV/AIDS in Low- and Middle-Income Countries. J Smok Cessat 2022; 2022:6835146. [PMID: 35821759 PMCID: PMC9232349 DOI: 10.1155/2022/6835146] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Tobacco use is a leading cause of cancer death among people living with HIV (PLWH) worldwide, and smoking prevalence tends to be higher among PLWH. The burden of both HIV/AIDS and tobacco use is increasingly concentrated in low- and middle-income countries (LMICs), where resources to address these challenges are often limited. However, there has been limited effort to date to integrate tobacco cessation into HIV programs in LMICs. Methods We searched the literature (searching was conducted between October 1 and December 31, 2020) using PubMed including search terms "tobacco" and "HIV" and "cessation" over the past ten years (searching for articles published between December 1, 2010, and December 1, 2020) to identify original research studies on tobacco cessation interventions conducted in LMICs for PLWH. We also conducted an analysis of NCI-funded research grants on tobacco cessation and HIV awarded during fiscal years 2010 to 2020. Results and Discussion. Existing evidence suggests that conventional tobacco cessation treatments may be less effective among PLWH. Moreover, while substantial evidence exists to support a range of cessation interventions, most of this evidence comes from HICs and is only partly applicable to the evolving social, economic, and cultural climate of many LMICs. There is an urgent need to develop, adapt, and implement effective tobacco control and cessation interventions targeted to PLWH in LMICs, as well as to generate evidence from these settings. Implementation science provides tools develop and test strategies to overcome barriers and to integrate and scale up cessation services within existing HIV treatment settings. Conclusion There is a unique opportunity to address HIV and tobacco use in a coordinated way in LMICs by integrating evidence-based tobacco cessation into HIV programs.
Collapse
Affiliation(s)
- Mark Parascandola
- Center for Global Health, National Cancer Institute, Bethesda, Maryland, USA
| | - Gila Neta
- Office of the Director, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Michele Bloch
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Bethesda, Maryland, USA
| |
Collapse
|
31
|
Kim SH, Park YM, Han K, Ko SH, Kim SY, Song SH, Kim CH, Hur KY, Kim SK. Association of weight change following smoking cessation with the risk of tuberculosis development: A nationwide population-based cohort study. PLoS One 2022; 17:e0266262. [PMID: 35390038 PMCID: PMC8989195 DOI: 10.1371/journal.pone.0266262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 03/17/2022] [Indexed: 12/22/2022] Open
Abstract
Background Smoking or weight loss is a risk of tuberculosis (TB) development. However, the impact of weight change after smoking cessation on the occurrence of TB remains elusive. We aimed to determine the relationship between weight change after smoking cessation and the risk of TB development. Methods We conducted a population-based cohort study using the national database in Republic of Korea. Of the 10,490,491 subjects who underwent health check-up in 2009, we enrolled 9,953,124 subjects without a previous TB history and followed them until 2017. We divided all study participants into the following three groups: never, former, and current smokers. The primary endpoint was newly developed TB. Results Among 9,953,124 subjects analyzed, 5,922,845 (59.5%) were never smokers, 1,428,209 (14.4%) were former smokers, and 2,602,080 (26.1%) were current smokers. The risk of TB development was significantly higher in current smokers than in never smokers (adjusted hazard ratio (aHR) 1.158; 95% confidence interval [CI] 1.131–1.186). Among current smokers, individuals who stopped smoking and maintained weight after baseline evaluation had a significantly lower risk of TB development compared with those who continued to smoke (aHR 0.771; 95% CI 0.741–0.892). However, even after smoking cessation, individuals who lost weight were at a significantly higher risk of TB development compared with those who continued to smoke (aHR 1.327; 95% CI 1.119–1.715). Conclusions Our findings suggest that smoking is a risk factor for TB and weight maintenance (neither gaining or losing) after quitting smoking might reduce the risk of TB development.
Collapse
Affiliation(s)
- Seung Hoon Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Yong-Moon Park
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Seung Hyun Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Shin Young Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - So Hyang Song
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Chi Hong Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kyu Yeon Hur
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Kyoung Kim
- Division of Pulmonology, Department of Internal Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
- * E-mail:
| |
Collapse
|
32
|
Katare S, Harsha A. Correlations Between Inflammatory Biomarkers in Tuberculosis-Associated Obstructive Pulmonary Disease Patients With Anxiety and Depression. Cureus 2022; 14:e22742. [PMID: 35371847 PMCID: PMC8971095 DOI: 10.7759/cureus.22742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Tuberculosis-associated obstructive pulmonary disease (TOPD), anxiety, and depression are significant public health problems worldwide and their prevalence is common. These diseases interfere with physical, psychosocial, and economic well-being, resulting in unemployment, prolonged hospitalization, abstinence from working, and isolation. Subjects and methods This is a single-center, cross-sectional cohort, observational study conducted in a tertiary care hospital over six years to understand spirometry, laboratory profiles, as well as the impact on overall health, daily life, and perceived well-being in patients with TOPD. Result The sample size of the study was 73 patients. A total of 43 (58.5%) patients had depression with an average St. George's Respiratory Questionnaire for chronic obstructive pulmonary disease (SGRQ-C) score of 67.5, and 16 (21.9%) patients had anxiety with an average SGRQ-C score of 78.9. In the patients who scored higher on the Hamilton Depression Rating Scale (HAM-D), there was a significant correlation between Hamilton Anxiety Rating Scale (HAM-A) and HAM-D scores, as well as C-reactive protein (CRP) levels and WBC counts. In 16 (21.9%) of the patients with moderate to severe anxiety, there was a statistically significant negative correlation between higher HAM-A scores and lower WBC counts. Anxiety, depression, CRP level, WBC count, and serum fibrinogen did not show a significant correlation with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups-based assessment of TOPD severity. A high serum fibrinogen level did not correlate with a high HAM-D score, nor did a high CRP level correlate with a high HAM-A score. Conclusion Psychiatric comorbidities like depression are associated with increased inflammation in chronic diseases like TOPD, but no definitive biomarker has been identified and further studies are required to identify suitable biomarkers.
