BACKGROUND Tuberculous osteitis is a chronic,granulomatous bone infection that frequently results in impaired bone healing following surgery.Despite surgical intervention and prolonged anti-tuberculous therapy,complet...BACKGROUND Tuberculous osteitis is a chronic,granulomatous bone infection that frequently results in impaired bone healing following surgery.Despite surgical intervention and prolonged anti-tuberculous therapy,complete bone regeneration often remains unachieved,contributing to subsequent orthopedic complications.AIM To investigate the efficacy and safety of pamidronate in promoting bone regeneration following surgical treatment of experimental animal tuberculous osteitis.METHODS A controlled randomized basic study of rabbit femoral tuberculosis induced by Mycobacterium tuberculosis strain H37Rv included surgical removal of infected tissue and implantation of osteoinductive bone grafts with the following animal allocation to one of three groups:(1)Bisphosphonates alone;(2)Bisphosphonates combined with anti-tuberculous therapy;and(3)Anti-tuberculous therapy alone.The control group consisted of animals that received no surgical or medical treatment.Clinical evaluations,biochemical markers,micro-computed tomography imaging,and histomorphometry analyses were conducted at 3 months and 6 months postoperatively.RESULTS Pamidronate treatment significantly reduced early implant resorption,increased osteoblastic activity,improved trabecular bone regeneration,and maintained graft integrity compared to the anti-tuberculous therapy-only group.Histologically,pamidronate led to enhanced vascular remodeling and increased bone matrix formation.Crucially,bisphosphonate therapy demonstrated safety,compatibility with anti-tuberculous medications,and did not exacerbate tuberculous inflammation.Furthermore,micro-computed tomography analysis revealed a significant increase in trabecular thickness and density in pamidronate-treated groups,underscoring the anabolic effects of bisphosphonates.Morphometric evaluation confirmed a marked reduction in osteoclast number and activity at graft interfaces.These combined radiological,histological,and biochemical data collectively demonstrate the efficacy of pamidronate as an adjunctive agent in enhancing bone repair outcomes following surgical intervention for tuberculous osteitis.CONCLUSION A single intravenous dose of pamidronate significantly enhances bone regeneration and prevents implant resorption following surgical treatment of tuberculous osteitis.The following prospective studies are needed.展开更多
Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese...Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia,fever,weight loss and an epigastric mass.The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome,and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy.The clinical presentation,radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection.I also emphasize the need for both histopathological and microbiological diagnosis via fineneedle aspiration.展开更多
Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP) are common causes of consolidation patch in chest radiograph. Sputum Z-N staining is positive in 30% to 60% cases only and sputum examination has poo...Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP) are common causes of consolidation patch in chest radiograph. Sputum Z-N staining is positive in 30% to 60% cases only and sputum examination has poor yield in CAP. This study aimed to assess the value of serum Procalcitonin (PCT) levels in patients with Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP). Patients with new opacity in chest radiograph were included in the study. Serum sample were taken at admission and stored. Patient’s diagnosis were confirmed and categorized into pulmonary TB group (32) and community-acquired pneumonia group (23). Their mean PCT level was compared with mean PCT level of 25 controls. Serum procalcitonin levels were found to be significantly elevated in patients of community-acquired pneumonia as compared to patients of pulmonary tuberculosis. In presence of consolidation in x-ray chest, increased level of serum procalcitonin might be used to differentiate pulmonary tuberculosis from community-acquired pneumonia. High level of serum procalcitonin was associated with high mortality rate in community-acquired pneumonia patients.展开更多
Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic a...Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by postpartum hemorrhage due to uterine atony and another by placental adhesion.Conclusion:Endometrial tuberculosis can lead to severe IUA.Hysteroscopic adhesiolysis facilitates cavity restoration and improvement of menstrual conditions,but the overall reproductive outcomes remain suboptimal.展开更多
BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spi...BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia.In this study,we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging,general observations,and histopathological and bacteriological studies.AIM To establish a rabbit model of spinal tuberculosis and examine the effect on the model’s efficacy using different concentrations of Mycobacterium tuberculosis(M.tuberculosis)inoculum.METHODS New Zealand rabbits were randomly divided into experimental,control and blank groups.The experimental and control animals were sensitized with complete Freund′s adjuvant,a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge.The experimental group was divided into three subgroups(experimental 1,experimental 2,experimental 3)and infused with M.tuberculosis suspension at various concentrations.The control group was inoculated with saline and the blank group received no treatment.The 12-week post-operative survival rates were 100%,80%and 30%in the experimental groups inoculated with concentrations of 106,107 and 108 CFU/mL bacteria,respectively.RESULTS The survival rate of the control and blank groups was 100%.Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%,62.5%and 66.7%,and by computed tomography(CT)and 3-dimensional CT 44.4%,75%and 100%,respectively.At 12 weeks,the figures were 44.4%,75%and 100%by X-ray analysis and 44.4%,100%and 100%by CT and 3-dimensional CT,respectively.All surviving rabbits of the experimental groups had vertebral destruction.The positive bacterial culture rates were 22.2%,75%and 66.7%,respectively,in the experimental groups.After being sensitized with complete Freund's adjuvant,large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M.tuberculosis.CONCLUSION The experimental 1 had a low success rate at establishing an infection.The experimental 3 resulted in high mortality and complication rates.The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.展开更多
BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated w...BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated with autoimmune diseases,cancers, medication use, pregnancy, and the post-partum period. Bullous pemphigoid(BP) is a chronic autoimmune subepidermal blistering disease associatedwith tissue-bound and circulating autoantibodies against BP antigens 180 (BP180)and 230 (BP230). AHA-associated BP has a high mortality rate;hence, the understandingof this disease must improve.CASE SUMMARY A 69-year-old man presented with erythema, blisters, blood blisters, and crustsaccompanied by severe pruritus for more than 20 days, and ecchymosis andswelling on his left upper arm for 3 days. Pathological examination revealed asubepidermal blister that contained eosinophils. Laboratory tests showed that theBP180 autoantibody levels had increased, isolated activated partial thromboplastintime was notably prolonged (115.6 s), and coagulation FⅧ activity wasextremely low (< 1.0%). Furthermore, the FⅧ inhibitor titer had greatlyincreased (59.2 Bethesda units). Therefore, the patient was diagnosed as having BP associated with AHA, prescribed 0.05% topical halometasone cream, and transferred to a higher-level hospitalfor effective treatment;however, he died after 2 days.CONCLUSION AHA associated BP is rare, dangerous, and has a high mortality rate. Therefore, its timely diagnosis and effectivetreatment are necessary.展开更多
Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely availabl...Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. Patients and Methods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.展开更多
Chronic obstructive pulmonary disease(COPD)and respiratory tuberculosis are important respiratory problems.Meeting together,these diseases can mutually worsen the severity of clinical manifestations and negatively aff...Chronic obstructive pulmonary disease(COPD)and respiratory tuberculosis are important respiratory problems.Meeting together,these diseases can mutually worsen the severity of clinical manifestations and negatively affect prognosis.COPD and tuberculosis share a number of common risk factors and pathogenetic mechanisms involving various immune and non-immune cells.Inflammation,hypoxia,oxidative stress,and lung tissue remodeling play an important role in the comorbid course of COPD and respiratory tuberculosis.These mechanisms are of diagnostic interest and are promising therapeutic targets.Thus,the aim of the current review is to discuss the mechanisms of the comorbid course of chronic obstructive pulmonary disease and respiratory tuberculosis.展开更多
Detection and treatment of drug resistance in extrapulmonary tuberculosis(EPTB)is a major challenge worldwide.Drug resistance in EPTB has not been studied extensively.However,patients with drug-resistant EPTB have bee...Detection and treatment of drug resistance in extrapulmonary tuberculosis(EPTB)is a major challenge worldwide.Drug resistance in EPTB has not been studied extensively.However,patients with drug-resistant EPTB have been reported to have poor outcomes[1].Rifampicin and isoniazid are the cornerstone drugs in the management of EPTB.Resistance in Mycobacterium(M.)tuberculosis to these drugs commonly arises due to mutations in the‘rpoB’gene and‘katG&inhA’genes,which confer resistance to rifampicin and isoniazid,respectively.Treatment outcomes are affected by the presence of these mutations.In addition,anatomical and physiological barriers impede the effective delivery of drugs to the affected extrapulmonary site[1].An analysis of the frequency of mutations in drug resistant M.tuberculosis strains causing EPTB in our region can help identify patterns of drug resistance.This,in turn,can provide inputs that may be used for modifying standard treatment regimens to make them more effective.The present study aims to identify the frequency and pattern of mutations in the‘rpoB’gene and‘katG&inhA’genes in M.tuberculosis strains isolated from EPTB samples.展开更多
Tuberculosis(TB)remains a critical global health challenge,with 10.8 million new cases and over 1.25 million deaths reported annually,disproportionately affecting low-income regions.Despite its use,the Bacillus Calmet...Tuberculosis(TB)remains a critical global health challenge,with 10.8 million new cases and over 1.25 million deaths reported annually,disproportionately affecting low-income regions.Despite its use,the Bacillus Calmette-Guérin(BCG)vaccine provides limited protection against adult pulmonary TB,necessitating novel solutions.The messenger RNA(mRNA)vaccine technology,proven effective in combating coronavirus disease 2019,offers significant promise for TB prevention.These vaccines elicit robust immune responses by encoding antigens that stimulate humoral and cell-mediated immunity,essential for combating mycobacterium TB.Unlike traditional methods,mRNA vaccines are highly adaptable,scalable,and capable of targeting emerging strains.Preclinical studies highlight the enhanced efficacy of mRNA TB vaccines over BCG,demonstrating their ability to reduce bacterial burdens and generate memory T-cell responses critical for long-term protection.However,challenges persist,including mRNA instability,cold-chain storage needs,and mycobacterium’s complex immune evasion strategies.Innovative solutions,such as lipid nanoparticle delivery systems and selfamplifying mRNA platforms,are being developed to address these barriers.The initiation of clinical trials,notably BioNTech’s BNT164,marks a pivotal advancement in TB vaccine development.These trials focus on safety,immuno genicity,and efficacy,particularly in regions with high TB prevalence.While logistical and financial hurdles remain,mRNA vaccines hold transformative potential to bridge critical gaps in TB prevention.Their adaptability extends to tackling co-infections like human immunodeficiency virus,further amplifying their impact on global health.By integrating mRNA vaccines into existing TB control strategies,these advancements could revolutionize prevention efforts,especially in regions where current solutions fall short.Continued innovation and investment are crucial to harnessing the full potential of mRNA vaccines,positioning them as a cornerstone in the fight against TB and its global eradication.展开更多
BACKGROUND Due to low bacteria count and high likelihood of having extrapulmonary tuberculosis(TB)among patients with advanced human immunodeficiency virus(HIV)disease,the World Health Organization(WHO)recommended the...BACKGROUND Due to low bacteria count and high likelihood of having extrapulmonary tuberculosis(TB)among patients with advanced human immunodeficiency virus(HIV)disease,the World Health Organization(WHO)recommended the use of urine lateral flow urine lipoarabinomannan(LF-LAM)or sputum-Xpert to screen for TB.AIM To estimate pooled prevalence of TB screening uptake,TB diagnosis,TB treatment initiation and mortality among patients with advanced HIV disease in Africa.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.TB screening uptake was defined as percentage of patients with advanced HIV disease(CD4≤200 cells/mm3 or WHO stage III/IV)who tested for TB.Using random effects models,we computed the pooled estimate of TB screening uptake,TB prevalence,TB treatment initiation and mortality and their corresponding 95%CIs.Stratified analysis to compare uptake of TB testing and TB prevalence between children vs adults and multisite vs single site studies was performed.RESULTS A total of nineteen studies with 16065 people with advanced HIV disease were analyzed.The pooled prevalence of TB screening uptake was 64.6%(95%CI:49.2–80.1).The pooled prevalence of TB was 29.4%(95%CI:22.0–36.8),and TB treatment initiation was 77.9%(95%CI:63.9–91.8),and mortality was 19.5%(95%CI:8.9–30.0).The pooled prevalence of TB testing uptake was significantly lower among children compared to adults(28.2%vs 66.4%,P=0.003)and lower for multi-sites compared to single site studies(58.8%vs 82.9%,P=0.002).The pooled prevalence of TB was significantly lower among children compared to adults(24.2%vs 27.6%,P=0.012)and higher among studies that involved multi vs single sites(30.0%vs 21.9%,P=0.001).CONCLUSION Four in ten people with advanced HIV disease were not screened for TB as recommended by the WHO,indicating significant gaps in identifying patients with TB.Excluding patients with evidence of TB is critical to avoid exposing them to subtherapeutic levels of anti TB treatment.展开更多
Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions r...Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.展开更多
