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The International Journal of... Apr 2016D-Cycloserine, known from tuberculosis therapy, has been widely introduced to neuropsychiatric studies, since its central active mechanism as a partial NMDA-agonist has... (Review)
Review
D-Cycloserine, known from tuberculosis therapy, has been widely introduced to neuropsychiatric studies, since its central active mechanism as a partial NMDA-agonist has been found. In this review, we evaluate its therapeutic potential in neuropsychological disorders and discuss its pitfalls in terms of dosing and application frequency as well as its safety in low-dose therapy. Therefore, we identified 91 clinical trials by performing a Medline search. We demonstrate in part preliminary but increasing evidence that D-cycloserine may be effective in various psychiatric diseases, including schizophrenia, anxiety disorders, addiction, eating disorders, major depression, and autism as well as in neurological diseases, including dementia, Alzheimer's disease, and spinocerebellar degeneration. D-Cycloserine in low-dose therapy is safe, but there is still a need for new drugs with higher specificity to the different N-methyl-D-aspartate-receptor subunits.
Topics: Animals; Cycloserine; Excitatory Amino Acid Agonists; Humans; Mental Disorders; Nervous System Diseases; Psychotropic Drugs; Receptors, N-Methyl-D-Aspartate
PubMed: 26364274
DOI: 10.1093/ijnp/pyv102 -
The International Journal of... Aug 2017To describe mandates and policy gaps in tuberculosis (TB) contact investigation and management. (Review)
Review
OBJECTIVE
To describe mandates and policy gaps in tuberculosis (TB) contact investigation and management.
DESIGN
We conducted a systematic review of national TB policy documents obtained using a systematic internet search and by contacting national TB programs. We included policies published in English, Spanish, and French, and abstracted data using a standardized form.
RESULTS
We reviewed policy documents for 68 of 216 (31%) countries and territories. All countries recommended performing contact investigations, but 40% did not specify how contacts enter the health system for evaluation or who was responsible for this process. All countries recommended preventive therapy for contacts, but in 14 (21%) countries only young children were eligible. While four preventive therapy regimens exist, 48 (71%) countries recommended only isoniazid monotherapy. In addition, 28 (41%) countries lacked guidance on whether to give preventive therapy to contacts exposed to drug-resistant TB. Policies in 28 (41%) countries lacked recommendations for managing contacts with the human immunodeficiency virus (HIV) after new TB exposure.
CONCLUSION
Policies recommending contact investigation and preventive therapy for contacts are widespread, but policy gaps exist in the areas of ensuring accountability and the management of vulnerable populations such as people living with HIV and those exposed to drug-resistant TB.
Topics: Antitubercular Agents; Contact Tracing; Health Policy; Humans; Isoniazid; National Health Programs; Tuberculosis; Tuberculosis, Multidrug-Resistant; Vulnerable Populations
PubMed: 28786803
DOI: 10.5588/ijtld.17.0061 -
BMC Medicine Feb 2018Multidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) is a growing concern in meeting global targets for TB control. In high-income low-TB-incidence countries, a disproportionate number of MDR-TB cases occur in migrant (foreign-born) populations, with concerns about low adherence rates in these patients compared to the host non-migrant population. Tackling MDR-TB in this context may, therefore, require unique approaches. We conducted a systematic review and meta-analysis to identify and synthesise data on MDR-TB treatment adherence in migrant patients to inform evidence-based strategies to improve care pathways and health outcomes in this group.
METHODS
This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO 42017070756). The databases Embase, MEDLINE, Global Health and PubMed were searched to 24 May 2017 for primary research reporting MDR-TB treatment adherence and outcomes in migrant populations, with no restrictions on dates or language. A meta-analysis was conducted using random-effects models.
RESULTS
From 413 papers identified in the database search, 15 studies reporting on MDR-TB treatment outcomes for 258 migrants and 174 non-migrants were included in the systematic review and meta-analysis. The estimated rate of adherence to MDR-TB treatment across migrant patients was 71% [95% confidence interval (CI) = 58-84%], with non-adherence reported among 20% (95% CI = 4-37%) of migrant patients. A key finding was that there were no differences in estimated rates of adherence [risk ratio (RR) = 1.05; 95% CI = 0.82-1.34] or non-adherence (RR = 0.97; 95% CI = 0.79-1.36) between migrants and non-migrants.
CONCLUSIONS
MDR-TB treatment adherence rates among migrants in high-income low-TB-incidence countries are approaching global targets for treatment success (75%), and are comparable to rates in non-migrants. The findings highlight that only just over 70% of migrant and non-migrant patients adhere to MDR-TB treatment. The results point to the importance of increasing adherence in all patient groups, including migrants, with an emphasis on tailoring care based on social risk factors for poor adherence. We believe that MDR-TB treatment targets are not ambitious enough.
