Adjuvant Efficacy of Nutrition Support During Pulmonary Tuberculosis Treating Course: Systematic Review and Meta-analysis

Analyzing nutrition risks and blood biomarkers in hospitalized patients with tuberculosis: Insights from a 2020 hospital-based study

BACKGROUND

There exists a bidirectional relationship between tuberculosis (TB) and nutrition, wherein they mutually influence and interact causally. However, current guidance for providing nutrition support to individuals diagnosed with TB remains inadequate, leading to a significant gap in comprehensive patient care. This study aims to assess the nutrition status of patients with TB and endeavors to provide insights into early nutrition interventions for individuals vulnerable to TB-associated malnutrition.

METHODS

Data from 2204 newly admitted patients at Beijing Chest Hospital in 2020 were collected, with 1735 patients with confirmed TB aged ≥18 years after exclusions. Patient data, encompassing diagnosis and results from routine blood tests and biochemical analyses conducted on the day after admission, were gathered using the electronic medical records system. Nutrition risk screening was conducted using the Nutritional Risk Screening 2002 (NRS 2002) tool, and questionnaire-based assessments were administered. Statistical analyses were performed using SPSS 17.0 software.

RESULTS

Among 1735 patients with TB, the occurrence rate of nutrition risk was 74.58%. Factors such as age ≥65 years, sputum smear positivity for TB, and concurrent illnesses significantly increased the occurrence rate of nutrition risk. Nutrition risk among patients with TB exhibited negative correlations with parameters such as body weight, hemoglobin, and serum albumin level while showing positive correlations with white blood cell count and C-reactive protein, among others.

CONCLUSION

The occurrence rate of nutrition risk among patients with TB at Beijing Chest Hospital was notably high, particularly among older individuals, those with sputum smear positivity, and those with concurrent illnesses.

Effectiveness of nutritional support to improve treatment adherence in patients with tuberculosis: a systematic review

CONTEXT

Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence.

OBJECTIVE

The aim of this study was to determine the effectiveness of nutritional support in improving treatment adherence among patients with TB.

DATA SOURCES

Databases, including PubMed, Embase (Ovid), Web of Science, and Scopus, were comprehensively reviewed to identify relevant studies reporting the impacts of nutritional support on TB treatment adherence.

DATA EXTRACTION

Two authors independently screened the title, abstracts, and full article texts to identify eligible studies and assess the risk of bias. Observational and interventional studies were included.

DATA ANALYSIS

A narrative synthesis approach was used to summarize the findings qualitatively.

RESULTS

From the search, 3059 publications were identified; of these, 8 studies were included in this systematic review. Three types of nutritional interventions were identified: food baskets (eg, energy, micronutrient- or macronutrient-enriched food support), nutritional advice and guidance, and incentives for buying foods. Although 5 studies reported that nutritional support significantly improved treatment adherence in patients with TB, 3 studies showed that nutritional support had no effect on TB treatment adherence.

CONCLUSIONS

Providing nutritional support may improve adherence to TB treatment. However, more well-powered, high-quality trials are warranted to demonstrate the effect of nutrition support on cost-effectively improving adherence to TB treatment.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023392162.

Undernutrition increases the risk of unsuccessful treatment outcomes of patients with tuberculosis in Ethiopia: A multicenter retrospective cohort study

BACKGROUND

While undernutrition has been identified as a common risk factor for tuberculosis (TB), its impact on treatment outcomes has yet to be investigated in high TB burden and low-income countries such as Ethiopia. Therefore, this study aimed to investigate the effect of undernutrition on treatment outcomes among patients with TB in northwest Ethiopia.

METHODS

A retrospective cohort study was conducted using data from different hospitals in northwest Ethiopia, for the period from July 2017 to August 2023. A Cox proportional hazard model was performed to determine the effect of undernutrition on TB treatment outcomes, which were defined as a composite of death, treatment failure, or loss to follow-up.

