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Wennemann S, Mudarshiru B, Zawedde-Muyanja S, Siddharthan T, Jackson PD. The effect of biomass smoke exposure on quality-of-life among Ugandan patients treated for tuberculosis: A cross-sectional analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002892. [PMID: 38330053 PMCID: PMC10852290 DOI: 10.1371/journal.pgph.0002892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/17/2024] [Indexed: 02/10/2024]
Abstract
More than half the global population burns biomass fuels for cooking and home heating, especially in low-middle income countries. This practice is a prominent source of indoor air pollution and has been linked to the development of a variety of cardiopulmonary diseases, including Tuberculosis (TB). The purpose of this cross-sectional study was to investigate the association between current biomass smoke exposure and self-reported quality of life scores in a cohort of previous TB patients in Uganda. We reviewed medical records from six TB clinics from 9/2019-9/2020 and conducted phone interviews to obtain information about biomass smoke exposure. A random sample of these patients were asked to complete three validated quality-of-life surveys including the St. Georges Respiratory Questionnaire (SGRQ), the EuroQol 5 Dimension 3 Level system (EQ-5D-3L) which includes the EuroQol Visual Analog Scale (EQ-VAS), and the Patient Health Questionnaire 9 (PHQ-9). The cohort was divided up into 3 levels based on years of smoke exposure-no-reported smoke exposure (0 years), light exposure (1-19 years), and heavy exposure (20+ years), and independent-samples-Kruskal-Wallis testing was performed with post-hoc pairwise comparison and the Bonferroni correction. The results of this testing indicated significant increases in survey scores for patients with current biomass exposure and a heavy smoke exposure history (20+ years) compared to no reported smoke exposure in the SGRQ activity scores (adj. p = 0.018) and EQ-5D-3L usual activity scores (adj. p = 0.002), indicating worse activity related symptoms. There was a decrease in EQ-VAS scores for heavy (adj. p = 0.007) and light (adj. p = 0.017) exposure groups compared to no reported exposure, indicating lower perceptions of overall health. These results may suggest worse outcomes or baseline health for TB patients exposed to biomass smoke at the time of treatment and recovery, however further research is needed to characterize the effect of indoor air pollution on TB treatment outcomes.
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Affiliation(s)
- Sophie Wennemann
- Virginia Commonwealth University School of Medicine, Richmond, Virginia, United States of America
| | | | - Stella Zawedde-Muyanja
- Infectious Disease Institute, Makerere University College of Health Science, Kampala, Uganda
| | - Trishul Siddharthan
- Division of Pulmonary and Critical Care, University of Miami, Miami, Florida, United States of America
| | - Peter D. Jackson
- Division of Pulmonary Critical Care, Virginia Commonwealth University, Richmond, Virginia, United States of America
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Katoto PDMC, Mukasa SL, Sani MU, Karaye KM, Mbanze I, Damasceno A, Mocumbi AO, Dzudie A, Sliwa K, Thienemann F. HIV status and survival of patients with pulmonary hypertension due to left heart disease: the Pan African Pulmonary Hypertension Cohort. Sci Rep 2023; 13:9790. [PMID: 37328533 PMCID: PMC10275898 DOI: 10.1038/s41598-023-36375-y] [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: 11/25/2022] [Accepted: 06/02/2023] [Indexed: 06/18/2023] Open
Abstract
In sub-Saharan Africa, little is known about pulmonary hypertension in left heart disease (PH-LHD). We used multivariate logistic and cox-hazard proportional regression models to examine factors associated with increased right ventricular systolic pressure (RVSP) and the effect of real-world HIV status scenarios on 6-month survival rate in the Pan African Pulmonary Hypertension Cohort (PAPUCO) study, a prospective cohort from four African countries. Exposure to biomass fuel smoke (aOR, 95%CI 3.07, 1.02-9.28), moderate to severe NYHA/FC III/IV (aOR, 95%CI 4.18, 1.01-17.38), and unknown HIV status (aOR, 95%CI 2.73, 0.96-7.73) predicted moderate to severe RVSP at the time of presentation. Six months later, HIV infection, moderate-to-severe NYHA/FC, and alcohol consumption were associated with decreased survival probabilities. Upon adjusting for HIV infection, it was observed that an incremental rise in RVSP (1 mmHg) and inter-ventricular septal thickness (1 mm) resulted in an 8% (aHR, 95%CI 1.08, 1.02-1.13) and 20% (aHR, 95%CI 1.2, 1.00-1.43) increase in the probability of mortality due to PH-LHD. In contrast, the risk of death from PH-LHD was reduced by 23% for each additional unit of BMI. (aHR, 95%CI 0.77, 0.59-1.00). In conclusion, the present study offers insights into the determinants that are notably linked to unfavorable survival outcomes in patients with pulmonary hypertension due to left heart disease. Certain factors identified in this study are readily evaluable and amenable to modification, even in settings with limited resources.
