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BMJ Open May 2024The aim of this study was to assess the quality of tuberculosis (TB) care for the whole course and assess factors that affect completing treatment. (Observational Study)
Observational Study
OBJECTIVES
The aim of this study was to assess the quality of tuberculosis (TB) care for the whole course and assess factors that affect completing treatment.
DESIGN
This is an observational retrospective study using chart abstraction for the whole course of TB care conducted at two underserved provinces in China.
SETTING
The study was conducted from June 2021 to July 2021. All medical records (outpatient and inpatient) for the whole course (6-8 months) of patients with TB newly registered from July 2020 to December 2020 were reviewed and abstracted using predetermined checklists.
PARTICIPANTS
A total of 268 outpatient medical records and 126 inpatient records were included.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary outcome included diagnostic quality, treatment quality and management quality. The secondary outcome was completing treatment.
RESULTS
For diagnostic quality, 94.2% of the diagnosis were based on adequate evidence. For treatment quality, 240 (91.6%) outpatients and 100 (85.5%) inpatients took the standard chemotherapy regimens. 234 (87.3%) patients completed treatment. 85.1% of the inpatients prescribed with second-line drugs were inappropriate. For management quality, 128 (47.9%) patients received midterm assessments, but only 47 (19.7%) received sufficient services for the whole course. Patients with TB symptoms were 1.8 times more likely to complete treatment (p=0.011).
CONCLUSION
Patients with TB received high-quality diagnosis and treatment services, but low-quality whole-course management. Integration of medical and public health services should be strengthened to improve whole-course quality.
Topics: Humans; Retrospective Studies; China; Female; Male; Adult; Middle Aged; Tuberculosis; Quality of Health Care; Antitubercular Agents; Rural Population; Young Adult; Aged; Adolescent; Medical Records
PubMed: 38821576
DOI: 10.1136/bmjopen-2023-080844 -
BMJ Open May 2024To systematically assess the diagnostic accuracy of CXCL13 testing of cerebrospinal fluid (CSF) for neurosyphilis diagnosing. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically assess the diagnostic accuracy of CXCL13 testing of cerebrospinal fluid (CSF) for neurosyphilis diagnosing.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Embase, Cochrane Library and Web of Science databases from their inception until 1 May 2023.
ELIGIBILITY CRITERIA
Both cross-sectional and case-control diagnostic test studies evaluating the diagnostic value of CSF CXCL13 in diagnosing neurosyphilis were included, with no language restrictions.
DATA EXTRACTION AND SYNTHESIS
Two researchers extracted data independently from all finally included articles. The updated Quality Assessment of Diagnostic Accuracy Studies tool was used to assess the quality of the included studies. Quantitative synthesis was done using a bivariate random-effects model.
RESULTS
This meta-analysis included seven eligible studies involving a total of 1152 patients with syphilis and 430 patients with neurosyphilis. The pooled sensitivity, specificity and summary area under the curve (AUC) of CSF CXCL13 testing for the diagnosis of neurosyphilis were 0.76 (95% CI 0.64 to 0.85; I=82%), 0.83 (95% CI 0.80 to 0.85; I=32.29%) and 0.84 (95% CI 0.81 to 0.87), respectively. Sensitivity analysis confirmed the stability of the combined results. Meta-regression analysis revealed that the heterogeneity of pooled sensitivity was related to different study regions; subgroup analysis indicated that the diagnostic value of CSF CXCL13 testing reported in studies from China was superior to that reported in non-Chinese studies (pooled sensitivity, specificity and summary AUC values were 0.84 I=0) vs 0.64 (I=79.53%), 0.83 (I=42.03%) vs 0.83 (I=32.87%) and 0.87 vs 0.83, respectively). The diagnostic value reported in studies with a sample size ≥200, unclassified neurosyphilis and HIV-negative subgroups was superior to the total combined value.
CONCLUSIONS
This meta-analysis has demonstrated a reasonable level of accuracy for diagnosis of neurosyphilis with CSF CXCL13 testing. Further multicentre, prospective diagnostic studies, especially in asymptomatic neurosyphilis and HIV-infected patients, are needed to provide more evidence for evaluation before clinical application.
PROSPERO REGISTRATION NUMBER
CRD42023414212.
Topics: Humans; Neurosyphilis; Chemokine CXCL13; Sensitivity and Specificity; Biomarkers
PubMed: 38821573
DOI: 10.1136/bmjopen-2023-078527 -
JMIR Human Factors May 2024Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the...
Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study.
