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Cox SR, Padmapriyadarsini C, Mave V, Seth B, Thiruvengadam K, Gaikwad S, Sahasrabudhe TR, Sane M, Tornheim JA, Shrinivasa BM, Lokhande R, Barthwal MS, Shivakumar SVBY, Krishnan S, Santhappan R, Kinikar A, Kakrani AL, Paradkar M, Bollinger RC, Sekar K, Gupte AN, Hanna LE, Gupta A, Golub JE. Characterising cause of death among people treated for drug-susceptible TB in India. Int J Tuberc Lung Dis 2023; 27:78-80. [PMID: 36853129 DOI: 10.5588/ijtld.22.0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- S R Cox
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C Padmapriyadarsini
- Indian Council of Medical Research-National Institute of Research in Tuberculosis, Chennai, India
| | - V Mave
- Johns Hopkins University School of Medicine, Baltimore, MD, USA, Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University (BJGMC-JHU) Clinical Research Site, Pune, India, Johns Hopkins India, Pune, India
| | - B Seth
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K Thiruvengadam
- Indian Council of Medical Research-National Institute of Research in Tuberculosis, Chennai, India
| | - S Gaikwad
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, India
| | - T R Sahasrabudhe
- Dr D. Y. Patil Medical College, Hospital and Research Centre, Dr D. Y. Patil Vidyapeeth, Pimpri-Chinchwad, India
| | - M Sane
- Johns Hopkins India, Pune, India
| | - J A Tornheim
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B M Shrinivasa
- Indian Council of Medical Research-National Institute of Research in Tuberculosis, Chennai, India
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, India
| | - M S Barthwal
- Dr D. Y. Patil Medical College, Hospital and Research Centre, Dr D. Y. Patil Vidyapeeth, Pimpri-Chinchwad, India
| | | | - S Krishnan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - R Santhappan
- Indian Council of Medical Research-National Institute of Research in Tuberculosis, Chennai, India
| | - A Kinikar
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospital, Pune, India
| | - A L Kakrani
- Dr D. Y. Patil Medical College, Hospital and Research Centre, Dr D. Y. Patil Vidyapeeth, Pimpri-Chinchwad, India
| | - M Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University (BJGMC-JHU) Clinical Research Site, Pune, India, Johns Hopkins India, Pune, India
| | - R C Bollinger
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - K Sekar
- Indian Council of Medical Research-National Institute of Research in Tuberculosis, Chennai, India
| | - A N Gupte
- Boston University School of Public Health, Boston, MA, USA
| | - L E Hanna
- Indian Council of Medical Research-National Institute of Research in Tuberculosis, Chennai, India
| | - A Gupta
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J E Golub
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Cox SR, Gupte AN, Thomas B, Gaikwad S, Mave V, Padmapriyadarsini C, Sahasrabudhe TR, Kadam D, Gupte N, Hanna LE, Kagal A, Paradkar M, Thiruvengadam K, Jain D, Atre S, Sekar K, Raskar S, Shivakumar SVBY, Santhappan R, Deshmukh S, Pradhan N, Kulkarni V, Kakrani A, Barthwal MS, Sawant T, DeLuca A, Suryavanshi N, Chander G, Bollinger R, Golub JE, Gupta A. Unhealthy alcohol use independently associated with unfavorable TB treatment outcomes among Indian men. Int J Tuberc Lung Dis 2021; 25:182-190. [PMID: 33688806 DOI: 10.5588/ijtld.20.0778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Approximately 10% of incident TB cases worldwide are attributable to alcohol. However, evidence associating alcohol with unfavorable TB treatment outcomes is weak.METHODS: We prospectively evaluated men (≥18 years) with pulmonary TB in India for up to 24 months to investigate the association between alcohol use and treatment outcomes. Unhealthy alcohol use was defined as a score of ≥4 on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scale at entry. Unfavorable TB treatment outcomes included failure, recurrence, and all-cause mortality, analyzed as composite and independent endpoints.RESULTS: Among 751 men, we identified unhealthy alcohol use in 302 (40%). Median age was 39 years (IQR 28-50); 415 (55%) were underweight (defined as a body mass index [BMI] <18.5 kg/m²); and 198 (26%) experienced an unfavorable outcome. Unhealthy alcohol use was an independent risk factor for the composite unfavorable outcome (adjusted incidence rate ratio [aIRR] 1.47, 95% CI 1.05-2.06; P = 0.03) and death (aIRR 1.90, 95% CI 1.08-3.34; P = 0.03), specifically. We found significant interaction between AUDIT-C and BMI; underweight men with unhealthy alcohol use had increased risk of unfavorable outcomes (aIRR 2.22, 95% CI 1.44-3.44; P < 0.001) compared to men with BMI ≥18.5 kg/m² and AUDIT-C <4.CONCLUSION: Unhealthy alcohol use was independently associated with unfavorable TB treatment outcomes, highlighting the need for integrating effective alcohol interventions into TB care.