BACKGROUND India has the highest tuberculosis(TB)burden in the world.Of the estimated annual 10 million TB cases,features of extra pulmonary TB are evident in up to 45%.Urogenital TB(UGTB)accounts for approximately 20...BACKGROUND India has the highest tuberculosis(TB)burden in the world.Of the estimated annual 10 million TB cases,features of extra pulmonary TB are evident in up to 45%.Urogenital TB(UGTB)accounts for approximately 20%of those cases.The lack of non-sputum based diagnostic tools continue to hinder efforts to reduce the burden of UGTB.MicroRNAs(miRNAs)play a crucial role in biological pathways and can be used as a potential biomarker for TB.We evaluated urinary extracellular vesicles(uEVs)as non-invasive source to explore miRNAs with biomarker potential for UGTB.AIM To evaluate the potential of miRNA-155-5p,miRNA-26a-5p and miRNA-29a-3p in uEVs to diagnose UGTB in adults.METHODS uEV characterization was done using nanoparticle tracking analysis and flow cytometry.Quantitative reverse transcriptase polymerase chain reaction(qRTPCR)for urinary uEV-miRNAs were carried out in samples from patients with suspected UGTB,or Urinary tract infections[UTI,disease controls(DC)]and healthy controls(HCs)(n=20/group).U6 was used to normalize the qRT-PCR data.Receivers operating characteristic curves was used to calculate the diagnostic accuracy of uEV-miRNAs to differentiate UGTB from controls(DC and HCs).RESULTS uEVs from UGTB or UTI patients had higher mean size,and also lower proportion of CD63 positive vesicles as compared to HC’s uEVs.Between UTI and UGTB,the mean size of uEVs was significantly higher in UTI cases.qRT-PCR analysis revealed a significantly lower abundance of miRNA-155-5p and miRNA-26a-5p in uEVs from UGTB relative to UTI(P value=0.004)and HC(P value=0.009)respectively n=20/group).While,miRNA-29a-3p was higher in abundance in both UGTB and HCs’uEV,relative to uEVs from UTI cases(P values=0.004 and 0.002 respectively,n=20/group).Moreover,miRNA-155-5p[area under curve(AUC)=0.88,P≤0.0001]and miRNA-29a-3p(AUC=0.76,P value=0.005)had optimal diagnostic accuracy to differentiate UGTB from DC(n=20/groups)with a likelihood ratio of 5.2 and 4.3,respectively through receivers operating characteristic curve.While,miRNA-155-5p(AUC=0.68,P value=0.05)and miRNA-26a-5p(AUC=0.78,P value=0.002)had optimal diagnostic accuracy to differentiate UGTB from HCs with a likelihood ratio of>2.CONCLUSION The differential expression of uEV-miRNAs,miRNA-155-5p and miRNA-29a-3p in UTGB and UTI cases hold promise in the specific diagnosis of UGTB.Further studies in large cohort are,however,needed to confirm the diagnostic accuracy of these uEV-miRNAs.展开更多
Objective:To assess aptamer-based assays for diagnosing latent tuberculosis infection(LTBI).Methods:Literature from Medline,ScienceDirect,and Scopus,covering publications from January 1,2012,to December 31,2023,was ex...Objective:To assess aptamer-based assays for diagnosing latent tuberculosis infection(LTBI).Methods:Literature from Medline,ScienceDirect,and Scopus,covering publications from January 1,2012,to December 31,2023,was examined.This review evaluates different aptamers,biomarkers,sample types,sample sizes,reference assays,and the assays'sensitivity and specificity.By using the Quality Assessment of Diagnostic Accuracy Studies 2,the risk of bias in each study was evaluated.Results:Aptamer-based assays generally showed a sensitivity of 90%(95%CI:75%-100%)and specificity of 90%(95%CI:50%-100%),where optical aptasensor showed the highest sensitivity and specificity at 100%.Serum samples were frequently used to enhance antigen detectability,improving the assay’s performance.Meanwhile,HspX was the most studied biomarker,followed by MPT64,and IFN-γ.Conclusions:Aptamer-based assays could be reliable alternatives to current LTBI detection methods,but further research is needed to validate their clinical efficacy.展开更多
Objective:To analyze the risk factors associated with multidrug-resistant tuberculosis(MDR-TB)as a first national survey in Indonesia.Methods:This national coverage cross-sectional study was conducted from 2017 to 201...Objective:To analyze the risk factors associated with multidrug-resistant tuberculosis(MDR-TB)as a first national survey in Indonesia.Methods:This national coverage cross-sectional study was conducted from 2017 to 2018.The study subjects were selected using a multi-stage probability random sampling method.MDR-TB is tuberculosis caused by bacteria resistant to at least isoniazid and rifampicin.The dependent variable was MDR-TB.Independent variables included age,sex,education,employment status,place of residence,history of living with TB patients,and the number of household members.Univariate and multivariate logistic regression models were used to analyze the risk factors associated with MDR-TB.All the data were analyzed using STATA V.14.0(Stata Corp LLC,College Station,TX).Results:This study found the MDR rate was 109/3234(3.4%)among positive pulmonary TB patients.More than twice as many patients had MDR re-treatment(74/3234,2.3%),compared to 35/3234(1.1%)who had new TB diagnoses or were getting initial treatment.After adjusting for employment status,individuals with a prior history of tuberculosis treatment were found to have significantly higher odds of developing MDR-TB,with an odds ratio of 7.22(95%CI 3.87-13.44).Conclusions:Increasing attention should be paid to these patients to prevent MDR-TB,and MDR-TB transmission is an urgent challenge for controlling TB worldwide.Early detection of MDR-TB is a critical part of TB control programs.展开更多
Objective To investigate the spatiotemporal patterns and socioeconomic factors influencing the incidence of tuberculosis(TB)in the Guangdong Province between 2010 and 2019.Method Spatial and temporal variations in TB ...Objective To investigate the spatiotemporal patterns and socioeconomic factors influencing the incidence of tuberculosis(TB)in the Guangdong Province between 2010 and 2019.Method Spatial and temporal variations in TB incidence were mapped using heat maps and hierarchical clustering.Socioenvironmental influencing factors were evaluated using a Bayesian spatiotemporal conditional autoregressive(ST-CAR)model.Results Annual incidence of TB in Guangdong decreased from 91.85/100,000 in 2010 to 53.06/100,000in 2019.Spatial hotspots were found in northeastern Guangdong,particularly in Heyuan,Shanwei,and Shantou,while Shenzhen,Dongguan,and Foshan had the lowest rates in the Pearl River Delta.The STCAR model showed that the TB risk was lower with higher per capita Gross Domestic Product(GDP)[Relative Risk(RR),0.91;95%Confidence Interval(CI):0.86–0.98],more the ratio of licensed physicians and physician(RR,0.94;95%CI:0.90-0.98),and higher per capita public expenditure(RR,0.94;95%CI:0.90–0.97),with a marginal effect of population density(RR,0.86;95%CI:0.86–1.00).Conclusion The incidence of TB in Guangdong varies spatially and temporally.Areas with poor economic conditions and insufficient healthcare resources are at an increased risk of TB infection.Strategies focusing on equitable health resource distribution and economic development are the key to TB control.展开更多
AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at Fir...AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People’s Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study.Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality.Further stratification was performed according to preoperative deviation angles[>35 prism diopters(PD)vs≤35 PD]and age(≥18 years adult group vs<18 years adolescent group).The baseline patient characteristics were collected,deviation angles at multiple timepoints before and after treatment were measured,and stereopsis test results were documented.Through comparative analysis of therapeutic outcomes across subgroups,we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included.At the final follow-up,both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001).Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05).For patients with deviations>35 PD,surgery yielded significantly better outcomes than injection therapy in postoperative angle,success rate,and stereopsis recovery(P<0.05).Similarly,in patients aged≥18 years,surgical treatment was superior to injections in reducing strabismus angle,improving success rates,and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE.Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy,particularly in patients with deviations>35 PD and those aged≥18 years.For patients with angles≤35 PD or under 18 years,BTXA injection remains a viable treatment option.展开更多
