Evaluation of Active Pulmonary Tuberculosis Among Patients With Diabetes

Formulation of Fast Dissolving β-Glucan/Bilberry Juice Films for Packaging Dry Powdered Pharmaceuticals for Diabetes

The aim of this study was to develop fast dissolving films based on β-glucan and bilberry juice due to the bioactive potential of β-glucan and antidiabetic effect of bilberry juice. The benefit of incorporation of bioactive compounds into the films is due to the removal of unnecessary excipients and to confer protection as well as increase stability and shelf life to the packaged product. Due to the fast dissolving requirements of the European Pharmacopeia, which reduced the dissolution time from 180 to 60 s, indicating less than a minute, hygroscopic materials, such as sodium alginate and a suitable plasticizer, such as glycerin were incorporated. Moreover, the influence of ingredients and surfactants, such as soybean oil was studied in the design of fast dissolving films. Additionally, the steady state rate water vapor transmission rate (WVTR), water vapor permeability (WVP), and FT-IR spectroscopy tests were performed at high resolution to ensure the reliability of the films and composition as well as to validate the results. Our data suggest that the addition of surfactants contributed to the development of fast dissolving films without influencing the diffusion of water vapor. Low levels of WVTR and short dissolution time made from β-glucan and bilberry juice are a convenient candidate for packaging dry powdered pharmaceuticals for diabetes.

The prevalence and determinants of active tuberculosis among diabetes patients in Cape Town, South Africa, a high HIV/TB burden setting

AIMS

Studies addressing the association between diabetes mellitus (DM) and tuberculosis (TB) in sub-Saharan Africa are limited. We assessed the prevalence of active TB among DM patients at a primary care clinic, and identified risk factors for prevalent TB.

METHODS

A cross-sectional study was conducted in adult DM patients attending a clinic in Khayelitsha, Cape Town. Participants were screened for active TB (symptom screening and microbiological diagnosis) and HIV.

RESULTS

Among 440 DM patients screened, the active TB prevalence was 3.0% (95% CI 1.72-5.03). Of the 13 prevalent TB cases, 53.9% (n = 7; 95% CI 27.20-78.50) had no TB symptoms, and 61.5% (n = 8; 95% CI 33.30-83.70) were HIV-1 co-infected. There were no significant differences in either fasting plasma glucose or HbA_1c levels between TB and non-TB participants. On multivariate analysis, HIV-1 infection (OR 11.3, 95% CI 3.26-39.42) and hemoptysis (OR 31.4, 95% CI 3.62-273.35) were strongly associated with prevalent active TB, with no differences in this association by age or gender.

CONCLUSIONS

The prevalence of active TB among DM patients was 4-fold higher than the national prevalence; suggesting the need for active TB screening, particularly if hemoptysis is reported. Our results highlight the importance of HIV screening in this older population group. The high prevalence of sub-clinical TB among those diagnosed with TB highlights the need for further research to determine how best to screen for active TB in high-risk TB/HIV population groups and settings.

Diabetes-related tuberculosis in the Middle East: an urgent need for regional research

OBJECTIVES

Diabetes mellitus (DM) triples the risk of tuberculosis (TB) disease, complicates TB treatment, and increases the risk of a poor TB outcome. As DM prevalence is increasing across the Middle East, this review was performed to identify regional gaps in knowledge and research priorities for DM/TB.

METHODS

Online databases were searched for studies published from Middle East countries on DM and TB and the studies summarized based on topic and major findings. Studies included had a principle hypothesis related to both diseases, or described TB patients with individual data on DM.

RESULTS

Fifty-nine studies from 10 countries met search criteria. No published studies were found from Lebanon, Bahrain, Syria, Jordan, Cyprus, or the United Arab Emirates. DM prevalence among TB patients was high, but varied considerably across studies. The vast majority of studies were not specifically designed to compare DM/TB and non-DM/TB patients, but many suggested worse treatment outcomes for DM/TB, in accordance with reports from other regions.

CONCLUSIONS

Opportunity exists for the regional study of bidirectional screening, management strategies for both DM and TB diseases, and whether such efforts could take place through the integration of services.

Tuberculosis and diabetes mellitus in the Republic of Kiribati: a case-control study

OBJECTIVES

To better inform local management of TB-diabetes collaborative activities, we aimed to determine the prevalence of diabetes among persons with and without TB and to determine the association between TB and diabetes in Kiribati, a Pacific Island nation.

METHODS

We compared consecutively enrolled TB cases to a group of randomly selected community controls without evidence of TB. Diabetes was diagnosed by HbA1c, and clinical and demographic data were collected. A tuberculin skin test was administered to controls. The chi-square test was used to assess significance in differences between cases and controls. We also calculated an odds ratio, with 95% confidence intervals, for the odds of diabetes among cases relative to controls. Unweighted multivariate logistic regression was performed to adjust for the effects of age and sex.

RESULTS

A total of 275 TB cases and 499 controls were enrolled. The diabetes prevalence in cases (101, 37%) was significantly greater than in controls (94, 19%) (adjusted odds ratio: 2.8; 95% CI 2.0-4.1). Fifty-five percent (108) of all diabetic diagnoses were new; this proportion was higher among controls (64.8%) than cases (46.5%). Five patients with TB were screened to detect one patient with diabetes.

CONCLUSIONS

There is a strong association between TB and diabetes in Kiribati and bidirectional screening should be conducted in this setting.