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Affiliation(s)
- S R Cox
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - A N Gupte
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - B Thomas
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Gaikwad
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - V Mave
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune
| | | | - T R Sahasrabudhe
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - N Gupte
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune
| | - L E Hanna
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - A Kagal
- Byramjee Jeejeebhoy Government Medical College (BJGMC) and Sassoon General Hospital, Pune
| | - M Paradkar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - K Thiruvengadam
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - D Jain
- BJGMC Clinical Research Site, Pune
| | - S Atre
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune, Johns Hopkins India Private Limited, Pune, India
| | - K Sekar
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Raskar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - S V B Y Shivakumar
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, Johns Hopkins India Private Limited, Pune, India
| | - R Santhappan
- National Institute of Research in Tuberculosis (NIRT), Chennai
| | - S Deshmukh
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - N Pradhan
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - V Kulkarni
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - A Kakrani
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - M S Barthwal
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - T Sawant
- Dr DY Patil Medical College Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pune
| | - A DeLuca
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - N Suryavanshi
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA, BJGMC Clinical Research Site, Pune, Johns Hopkins India Private Limited, Pune, India
| | - G Chander
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - R Bollinger
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - J E Golub
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
| | - A Gupta
- Johns Hopkins University (JHU), School of Medicine, Baltimore, USA
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Gupte AN, Selvaraju S, Paradkar M, Danasekaran K, Shivakumar SVBY, Thiruvengadam K, Dolla C, Shivaramakrishnan G, Pradhan N, Kohli R, John S, Raskar S, Jain D, Momin A, Subramanian B, Gaikwad A, Lokhande R, Suryavanshi N, Gupte N, Salvi S, Murali L, Checkley W, Golub JE, Bollinger R, Chandrasekaran P, Mave V, Gupta A. Respiratory health status is associated with treatment outcomes in pulmonary tuberculosis. Int J Tuberc Lung Dis 2020; 23:450-457. [PMID: 31064624 DOI: 10.5588/ijtld.18.0551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
<sec id="st1"> <title>BACKGROUND</title> The association between respiratory impairment and tuberculosis (TB) treatment outcomes is not clear. </sec> <sec id="st2"> <title>METHODS</title> We prospectively evaluated respiratory health status, measured using the Saint George's Respiratory Questionnaire (SGRQ), in a cohort of new adult pulmonary TB cases during and up to 18 months following treatment in India. Associations between total SGRQ scores and poor treatment outcomes of failure, recurrence and all-cause death were measured using multivariable Poisson regression. </sec> <sec id="st3"> <title>RESULTS</title> We enrolled 455 participants contributing 619 person-years at risk; 39 failed treatment, 23 had recurrence and 16 died. The median age was 38 years (interquartile range 26-49); 147 (32%) ever smoked. SGRQ scores at treatment initiation were predictive of death during treatment (14% higher risk per 4-point increase in baseline SGRQ scores, 95%CI 2-28, P = 0.01). Improvement in SGRQ scores during treatment was associated with a lower risk of failure (1% lower risk for every per cent improvement during treatment, 95%CI 1-2, P = 0.05). Clinically relevant worsening in SGRQ scores following successful treatment was associated with a higher risk of recurrence (15% higher risk per 4-point increase scores, 95%CI 4-27, P = 0.004). </sec> <sec id="st4"> <title>CONCLUSION</title> Impaired respiratory health status was associated with poor TB treatment outcomes. The SGRQ may be used to monitor treatment response and predict the risk of death in pulmonary TB. </sec>.