BACKGROUND
Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear.
OBJECTIVE
This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting.
METHODS
We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ≥18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients' experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data.
RESULTS
All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox-based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as "being watched" while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82%) to reminders linked to missed doses (7/39, 18%), citing the fact that tuberculosis medication is taken daily.
CONCLUSIONS
The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care.
Topics: Humans; Medication Adherence; Feasibility Studies; Male; Female; Adult; Tuberculosis; Uganda; Motivation; Text Messaging; Reminder Systems; Middle Aged; Surveys and Questionnaires; Cell Phone; Qualitative Research; Antitubercular Agents
PubMed: 38819905
DOI: 10.2196/47996 -
International Journal of Medical... 2024Limited research has examined the association between Oxidative Balance Score (OBS) and mortality, particularly in individuals with infection. This study investigates...
Limited research has examined the association between Oxidative Balance Score (OBS) and mortality, particularly in individuals with infection. This study investigates the correlation between OBS and infection and their impacts on all-cause mortality within a cohort of individuals, considering both infected and uninfected individuals. Data from the National Health and Nutrition Examination Survey (NHANES) 1999-2018, comprising 4,532 participants, were analyzed. Logistic regression analyses assessed the relationship between infection and relevant covariates. Cox regression and restricted cubic spline analysis evaluated the association between total OBS, lifestyle OBS, dietary OBS, and all-cause mortality in -positive and -negative individuals. Restricted cubic spline modeling revealed a linear relationship between total OBS and all-cause mortality, particularly in -negative patients. Total OBS, dietary OBS, and lifestyle OBS inversely correlated with infection, even after adjusting for confounders. Higher dietary OBS was associated with decreased mortality risk exclusively in -positive individuals, while lifestyle OBS was associated with mortality only in -negative individuals. These findings underscore the complex relationships between OBS, infection, and mortality, stressing the importance of infection status in assessing oxidative balance's impact on health. In this sample, higher OBS was associated with lower infection risks. Dietary OBS correlated significantly with all-cause mortality in -positive individuals, while lifestyle OBS was notably associated with mortality in -negative participants. Further research is necessary to elucidate the underlying mechanisms and clinical implications of these findings.
Topics: Humans; Helicobacter Infections; Male; Female; Helicobacter pylori; Middle Aged; United States; Adult; Nutrition Surveys; Oxidative Stress; Aged; Life Style; Risk Factors
PubMed: 38818466
DOI: 10.7150/ijms.95292 -
World Journal of Clinical Cases May 2024The number of patients undergoing solid organ transplantation has increased annually. However, infections in solid organ transplant recipients can have a severe effect...
BACKGROUND
The number of patients undergoing solid organ transplantation has increased annually. However, infections in solid organ transplant recipients can have a severe effect on patient survival owing to the continued use of immunosuppressants. Carrimycin is a novel macrolide antibiotic produced by genetically engineered streptomyces spiramyceticus harboring a 4''-O-isovaleryltransferase gene (ist) from streptomyces thermotoleran. Carrimycin has good antibacterial and antiviral effects. However, no relevant studies have been conducted on the efficacy and safety of carrimycin in patients with severe pneumonia (SP) after solid organ transplantation.
AIM
To explore the efficacy and safety of carrimycin in patients with SP after solid organ transplantation to provide a medication reference for clinical treatment.
METHODS
In March 2022, ten patients with SP following solid-organ transplantation were treated at our hospital between January 2021 and March 2022. When the condition was critical and difficult to control with other drugs, carrimycin was administered. These ten patients' clinical features and treatment protocols were retrospectively analyzed, and the efficacy and safety of carrimycin for treating SP following solid organ transplantation were evaluated.
RESULTS
All ten patients were included in the analysis. Regarding etiological agent detection, there were three cases of fungal pneumonia, two cases of bacterial pneumonia, two cases of Pneumocystis pneumonia, and three cases of mixed infections. After treatment with carrimycin, the disease in seven patients significantly improved, the course of the disease was significantly shortened, fever was quickly controlled, chest computed tomography was significantly improved, and oxygenation was significantly improved. Finally, the patients were discharged after curing. One patient died of acute respiratory distress syndrome, and two patients discontinued treatment.
CONCLUSION
Carrimycin is a safe and effective treatment modality for SP following solid organ transplantation. Carrimycin may have antibacterial and antiviral effects in patients with SP following solid organ transplantation.