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Affiliation(s)
- Patrick D M C Katoto
- Cape Heart Institute and Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, 792, South Africa
- Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Faculty of Medicine and Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo
| | - Sandra L Mukasa
- Cape Heart Institute and Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, 792, South Africa
| | - Mahmoud U Sani
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, PMB 3011, Gwarzo Road, Kano, Kano, Nigeria
| | - Kamilu M Karaye
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, PMB 3011, Gwarzo Road, Kano, Kano, Nigeria
| | - Irina Mbanze
- Faculty of Medicine, Eduardo Mondlane University, Dr Salvador Allende, Cp 257, Maputo, Mozambique
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Dr Salvador Allende, Cp 257, Maputo, Mozambique
| | - Ana O Mocumbi
- Faculty of Medicine, Eduardo Mondlane University, Dr Salvador Allende, Cp 257, Maputo, Mozambique
- Instituto Nacional de Saúde, Maputo, Mozambique
| | - Anastase Dzudie
- Department of Internal Medicine, Douala General Hospital, PO Box 4856, Douala, Cameroon
| | - Karen Sliwa
- Cape Heart Institute and Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, 792, South Africa
| | - Friedrich Thienemann
- Cape Heart Institute and Department of Medicine, Faculty of Health Science, University of Cape Town, Cape Town, 792, South Africa.
- Department of Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Maleche-Obimbo E, Odhiambo MA, Njeri L, Mburu M, Jaoko W, Were F, Graham SM. Magnitude and factors associated with post-tuberculosis lung disease in low- and middle-income countries: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000805. [PMID: 36962784 PMCID: PMC10021795 DOI: 10.1371/journal.pgph.0000805] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/03/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Emerging evidence suggests that after completion of treatment for tuberculosis (TB) a significant proportion of patients experience sequelae. However, there is limited synthesized evidence on this from low-income countries, from Sub-Saharan Africa, and in HIV infected individuals. We seek to provide an updated comprehensive systematic review and meta-analysis on the magnitude and factors associated with post-TB lung disease (PTLD) in low- and middle-income countries (LMICs). METHODS We searched PubMed, Embase and CINAHL for studies from LMICs with data on post-TB lung health in patients who had previously completed treatment for pulmonary TB. Data on study characteristics, prevalence of PTLD-specifically abnormal lung function (spirometry), persisting respiratory symptoms and radiologic abnormalities were abstracted. Statistical analysis was performed using Microsoft Excel and R version 4.1 software, and random effects meta-analysis conducted to compute pooled prevalence of PTLD, evaluate heterogeneity, and assess factors associated with PTLD. RESULTS We identified 32 eligible studies with 6225 participants. Twenty-one studies were from Africa, 16 included HIV infected participants, spirometry was conducted in 20 studies, symptom assessment in 16 and chest imaging in eight. Pooled prevalence of abnormal lung function was 46.7%, persistent respiratory symptoms 41.0%, and radiologic abnormalities 64.6%. Magnitude of any type of PTLD varied by HIV status (HIV- 66.9%, HIV+ 32.8%, p = 0.0013), across geographic setting (SE Asia 57.5%, Southern America 50.8%, and Africa 38.2%, p = 0.0118), and across urban-rural settings (symptom prevalence: rural 68.8%, urban 39.1%, mixed settings 27.9%, p = 0.0035), but not by income settings, sex or age-group. CONCLUSIONS There is high burden of post-TB persistent respiratory symptoms, functional lung impairment and radiologic structural abnormalities in individuals living in LMICs. Burden varies across settings and by HIV status. This evidence may be valuable to advocate for and inform implementation of structured health care specific to the needs of this vulnerable population of individuals.