Collapse
|
33
|
Sussenbach AE, van Gijzel SW, Lalla-Edward ST, Venter WD, Shaddock E, Feldman C, Klipstein-Grobusch K, Vos AG. The influence of smoking and HIV infection on pulmonary function. South Afr J HIV Med 2022; 23:1329. [PMID: 35284096 PMCID: PMC8905446 DOI: 10.4102/sajhivmed.v23i1.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background Prevalence of HIV, smoking, and pulmonary infections in South Africa are high. Objectives We investigated the role of smoking and HIV status on lung function. Methods This is a secondary analysis of a cross-sectional study conducted in South Africa. Data included demographics, pulmonary risk factors and a spirometry test to obtain the forced expiratory volume in one second (FEV1) and the ratio of FEV1/forced vital capacity (FVC). In the initial multivariable regression analysis, the effect of smoking on pulmonary function in HIV-positive adults was assessed. The analysis was repeated, assessing the influence of HIV status on lung function in both HIV-negative and HIV-positive smokers. The models were adjusted for age, sex, body mass index (BMI), time since HIV diagnosis, antiretroviral treatment (ART) use, occupational hazards, history of tuberculosis or pneumonia, indoor smoking and the presence of an indoor fireplace during childhood. Results This study included 524 people living with HIV (PLWH, 66.7% female, mean age 40.9 years [s.d.; 9.4]) and 79 HIV-negative smokers (77.2% male, mean age 34.4 years [s.d.: 12.1]). Of the PLWH, 118 (22.5%) were past or current smokers and 406 (77.5%) were non-smokers. Smoking was not associated with changes in the FEV1 or FEV1/FVC ratio in multivariable regression analysis. In the second analysis, HIV status was also not associated with reduced pulmonary function following adjustment for confounders. Conclusion Neither smoking nor being HIV-positive was associated with decreased pulmonary function in this relatively young population. These findings should be confirmed in a longitudinal study, including an older population.
Collapse
Affiliation(s)
- Annelotte E. Sussenbach
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sjors W.L. van Gijzel
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Samanta T. Lalla-Edward
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Willem D.F. Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica Shaddock
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Division of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
- Division of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alinda G. Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
34
|
Ismail N, Hassan N, Abd Hamid MHN, Yusoff UN, Khamal NR, Omar MA, Wong XC, Pathmanathan MD, Mohd Zin S, Muhammad Zin F, Nik Mohamed MH, Mohd Nor N. ASSOCIATION OF SMOKING AND SEVERITY OF COVID-19 INFECTION AMONG 5,889 PATIENTS IN MALAYSIA: A MULTI-CENTER OBSERVATIONAL STUDY. Int J Infect Dis 2022; 116:189-196. [PMID: 35021062 PMCID: PMC8743378 DOI: 10.1016/j.ijid.2022.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 01/08/2023] Open
Abstract
Objective This study aims to investigate the association between smoking and the severity of COVID-19 infection during the initial wave of this pandemic in Malaysia. Methods This is a multi-center observational study using secondary hospital data collected retrospectively from February 1, 2020, until May 30, 2020. Clinical records of all real-time polymerase chain reaction (RT-PCR)-confirmed COVID-19 cases with smoking status, co-morbidities, clinical features, and disease management were retrieved. Severity was assessed by the presence of complications and outcomes of COVID-19 infection. Logistic regression was used to determine the association between COVID-19 disease severity and smoking status. Results A total of 5,889 COVID-19 cases were included in the analysis. Ever smokers had a higher risk of having COVID-19 complications, such as acute respiratory distress syndrome (odds ratio [OR] 1.69; 95% confidence interval [CI] 1.09-2.55), renal injury (OR 1.55; 95% CI 1.10-2.14), and acute liver injury (OR 1.33; 95% CI 1.01-1.74), compared with never smokers. However, in terms of disease outcomes, there were no differences between the two groups. Conclusion Although no significant association was found in terms of disease outcomes, smoking is associated with a higher risk of having complications owing to COVID-19 infection.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Xin Ci Wong
- Digital Health Research and Innovation Unit, Institute for Clinical Research, Malaysia
| | | | | | | | - Mohamad Haniki Nik Mohamed
- Kulliyyah of Pharmacy, International Islamic University of Malaysia (Chairman of Technical Working Group World Health Organization Framework Convention on Tobacco Control Malaysia)
| | - Norashidah Mohd Nor
- Faculty of Economy, University Putra Malaysia (Vice Chairman of Technical Working Group World Health Organization Framework Convention on Tobacco Control Malaysia)
| |
Collapse
|
35
|
Badiger S, Purushothama J, Kumar N, Baikunje N, D'Souza N, Olickal J, Dmello M. “Once a smoker, always a smoker: Primary care physicians” views on integrating smoking cessation with antitubercular treatment in primary health centers – A qualitative study. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2022. [DOI: 10.4103/jmhhb.jmhhb_60_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
36
|
Duedu KO, Aninagyei E, Akila DA, Kweku M. Active tuberculosis case findings in Ghanaian health facilities: effectiveness and sensitivity of the symptoms-based screening tool. Pan Afr Med J 2021; 40:111. [PMID: 34887985 PMCID: PMC8627140 DOI: 10.11604/pamj.2021.40.111.28798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction the National Tuberculosis Programme (NTP), Ghana, introduced Symptoms-Based Screening (SBS) Tool for TB case finding. This study aimed to determine the challenges and limitations associated with the use of the SBS Tool for active tuberculosis case finding in Ghanaian health facility settings. Methods this study targeted suspected TB patients attending two health facilities in the Ho Municipality, Ghana. Initially, suspected TB patients were screened with the SBS tool and presumptive patients subsequently tested for M. tuberculosis using microscopy and geneXpert assay. Additionally, health personnel were interviewed to assess the user-friendliness, challenges, and limitations associated with the tool. Results of 636 presumptive TB patients identified, 1.73% had tuberculosis. Coughing for > 2 weeks (χ2=24.8; p<0.05); chest pain (χ2=28.3; p<0.01) and night sweat (χ2=34.8; p<0.05) associated significantly with M. tuberculosis infection status. The health personnel found the tool to be not user-friendly and it also lacked indicators to identify other vulnerable individuals such as diabetics, cigarette smokers, alcoholics, immunocompromised, and malnourished individuals. Therefore, the SBS tool was found not to be sensitive enough to identify probable cases. Conclusion the SBS tool is useful for detecting active TB cases, however, it must be improved to identify vulnerable individuals such as diabetics, immunosuppressed, and malnourished.