Objective:To identify factors associated with hepatotoxicity during the intensive phase of treatment in tuberculosis(TB)patients.Methods:A case-control study was conducted of TB patients treated with first-line anti-T...Objective:To identify factors associated with hepatotoxicity during the intensive phase of treatment in tuberculosis(TB)patients.Methods:A case-control study was conducted of TB patients treated with first-line anti-TB drugs from 2013 to 2020.Cases were defined as patients who developed hepatotoxicity,while controls were those without hepatotoxicity,at a 1:2 ratio.Controls were randomly selected from the same hospitals as the cases.The primary outcome was the occurrence of hepatotoxicity during the intensive treatment phase,with data retrospectively collected from medical records.Descriptive statistics and multiple logistic regression with backward elimination were used for analysis.Results:Among 3021 tuberculosis patients who received first-line anti-tuberculosis regimen,50 had abnormal liver function and 14 developed hepatotoxictiy.In addition,2957 patients had normal liver function and 128 served as controls for this analysis.Multiple logistic regression analysis revealed that female patients had about twice the risk of hepatotoxicity compared to males(adjusted OR 2.25,95%CI 1.11-4.59),and patients with HIV coinfection were nearly 10 times more likely to develop hepatotoxicity than those without HIV(adjusted OR 9.74,95%CI 3.12-30.41).Conclusions:Female sex and HIV coinfection were found to be significant risk factors for hepatotoxicity during the intensive phase of TB treatment.Enhanced monitoring and preventive strategies are recommended for these high-risk groups to reduce the risk of hepatotoxicity.展开更多
Background:C hina is a high-burden country for multidrug-r esistant tuberculosis/rifampin-resistant tuberculosis(MDR/RR-T B).Fluoroquinolones(FQs)are key drugs for the treatment of patients with MDR/RR-T B.However,res...Background:C hina is a high-burden country for multidrug-r esistant tuberculosis/rifampin-resistant tuberculosis(MDR/RR-T B).Fluoroquinolones(FQs)are key drugs for the treatment of patients with MDR/RR-T B.However,research on the resistance of FQs in Beijing is limited.Methods:W e collected clinical isolates from all patients with pulmonary TB in Beijing from January 2016 to December 2021,conducted drug-s ensitivity tests and sequencing for levofloxacin(LFX)and moxifloxacin(MFX),and collected the treatment plans and outcomes of the patients.Results:A total of 8512 clinical isolates were collected from patients with pulmonary TB,and 261 RR-T B strains were screened.The proportions of drug-s ensitive and drugresistant strains significantly differed by age group and treatment history.The rates of LFX and MFX resistance were 27.6%(72/261)and 36.4%(95/261),respectively.The detection rates of MDR-T B and pre-e xtensively drug-resistant TB(pre-X DR-T B)were 73.2%(191/261)and 36.4%(95/261),respectively,and the trends were significant(χ^(2)trend=9.995,p=0.002;χ^(2)trend=12.744,p=0.026).Among the 261 RR-T B strains,14.9%(24/261)were sensitive to LFX but resistant to MFX.Among the four patients with LFX-r esistant TB who received LFX treatment failed in three patients(Fisher's exact test,p=0.009).The common mutation sites were 94 and 90 in gyrA.A novel mutation Ala90Ser was discovered.Conclusions:F Qs resistance trends in RR-T B patients in Beijing are striking.Strains showed incomplete cross-resistance to LFX and MFX.Testing for FQs resistance and developing a reasonable treatment plan are recommended.Attention should be given to the changing trends in MDR-T B and pre-X DR-TB.展开更多
Objectives This study aimed to investigate the impact of foam macrophages(FMs) on the intracellular survival of Mycobacterium tuberculosis(MTB) and identify the molecular mechanisms influencing MTB survival.Methods An...Objectives This study aimed to investigate the impact of foam macrophages(FMs) on the intracellular survival of Mycobacterium tuberculosis(MTB) and identify the molecular mechanisms influencing MTB survival.Methods An in vitro FM model was established using oleic acid induction. Transcriptomic and metabolomic analyses were conducted to identify the key molecular pathways involved in FM-mediated MTB survival.Results Induced FMs effectively restricted MTB survival. Transcriptomic and metabolomic profiling revealed distinct changes in gene and metabolite expression in FMs during MTB infection compared with normal macrophages. Integrated analyses identified significant alterations in the cyclic adenosine monophosphate(cAMP) signaling pathway, indicating that its activation contributes to the FM-mediated restriction of MTB survival.Conclusions FMs inhibit MTB survival. The cAMP signaling pathway is a key contributor. These findings enhance the understanding of the role of FMs in tuberculosis progression, suggest potential targets for host-directed therapies, and offer new directions for developing diagnostic and therapeutic strategies against tuberculosis.展开更多
基金Supported by Russian Science Foundation Grant,No.24-15-00185.
文摘BACKGROUND Tuberculous osteitis is a chronic,granulomatous bone infection that frequently results in impaired bone healing following surgery.Despite surgical intervention and prolonged anti-tuberculous therapy,complete bone regeneration often remains unachieved,contributing to subsequent orthopedic complications.AIM To investigate the efficacy and safety of pamidronate in promoting bone regeneration following surgical treatment of experimental animal tuberculous osteitis.METHODS A controlled randomized basic study of rabbit femoral tuberculosis induced by Mycobacterium tuberculosis strain H37Rv included surgical removal of infected tissue and implantation of osteoinductive bone grafts with the following animal allocation to one of three groups:(1)Bisphosphonates alone;(2)Bisphosphonates combined with anti-tuberculous therapy;and(3)Anti-tuberculous therapy alone.The control group consisted of animals that received no surgical or medical treatment.Clinical evaluations,biochemical markers,micro-computed tomography imaging,and histomorphometry analyses were conducted at 3 months and 6 months postoperatively.RESULTS Pamidronate treatment significantly reduced early implant resorption,increased osteoblastic activity,improved trabecular bone regeneration,and maintained graft integrity compared to the anti-tuberculous therapy-only group.Histologically,pamidronate led to enhanced vascular remodeling and increased bone matrix formation.Crucially,bisphosphonate therapy demonstrated safety,compatibility with anti-tuberculous medications,and did not exacerbate tuberculous inflammation.Furthermore,micro-computed tomography analysis revealed a significant increase in trabecular thickness and density in pamidronate-treated groups,underscoring the anabolic effects of bisphosphonates.Morphometric evaluation confirmed a marked reduction in osteoclast number and activity at graft interfaces.These combined radiological,histological,and biochemical data collectively demonstrate the efficacy of pamidronate as an adjunctive agent in enhancing bone repair outcomes following surgical intervention for tuberculous osteitis.CONCLUSION A single intravenous dose of pamidronate significantly enhances bone regeneration and prevents implant resorption following surgical treatment of tuberculous osteitis.The following prospective studies are needed.