RESULTS

A total of 602 patients with TB were included in the analysis. Of these, 367 (60.9%) were male, and 344 (57.1%) were undernourished. Upon completion of the follow-up period, 65 (10.8%) adults with TB had unsuccessful treatment outcomes. After adjusting for potential confounders, patients with undernutrition had a two times higher risk of experiencing unsuccessful treatment outcomes compared to well-nourished patients (AHR: 2.0, 95% CI: 1.2, 3.6). In addition, patients residing in rural areas (AHR: 3.1, 95% CI: 1.7, 5.4), having a history of prior TB treatment (AHR: 2.2, 95%CI: 1.1, 4.1), and the presence of diabetes comorbidity (AHR: 2.4, 95% CI: 1.1, 5.2) were at higher risk of unsuccessful treatment outcomes.

CONCLUSIONS

Undernutrition increases the risk of unsuccessful treatment outcomes in Ethiopia. This finding suggests that nutritional support during TB treatment can improve successful treatment outcomes in high TB burden and low-income countries such as Ethiopia.

Impact of Health Education in Combination with Nutrition Support Nursing on the Nutritional Status and Quality of Life in Patients with Pulmonary Tuberculosis

This study aimed to ascertain the effects of health education combined with nutrition support nursing on the nutritional status and quality of life of patients with pulmonary tuberculosis. A clinical study was conducted. Sixty-four patients with tuberculosis were selected as the study participants and divided into control and observation groups (n = 32). Both groups received antituberculosis drugs. The control group received standard nursing care, while the observation group received health education in conjunction with nutrition support nursing. After 3 months of intervention, the total effective treatment rate and adherence were compared. Before and after the intervention, the albumin (ALB), prealbumin (PA), transferrin (TF), and hemoglobin (Hb) level, body mass index (BMI), and Short Form-36 (SF-36) scores were compared. The occurrence of adverse reactions during intervention was recorded. Following the intervention, the observation group exhibited a higher treatment total effective rate and increased levels of ALB, PA, TF, Hb, and BMI compared with the control group (p < 0.05). The observation group demonstrated a higher total adherence rate and a lower incidence of adverse reactions compared with the control group (p < 0.05); the SF-36 score of the observation group was higher than that of the control group (p < 0.05). The integration of health education and nutrition support nursing can effectively enhance the therapeutic outcomes of patients with pulmonary tuberculosis. This approach not only improves their nutritional status, treatment adherence, and quality of life, but also reduces the incidence of adverse reactions. The findings of this study lay a solid foundation for further exploration of the combined effects of health education and nutrition support nursing on pulmonary tuberculosis.

A cross-sectional analysis of the effectiveness of a nutritional support programme for people with tuberculosis in Southern Madagascar using secondary data from a non-governmental organisation

BACKGROUND

There is a strong, bi-directional link between tuberculosis (TB) and undernutrition: TB often causes undernutrition, and undernourished people are more likely to contract TB and experience worse outcomes. Globally, several TB nutritional support programmes exist; however, evidence on their effectiveness is limited and contested. This study evaluates the effect of a nutritional support programme implemented for people with TB in the Atsimo-Andrefana region, Madagascar in 2022. Within this programme, undernourished people with TB [with a body mass index (BMI) of < 18.5 kg/m2] receive 0.6 L of vegetable oil and 6.0 kg of a soy-wheat blend per month throughout their TB treatment.

METHODS

We analysed secondary non-governmental organisation data collected between January and November 2022 in the Atsimo-Andrefana region, Southern Madagascar, including information on an individual's medical conditions (e.g., type of TB, treatment outcomes) and nutritional status measured prior to, during, and after completion of treatment (e.g., height, weight, mid-upper arm circumference). We conducted descriptive analyses of patient baseline characteristics and outcomes to assess the impact of the provided nutritional support on the BMI of people with TB.