Collapse
Affiliation(s)
- Kwabena Obeng Duedu
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Hohoe, Ghana
| | - Enoch Aninagyei
- Department of Biomedical Sciences, School of Basic and Biomedical Sciences, University of Health and Allied Sciences, Hohoe, Ghana
| | - Diana Ayinpokbila Akila
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Margaret Kweku
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| |
Collapse
|
37
|
Mbuh TP, Wandji A, Keugni L, Mboh S, Ane-Anyangwe I, Mbacham WF, Meriki HD. Predictors of Drug-Resistant Tuberculosis among High-Risk Population Diagnosed under National Program Conditions in the Littoral Region, Cameroon. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8817442. [PMID: 34840984 PMCID: PMC8626195 DOI: 10.1155/2021/8817442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 04/21/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022]
Abstract
Multiple drug resistance TB (MDR-TB) has greatly jeopardized the effective control of tuberculosis in Africa. This study is aimed at determining the incidence and predictors of drug resistant-TB amongst bacteriologically diagnosed cases in the Littoral region of Cameroon. This was a descriptive cross-sectional survey conducted from January 2016 to December 2017. A total of 1665 participants were enrolled from 32 diagnostic and treatment centers (DTCs) in the Littoral region. Demographic, clinical, socioeconomic, and behavioral data were obtained using a pretested structured questionnaire. Drug susceptibility testing was performed using Gene Xpert MTB/RIF assay and line probe assay (LPA). Consent was obtained from participant/guidance. Data analysis was carried with SPSS version 21. Univariate and multiple logistic regression was performed at 5% significance level. The incidence of rifampicin and MDR-TB was 86 (5.2%) and 75 (4.5%), respectively. More (11.3%) cases of drug resistance were diagnosed in 2016 compared to 2017 (3.7%). Eleven (0.7%) were resistant to rifampicin only. A total of 19 (4.4%) cases of rifampicin resistance were detected from newly diagnosed cases and 67 (5.4%) from previously retreated cases. Pre-XDR-TB was detected in 2 (2.7%) of the MDR-TB cases amongst whom 1 (1.3%) was extensive drug resistance TB (XDR-TB). Age greater than 60 years old (OR = 4.98, p = 0.047), being married (OR = 1.91, p = 0.006), being currently incarcerated (OR = 1.74, p = 0.027), and having contact with known TB cases (OR = 1.88, p = 0.007) were associated to MDR-TB in a univariate analysis. This study highlights the declining rates of TB drug resistance in the region over the years probably due to the introduction of Gene Xpert that results in early detection of RR-TB. It also shows that age greater than 60 years, being married, and incarcerated are predictors of drug resistant-TB, while the year of patient enrolment and previous exposure to TB treatment were independent predictors of drug resistance in the Littoral region of Cameroon.
Collapse
Affiliation(s)
- Teyim Pride Mbuh
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Cameroon
- Tuberculosis Reference Laboratory Douala, Cameroon
| | - Adeline Wandji
- Littoral Regional Technical Group for the Control of Tuberculosis/Littoral Regional Delegation for Public Health, Cameroon
| | | | | | - Irene Ane-Anyangwe
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Cameroon
| | | | - Henry Dilonga Meriki
- Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Cameroon
| |
Collapse
|
38
|
Vidrine DJ, Bui TC, Businelle MS, Shih YCT, Sutton SK, Shahani L, Hoover DS, Bowles K, Vidrine JI. Evaluating the Efficacy of Automated Smoking Treatment for People With HIV: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e33183. [PMID: 34787590 PMCID: PMC8663670 DOI: 10.2196/33183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/03/2021] [Indexed: 11/29/2022] Open
Abstract
Background Smoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV. Objective This study will consist of a 2-group randomized controlled trial to evaluate a fully automated smartphone intervention for people with HIV seeking cessation treatment. Methods Participants (N=500) will be randomized to receive either standard treatment (ST; 250/500, 50%) or automated treatment (AT; 250/500, 50%). ST participants will be connected to the Florida Quitline and will receive nicotine replacement therapy in the form of transdermal patches and lozenges. This approach, referred to as Ask Advise Connect, was developed by our team and has been implemented in numerous health systems. ST will be compared with AT, a fully automated behavioral treatment approach. AT participants will receive nicotine replacement therapy and an interactive smartphone-based intervention that comprises individually tailored audiovisual and text content. The major goal is to determine whether AT performs better in terms of facilitating long-term smoking abstinence than the more resource-intensive ST approach. Our primary aim is to evaluate the efficacy of AT in facilitating smoking cessation among people with HIV. As a secondary aim, we will explore potential mediators and moderators and conduct economic evaluations to assess the cost and cost-effectiveness of AT compared with ST. Results The intervention content has been developed and finalized. Recruitment and enrollment will begin in the fall of 2021. Conclusions There is a critical need for efficacious, cost-effective, and sustainable cessation treatments for people with HIV who smoke. The AT intervention was designed to help fill this need. If efficacy is established, the AT approach will be readily adoptable by HIV clinics and community-based organizations, and it will offer an efficient way to allocate limited public health resources to tobacco control interventions. Trial Registration ClinicalTrials.gov NCT05014282; https://clinicaltrials.gov/ct2/show/NCT05014282 International Registered Report Identifier (IRRID) PRR1-10.2196/33183
Collapse
Affiliation(s)
- Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Thanh C Bui
- Stephenson Cancer Center, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Michael S Businelle
- Stephenson Cancer Center, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ya-Chen Tina Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Steven K Sutton
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, United States
| | - Lokesh Shahani
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | | | - Kristina Bowles
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Jennifer I Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| |
Collapse
|
39
|
Twabi HH, Semphere R, Mukoka M, Chiume L, Nzawa R, Feasey HRA, Lipenga T, MacPherson P, Corbett EL, Nliwasa M. Pattern of abnormalities amongst chest X-rays of adults undergoing computer-assisted digital chest X-ray screening for tuberculosis in Peri-Urban Blantyre, Malawi: A cross-sectional study. Trop Med Int Health 2021; 26:1427-1437. [PMID: 34297430 DOI: 10.1111/tmi.13658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prevalence of diseases other than tuberculosis (TB) detected during chest X-ray screening is poorly described in sub-Saharan Africa. Computer-assisted digital chest X-ray technology is available for TB screening and has the potential to be a screening tool for non-communicable diseases as well. Low- and middle-income countries are in a transition period where the burden of non-communicable diseases is increasing, but health systems are mainly focused on addressing infectious diseases. METHODS Participants were adults undergoing computer-assisted chest X-ray screening for tuberculosis in a community-wide tuberculosis prevalence survey in Blantyre, Malawi. Adults with abnormal radiographs by field radiographer interpretation were evaluated by a physician in a community-based clinic. X-ray classifications were compared to classifications of a random sample of normal chest X-rays by radiographer interpretation. Radiographic features were classified using WHO Integrated Management for Adult Illnesses (IMAI) guidelines. All radiographs taken at the screening tent were analysed by the Qure.ai qXR v2.0 software. RESULTS 5% (648/13,490) of adults who underwent chest radiography were identified to have an abnormal chest X-ray by the radiographer. 387 (59.7%) of the participants attended the X-ray clinic, and another 387 randomly sampled normal X-rays were available for comparison. Participants who were referred to the community clinic had a significantly higher HIV prevalence than those who had been identified to have a normal CXR by the field radiographer (90 [23.3%] vs. 43 [11.1%] p-value < 0.001). The commonest radiographic finding was cardiomegaly (20.7%, 95% CI 18.0-23.7). One in five (81/387) chest X-rays were misclassified by the radiographer. The overall mean Qure.ai qXR v2.0 score for all reviewed X-rays was 0.23 (SD 0.20). There was a high concordance of cardiomegaly classification between the physician and the computer-assisted software (109/118, 92.4%). CONCLUSION There is a high burden of cardiomegaly on a chest X-ray at a community level, much of which is in patients with diabetes, heart disease and high blood pressure. Cardiomegaly on chest X-ray may be a potential tool for screening for cardiovascular NCDs at the primary care level as well as in the community.