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Affiliation(s)
| | | | - Lynette Njeri
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Moses Mburu
- Clinical Trials Facility, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Walter Jaoko
- Department of Medical Microbiology & Immunology, University of Nairobi, Nairobi, Kenya
| | - Fredrick Were
- Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya
| | - Stephen M. Graham
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Association of Single Nucleotide Polymorphism rs17580 with Smoking and Pulmonary Tuberculosis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6984403. [PMID: 35437467 PMCID: PMC9013310 DOI: 10.1155/2022/6984403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/27/2022] [Accepted: 03/31/2022] [Indexed: 11/18/2022]
Abstract
This study aimed to investigate the correlation between SERPINA1 single nucleotide polymorphism (SNP) rs17580, smoking, and pulmonary tuberculosis (TB). A total of 420 TB patients (observation group) and 640 patients without pulmonary disease (control group) were randomly included. The frequencies of different genotypes were counted in both groups, and the correlation between SNP genotypes and the occurrence of TB was analyzed. Statistical models were performed to analyze the correlation between rs17580 and TB and the correlation between rs17580. The frequencies of genotypes TT, TA, and AA at the rs17580 locus in patients with TB were not statistically different from those in the control group (
), and the distributions of the two groups were in accordance with the Hardy–Weinberg equilibrium law. rs17580 was analyzed in dominant, recessive, and codominant models, exhibiting no statistical difference (
). There was no significant difference among the three genotypes in the 1–5 typing (χ2 = 1.034,
), and the difference between T and C was not statistically significant (χ2 = 0.012,
). There was a significant difference between the three genotypes between the smoking group and the nonsmoking group in TB patients (
). There was no significant difference among three genotypes in the alcoholic group and the nonalcoholic group in TB patients (
). There was no statistical difference in the time to cure among the 3 genotypes in TB patients (
). A type mutation of rs17580 in the SERPINA1 gene was strongly associated with a higher risk of development of TB in smoking patients.
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Ogata H, Moriwaki A, Nakagawa T, Sakoda S, Ishimatsu A, Taguchi K, Aso H, Nogami H, Kadowaki M, Tateshi Y, Yoshida M. Association of serum antibodies against the Mycobacterium avium complex and hemoptysis: a cross-sectional study. BMC Infect Dis 2021; 21:480. [PMID: 34039293 PMCID: PMC8157429 DOI: 10.1186/s12879-021-06182-9] [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: 10/22/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hemoptysis is very common and can be life threatening in clinical practice for nontuberculous mycobacteria. The serum antibody against the Mycobacterium avium complex (MAC-Ab), the majority of nontuberculous mycobacteria species, is well known to reflect the activity of MAC lung disease; however, there is no study investigating the association between the MAC-Ab and hemoptysis in MAC patients. Therefore, we assessed whether the MAC-Ab is a good biomarker for hemoptysis among subjects with MAC lung disease. METHODS This study was conducted as a five-year retrospective survey at the National Hospital Organization Fukuoka National Hospital. A total of 155 patients aged ≥20 years with MAC lung disease were enrolled and separated into seropositive and seronegative groups using the cutoff for MAC-Ab levels of 0.7 U/ml. The prevalence of hemoptysis and odds ratios for the presence of hemoptysis were estimated and compared between the groups. To investigate the linear trends in the relationship between MAC-Ab levels and hemoptysis, the subjects were classified into three groups using the tertile distribution of the MAC-Ab. RESULTS The prevalence of hemoptysis was twice as high in the seropositive group than in the seronegative group (42.2 and 21.7%, respectively, P = 0.02). The multivariable-adjusted risk of hemoptysis was elevated in the seropositive group as compared with the seronegative group (odds ratio = 2.79 (95% confidence interval 1.15-7.44)). Likewise, when categorizing the subjects into three groups, the risk of hemoptysis increased with increasing MAC-Ab levels (P = 0.03 for trend). CONCLUSIONS A positive MAC-Ab level was a significant risk factor for hemoptysis among patients with MAC lung disease. There were also positive trends in the association between the MAC-Ab titer and the likelihood of hemoptysis. Measuring the MAC-Ab may contribute not only to early detection of the risk of hemoptysis but also to early intervention with anti-NTM therapy and, as a result, to the prevention of hemoptysis in MAC patients.
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Affiliation(s)
- Hiroaki Ogata
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan.
| | - Atsushi Moriwaki
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Taisuke Nakagawa
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Soichiro Sakoda
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Akiko Ishimatsu
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Kazuhito Taguchi
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Hiroshi Aso
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Hiroko Nogami
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Masako Kadowaki
- Department of Infectious Diseases, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Yuko Tateshi
- Department of Radiology, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
| | - Makoto Yoshida
- Department of Respiratory Medicine, National Hospital Organization Fukuoka National Hospital, 4-39-1 Yakatabaru, Minami-ku, Fukuoka, 811-1394, Japan
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Abstract
Cough is a common symptom often confronted in the clinical setting. Time and resources attributed to cough place an undue burden on patients and the health care system. One characteristic of cough that likely contributes to this is the multifactorial nature of cough. Physicians are trained to find a single diagnosis to explain symptoms. With cough, if all factors contributing are not identified and treated together, the cough often remains unresolved. This article provides a practical approach to treatment and management of cough, emphasizing causes and potentiators.
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Affiliation(s)
- Baotran B Tran
- Division of Allergy-Immunology, Northwestern Medicine, Chicago, IL, USA
| | - Anne Marie Ditto
- Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, 211 East Ontario Ste. 1000, Chicago, IL 60611, USA.
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