RESULTS

A total of 1310 people with TB were included in the study [9.9% (130) children under the age of 5, 32.1% (420) children between 5 and 18 years, 58.0% (760) adults]. 55.4% of children under 5, 28.1% of children between ages 5 and 18, and 81.3% of adults were undernourished at treatment initiation. 42.3% (55/130) of children under 5 experienced severe acute malnutrition at treatment uptake. While the average BMI of adults with TB receiving food support increased over time, from 17.1 kg/m2 (interquartile range: 15.8-18.3, range: 10.3-22.5) to 17.9 kg/m2 (interquartile range: 16.6-19.1, range: 11.9-24.1), most adults remained undernourished even after completing TB treatment.

CONCLUSIONS

The current TB nutritional support programme falls short of sufficiently increasing the BMI of people with TB to overcome malnutrition. There is an urgent need to revise the nutritional support available for people with TB, particularly for children under 5.

Epidemiology of Tuberculosis Among People Living With HIV in the African Cohort Study From 2013 to 2021

BACKGROUND

The prevalence and incidence of tuberculosis (TB) is high among people living with HIV (PLWH) but is often underdiagnosed in HIV programmatic settings.

SETTING

President's Emergency Plan for AIDS Relief (PEPFAR)-supported research sites in Uganda, Kenya, Tanzania, and Nigeria.

METHODS

All patients underwent molecular testing at entry into a longitudinal cohort of PLWH and annually thereafter. We assessed the prevalence and incidence of TB and identified clinical and demographic factors associated with prevalent and incident TB using logistic regression and Cox proportional hazard models.

RESULTS

From 21 January, 2013, to 1 December 2021, 3171 PLWH were enrolled with a TB prevalence of 3% (n = 93). Of the cases with prevalent TB, 66% (n = 61) were bacteriologically confirmed. The adjusted odds of prevalent TB were significantly higher among those with higher educational attainment, PLWH for 1-5 years since their HIV diagnosis, those who were underweight, and those with CD4 counts <200 cells/mm 3 . The overall TB incidence rate was 600 per 100,000 person-years (95% CI: 481-748). We found that shorter time since HIV diagnosis, being underweight, taking antiretroviral therapy <6 months, and having a CD4 count <200 cells/mm 3 were significantly associated with incident TB. PLWH on dolutegravir/lamivudine/tenofovir had a 78% lower risk of incident TB compared with those on tenofovir/lamivudine/efavirenz (hazard ratio: 0.22; 95% CI: 0.08-0.63).

CONCLUSION

The prevalence and incidence of TB was notably high in this cohort sourced from PEPFAR clinics. Aggressive efforts to enhance HIV diagnosis and optimize treatment in programmatic settings are warranted to reduce the risk of HIV-TB co-occurrence in this cohort.

Conditional Cash Transfer to Improve TB Outcomes: Necessary but Not Sufficient Comment on "Does Direct Benefit Transfer Improve Outcomes Among People With Tuberculosis? - A Mixed-Methods Study on the Need for a Review of the Cash Transfer Policy in India"

Tuberculosis (TB) still represents a major public health problem in many regions of the world. TB control can only be achieved through a comprehensive and inclusive response which takes into account both upstream and downstream coordinated interventions related to structural determinants such as poverty, nutrition, sanitation, housing and access to healthcare as well as timely diagnosis and support throughout the course of treatment. Several social and financial support strategies have been proposed to improve TB treatment adherence, including conditional cash transfers (CCTs). In this context, demonstrating that social protection directly improves a specific health outcome using routinely collected data, incomplete registries or surveillance reports brings about many methodological challenges. We briefly discuss this paper and some limitations, describe main findings from our own research in this area and make a call to expand social protection interventions to address structural conditions of those most affected.

Impact and cost-effectiveness evaluation of nutritional supplementation and complementary interventions for tuberculosis treatment outcomes under mukti pay-for-performance model in Madhya Pradesh, India: A study protocol

Background

A.