Collapse
Affiliation(s)
- Hussein H Twabi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,College of Medicine, Helse Nord TB Initiative, University of Malawi, Blantyre, Malawi
| | - Robina Semphere
- College of Medicine, Helse Nord TB Initiative, University of Malawi, Blantyre, Malawi
| | - Madalo Mukoka
- College of Medicine, Helse Nord TB Initiative, University of Malawi, Blantyre, Malawi
| | - Lingstone Chiume
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Rebecca Nzawa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Helena R A Feasey
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,London School of Hygiene and Tropical Medicine, London, UK
| | - Trancizeo Lipenga
- College of Medicine, Helse Nord TB Initiative, University of Malawi, Blantyre, Malawi
| | - Peter MacPherson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,London School of Hygiene and Tropical Medicine, London, UK.,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elizabeth L Corbett
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.,London School of Hygiene and Tropical Medicine, London, UK
| | - Marriott Nliwasa
- College of Medicine, Helse Nord TB Initiative, University of Malawi, Blantyre, Malawi
| |
Collapse
|
40
|
Dheda K, Charalambous S, Karat AS, von Delft A, Lalloo UG, van Zyl Smit R, Perumal R, Allwood BW, Esmail A, Wong ML, Duse AG, Richards G, Feldman C, Mer M, Nyamande K, Lalla U, Koegelenberg CFN, Venter F, Dawood H, Adams S, Ntusi NAB, van der Westhuizen HM, Moosa MYS, Martinson NA, Moultrie H, Nel J, Hausler H, Preiser W, Lasersohn L, Zar HJ, Churchyard GJ. A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2. Afr J Thorac Crit Care Med 2021; 27:10.7196/AJTCCM.2021.v27i4.173. [PMID: 34734176 PMCID: PMC8545268 DOI: 10.7196/ajtccm.2021.v27i4.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 12/21/2022] Open
Abstract
SUMMARY Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators ('respirators'; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations now recommend that health workers (HWs) wear a respirator when caring for individuals who may have COVID-19. In South Africa (SA), however, surgical masks are still recommended for the routine care of individuals with possible or confirmed COVID-19, with respirators reserved for so-called aerosol-generating procedures. In contrast, SA guidelines do recommend respirators for routine care of individuals with possible or confirmed tuberculosis (TB), which is also transmitted via aerosol. In health facilities in SA, distinguishing between TB and COVID-19 is challenging without examination and investigation, both of which may expose HWs to potentially infectious individuals. Symptom-based triage has limited utility in defining risk. Indeed, significant proportions of individuals with COVID-19 and/or pulmonary TB may not have symptoms and/or test negative. The prevalence of undiagnosed respiratory disease is therefore likely significant in many general clinical areas (e.g. waiting areas). Moreover, a proportion of HWs are HIV-positive and are at increased risk of severe COVID-19 and death. RECOMMENDATIONS Sustained improvements in infection prevention and control (IPC) require reorganisation of systems to prioritise HW and patient safety. While this will take time, it is unacceptable to leave HWs exposed until such changes are made. We propose that the SA health system adopts a target of 'zero harm', aiming to eliminate transmission of respiratory pathogens to all individuals in every healthcare setting. Accordingly, we recommend: the use of respirators by all staff (clinical and non-clinical) during activities that involve contact or sharing air in indoor spaces with individuals who: (i) have not yet been clinically evaluated; or (ii) are thought or known to have TB and/or COVID-19 or other potentially harmful respiratory infections;the use of respirators that meet national and international manufacturing standards;evaluation of all respirators, at the least, by qualitative fit testing; andthe use of respirators as part of a 'package of care' in line with international IPC recommendations. We recognise that this will be challenging, not least due to global and national shortages of personal protective equipment (PPE). SA national policy around respiratory protective equipment enables a robust framework for manufacture and quality control and has been supported by local manufacturers and the Department of Trade, Industry and Competition. Respirator manufacturers should explore adaptations to improve comfort and reduce barriers to communication. Structural changes are needed urgently to improve the safety of health facilities: persistent advocacy and research around potential systems change remain essential.