PubMed: 38817218
DOI: 10.12998/wjcc.v12.i15.2542 -
Neurology India Mar 2024The purpose of the study is to establish the prevalence of stroke as well as the clinical and radiological correlates of stroke in children with tuberculous meningitis... (Observational Study)
Observational Study
OBJECTIVE
The purpose of the study is to establish the prevalence of stroke as well as the clinical and radiological correlates of stroke in children with tuberculous meningitis (TBM).
METHODS AND MATERIALS
A prospective observational study was conducted at the Pediatric Department, King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India. Using a computed tomography (CT) scan/brain magnetic resonance imaging (MRI), patients were divided into stroke and non-stroke groups. Demographic characteristics, clinical presentations, cerebrospinal fluid examination, basal meningeal enhancement, hydrocephalus, tuberculoma, and clinical outcome were compared between the two groups.
RESULTS
Seventy-eight TBM patients, aged between 6 months and 14 years, were included. Out of 78 enrolled patients, 3 (3.8%) had definite TBM, 73 (91%) had probable TBM, and 4 (5.1%) had possible TBM (LCS). As per the Medical Research Council (MRC) staging, 13% had Stage 1 TBM, 26% had stage 2, and 61% had stage 3 TBM. Out of 78 patients with chest X-ray findings, 42 (53%) had findings suggestive of tuberculosis (TB), which included 33 (42%) with hilar lymphadenopathy and 9 (11%) with a miliary pattern. On neuroimaging, hydrocephalous was seen in 62.8% of cases, basal meningeal enhancement in 64.1%, tuberculoma in 6.4% of cases, and infarction in 53.8% of cases. There was no statistically significant association found between the staging of TBM and the presence of infarction as the majority of cases involved were in stage 3 of the disease (61.5%). TBM patients with stroke had poor clinical outcomes.
CONCLUSION
Age, altered sensorium, focal neurological deficits, vomiting, and basal meningeal enhancement can predict the occurrence of stroke in young adults with TBM.
Topics: Humans; Tuberculosis, Meningeal; Child; Child, Preschool; Adolescent; Male; Female; Prospective Studies; Stroke; Risk Factors; Infant; India; Magnetic Resonance Imaging; Tomography, X-Ray Computed
PubMed: 38817172
DOI: 10.4103/ni.ni_740_22 -
Journal of Biosciences 2024Milk is a source of essential nutrients, but food safety across the milk supply chain has emerged as an integral part of food trade. Of the several food safety hazards,...
Milk is a source of essential nutrients, but food safety across the milk supply chain has emerged as an integral part of food trade. Of the several food safety hazards, antimicrobial-resistant species have emerged as one of the major microbial hazards with significant public health concerns. The present crosssectional study was undertaken with the objective to isolate species from the milk supply chain, characterize isolates for antimicrobial resistance, and trace the origin of isolates using molecular techniques. Samples collected from the formal and informal milk supply chains showed prevalence of species of 4.3% (n=720); isolates were identified as coagulase-positive ( 67.7% and 6.4%) and coagulase-negative ( 9.6%, 3.2%, 3.2%, 3.2%, 3.2%, and 3.2%) species. isolates showed antimicrobial resistance to methicillin (32.2%), β-lactam (41.9%), and macrolide-lincosamide-streptogramin B (3.2%). isolates phenotypically resistant to methicillin also carried the A gene and displayed diverse pulsed field gel electrophoresis (PFGE) profiles, indicating their diverse origins in the milk supply chain. Based on the similarity of PFGE profile, the origin of one of the isolates was traced to the soil in contact with milch cows. The findings of this study highlight the need for more comprehensive microbial risk analysis studies across the milk supply chain, capacity building, creation of awareness among stakeholders about the judicious use of antimicrobials, and protection of public health using a One-Health approach.
Topics: Milk; Animals; Staphylococcus; Anti-Bacterial Agents; Microbial Sensitivity Tests; Staphylococcal Infections; Food Microbiology; Humans; Cattle; Bacterial Proteins; Coagulase; Drug Resistance, Bacterial
PubMed: 38817159
DOI: No ID Found -
The Medical Journal of Malaysia May 2024The aim of this study was to evaluate a group of infants born to women with tuberculosis (TB) during pregnancy to determine the neonatal morbidities and its outcomes...
INTRODUCTION
The aim of this study was to evaluate a group of infants born to women with tuberculosis (TB) during pregnancy to determine the neonatal morbidities and its outcomes associated with tuberculosis in pregnancy.