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Affiliation(s)
- A N Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Selvaraju
- National Institute for Research in Tuberculosis, Chennai
| | - M Paradkar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - K Danasekaran
- National Institute for Research in Tuberculosis, Chennai
| | | | | | - C Dolla
- National Institute for Research in Tuberculosis, Chennai
| | | | - N Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Kohli
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S John
- National Institute for Research in Tuberculosis, Chennai
| | - S Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - D Jain
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - A Momin
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - B Subramanian
- National Institute for Research in Tuberculosis, Chennai
| | - A Gaikwad
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - N Gupte
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Salvi
- Chest Research Foundation, Pune, India
| | - L Murali
- National Institute for Research in Tuberculosis, Chennai
| | - W Checkley
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - R Bollinger
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - V Mave
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Gupta
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Gupte AN, Mave V, Meshram S, Lokhande R, Kadam D, Dharmshale S, Bharadwaj R, Kagal A, Pradhan N, Deshmukh S, Atre S, Sahasrabudhe T, Barthwal M, Meshram S, Kakrani A, Kulkarni V, Raskar S, Suryavanshi N, Shivakoti R, Chon S, Selvin E, Gupte N, Gupta A, Golub JE. Trends in HbA1c levels and implications for diabetes screening in tuberculosis cases undergoing treatment in India. Int J Tuberc Lung Dis 2019; 22:800-806. [PMID: 30041729 DOI: 10.5588/ijtld.18.0026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
SETTING The optimal timing of screening for diabetes mellitus (DM) among tuberculosis (TB) cases is unclear due to the possibility of stress hyperglycemia. DESIGN We evaluated adult (18 years) pulmonary TB cases at treatment initiation as well as at 3 months, 6 months and 12 months. DM was identified by self-report (known DM) or glycated hemoglobin (HbA1c) 6.5% (new DM). Trends in HbA1c levels during treatment were assessed using non-parametric tests. RESULTS Of the 392 participants enrolled, 75 (19%) had DM, 30 (40%) of whom had new DM. Of the 45 participants with known DM, respectively 37 (82%) and 40 (89%) received medication to lower glucose levels at treatment initiation and completion; one participant with new DM initiated glucose-lowering medication during follow-up. The median HbA1c level in participants with known, new and no DM was respectively 10.1% (interquartile range [IQR] 8.3-11.6), 8.5% (IQR 6.7-11.5) and 5.6% (IQR 5.3-5.9) at treatment initiation, and 8.7% (IQR 6.8-11.3), 7.1% (IQR 5.8-9.5) and 5.3% (IQR 5.1-5.6) at treatment completion (P < 0.001). Overall, 5 (12%) with known and 13 (43%) with new DM at treatment initiation had reverted to HbA1c < 6.5% by treatment completion (P = 0.003); the majority of reversions occurred during the first 3 months, with no significant reversions beyond 6 months. CONCLUSION HbA1c levels declined with anti-tuberculosis treatment. Repeat HbA1c testing at treatment completion could reduce the risk of misdiagnosis of DM.
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Affiliation(s)
- A N Gupte
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - V Mave
- Johns Hopkins University School of Medicine
| | - S Meshram
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - R Lokhande
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - D Kadam
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - S Dharmshale
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - R Bharadwaj
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - A Kagal
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals
| | - N Pradhan
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S Deshmukh
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S Atre
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - T Sahasrabudhe
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - M Barthwal
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - S Meshram
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - A Kakrani
- Dr D Y Patil Medical College, Hospital and Research Centre, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - V Kulkarni
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - S Raskar
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | - N Suryavanshi
- Byramjee Jeejeebhoy Government Medical College-Johns Hopkins University Clinical Research Site, Pune
| | | | - S Chon
- Johns Hopkins University School of Medicine
| | - E Selvin
- Johns Hopkins University School of Medicine
| | - N Gupte
- Johns Hopkins University School of Medicine
| | - A Gupta
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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