Collapse
Affiliation(s)
- K Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for
the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - S Charalambous
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - A S Karat
- TB Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - A von Delft
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- TB Proof, South Africa
| | - U G Lalloo
- Gateway Private Hospital Medical Centre, Umhlanga Ridge, South Africa
- Durban International Clinical Research Site, Durban, South Africa
| | - R van Zyl Smit
- Division of Pulmonology and Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - R Perumal
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for
the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - A Esmail
- Clinical Trials Unit, University of Cape Town Lung Institute, South Africa
| | - M L Wong
- Division of Pulmonology, Department of Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A G Duse
- Clinical Microbiology & Infectious Diseases, School of Pathology of the NHLS & University of the Witwatersrand, Johannesburg, South Africa
| | - G Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - C Feldman
- Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M Mer
- Department of Medicine, Divisions of Pulmonology and Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - K Nyamande
- Department of Pulmonology, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - U Lalla
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - C F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - F Venter
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - H Dawood
- Greys Hospital, Pietermaritzburg, South Africa
| | - S Adams
- Division of Occupational Medicine, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - N A B Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - H-M van der Westhuizen
- TB Proof, South Africa
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| | - M-Y S Moosa
- Department of Infectious Diseases, Division of Internal Medicine, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Southern African HIV Clinicians Society
| | - N A Martinson
- Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Johannesburg, South Africa
- Johns Hopkins University Center for TB Research, Baltimore, MD, USA
| | - H Moultrie
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Clinical Microbiology & Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J Nel
- Division of Infectious Diseases, Department of Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - H Hausler
- TB HIV Care, Cape Town, South Africa
| | - W Preiser
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service Tygerberg, Cape Town,
South Africa
| | - L Lasersohn
- South African Society of Anaesthesiologists
- Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Critical Care, Chris Hani Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
| | - H J Zar
- Department of Paediatrics & Child Health, Red Cross Children’s Hospital and SAMRC Unit on Child and Adolescent Health, University of Cape Town, South Africa
| | - G J Churchyard
- The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| |
Collapse
|
41
|
Philip KE, Cartwright LL, Westlake D, Nyakoojo G, Kimuli I, Kirenga B, Brakema EA, Orme MW, Fancourt D, Hopkinson NS, Jones R, Katagira W. Music and dance in respiratory disease management in Uganda: a qualitative study of patient and healthcare professional perspectives. BMJ Open 2021; 11:e053189. [PMID: 34556518 PMCID: PMC8461694 DOI: 10.1136/bmjopen-2021-053189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Music and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking. METHODS We delivered sample sessions of music and dance for chronic respiratory disease (CRD) to patients and healthcare professionals. Seven participants took part in one singing and dance sample session. One patient completed only the dance session. We then conducted an exploratory qualitative study using thematic analysis of semistructured interviews with healthcare professionals and patients regarding (1) the role of music and dance in Ugandan life and (2) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda. RESULTS We interviewed 19 participants, made up of 11 patients with long-term respiratory conditions and 8 healthcare professionals, who were selected by purposeful convenience sampling. Four key themes were identified from interview analysis: music and dance (1) were central components of daily life; (2) had an established role supporting health and well-being; and (3) had strong therapeutic potential in respiratory disease management. The fourth theme was (4) the importance of modulating demographic considerations of culture, religion and age. CONCLUSION Music and dance are central to life in Uganda, with established roles supporting health and well-being. These roles could be built on in the development of music and dance interventions as adjuncts to established components of CRD disease management like pulmonary rehabilitation. Through consideration of key contextual factors and codevelopment and adaptation of interventions, such approaches are likely to be well received.
Collapse
Affiliation(s)
- Keir Ej Philip
- National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Imperial Biomedical Research Centre, Imperial College London, London, UK
| | | | | | - Grace Nyakoojo
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | - Ivan Kimuli
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, Makerere University, Kampala, Uganda
| | - Evelyn A Brakema
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark W Orme
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | | | | | | |
Collapse
|
42
|
Tao NN, Li YF, Song WM, Liu JY, Zhang QY, Xu TT, Li SJ, An QQ, Liu SQ, Li HC. Risk factors for drug-resistant tuberculosis, the association between comorbidity status and drug-resistant patterns: a retrospective study of previously treated pulmonary tuberculosis in Shandong, China, during 2004-2019. BMJ Open 2021; 11:e044349. [PMID: 34135033 PMCID: PMC8211042 DOI: 10.1136/bmjopen-2020-044349] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study was designed to identify the risk factors for drug-resistant tuberculosis (DR-TB) and the association between comorbidity and drug resistance among retreated pulmonary tuberculosis (PTB). DESIGN A retrospective study was conducted among all the 36 monitoring sites in Shandong, China, over a 16-year period. Baseline characteristics were collected from the TB Surveillance System. Categorical variables were compared by Fisher's exact or Pearson's χ2 test. The risk factors for drug resistance were identified using univariable analysis and multivariable logistic models. The influence of comorbidity on different types of drug resistance was evaluated by performing multivariable logistic models with the covariates adjusted by age, sex, body mass index, drinking/smoking history and cavity. RESULTS A total of 10 975 patients with PTB were recorded during 2004-2019, and of these 1924 retreated PTB were finally included. Among retreated PTB, 26.2% were DR-TB and 12.5% had comorbidity. Smoking (adjusted OR (aOR): 1.69, 95% CI 1.19 to 2.39), cavity (aOR: 1.55, 95% CI 1.22 to 1.97) and comorbidity (aOR: 1.44, 95% CI 1.02 to 2.02) were risk factors for DR-TB. Of 504 DR-TB, 9.5% had diabetes mellitus, followed by hypertension (2.0%) and chronic obstructive pulmonary disease (1.8%). Patients with retreated PTB with comorbidity were more likely to be older, have more bad habits (smoking, alcohol abuse) and have clinical symptoms (expectoration, haemoptysis, weight loss). Comorbidity was significantly associated with DR-TB (aOR: 1.44, 95% CI 1.02 to 2.02), overall rifampin resistance (aOR: 2.17, 95% CI 1.41 to 3.36), overall streptomycin resistance (aOR: 1.51, 95% CI 1.00 to 2.27) and multidrug resistance (aOR: 1.96, 95% CI 1.17 to 3.27) compared with pan-susceptible patients (p<0.05). CONCLUSION Smoking, cavity and comorbidity lead to an increased risk of drug resistance among retreated PTB. Strategies to improve the host's health, including smoking cessation, screening and treatment of comorbidity, might contribute to the control of tuberculosis, especially DR-TB, in China.
Collapse
Affiliation(s)
- Ning-Ning Tao
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Yi-Fan Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wan-Mei Song
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jin-Yue Liu
- Department of Critical Care Medicine, Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Qian-Yun Zhang
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Ting-Ting Xu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Shi-Jin Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Qi-Qi An
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Si-Qi Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Huai-Chen Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| |
Collapse
|
43
|
Abstract
BACKGROUND It is unknown if the carcinogenic effect of smoking is influenced by CD4+ cell count and viral load in persons living with HIV. MATERIAL AND METHODS RESPOND participants with known smoking status were included. Poisson regression adjusting for baseline confounders investigated the interaction between current CD4+/viral load strata [good (CD4+ cell count ≥500 cells/μl and viral load <200 copies/ml], poor [CD4+ cell count ≤350 cells/μl and viral load >200 copies/ml] and intermediate [all other combinations]), smoking status and all cancers, non-AIDS defining cancers (NADCs), smoking-related cancers (SRCs) and infection-related cancers (IRCs). RESULTS Out of 19 602 persons, 41.3% were never smokers, 44.4% current and 14.4% previous smokers at baseline. CD4+/viral load strata were poor in 3.4%, intermediate in 44.8% and good in 51.8%. There were 513 incident cancers; incidence rate 6.9/1000 person-years of follow-up (PYFU) [95% confidence interval (95% CI) 6.3-7.5]. Current smokers had higher incidence of all cancer (adjusted incidence rate ratio 1.45; 1.17-1.79), NADC (1.65; 1.31-2.09), SRC (2.21; 1.53-3.20) and IRC (1.38; 0.97-1.96) vs. never smokers. Those with poor CD4+/viral load had increased incidence of all cancer (5.36; 95% CI 3.71-7.75), NADC (3.14; 1.92-5.14), SRC (1.82; 0.76-4.41) and IRC (10.21; 6.06-17.20) vs. those with good CD4+/viral load. There was no evidence that the association between smoking and cancer subtypes differed depending on the CD4+/viral load strata (P > 0.1, test for interaction). CONCLUSION In the large RESPOND consortium, the impact of smoking on cancer was clear and reducing smoking rates should remain a priority. The association between current immune deficiency, virological control and cancer was similar for never smokers, current smokers and previous smokers suggesting similar carcinogenic effects of smoking regardless of CD4+ cell count and viral load.