"pay-for-performance" (P4P) intervention model for improved tuberculosis (TB) outcomes, called "Mukti," has been implemented in an underdeveloped tribal area of central India. The target of this project is to improve nutritional status, quality of life (QoL), and treatment outcomes of 1000 TB patients through four interventions: food baskets, personal counseling, peer-to-peer learning and facilitation for linkage to government schemes. The current study aims to assess the success of this model by evaluating its impact and cost-effectiveness using a quasi-experimental approach.

Methods

Data for impact assessment have been collected from 1000 intervention and control patients. Study outcomes such as treatment completion, sputum negativity, weight gain, and health-related QoL will be compared between matched samples. Micro costing approach will be used for assessing the cost of routine TB services provision under the national program and the incremental cost of implementing our interventions. A decision and Markov hybrid model will estimate long-term costs and health outcomes associated with the use of study interventions. Measures of health outcomes will be mortality, morbidity, and disability. Cost-effectiveness will be assessed in terms of incremental cost per quality-adjusted life-years gained and cost per unit increase in patient weight in intervention versus control groups.

Results

The evidence generated from the present study in terms of impact and cost-effectiveness estimates will thus help to identify not only the effectiveness of these interventions but also the optimal mode of financing such measures. Our estimates on scale-up costs for these interventions will also help the state and the national government to consider scale-up of such interventions in the entire state or country.

Discussion

The study will generate important evidence on the impact of nutritional supplementation and other complementary interventions for TB treatment outcomes delivered through P4P financing models and on the cost of scaling up these to the state and national level in India.

Tuberkulose im Erwachsenenalter

Die 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.

Effects of zinc and vitamin A supplementation on prognostic markers and treatment outcomes of adults with pulmonary tuberculosis: a systematic review and meta-analysis

INTRODUCTION

Undernutrition is a major risk factor for tuberculosis (TB), which is estimated to be responsible for 1.9 million TB cases per year globally. The effectiveness of micronutrient supplementation on TB treatment outcomes and its prognostic markers (sputum conversion, serum zinc, retinol and haemoglobin levels) has been poorly understood. This study aimed to determine the effect of zinc and vitamin A supplementation on prognostic markers and TB treatment outcomes among adults with sputum-positive pulmonary TB.

METHODS

A systematic literature search for randomised controlled trials (RCTs) was performed in PubMed, Embase and Scopus databases. Meta-analysis with a random effect model was performed to estimate risk ratio (RR) and mean difference (MD), with a 95% CI, for dichotomous and continuous outcomes, respectively.

RESULTS

Our search identified 2195 records. Of these, nine RCTs consisting of 1375 participants were included in the final analyses. Among adults with pulmonary TB, zinc (RR: 0.94, 95% CI: 0.86 to 1.03), vitamin A (RR: 0.90, 95% CI: 0.80 to 1.01) and combined zinc and vitamin A (RR: 0.98, 95% CI: 0.89 to 1.08) supplementation were not significantly associated with TB treatment success. Combined zinc and vitamin A supplementation was significantly associated with increased sputum smear conversion at 2 months (RR: 1.16, 95% CI: 1.03 to 1.32), serum zinc levels at 2 months (MD: 0.86 μmol/L, 95% CI: 0.14 to 1.57), serum retinol levels at 2 months (MD: 0.06 μmol/L, 95% CI: 0.04 to 0.08) and 6 months (MD: 0.12 μmol/L, 95% CI: 0.10 to 0.14) and serum haemoglobin level at 6 months (MD: 0.29 μg/dL, 95% CI: 0.08 to 0.51), among adults with pulmonary TB.

CONCLUSIONS

Providing zinc and vitamin A supplementation to adults with sputum-positive pulmonary TB during treatment may increase early sputum smear conversion, serum zinc, retinol and haemoglobin levels. However, the use of zinc, vitamin A or both was not associated with TB treatment success.

PROSPERO REGISTRATION NUMBER

CRD42021248548.