文摘Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma,lymphoma,cystic neoplasia,retroperitoneal tumors,pancreatitis or pseudocysts.Here,I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia,fever,weight loss and an epigastric mass.The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome,and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy.The clinical presentation,radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection.I also emphasize the need for both histopathological and microbiological diagnosis via fineneedle aspiration.
文摘Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP) are common causes of consolidation patch in chest radiograph. Sputum Z-N staining is positive in 30% to 60% cases only and sputum examination has poor yield in CAP. This study aimed to assess the value of serum Procalcitonin (PCT) levels in patients with Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP). Patients with new opacity in chest radiograph were included in the study. Serum sample were taken at admission and stored. Patient’s diagnosis were confirmed and categorized into pulmonary TB group (32) and community-acquired pneumonia group (23). Their mean PCT level was compared with mean PCT level of 25 controls. Serum procalcitonin levels were found to be significantly elevated in patients of community-acquired pneumonia as compared to patients of pulmonary tuberculosis. In presence of consolidation in x-ray chest, increased level of serum procalcitonin might be used to differentiate pulmonary tuberculosis from community-acquired pneumonia. High level of serum procalcitonin was associated with high mortality rate in community-acquired pneumonia patients.
基金supported by the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hosipital of Central South University,China(YX202112).
文摘Objective:Endometrial tuberculosis,which commonly affects women of reproductive age,is a significant cause of intrauterine adhesions(IUA),potentially leading to hypomenorrhea,amenorrhea,and infertility.Hysteroscopic adhesiolysis is the primary treatment for IUA;however,studies specifically addressing its efficacy in tuberculosisinduced IUA remain scarce.This study aims to evaluate the therapeutic outcomes of hysteroscopic adhesiolysis for IUA caused by endometrial tuberculosis.Methods:This retrospective cohort study included patients diagnosed with tuberculosisinduced IUA who underwent hysteroscopic adhesiolysis at the Third Xiangya Hospital of Central South University between May 2014 and October 2022.Clinical data including age,medical history,adhesion severity,surgical treatment,and reproductive outcomes were analyzed.Results:Among 39 patients identified,2 were lost to follow-up.A total of 37 patients were included,with a follow-up duration ranging from 6 months to 9 years.Hypomenorrhea was reported in 24(64.9%)patients,secondary amenorrhea in 10(27.0%)patients,and normal menstruation in 3(8.1%)patients.Most patients presented with primary infertility(59.5%),and only 2(5.4%)had secondary infertility.The median American Fertility Society(AFS)score at initial assessment was 10(range,8−12);8(21.6%)patients had moderate IUA,and 29(78.4%)had severe IUA.A total of 86 surgical procedures were performed across 37 patients,with 27 patients undergoing 2 or more surgeries.Postoperatively,25(67.6%)patients achieved normalization of the uterine cavity,while 12(32.4%)still had a reduced cavity.Only 7(18.9%)patients had a grossly normal endometrium at the final surgery,all of whom had moderate adhesions at the initial procedure.Menstrual flow returned to normal in 12(32.4%)patients,while 25(67.6%)continued to experience hypomenorrhea.Of 29 patients who attempted in vitro fertilization and embryo transfer(IVF-ET),only 6(20.7%)conceived.Among these,4(13.8%)delivered at term via cesarean section;one case was complicated by postpartum hemorrhage due to uterine atony and another by placental adhesion.Conclusion:Endometrial tuberculosis can lead to severe IUA.Hysteroscopic adhesiolysis facilitates cavity restoration and improvement of menstrual conditions,but the overall reproductive outcomes remain suboptimal.
基金Supported by Lanzhou City Science and Technology Development Guiding Plan Project,No.2023-ZD-170Lanzhou Science and Technology Plan Project,No.2023-2-11High-Level Talent Training Project At the 940th Hospital of the Joint Logistics Force,No.2024-G3-5.
文摘BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia.In this study,we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging,general observations,and histopathological and bacteriological studies.AIM To establish a rabbit model of spinal tuberculosis and examine the effect on the model’s efficacy using different concentrations of Mycobacterium tuberculosis(M.tuberculosis)inoculum.METHODS New Zealand rabbits were randomly divided into experimental,control and blank groups.The experimental and control animals were sensitized with complete Freund′s adjuvant,a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge.The experimental group was divided into three subgroups(experimental 1,experimental 2,experimental 3)and infused with M.tuberculosis suspension at various concentrations.The control group was inoculated with saline and the blank group received no treatment.The 12-week post-operative survival rates were 100%,80%and 30%in the experimental groups inoculated with concentrations of 106,107 and 108 CFU/mL bacteria,respectively.RESULTS The survival rate of the control and blank groups was 100%.Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%,62.5%and 66.7%,and by computed tomography(CT)and 3-dimensional CT 44.4%,75%and 100%,respectively.At 12 weeks,the figures were 44.4%,75%and 100%by X-ray analysis and 44.4%,100%and 100%by CT and 3-dimensional CT,respectively.All surviving rabbits of the experimental groups had vertebral destruction.The positive bacterial culture rates were 22.2%,75%and 66.7%,respectively,in the experimental groups.After being sensitized with complete Freund's adjuvant,large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M.tuberculosis.CONCLUSION The experimental 1 had a low success rate at establishing an infection.The experimental 3 resulted in high mortality and complication rates.The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.
基金Supported by Traditional Chinese Medicine Research Program of Hebei Provincial Administration of Traditional Chinese Medicine,No.2025313 and No.2025448.