Collapse
|
44
|
de Vargas KR, Freitas AA, Azeredo ACV, Silva DR. Smoking prevalence and effects on treatment outcomes in patients with tuberculosis. Rev Assoc Med Bras (1992) 2021; 67:406-410. [PMID: 34468606 DOI: 10.1590/1806-9282.20200825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/27/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE More than 20% of tuberculosis (TB) cases worldwide are attributable to smoking, and it is associated with an increased risk of latent and active TB, recurrence, and mortality. The aim of this study is to assess the smoking prevalence and the effects on treatment outcomes in TB patients. METHODS A prospective cohort study was conducted in patients with a recent TB diagnosis. The smoking status was defined, in addition to the patients' knowledge and attitudes toward smoking. The patients were followed up until the end of the treatment, and the treatment result was recorded. RESULTS Ninety-two patients were included in this study. The prevalence of active smoking was 31.5%. Active smokers had less chance for cure (62.1% versus 82.5%; p=0.032) and more treatment dropout (31.0% versus 12.7%; p=0.035) than non-active smokers. Patients demonstrated positive attitudes and good knowledge about smoking. CONCLUSIONS Active smokers had less chance for cure and more abandonment than non-active smokers. These results can be useful for the proper planning of actions that impact TB control, especially in the treatment results, such as cognitive-behavioral approaches to smoking cessation.
Collapse
Affiliation(s)
- Kellyn Rocha de Vargas
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Pneumológicas - Porto Alegre (RS), Brazil
| | - Alana Ambos Freitas
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina - Porto Alegre (RS), Brazil
| | | | - Denise Rossato Silva
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Ciências Pneumológicas - Porto Alegre (RS), Brazil.,Universidade Federal do Rio Grande do Sul, Faculdade de Medicina - Porto Alegre (RS), Brazil
| |
Collapse
|
45
|
Thirlway F, Nyamurungi KN, Matovu JKB, Miti AK, Mdege ND. Tobacco use and cessation in the context of ART adherence: Insights from a qualitative study in HIV clinics in Uganda. Soc Sci Med 2021; 273:113759. [PMID: 33631533 PMCID: PMC7610397 DOI: 10.1016/j.socscimed.2021.113759] [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] [Revised: 12/24/2020] [Accepted: 02/04/2021] [Indexed: 11/28/2022]
Abstract
Sub-Saharan Africa carries a disproportionate burden of human immunodeficiency virus (HIV). Tobacco use amongst people living with HIV is higher than in the general population even though it increases the risk of life-threatening opportunistic infections including tuberculosis (TB). Research on tobacco use and cessation amongst people living with HIV in Africa is sparse and it is not clear what interventions might achieve lasting cessation. We carried out qualitative interviews in Uganda in 2019 with 12 current and 13 former tobacco users (19 men and 6 women) receiving antiretroviral therapy (ART) in four contrasting locations. We also interviewed 13 HIV clinic staff. We found that tobacco use and cessation were tied into the wider moral framework of ART adherence, but that the therapeutic citizenship fashioned by ART regimes was experienced more as social control than empowerment. Patients were advised to stop using tobacco; those who did not concealed this from health workers, who associated both tobacco and alcohol use with ART adherence failure. Most of those who quit tobacco did so following the biographical disruption of serious TB rather than HIV diagnosis or ART treatment, but social support from family and friends was key to sustained cessation. We put forward a model of barriers and facilitators to smoking cessation and ART adherence based on engagement with either ‘reputation’ or ‘respectability’. Reputation involved pressure to enjoy tobacco with friends whereas family-oriented respectability demanded cessation, but those excluded by isolation or precarity escaped anxiety and depression by smoking and drinking with their peers. People living with HIV in Uganda hid their tobacco use from health workers. The experience of tuberculosis was the most common trigger to quit smoking. Engagement with ‘respectable’ masculinity promoted smoking cessation. Engagement with ‘reputational’ masculinity made it hard to quit. This model has wider applicability for antiretroviral therapy adherence.
Collapse
Affiliation(s)
- Frances Thirlway
- Department of Sociology, University of York, York, YO10 5DD, UK.
| | - Kellen Namusisi Nyamurungi
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala P.O Box 7072, Kampala, Uganda
| | - Joseph K B Matovu
- Department of Community & Public Health Faculty of Health Sciences, Busitema University, Mbale, Uganda; Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Uganda
| | - Andrew Kibuuka Miti
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala P.O Box 7072, Kampala, Uganda
| | - Noreen Dadirai Mdege
- Department of Health Sciences, Faculty of Sciences, University of York, York, YO10 5DD, UK
| |
Collapse
|
46
|
Auld SC, Kornfeld H, Maenetje P, Mlotshwa M, Chase W, Vangu MDT, Torigian DA, Wallis RS, Churchyard G, Bisson GP. Pulmonary restriction predicts long-term pulmonary impairment in people with HIV and tuberculosis. BMC Pulm Med 2021; 21:19. [PMID: 33413293 PMCID: PMC7791797 DOI: 10.1186/s12890-020-01368-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/24/2020] [Indexed: 01/26/2023] Open
Abstract
Background While tuberculosis is considered a risk factor for chronic obstructive pulmonary disease, a restrictive pattern of pulmonary impairment may actually be more common among tuberculosis survivors. We aimed to determine the nature of pulmonary impairment before and after treatment among people with HIV and tuberculosis and identify risk factors for long-term impairment.
Methods In this prospective cohort study conducted in South Africa, we enrolled adults newly diagnosed with HIV and tuberculosis who were initiating antiretroviral therapy and tuberculosis treatment. We measured lung function and symptoms at baseline, 6, and 12 months. We compared participants with and without pulmonary impairment and constructed logistic regression models to identify characteristics associated with pulmonary impairment.