Topics: Antitubercular Agents; Humans; Transients and Migrants; Treatment Adherence and Compliance; Tuberculosis, Multidrug-Resistant
PubMed: 29466983
DOI: 10.1186/s12916-017-1001-7 -
The International Journal of... Nov 2017To reduce transmission and improve patient outcomes, rapid diagnosis and treatment of rifampicin-resistant tuberculosis (RR-TB) is required. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To reduce transmission and improve patient outcomes, rapid diagnosis and treatment of rifampicin-resistant tuberculosis (RR-TB) is required.
OBJECTIVE
To conduct a systematic review and meta-analysis assessing time to treatment for RR-TB and variability using diagnostic testing methods and treatment delivery approach.
DESIGN
Studies from 2000 to 2015 reporting time to second-line treatment initiation were selected from PubMed and published conference abstracts.
RESULTS
From 53 studies, 83 cohorts (13 034 patients) were included. Overall weighted mean time to treatment from specimen collection was 81 days (95%CI 70-91), and was shorter with ambulatory (57 days, 95%CI 40-74) than hospital-based treatment (86 days, 95%CI 71-102). Time to treatment was shorter with genotypic susceptibility testing (38 days, 95%CI 27-49) than phenotypic testing (108 days, 95%CI 98-117). The mean percentage of diagnosed patients initiating treatment was 76% (95%CI 70-83, range 25-100).
CONCLUSION
Time to second-line anti-tuberculosis treatment initiation is extremely variable across studies, and often unnecessarily long. Reduced delays are associated with genotypic testing and ambulatory treatment settings. Routine monitoring of the proportion of diagnosed patients initiating treatment and time to treatment are necessary to identify areas for intervention.
Topics: Ambulatory Care; Antitubercular Agents; Genotype; Hospitalization; Humans; Microbial Sensitivity Tests; Mycobacterium tuberculosis; Rifampin; Time-to-Treatment; Tuberculosis, Multidrug-Resistant
PubMed: 29037299
DOI: 10.5588/ijtld.17.0230 -
Frontiers in Immunology 2023IgA nephropathy may recur in patients receiving kidney transplantation due to IgA nephropathy induced renal failure. The risk factors for recurrence are still at issue.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
IgA nephropathy may recur in patients receiving kidney transplantation due to IgA nephropathy induced renal failure. The risk factors for recurrence are still at issue. The aim of this study was to conduct a systematic review and meta-analysis to assess risk factors and outcomes for IgA nephropathy recurrence.
METHODS
We used PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, CNKI, WanFang, VIP and CBM to search for relevant studies published in English and Chinese. Cohort or case-control studies reporting risk factors or outcomes for IgA nephropathy recurrence were included.
RESULTS
Fifty-eight studies were included. Compare to no recurrence group, those with IgAN recurrence had younger age (mean difference [MD]=-4.27 years; risk ratio [RR]=0.96), younger donor age (MD=-2.19 years), shorter time from IgA nephropathy diagnosis to end stage renal disease (MD=-1.84 years; RR=0.94), shorter time on dialysis (MD=-3.14 months), lower human leukocyte-antigen (HLA) mismatches (MD=-0.11) and HLA-DR mismatches (MD=-0.13). HLA-B46 antigen (RR=0.39), anti-IL-2-R antibodies induction (RR=0.68), mycophenolate mofetil (RR=0.69), and pretransplant tonsillectomy (RR=0.43) were associated with less IgAN recurrence. Of note, male recipient gender (RR=1.17), related donor (RR=1.53), retransplantation (RR=1.43), hemodialysis (RR=1.68), no induction therapy (RR=1.73), mTOR inhibitor (RR=1.51), angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (RR=1.63) were risk factors for IgAN recurrence. Recurrence increased the risk of graft loss (RR=2.19).
CONCLUSIONS
This study summarized the risk factors for recurrence of IgA nephropathy after kidney transplantation. Well-designed prospective studies are warranted for validation.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=377480, identifier CRD42022377480.