文摘BACKGROUND Acquired hemophilia A (AHA) is a rare and potentially severe bleeding disordercaused by circulating autoantibodies against factor Ⅷ (FⅧ). In approximately50% of the patients, the condition is associated with autoimmune diseases,cancers, medication use, pregnancy, and the post-partum period. Bullous pemphigoid(BP) is a chronic autoimmune subepidermal blistering disease associatedwith tissue-bound and circulating autoantibodies against BP antigens 180 (BP180)and 230 (BP230). AHA-associated BP has a high mortality rate;hence, the understandingof this disease must improve.CASE SUMMARY A 69-year-old man presented with erythema, blisters, blood blisters, and crustsaccompanied by severe pruritus for more than 20 days, and ecchymosis andswelling on his left upper arm for 3 days. Pathological examination revealed asubepidermal blister that contained eosinophils. Laboratory tests showed that theBP180 autoantibody levels had increased, isolated activated partial thromboplastintime was notably prolonged (115.6 s), and coagulation FⅧ activity wasextremely low (< 1.0%). Furthermore, the FⅧ inhibitor titer had greatlyincreased (59.2 Bethesda units). Therefore, the patient was diagnosed as having BP associated with AHA, prescribed 0.05% topical halometasone cream, and transferred to a higher-level hospitalfor effective treatment;however, he died after 2 days.CONCLUSION AHA associated BP is rare, dangerous, and has a high mortality rate. Therefore, its timely diagnosis and effectivetreatment are necessary.
文摘Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. Patients and Methods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.
文摘Chronic obstructive pulmonary disease(COPD)and respiratory tuberculosis are important respiratory problems.Meeting together,these diseases can mutually worsen the severity of clinical manifestations and negatively affect prognosis.COPD and tuberculosis share a number of common risk factors and pathogenetic mechanisms involving various immune and non-immune cells.Inflammation,hypoxia,oxidative stress,and lung tissue remodeling play an important role in the comorbid course of COPD and respiratory tuberculosis.These mechanisms are of diagnostic interest and are promising therapeutic targets.Thus,the aim of the current review is to discuss the mechanisms of the comorbid course of chronic obstructive pulmonary disease and respiratory tuberculosis.
文摘Detection and treatment of drug resistance in extrapulmonary tuberculosis(EPTB)is a major challenge worldwide.Drug resistance in EPTB has not been studied extensively.However,patients with drug-resistant EPTB have been reported to have poor outcomes[1].Rifampicin and isoniazid are the cornerstone drugs in the management of EPTB.Resistance in Mycobacterium(M.)tuberculosis to these drugs commonly arises due to mutations in the‘rpoB’gene and‘katG&inhA’genes,which confer resistance to rifampicin and isoniazid,respectively.Treatment outcomes are affected by the presence of these mutations.In addition,anatomical and physiological barriers impede the effective delivery of drugs to the affected extrapulmonary site[1].An analysis of the frequency of mutations in drug resistant M.tuberculosis strains causing EPTB in our region can help identify patterns of drug resistance.This,in turn,can provide inputs that may be used for modifying standard treatment regimens to make them more effective.The present study aims to identify the frequency and pattern of mutations in the‘rpoB’gene and‘katG&inhA’genes in M.tuberculosis strains isolated from EPTB samples.
文摘Tuberculosis(TB)remains a critical global health challenge,with 10.8 million new cases and over 1.25 million deaths reported annually,disproportionately affecting low-income regions.Despite its use,the Bacillus Calmette-Guérin(BCG)vaccine provides limited protection against adult pulmonary TB,necessitating novel solutions.The messenger RNA(mRNA)vaccine technology,proven effective in combating coronavirus disease 2019,offers significant promise for TB prevention.These vaccines elicit robust immune responses by encoding antigens that stimulate humoral and cell-mediated immunity,essential for combating mycobacterium TB.Unlike traditional methods,mRNA vaccines are highly adaptable,scalable,and capable of targeting emerging strains.Preclinical studies highlight the enhanced efficacy of mRNA TB vaccines over BCG,demonstrating their ability to reduce bacterial burdens and generate memory T-cell responses critical for long-term protection.However,challenges persist,including mRNA instability,cold-chain storage needs,and mycobacterium’s complex immune evasion strategies.Innovative solutions,such as lipid nanoparticle delivery systems and selfamplifying mRNA platforms,are being developed to address these barriers.The initiation of clinical trials,notably BioNTech’s BNT164,marks a pivotal advancement in TB vaccine development.These trials focus on safety,immuno genicity,and efficacy,particularly in regions with high TB prevalence.While logistical and financial hurdles remain,mRNA vaccines hold transformative potential to bridge critical gaps in TB prevention.Their adaptability extends to tackling co-infections like human immunodeficiency virus,further amplifying their impact on global health.By integrating mRNA vaccines into existing TB control strategies,these advancements could revolutionize prevention efforts,especially in regions where current solutions fall short.Continued innovation and investment are crucial to harnessing the full potential of mRNA vaccines,positioning them as a cornerstone in the fight against TB and its global eradication.
文摘BACKGROUND Due to low bacteria count and high likelihood of having extrapulmonary tuberculosis(TB)among patients with advanced human immunodeficiency virus(HIV)disease,the World Health Organization(WHO)recommended the use of urine lateral flow urine lipoarabinomannan(LF-LAM)or sputum-Xpert to screen for TB.AIM To estimate pooled prevalence of TB screening uptake,TB diagnosis,TB treatment initiation and mortality among patients with advanced HIV disease in Africa.METHODS PubMed,Cochrane Library and EMBASE were searched for articles published between January 2011 and December 2024.TB screening uptake was defined as percentage of patients with advanced HIV disease(CD4≤200 cells/mm3 or WHO stage III/IV)who tested for TB.Using random effects models,we computed the pooled estimate of TB screening uptake,TB prevalence,TB treatment initiation and mortality and their corresponding 95%CIs.Stratified analysis to compare uptake of TB testing and TB prevalence between children vs adults and multisite vs single site studies was performed.RESULTS A total of nineteen studies with 16065 people with advanced HIV disease were analyzed.The pooled prevalence of TB screening uptake was 64.6%(95%CI:49.2–80.1).The pooled prevalence of TB was 29.4%(95%CI:22.0–36.8),and TB treatment initiation was 77.9%(95%CI:63.9–91.8),and mortality was 19.5%(95%CI:8.9–30.0).The pooled prevalence of TB testing uptake was significantly lower among children compared to adults(28.2%vs 66.4%,P=0.003)and lower for multi-sites compared to single site studies(58.8%vs 82.9%,P=0.002).The pooled prevalence of TB was significantly lower among children compared to adults(24.2%vs 27.6%,P=0.012)and higher among studies that involved multi vs single sites(30.0%vs 21.9%,P=0.001).CONCLUSION Four in ten people with advanced HIV disease were not screened for TB as recommended by the WHO,indicating significant gaps in identifying patients with TB.Excluding patients with evidence of TB is critical to avoid exposing them to subtherapeutic levels of anti TB treatment.