Results Among 134 participants with a median CD4 count of 110 cells/μl, 112 (83%) completed baseline spirometry at which time 32 (29%) had restriction, 13 (12%) had obstruction, and 9 (7%) had a mixed pattern. Lung function was dynamic over time and 30 (33%) participants had impaired lung function at 12 months. Baseline restriction was associated with greater symptoms and with long-term pulmonary impairment (adjusted odds ratio 5.44, 95% confidence interval 1.16–25.45), while baseline obstruction was not (adjusted odds ratio 1.95, 95% confidence interval 0.28–13.78).
Conclusions In this cohort of people with HIV and tuberculosis, restriction was the most common, symptomatic, and persistent pattern of pulmonary impairment. These data can help to raise awareness among clinicians about the heterogeneity of post-tuberculosis pulmonary impairment, and highlight the need for further research into mediators of lung injury in this vulnerable population.
Collapse
Affiliation(s)
- Sara C Auld
- Departments of Medicine and Epidemiology, School of Medicine and Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, USA
| | | | | | - William Chase
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Mboyo di-Tamba Vangu
- Department of Nuclear Medicine, CM Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Drew A Torigian
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Gavin Churchyard
- The Aurum Institute, Johannesburg, South Africa.,School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Gregory P Bisson
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
47
|
Louwagie GM, Morojele N, Siddiqi K, Mdege ND, Tumbo J, Omole O, Pitso L, Bachmann MO, Ayo-Yusuf OA. Addressing tobacco smoking and drinking to improve TB treatment outcomes, in South Africa: a feasibility study of the ProLife program. Transl Behav Med 2020; 10:1491-1503. [PMID: 31233146 DOI: 10.1093/tbm/ibz100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Alcohol and tobacco use may lead to negative treatment outcomes in tuberculosis (TB) patients, and even more so if they are HIV-infected. We developed and tested the feasibility of a complex behavioral intervention (ProLife) delivered by lay health workers (LHWs) to improve treatment outcomes in TB patients who smoke tobacco and/or drink alcohol, at nine clinics in South Africa. The intervention comprised three brief motivational interviewing (MI) sessions augmented with a short message service (SMS) program, targeting as appropriate: tobacco smoking, harmful or hazardous drinking and medication adherence. Patients received SMSs twice a week. We measured recruitment and retention rates and assessed fidelity to the MI technique (MI Treatment Integrity 4.1 tool). Finally, we explored LHWs' and patients' experiences through interviews and semi-structured questionnaires, respectively. We screened 137 TB patients and identified 14 smokers, 13 alcohol drinkers, and 18 patients with both behaviors. Participants' mean age was 39.8 years, and 82.2% were men. The fidelity assessments pointed to the LHWs' successful application of key MI skills, but failure to reach MI competency thresholds. Nevertheless, most patients rated the MI sessions as helpful, ascribed positive attributes to their counselors, and reported behavioral changes. SMSs were perceived as reinforcing but difficult language and technical delivery problems were identified as problems. The LHWs' interview responses suggested that they (a) grasped the basic MI spirit but failed to understand specific MI techniques due to insufficient training practice; (b) perceived ProLife as having benefitted the patients (as well as themselves); (c) viewed the SMSs favorably; but (d) considered limited space and privacy at the clinics as key challenges. The ProLife program targeting multiple risk behaviors in TB patients is acceptable but LHW training protocol, and changes in wording and delivery of SMS are necessary to improve the intervention. Trial registration: ISRCTN62728852.
Collapse
Affiliation(s)
- Goedele M Louwagie
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.,Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Neo Morojele
- Alcohol, Tobacco and Other Drug Research Unit, Medical Research Council, Pretoria, South Africa
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Noreen D Mdege
- Department of Health Sciences, University of York, York, UK
| | - John Tumbo
- Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Olu Omole
- Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lerato Pitso
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Max O Bachmann
- Department of Public Health and Health Services Research, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Olalekan A Ayo-Yusuf
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.,Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| |
Collapse
|
48
|
An Q, Song W, Liu J, Tao N, Liu Y, Zhang Q, Xu T, Li S, Liu S, Li Y, Yu C, Li H. Primary Drug-Resistance Pattern and Trend in Elderly Tuberculosis Patients in Shandong, China, from 2004 to 2019. Infect Drug Resist 2020; 13:4133-4145. [PMID: 33223840 PMCID: PMC7671465 DOI: 10.2147/idr.s277203] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/09/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND With an aging population, China is facing a huge burden of elderly patients with drug resistant tuberculosis (DR-TB), which has become a significant obstacle for the global TB control. There is still little study on DR-TB in the elderly in China so far. Thus, more research on the epidemiological characteristics and trend of primary DR-TB among the elderly will be necessary. METHODS A retrospective study was conducted in Shandong, China from 2004 to 2019. We collected 12,661 primary TB cases, of which 4368 elderly (≥60 years) primary TB cases were involved. Clinical characteristics including age, sex, cavity, smoking, drinking, comorbidity and drug susceptibility data were collected from 36 TB prevention and control institutions of Shandong Province. Sputum samples were collected by each surveillance site, and examined in the TB Reference Laboratory of SPCH. Descriptive statistical analysis, chi-square and linear regression were used for analyzing. RESULTS Among 4368 elderly patients with primary TB, the DR-TB and multi-resistant tuberculosis (MDR-TB) accounted for 17.19% and 2.29%, respectively. During 2004-2019, the proportions of MDR-TB, polydrug resistant tuberculosis (PDR-TB), rifampin (RFP)-resistance increased by 160.00%, 18.18%, 231.82%, respectively and the rate of DR-TB among elderly patients with primary cavitary TB increased by 255%. Among the elderly with primary DR-TB during 2004-2019, the proportion of male (from 85.19 to 89.06), cavity (from 7.41 to 46.88), RFP-resistance (from 3.70 to 21.88), and streptomycin (SM)-resistance (from 37.04 to 62.5) increased significantly (P<0.05). And the proportion of female (from 14.81 to 10.94), non-cavity (from 92.59 to 32.81), INH-resistance (from 66.67 to 57.81) decreased significantly (P<0.05). CONCLUSION Among the elderly, the proportions of MDR-TB, PDR-TB, RFP-resistance and cavitary DR-TB increased significantly. The pattern of DR-TB changed from female, non-cavity and INH-resistant groups to male, cavity, RFP or SM-resistant groups. For a better control on the elderly DR-TB in the future, we should pay more attention to male, smoking, drinking, chronic obstructive pulmonary disease (COPD) and diabetes subgroups and take targeted measures to control these subgroups.