Topics: Humans; Male; Glomerulonephritis, IGA; Kidney Transplantation; Risk Factors; Kidney Failure, Chronic; Mycophenolic Acid
PubMed: 38090563
DOI: 10.3389/fimmu.2023.1277017 -
The International Journal of... Jul 2016Treatment guidance for non-multidrug-resistant (MDR) rifampicin-resistant (RMP-R) tuberculosis (TB) is variable. We aimed to undertake a systematic review and... (Meta-Analysis)
Meta-Analysis Review
Treatment guidance for non-multidrug-resistant (MDR) rifampicin-resistant (RMP-R) tuberculosis (TB) is variable. We aimed to undertake a systematic review and meta-analysis of the randomised controlled trial (RCT) data behind such guidelines to identify the most efficacious treatment regimens. Ovid MEDLINE, the Web of Science and EMBASE were mined using search terms for TB, drug therapy and RCTs. Despite 12 604 records being retrieved, only three studies reported treatment outcomes by regimen for patients with non-MDR RMP-R disease, preventing meta-analysis. Our systematic review highlights a substantial gap in the literature regarding evidence-based treatment regimens for RMP-R TB.
Topics: Antibiotics, Antitubercular; Biomedical Research; Drug Resistance, Bacterial; Evidence-Based Medicine; Humans; Microbial Sensitivity Tests; Predictive Value of Tests; Professional Practice Gaps; Randomized Controlled Trials as Topic; Rifampin; Tuberculosis
PubMed: 27287636
DOI: 10.5588/ijtld.16.0034 -
Systematic Reviews Aug 2022Tuberculosis (TB) is considered one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. Multidrug-resistant (MDR) TB...
BACKGROUND
Tuberculosis (TB) is considered one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. Multidrug-resistant (MDR) TB can affect people of all age groups, including children (aged 0-15 years). However, very little is known about the extent of this problem in children. This systematic review aims to investigate the incidence of TB and drug-resistant (DR) TB among the pediatric population. It also reviews the therapeutic options available to treat the condition.
METHODS
A comprehensive search for all relevant evidence was conducted. The following databases were searched: MEDLINE, CINAHL, and Web of Science. The searched time frame was limited from January 1990 to December 2020 with a focus on the incidence of TB and MDR-TB among pediatrics and the therapeutic options available.
RESULTS
A total of 537 articles were obtained via the selected databases. After title and abstract screening, 418 articles were excluded leaving 119 articles. Full-text screening was conducted on 119 articles, excluding a further 110 articles. Thus, 9 articles were subject to quality assessment and included in this review. The 9 articles represented the age group of 0-15 years and included both males and females. All studies included were of retrospective study design.
DISCUSSION
The included studies mentioned a moderate increase in TB cases among pediatrics exacerbated by malnutrition, lack of bacille Calmette-Guérin (BCG) vaccination, and human immunodeficiency virus (HIV) coinfection. MDR-TB prevalence was especially high in South Africa. Drug therapy for both TB and MDR-TB yielded favorable outcomes among pediatrics. However, one of the biggest challenges with drug therapy includes the dosage forms available.
SYSTEMATIC REVIEW REGISTRATION
DOI: 10.17605/OSF.IO/G34NF.
Topics: Adolescent; Antitubercular Agents; Child; Child, Preschool; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Retrospective Studies; Tuberculosis; Tuberculosis, Multidrug-Resistant
PubMed: 35927752
DOI: 10.1186/s13643-022-02023-1 -
BMC Gastroenterology Feb 2023Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Gastrointestinal strictures impact clinical presentation in abdominal tuberculosis and are associated with significant morbidity.
AIM
To conduct a systematic review of the prevalence of stricturing disease in abdominal and gastrointestinal tuberculosis and response to antitubercular therapy (ATT).
METHODS
We searched Pubmed and Embase on 13th January 2022, for papers reporting on the frequency and outcomes of stricturing gastrointestinal tuberculosis. The data were extracted, and pooled prevalence of stricturing disease was estimated in abdominal tuberculosis and gastrointestinal (intestinal) tuberculosis. The pooled clinical response and stricture resolution (endoscopic or radiologic) rates were also estimated. Publication bias was assessed using the Funnel plot and Egger test. The risk of bias assessment was done using a modified Newcastle Ottawa Scale.
RESULTS
Thirty-three studies reporting about 1969 patients were included. The pooled prevalence of intestinal strictures in abdominal tuberculosis and gastrointestinal TB was 0.12 (95%CI 0.07-0.20, I = 89%) and 0.27 (95% CI 0.21-0.33, I = 85%), respectively. The pooled clinical response of stricturing gastrointestinal tuberculosis to antitubercular therapy was 0.77 (95%CI 0.65-0.86, I = 74%). The pooled stricture response rate (endoscopic or radiological) was 0.66 (95%CI 0.40-0.85, I = 91%). The pooled rate of need for surgical intervention was 0.21 (95%CI 0.13-0.32, I = 70%), while endoscopic dilatation was 0.14 (95%CI 0.09-0.21, I = 0%).