文摘Intensive care unit(ICU)acquired sarcopenia and myosteatosis are increasingly recognized complications of critical illness,characterized by a rapid loss of ske-letal muscle mass,quality,and function.These conditions result from a complex interplay of systemic inflammation,immobilization,catabolic stress,mitochon-drial dysfunction,and immune dysregulation,often culminating in impaired recovery,prolonged hospitalization,and increased long-term mortality.First identified in survivors of sepsis and prolonged mechanical ventilation,these muscle abnormalities were initially described using computed tomography-based assessments of muscle area and density.Subsequent advances in imaging,biomarker discovery,and functional testing have enabled earlier detection and risk stratification across diverse ICU populations.While nutritional optimization and early mobilization form the cornerstone of current prevention and treatment strategies,the emergence of novel approaches,including automated artificial intelligence-based screening,neuromuscular electrical stimulation,and targeted pharmacologic therapies,has broadened the clinical scope of interventions.Despite their significant prognostic implications,ICU-acquired sarcopenia and myosteatosis remain under-recognized in routine critical care practice.This mini-review aims to synthesize current knowledge regarding their pathophysiology,available diagnostic modalities,prognostic relevance,and the evolving landscape of therapeutic strategies for long-term functional recovery in critically ill patients.
基金Supported by the Indian Council of Medical Research,No.Coord/7(1)/CARE-KD/18-NCD-II.
文摘BACKGROUND India has the highest tuberculosis(TB)burden in the world.Of the estimated annual 10 million TB cases,features of extra pulmonary TB are evident in up to 45%.Urogenital TB(UGTB)accounts for approximately 20%of those cases.The lack of non-sputum based diagnostic tools continue to hinder efforts to reduce the burden of UGTB.MicroRNAs(miRNAs)play a crucial role in biological pathways and can be used as a potential biomarker for TB.We evaluated urinary extracellular vesicles(uEVs)as non-invasive source to explore miRNAs with biomarker potential for UGTB.AIM To evaluate the potential of miRNA-155-5p,miRNA-26a-5p and miRNA-29a-3p in uEVs to diagnose UGTB in adults.METHODS uEV characterization was done using nanoparticle tracking analysis and flow cytometry.Quantitative reverse transcriptase polymerase chain reaction(qRTPCR)for urinary uEV-miRNAs were carried out in samples from patients with suspected UGTB,or Urinary tract infections[UTI,disease controls(DC)]and healthy controls(HCs)(n=20/group).U6 was used to normalize the qRT-PCR data.Receivers operating characteristic curves was used to calculate the diagnostic accuracy of uEV-miRNAs to differentiate UGTB from controls(DC and HCs).RESULTS uEVs from UGTB or UTI patients had higher mean size,and also lower proportion of CD63 positive vesicles as compared to HC’s uEVs.Between UTI and UGTB,the mean size of uEVs was significantly higher in UTI cases.qRT-PCR analysis revealed a significantly lower abundance of miRNA-155-5p and miRNA-26a-5p in uEVs from UGTB relative to UTI(P value=0.004)and HC(P value=0.009)respectively n=20/group).While,miRNA-29a-3p was higher in abundance in both UGTB and HCs’uEV,relative to uEVs from UTI cases(P values=0.004 and 0.002 respectively,n=20/group).Moreover,miRNA-155-5p[area under curve(AUC)=0.88,P≤0.0001]and miRNA-29a-3p(AUC=0.76,P value=0.005)had optimal diagnostic accuracy to differentiate UGTB from DC(n=20/groups)with a likelihood ratio of 5.2 and 4.3,respectively through receivers operating characteristic curve.While,miRNA-155-5p(AUC=0.68,P value=0.05)and miRNA-26a-5p(AUC=0.78,P value=0.002)had optimal diagnostic accuracy to differentiate UGTB from HCs with a likelihood ratio of>2.CONCLUSION The differential expression of uEV-miRNAs,miRNA-155-5p and miRNA-29a-3p in UTGB and UTI cases hold promise in the specific diagnosis of UGTB.Further studies in large cohort are,however,needed to confirm the diagnostic accuracy of these uEV-miRNAs.
基金supported by Higher Institution Centre of Excellence(HICoE)Grant(A305-KR-AKH002-0000000278-K134)from the Ministry of Higher Education,Malaysia.
文摘Objective:To assess aptamer-based assays for diagnosing latent tuberculosis infection(LTBI).Methods:Literature from Medline,ScienceDirect,and Scopus,covering publications from January 1,2012,to December 31,2023,was examined.This review evaluates different aptamers,biomarkers,sample types,sample sizes,reference assays,and the assays'sensitivity and specificity.By using the Quality Assessment of Diagnostic Accuracy Studies 2,the risk of bias in each study was evaluated.Results:Aptamer-based assays generally showed a sensitivity of 90%(95%CI:75%-100%)and specificity of 90%(95%CI:50%-100%),where optical aptasensor showed the highest sensitivity and specificity at 100%.Serum samples were frequently used to enhance antigen detectability,improving the assay’s performance.Meanwhile,HspX was the most studied biomarker,followed by MPT64,and IFN-γ.Conclusions:Aptamer-based assays could be reliable alternatives to current LTBI detection methods,but further research is needed to validate their clinical efficacy.
基金supported by the Global Alliance for TB Drug Development(TB Alliance)the Global Fund(No.:HK.05.01/1/34.3/2018)the World Health Organization(WHO).
文摘Objective:To analyze the risk factors associated with multidrug-resistant tuberculosis(MDR-TB)as a first national survey in Indonesia.Methods:This national coverage cross-sectional study was conducted from 2017 to 2018.The study subjects were selected using a multi-stage probability random sampling method.MDR-TB is tuberculosis caused by bacteria resistant to at least isoniazid and rifampicin.The dependent variable was MDR-TB.Independent variables included age,sex,education,employment status,place of residence,history of living with TB patients,and the number of household members.Univariate and multivariate logistic regression models were used to analyze the risk factors associated with MDR-TB.All the data were analyzed using STATA V.14.0(Stata Corp LLC,College Station,TX).Results:This study found the MDR rate was 109/3234(3.4%)among positive pulmonary TB patients.More than twice as many patients had MDR re-treatment(74/3234,2.3%),compared to 35/3234(1.1%)who had new TB diagnoses or were getting initial treatment.After adjusting for employment status,individuals with a prior history of tuberculosis treatment were found to have significantly higher odds of developing MDR-TB,with an odds ratio of 7.22(95%CI 3.87-13.44).Conclusions:Increasing attention should be paid to these patients to prevent MDR-TB,and MDR-TB transmission is an urgent challenge for controlling TB worldwide.Early detection of MDR-TB is a critical part of TB control programs.