Association between depression and malnutrition in pulmonary tuberculosis patients: A cross-sectional study

BACKGROUND

Depression has been reported to be prevalent in patients with pulmonary tuberculosis (PTB). Moreover, several clinical symptoms of PTB and depression overlap, such as loss of appetite and malnutrition. However, the association between depression and malnutrition in TB patients has not been fully elucidated.

AIM

To explore the association between depression and malnutrition in patients with PTB.

METHODS

This hospital-based cross-sectional study included patients with PTB in Shanghai Pulmonary Hospital Affiliated to Tongji University from April 2019 to July 2019. The Patient Health Questionnaire-9 (PHQ-9) scale was used to evaluate depre-ssion. The cut-off value was set at 10, and the nutritional state was determined by the body mass index (BMI). In addition, the Quality of Life Instruments for Chronic Diseases was employed to establish the quality of life (QOL). Univariable analysis and multivariable analysis (forward mode) were implemented to identify the independent factors associated with depression.

RESULTS

A total of 328 PTB patients were screened for analysis. Eight were excluded for missing demographic data, four excluded for missing nutrition status, and sixteen for missing QOL data. Finally, 300 PTB patients were subjected to analysis. We found that depressive state was present in 225 PTB patients (75%). The ratio of malnutrition in the depressive PTB patients was 45.33%. Our results revealed significantly lower BMI, hemoglobin, and prealbumin in the depression group than in the control group (P < 0.05). Moreover, the social status differed significantly (P < 0.05) between the groups. In addition, glutamic pyruvic transaminase and glutamic oxaloacetic transaminase in the depression group were significantly higher than those in the control group (P < 0.05). Multivariable logistic regression analysis showed that BMI [odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.163-1.257, P < 0.001] and poor social function (OR = 0.95, 95%CI: 0.926-0.974, P = 0.038) were independently associated with depression.

CONCLUSION

Malnutrition and poor social function are significantly associated with depressive symptoms in PTB patients. A prospective large-scale study is needed to confirm these findings.

Determinants of Weight Gain among Adult Tuberculosis Patients during Intensive Phase in Debre Markos Town Public Health Facilities, Northwest Ethiopia, 2020: Unmatched Case-Control Study

Background

Ethiopia is one of the highest tuberculosis burden countries globally, and tuberculosis is one of the most pressing health problems nationally. Weight gain during treatment is the main indicator of good treatment outcome, but there is no adequate information regarding the factors that affect weight gain in Ethiopia.

Objective

The objective of this study was to identify determinants of weight gain among adult tuberculosis patients during the intensive phase, in Debre Markos town public health institutions Northwest Ethiopia, 2020.

Methods

Unmatched case-control study was conducted in Debre Markos town public health facilities with a total sample size of 236. Cases (clients who got weight) and controls (clients who did not get weight) were enrolled in the study consecutively, and data were collected using standardized questionnaires. Data were entered through Epi-Data version 4.2 and exported to SPSS version 25 for analysis. Bivariable analysis was done, and all independent variables that had p < 0.25 were entered into multivariable binary logistic regression analysis. Finally, independent variables which were significantly associated with weight gain at p < 0.05 were considered determinant factors of weight gain.

Result

Pulmonary tuberculosis (AOR: 5 (95% CI: 2.3, 11.2)), monitoring by health professionals (AOR: 3.7 (1.6, 8.4)), ≥18.5 baseline body mass index (AOR: 3.4 (95% CI: 1.6, 7.3)), parasitic disease (AOR: 3.2 (95% CI: 1.3, 7.99)), <30 days duration of illness before start of treatment (AOR: 2.8 (95% CI: 1.2, 6.1)), and human immune virus/acquired immune deficiency syndrome (AOR: 3.3 (95% CI: 1.2, 9.1)) were independently associated with weight gain compared to their counterpart.

Conclusion

Type of tuberculosis, monitoring by health professionals, baseline status, parasitic disease, duration of illness before start of treatment, and human immune virus/acquired immune deficiency syndrome were with the determinants of weight gain. Therefore, early detection, support and supervision, and attention for comorbidity are mandatory during antituberculosis treatment.