Collapse
Affiliation(s)
- Qiqi An
- Department of Respiratory Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong250012, People’s Republic of China
| | - Wanmei Song
- Department of Respiratory Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong250012, People’s Republic of China
| | - Jinyue Liu
- Intensive Care Unit, Shandong Provincial Third Hospital, Jinan, Shandong100191, People’s Republic of China
| | - Ningning Tao
- Peking Union Medical College, Beijing100005, People’s Republic of China
| | - Yao Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong250021, People’s Republic of China
| | - Qianyun Zhang
- Department of Respiratory Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong250012, People’s Republic of China
| | - Tingting Xu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong250021, People’s Republic of China
| | - Shijin Li
- Department of Respiratory Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong250012, People’s Republic of China
| | - Siqi Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong250012, People’s Republic of China
| | - Yifan Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong250021, People’s Republic of China
| | - Chunbao Yu
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital, Jinan, Shandong250013, People’s Republic of China
| | - Huaichen Li
- Department of Respiratory Medicine, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong250012, People’s Republic of China
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong250021, People’s Republic of China
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong250355, People’s Republic of China
| |
Collapse
|
49
|
Calligaro GL, Lalla U, Audley G, Gina P, Miller MG, Mendelson M, Dlamini S, Wasserman S, Meintjes G, Peter J, Levin D, Dave JA, Ntusi N, Meier S, Little F, Moodley DL, Louw EH, Nortje A, Parker A, Taljaard JJ, Allwood BW, Dheda K, Koegelenberg CFN. The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study. EClinicalMedicine 2020; 28:100570. [PMID: 33043285 PMCID: PMC7536126 DOI: 10.1016/j.eclinm.2020.100570] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The utility of heated and humidified high-flow nasal oxygen (HFNO) for severe COVID-19-related hypoxaemic respiratory failure (HRF), particularly in settings with limited access to intensive care unit (ICU) resources, remains unclear, and predictors of outcome have been poorly studied. METHODS We included consecutive patients with COVID-19-related HRF treated with HFNO at two tertiary hospitals in Cape Town, South Africa. The primary outcome was the proportion of patients who were successfully weaned from HFNO, whilst failure comprised intubation or death on HFNO. FINDINGS The median (IQR) arterial oxygen partial pressure to fraction inspired oxygen ratio (PaO2/FiO2) was 68 (54-92) in 293 enroled patients. Of these, 137/293 (47%) of patients [PaO2/FiO2 76 (63-93)] were successfully weaned from HFNO. The median duration of HFNO was 6 (3-9) in those successfully treated versus 2 (1-5) days in those who failed (p<0.001). A higher ratio of oxygen saturation/FiO2 to respiratory rate within 6 h (ROX-6 score) after HFNO commencement was associated with HFNO success (ROX-6; AHR 0.43, 0.31-0.60), as was use of steroids (AHR 0.35, 95%CI 0.19-0.64). A ROX-6 score of ≥3.7 was 80% predictive of successful weaning whilst ROX-6 ≤ 2.2 was 74% predictive of failure. In total, 139 patents (52%) survived to hospital discharge, whilst mortality amongst HFNO failures with outcomes was 129/140 (92%). INTERPRETATION In a resource-constrained setting, HFNO for severe COVID-19 HRF is feasible and more almost half of those who receive it can be successfully weaned without the need for mechanical ventilation.
Collapse
Affiliation(s)
- Gregory L Calligaro
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Usha Lalla
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Gordon Audley
- Division of General Medicine, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Phindile Gina
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Malcolm G Miller
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Sipho Dlamini
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Sean Wasserman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Graeme Meintjes
- Wellcome Centre for Infectious Disease Research in Africa (CIDRI-Africa), Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Jonathan Peter
- Division of Clinical Immunology and Allergology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Dion Levin
- Division of Gastroenterology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Joel A Dave
- Division of Endocrinology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Ntobeko Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Stuart Meier
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Desiree L Moodley
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Elizabeth H Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Andre Nortje
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Jantjie J Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Keertan Dheda
- Centre for Lung Infection and Immunity, Division of Pulmonology, Department of Medicine and UCT Lung Institute and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa
- Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Faculty of Infectious and Tropical Diseases, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Coenraad F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| |
Collapse
|
50
|
Chien J, Hwang JH, Nilaad S, Masso-Silva JA, Jeong Ahn S, McEachern EK, Moshensky A, Byun MK, Crotty Alexander LE. Cigarette Smoke Exposure Promotes Virulence of Pseudomonas aeruginosa and Induces Resistance to Neutrophil Killing. Infect Immun 2020; 88:e00527-20. [PMID: 32868344 PMCID: PMC7573448 DOI: 10.1128/iai.00527-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 08/28/2020] [Indexed: 01/19/2023] Open
Abstract
It is widely known that cigarette smoke damages host defenses and increases susceptibility to bacterial infections. Pseudomonas aeruginosa, a Gram-negative bacterium that commonly colonizes the airways of smokers and patients with chronic lung disease, can cause pneumonia and sepsis and can trigger exacerbations of lung diseases. Pseudomonas aeruginosa colonizing airways is consistently exposed to inhaled cigarette smoke. Here, we investigated whether cigarette smoke alters the ability of this clinically significant microbe to bypass host defenses and cause invasive disease. We found that cigarette smoke extract (CSE) exposure enhances resistance to human neutrophil killing, but this increase in pathogenicity was not due to resistance to neutrophil extracellular traps. Instead, Pseudomonas aeruginosa exposed to CSE (CSE-PSA) had increased resistance to oxidative stress, which correlated with increased expression of tpx, a gene essential for defense against oxidative stress. In addition, exposure to CSE induced enhanced biofilm formation and resistance to the antibiotic levofloxacin. Finally, CSE-PSA had increased virulence in a model of pneumonia, with 0% of mice infected with CSE-PSA alive at day 6, while 28% of controls survived. Altogether, these data show that cigarette smoke alters the phenotype of P. aeruginosa, increasing virulence and making it less susceptible to killing by neutrophils and more capable of causing invasive disease. These findings provide further explanation of the refractory nature of respiratory illnesses in smokers and highlight cigarette smoking as a potential driver of virulence in this important airway pathogen.
Collapse
Affiliation(s)
- Jason Chien
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - John H Hwang
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Sedtavut Nilaad
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jorge A Masso-Silva
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Sae Jeong Ahn
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Elisa K McEachern
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alexander Moshensky
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Min-Kwang Byun
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
- Division of Pulmonology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Laura E Crotty Alexander
- Pulmonary and Critical Care Section, VA San Diego Healthcare System, La Jolla, California, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
| |
Collapse
|