CONCLUSION
Stricturing gastrointestinal tuberculosis occurs in around a quarter of patients with gastrointestinal tuberculosis, and around two-thirds of patients have a clinical response with antitubercular therapy. A subset of patients may need endoscopic or surgical intervention. The estimates for the pooled prevalence of stricturing disease and response to ATT had significant heterogeneity.
Topics: Humans; Constriction, Pathologic; Tuberculosis, Gastrointestinal; Antitubercular Agents; Intestinal Obstruction; Abdomen
PubMed: 36814249
DOI: 10.1186/s12876-023-02682-x -
Recommendations Concerning the Therapeutic Approach to Immunocompromised Children With Tuberculosis.Clinical Therapeutics Jan 2016This article describes the recommendations of a group of scientific societies concerning the therapeutic approach to immunocompromised children with tuberculosis (TB). (Review)
Review
PURPOSE
This article describes the recommendations of a group of scientific societies concerning the therapeutic approach to immunocompromised children with tuberculosis (TB).
METHODS
Using the Consensus Conference method, relevant publications in English were identified by a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until December 31, 2014.
FINDINGS
On the basis of their clinical experience and the published evidence, the group of experts concluded that, although immunosuppressed subjects are at greater risk of developing TB, none of the signs or symptoms is sensitive or specific enough to enable a diagnosis. Immunocompromised patients are at greater risk of developing extrapulmonary forms of TB, especially if they are adolescents, whereas pulmonary forms are more prevalent among younger patients. When TB is suspected, a combination of skin and immunologic tests and other clinical, radiologic, and microbiologic examinations can be used to assess the risk of infection or disease. If the TB diagnosis is confirmed, immunocompromised children should be treated by using a standard regimen with a minimum of 4 drugs for at least 9 to 12 months, during which the tolerability of the drugs and their interactions should be carefully evaluated.
IMPLICATIONS
It is difficult to diagnose and treat TB in immunocompromised children. Thus, all pediatric patients undergoing immunosuppressive therapy who develop TB should be diagnosed and treated at a TB reference center, which should also be responsible for the recommended follow-up.
Topics: Adolescent; Antitubercular Agents; Child; Child, Preschool; Coinfection; Consensus; Delphi Technique; Drug Therapy, Combination; HIV Infections; Humans; Immunocompromised Host; Infant; Infant, Newborn; Tuberculosis, Pulmonary
PubMed: 26548321
DOI: 10.1016/j.clinthera.2015.10.012 -
The Cochrane Database of Systematic... Mar 2015Multifocal motor neuropathy (MMN) is characterised by progressive, predominantly distal, asymmetrical limb weakness and usually multiple partial motor nerve conduction... (Review)
Review
BACKGROUND
Multifocal motor neuropathy (MMN) is characterised by progressive, predominantly distal, asymmetrical limb weakness and usually multiple partial motor nerve conduction blocks. Intravenous immunoglobulin (IVIg) is beneficial but the role of immunosuppressive agents is uncertain. This is an update of a review first published in 2002 and previously updated in 2003, 2005, 2008 and 2011.
OBJECTIVES
To assess the effects of immunosuppressive agents for the treatment of multifocal motor neuropathy.
SEARCH METHODS
On 22 September 2014 we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE and LILACS for trials of MMN. We also searched two trials registers for ongoing studies.
SELECTION CRITERIA
We planned to include randomised controlled trials (RCTs) and quasi-RCTs. We considered prospective and retrospective case series and case reports in the Discussion.
DATA COLLECTION AND ANALYSIS
Two review authors searched the titles and abstracts of the articles identified and extracted the data independently.
MAIN RESULTS
Only one RCT of an immunosuppressive or immunomodulatory agent has been performed in MMN. This study randomised 28 participants and showed that mycophenolate mofetil, when used with IVIg, did not significantly improve strength, function or reduce the need for IVIg. No serious adverse events were observed. The study was deemed at low risk of bias. We summarised the results of retrospective and prospective case series in the discussion.
AUTHORS' CONCLUSIONS
According to moderate quality evidence, mycophenolate mofetil did not produce significant benefit in terms of reducing need for IVIg or improving muscle strength in MMN. Trials of other immunosuppressants should be undertaken.
Topics: Drug Therapy, Combination; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Immunosuppressive Agents; Motor Neuron Disease; Muscle Strength; Mycophenolic Acid; Polyneuropathies; Randomized Controlled Trials as Topic
PubMed: 25739040
DOI: 10.1002/14651858.CD003217.pub5