A Supportive-Educative Intervention For Tuberculosis Patients: Integrated Self-Care And Family-Centered Nursing

Aim — This study aims to evaluate the effect of supportive educative system intervention on Tuberculosis (TB) patient’s family support. Material and Methods — This study was a quantitative study with a quasi-experimental design, conducted in the Public Health Center (PHC) of Kedungkandang and Ciptomulyo with 48 respondents. The respondents were divided into the control group with standard PHC intervention (n=24) and the treatment group with standard PHC intervention added with the supportive educative system (n=24). The data were analyzed by paired t-test and independent t-test. Results — There was a significant difference in family support between treatment and control. The results indicated that a supportive educative system significantly increases family support (p=0.003). Interestingly, PHC standard intervention showed improvement in family support (68.46±73.58) than supportive educative system (74.29±75.83). Supportive educative system interventions were less effective than standard PHC interventions. It could be influenced by sample characteristics, time of the study, control of variables, and other factors. Conclusion — Supportive educative interventions are effective in improving family support but are no better than standard PHC interventions.

Undernutrition and Treatment Success in Drug-Resistant Tuberculosis in Uganda

Background

Undernutrition is associated with unfavourable treatment outcomes among people with drug-resistant tuberculosis (DRTB). Factors influencing the treatment outcomes among undernourished people with DRTB are not well characterised. The aim of this study was to determine factors associated with treatment success among undernourished people with DRTB in Uganda.

Methods

We analysed data from a retrospective cohort of people with DRTB from 16 treatment sites in Uganda. We included participants with a pre-treatment body mass index (BMI) of <18.5 kilograms/meters² (kg/m²). Participants were categorised as having mild (BMI of 18.5–17 kg/m²), moderate (BMI of 16.9–16.0 kg/m²) or severe (BMI of <16.0 kg/m²) undernutrition. We performed logistic regression analysis to determine factors associated with treatment success.

Results

Among 473 people with DRTB, 276 (58.4%) were undernourished (BMI < 18.5 Kg/m²) and were included in the study. Of these, 92 (33.3%) had mild, 69 (25.0%) had moderate and 115 (41.7%) had severe undernutrition. The overall treatment success rate (TSR) for the undernourished was 71.4% (n = 197). Although the TSR was similar among participants with mild (71.7%), moderate (78.3%) and severe (67.0%) undernutrition (p = 0.258), all treatment failure cases (n =6) were among participants with severe undernutrition (p = 0.010). Cigarette smoking (odds ratio (OR) = 0.19, 95% CI 0.07–0.47, p < 0.001), urban residence (OR = 0.31, 95% CI 0.14–0.70, p = 0.005) and moderate (OR = 0.14, 95% CI 0.06–0.35, p < 0.001) and severe anaemia (OR = 0.06, 95% CI 0.01–0.29, p = 0.001) were associated with lower odds of treatment success.

Conclusion

Most undernourished people with DRTB have severe undernutrition. Smoking and anaemia are modifiable factors which upon appropriate intervention could improve treatment success. The effect of urban residence on the TSR needs to be evaluated further.

Changes of Anti-tuberculosis Herbs Formula During Past Three Decades in Contrast to Ancient Ones

OBJECTIVE

To investigate the evolution of herbal medicine in treating tuberculosis (TB) and encourage anti-TB drug discovery and development.

METHODS

In this study, 477 ancient traditional Chinese medicine formulae were collected from the Dictionary of Traditional Chinese Medicine Prescriptions and 172 modern Chinese medicine formulae (from 1986 to 2016) were collected by searching 4 databases: WanFang Data Knowledge Service Platform, China National Knowledge Infrastructure Database (CNKI), China Science and Technology Journal Database (VIP) and Chinese Bio-medical Literature and Retrieval System (SinoMed) in Chinese. We restricted the search to publications in Chinese. Further data analysis was done using the Traditional Chinese Medicine Inheritance Support System version 2 Software.