基金supported by the Guangdong Provincial Clinical Research Center for Tuberculosis(No.2020B1111170014)。
文摘Objective To investigate the spatiotemporal patterns and socioeconomic factors influencing the incidence of tuberculosis(TB)in the Guangdong Province between 2010 and 2019.Method Spatial and temporal variations in TB incidence were mapped using heat maps and hierarchical clustering.Socioenvironmental influencing factors were evaluated using a Bayesian spatiotemporal conditional autoregressive(ST-CAR)model.Results Annual incidence of TB in Guangdong decreased from 91.85/100,000 in 2010 to 53.06/100,000in 2019.Spatial hotspots were found in northeastern Guangdong,particularly in Heyuan,Shanwei,and Shantou,while Shenzhen,Dongguan,and Foshan had the lowest rates in the Pearl River Delta.The STCAR model showed that the TB risk was lower with higher per capita Gross Domestic Product(GDP)[Relative Risk(RR),0.91;95%Confidence Interval(CI):0.86–0.98],more the ratio of licensed physicians and physician(RR,0.94;95%CI:0.90-0.98),and higher per capita public expenditure(RR,0.94;95%CI:0.90–0.97),with a marginal effect of population density(RR,0.86;95%CI:0.86–1.00).Conclusion The incidence of TB in Guangdong varies spatially and temporally.Areas with poor economic conditions and insufficient healthcare resources are at an increased risk of TB infection.Strategies focusing on equitable health resource distribution and economic development are the key to TB control.
文摘AIM:To investigate the therapeutic effects of botulinum toxin A(BTXA)injection versus strabismus surgery in the treatment of acute acquired comitant esotropia(AACE).METHODS:Patient records of AACE cases treated at First People’s Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study.Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality.Further stratification was performed according to preoperative deviation angles[>35 prism diopters(PD)vs≤35 PD]and age(≥18 years adult group vs<18 years adolescent group).The baseline patient characteristics were collected,deviation angles at multiple timepoints before and after treatment were measured,and stereopsis test results were documented.Through comparative analysis of therapeutic outcomes across subgroups,we systematically evaluated the efficacy of different treatment approaches.RESULTS:A total of 43 AACE patients were included.At the final follow-up,both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001).Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05).For patients with deviations>35 PD,surgery yielded significantly better outcomes than injection therapy in postoperative angle,success rate,and stereopsis recovery(P<0.05).Similarly,in patients aged≥18 years,surgical treatment was superior to injections in reducing strabismus angle,improving success rates,and restoring stereopsis(P<0.05).CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE.Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy,particularly in patients with deviations>35 PD and those aged≥18 years.For patients with angles≤35 PD or under 18 years,BTXA injection remains a viable treatment option.
文摘Objective:To identify factors associated with hepatotoxicity during the intensive phase of treatment in tuberculosis(TB)patients.Methods:A case-control study was conducted of TB patients treated with first-line anti-TB drugs from 2013 to 2020.Cases were defined as patients who developed hepatotoxicity,while controls were those without hepatotoxicity,at a 1:2 ratio.Controls were randomly selected from the same hospitals as the cases.The primary outcome was the occurrence of hepatotoxicity during the intensive treatment phase,with data retrospectively collected from medical records.Descriptive statistics and multiple logistic regression with backward elimination were used for analysis.Results:Among 3021 tuberculosis patients who received first-line anti-tuberculosis regimen,50 had abnormal liver function and 14 developed hepatotoxictiy.In addition,2957 patients had normal liver function and 128 served as controls for this analysis.Multiple logistic regression analysis revealed that female patients had about twice the risk of hepatotoxicity compared to males(adjusted OR 2.25,95%CI 1.11-4.59),and patients with HIV coinfection were nearly 10 times more likely to develop hepatotoxicity than those without HIV(adjusted OR 9.74,95%CI 3.12-30.41).Conclusions:Female sex and HIV coinfection were found to be significant risk factors for hepatotoxicity during the intensive phase of TB treatment.Enhanced monitoring and preventive strategies are recommended for these high-risk groups to reduce the risk of hepatotoxicity.
基金The Research and Cultivation Spectial Project of Beijing Center for Disease Prevention and Control,Grant/Award Number:2023-KYJH-03。
文摘Background:C hina is a high-burden country for multidrug-r esistant tuberculosis/rifampin-resistant tuberculosis(MDR/RR-T B).Fluoroquinolones(FQs)are key drugs for the treatment of patients with MDR/RR-T B.However,research on the resistance of FQs in Beijing is limited.Methods:W e collected clinical isolates from all patients with pulmonary TB in Beijing from January 2016 to December 2021,conducted drug-s ensitivity tests and sequencing for levofloxacin(LFX)and moxifloxacin(MFX),and collected the treatment plans and outcomes of the patients.Results:A total of 8512 clinical isolates were collected from patients with pulmonary TB,and 261 RR-T B strains were screened.The proportions of drug-s ensitive and drugresistant strains significantly differed by age group and treatment history.The rates of LFX and MFX resistance were 27.6%(72/261)and 36.4%(95/261),respectively.The detection rates of MDR-T B and pre-e xtensively drug-resistant TB(pre-X DR-T B)were 73.2%(191/261)and 36.4%(95/261),respectively,and the trends were significant(χ^(2)trend=9.995,p=0.002;χ^(2)trend=12.744,p=0.026).Among the 261 RR-T B strains,14.9%(24/261)were sensitive to LFX but resistant to MFX.Among the four patients with LFX-r esistant TB who received LFX treatment failed in three patients(Fisher's exact test,p=0.009).The common mutation sites were 94 and 90 in gyrA.A novel mutation Ala90Ser was discovered.Conclusions:F Qs resistance trends in RR-T B patients in Beijing are striking.Strains showed incomplete cross-resistance to LFX and MFX.Testing for FQs resistance and developing a reasonable treatment plan are recommended.Attention should be given to the changing trends in MDR-T B and pre-X DR-TB.
基金supported by the Beijing Natural Science Foundation (grant number: 7232060)National Key Research and Development Program of China (grant number: 2023YFC2307301)Top Level Public Health Technical Personnel Training Plan (grant number: LJRC-03-09)。
文摘Objectives This study aimed to investigate the impact of foam macrophages(FMs) on the intracellular survival of Mycobacterium tuberculosis(MTB) and identify the molecular mechanisms influencing MTB survival.Methods An in vitro FM model was established using oleic acid induction. Transcriptomic and metabolomic analyses were conducted to identify the key molecular pathways involved in FM-mediated MTB survival.Results Induced FMs effectively restricted MTB survival. Transcriptomic and metabolomic profiling revealed distinct changes in gene and metabolite expression in FMs during MTB infection compared with normal macrophages. Integrated analyses identified significant alterations in the cyclic adenosine monophosphate(cAMP) signaling pathway, indicating that its activation contributes to the FM-mediated restriction of MTB survival.Conclusions FMs inhibit MTB survival. The cAMP signaling pathway is a key contributor. These findings enhance the understanding of the role of FMs in tuberculosis progression, suggest potential targets for host-directed therapies, and offer new directions for developing diagnostic and therapeutic strategies against tuberculosis.