RESULTS

There were 425 herbs in the 477 ancient formulae and 257 herbs in the 172 modern formulae. Half of the top 30 herbs were shared by both modern and ancient prescriptions. They are Radix Ophiopogonis, Astragalus membranaceus, Fritillaria cirrhosa, Dried rehmannia glutinosa, Poria cocos, Angelica sinensis, Prepared rehmannia glutinosa, Platycodon Root, Radix paeoniae alba, Schisandra chinensis, Bighead atractylodes rhizome, Rhizoma anemarrhenae, Cortex lycii radicis and Radix Scutellariae. Only two groups of herbs with a high correlation coefficient were found in both modern and ancient prescriptions, the Dried rehmannia glutinosa with Radix ophiopogonis, and Radix ophiopogonis with Prepared rehmannia glutinosa. There were 9 and 15 core herb combinations in modern and ancient prescriptions, respectively, but no one was found simutaniously in both modern and ancient prescriptions.

CONCLUSIONS

Although there were wide variations in the herb groups and herb combinations in the formulae, half of the top 30 herbs were found in both modern and ancient prescriptions. The core herb combinations in modern and ancient prescriptions could help us to improve the priscription for treatment of TB.

Effectiveness of interventions for reducing TB incidence in countries with low TB incidence: a systematic review of reviews

AIMS

What is the evidence base for the effectiveness of interventions to reduce tuberculosis (TB) incidence in countries which have low TB incidence?

METHODS

We conducted a systematic review of interventions for TB control and prevention relevant to low TB incidence settings (<10 cases per 100 000 population). Our analysis was stratified according to "direct" or "indirect" effects on TB incidence. Review quality was assessed using AMSTAR2 criteria. We summarised the strength of review level evidence for interventions as "sufficient", "tentative", "insufficient" or "no" using a framework based on the consistency of evidence within and between reviews.

RESULTS

We found sufficient review level evidence for direct effects on TB incidence/case prevention of vaccination and treatment of latent TB infection. We also found sufficient evidence of beneficial indirect effects attributable to drug susceptibility testing and adverse indirect effects (measured as sub-optimal treatment outcomes) in relation to use of standardised first-line drug regimens for isoniazid-resistant TB and intermittent dosing regimens. We found insufficient review level evidence for direct or indirect effects of interventions in other areas, including screening, adherence, multidrug-resistant TB, and healthcare-associated infection.

DISCUSSION

Our review has shown a need for stronger evidence to support expert opinion and country experience when formulating TB control policy.

Characteristics and sputum conversion of tuberculosis (TB) patients in Kalutara, Sri Lanka

BACKGROUND

Tuberculosis (TB) is an infectious bacterial disease; remains as one of the important public health problem affecting every part of the world. Substantial number of TB cases are reported from Sri Lanka every year irrespective of its strong preventive health system. The aim of this analysis is to describe the characteristics of TB patients and to assess the factors associated with sputum conversion. This analysis was based on the data from the District Chest Clinic of Kalutara district, Sri Lanka.

METHODS

Information of all newly diagnosed and registered patients in the District Chest Clinic, Kalutara in year 2013 were ascertained. Out of 687 newly reported TB patients, 669 records were included in final analysis.

RESULTS

Majority of patients were males (n=451, 67.4%), in the age group of 36-60 years (n=306, 45.7%) and underweight (n=359, 61.7%). Substantial proportion of normal weight or overweight adult patients (92.1%) had sputum conversion at 2-3 months as compared to underweight adult patients (82.5%) (p=0.034). Those who smoke tobacco is less likely to have sputum conversion at 2-3 months as compared to non-smokers (90.2% vs. 82.1%, p=0.045).

CONCLUSION

Provision of good nutrition, maintaining of appropriate body mass index (i.e., BMI), and abstinence from smoking and alcohol consumption are important for sputum conversion among smear-positive pulmonary TB patients.

Nutrition Status Among HIV-Positive and HIV-Negative Inpatients with Pulmonary Tuberculosis

BACKGROUND

The association between tuberculosis (TB) and malnutrition is well recognized. Considering the risk of mortality due to malnutrition in patients with TB, it is necessary to conduct a thorough nutrition assessment to identify individuals at nutrition risk. The study objective was to assess the nutrition status of hospitalized patients with TB, co-infected or not by human immunodeficiency virus (HIV).

METHODS

Patients with confirmed diagnosis of TB were included using a cross-sectional design. Nutrition assessment parameters included: body mass index (BMI), triceps skin-fold thickness (TSF), bioelectrical impedance analysis (BIA), mid-upper-arm circumference (MUAC), mid-arm muscle circumference (MAMC), food frequency questionnaire, Malnutrition Screening Tool (MST), Subjective Global Assessment (SGA), and serum levels of hemoglobin.

RESULTS

A total 108 patients completed the study. Forty-four patients (40.7%) were HIV positive. Considering the BMI, 36.1% of the patients met the criteria for nutrition deficiency. Body fat percentage was low in 27.8% of patients. In addition, more than half of the participants met criteria for malnutrition according to MUAC, MAMC, TSF, SGA, or MST. Malnutrition measured by MAMC was more frequent in HIV-positive patients (n=33, 75.0%) than in HIV-negative patients (n=31, 48.4%) (P = 0.010). Regarding the components of diet, selenium and vitamin C intake among HIV-positive patients was significantly lower than in HIV-negative patients.

CONCLUSIONS

We identified a high prevalence of malnutrition in hospitalized patients with pulmonary TB, regardless of the method used to assess nutrition status. In HIV-positive patients, malnutrition measured by MAMC was more frequent than in HIV-negative patients.

Diagnostic Significance of Mycobacterium tuberculosis T-cell Assays for Active Tuberculosis

BACKGROUND

Active tuberculosis (TB) with negative results of sputum smear is difficult to be identified. Till now, there is no effective and noninvasive diagnostic method. This study evaluated the diagnostic power of Mycobacterium tuberculosis T-cell (T.SPOT®.TB) assays for active TB.

METHODS

We retrospectively screened 450 suspected TB patients that were hospitalized in the Respiratory Department of Henan Province People's Hospital from June 2015 to June 2016. The patients were divided into the active, previous, and non-TB groups according to their final diagnosis. We evaluated the diagnostic value of the T-SPOT®.TB assay by constructing receiver operating characteristic (ROC) curves and calculating the optimal diagnostic cutoff value. In addition, we compared the levels of A antigen (ESAT-6) and B antigen (CFP-10) in active TB.

RESULTS

The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of T-SPOT®.TB for active TB were 89.78%, 63.16%, 0.56, 0.92, 2.47, and 0.16, respectively. For active TB, the area under the ROC curve (AUC) of the A antigen (0.89) was higher than that of the B antigen (0.86). The AUC of the A antigen for active TB was largest at a cutoff value of 13.5 spot-forming cells (SFCs) per 2.5 × 105 peripheral blood mononuclear cells (PBMCs). The AUC of the A and B antigens was 0.60 and 0.58 for previous TB. The levels of A and B antigen in the active TB group were significantly different from those in the previous- and non-TB groups (A antigen: χ2 = 105.41, P< 0.01 and B antigen: χ2 = 91.03, P< 0.01; A antigen: χ2 = 12.99, P< 0.01 and B antigen: χ2 = 8.56, P< 0.01, respectively). There were no significant differences in the levels of A and B antigens between the non-TB group and previous TB group (A antigen: χ2 = 1.07, P> 0.05 and B antigen: χ2 = 0.77, P> 0.05).

CONCLUSIONS

T-SPOT®.TB has high sensitivity and specificity for the diagnosis of active TB at a cutoff value of 13.5 SFCs per 2.5 × 105 PBMCs and is not influenced by previous TB.