MATERIALS AND METHODS
Data from January 2007 to December 2021 was collected for analysis as part of a retrospective cohort study. This study was conducted in a tertiary public hospital in Malaysia, Hospital Sultan Idris Shah (HSIS). Cases were identified from the hospital's bacille Calmette-Guerin (BCG) vaccination notification forms and merged with records from the neonatal intensive care unit's census. Controls were infants born to mothers unaffected by TB within the same hospital and year as the index case (1:4 ratio). Descriptive statistics and logistic regression were used to analyse the data. The main outcome measures were the risk of congenital tuberculosis, premature birth, low birth weight, small for gestational age and low APGAR score.
RESULTS
Data from January 2007 to December 2021 was collected for analysis as part of a retrospective cohort study. This study was conducted in a tertiary public hospital in Malaysia, Hospital Sultan Idris Shah (HSIS). Cases were identified from the hospital's bacille Calmette-Guerin (BCG) vaccination notification forms and merged with records from the neonatal intensive care unit's census. Controls were infants born to mothers unaffected by TB within the same hospital and year as the index case (1:4 ratio). Descriptive statistics and logistic regression were used to analyse the data. The main outcome measures were the risk of congenital tuberculosis, premature birth, low birth weight, small for gestational age and low APGAR score.
Topics: Humans; Female; Retrospective Studies; Pregnancy; Infant, Newborn; Malaysia; Tertiary Care Centers; Tuberculosis; Adult; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; Infant, Low Birth Weight; Male; Apgar Score; Cohort Studies
PubMed: 38817068
DOI: No ID Found -
PLoS Neglected Tropical Diseases May 2024Haemophilus ducreyi was historically known as the causative agent of chancroid, a sexually-transmitted disease causing painful genital ulcers endemic in many...
Haemophilus ducreyi was historically known as the causative agent of chancroid, a sexually-transmitted disease causing painful genital ulcers endemic in many low/middle-income nations. In recent years the species has been implicated as the causative agent of nongenital cutaneous ulcers affecting children of the South Pacific Islands and West African countries. Much is still unknown about the mechanism of H. ducreyi transmission in these areas, and recent studies have identified local insect species, namely flies, as potential transmission vectors. H. ducreyi DNA has been detected on the surface and in homogenates of fly species sampled from Lihir Island, Papua New Guinea. The current study develops a model system using Musca domestica, the common house fly, as a model organism to demonstrate proof of concept that flies are a potential vector for the transmission of viable H. ducreyi. Utilizing a green fluorescent protein (GFP)-tagged strain of H. ducreyi and three separate exposure methods, we detected the transmission of viable H. ducreyi by 86.11% ± 22.53% of flies sampled. Additionally, the duration of H. ducreyi viability was found to be directly related to the bacterial concentration, and transmission of H. ducreyi was largely undetectable within one hour of initial exposure. Push testing, Gram staining, and PCR were used to confirm the identity and presence of GFP colonies as H. ducreyi. This study confirms that flies are capable of mechanically transmitting viable H. ducreyi, illuminating the importance of investigating insects as vectors of cutaneous ulcerative diseases.
Topics: Animals; Houseflies; Haemophilus ducreyi; Chancroid; Papua New Guinea; Insect Vectors; Female; Male
PubMed: 38814945
DOI: 10.1371/journal.pntd.0012194 -
Pulmonary Therapy May 2024The asthma pandemic imposes a huge burden on patients and health systems in both developed and developing countries. Despite available treatments, symptom control is... (Review)
Review
The asthma pandemic imposes a huge burden on patients and health systems in both developed and developing countries. Despite available treatments, symptom control is generally suboptimal, and hospitalizations and deaths remain at unacceptably high levels. A pivotal aspect of asthma that warrants further exploration is the influence of the respiratory microbiome and virome in modulating disease activity. A plethora of studies report that the respiratory microbiome is characteristically dysbiotic in asthma. In addition, our data suggest that dysbiosis is also observed on the respiratory virome, partly characterized by the reduced abundance of bacteriophages (phages). Even though phages can naturally infect and control their bacterial prey, phage therapy has been grossly neglected in the Western world, although more recently it is more widely used as a novel tool against bacterial infections. However, it has never been used for tackling microbiome dysbiosis in human non-communicable diseases. This review provides an up-to-date understanding of the microbiome and virome's role within the airways in relation to asthma morbidity. It also advances the rationale and hypothesis for the CURE project. Specifically, the CURE project suggests that managing the respiratory microbiome through phage therapy is viable and may result in restoring eubiosis within the asthmatic airway. This entails controlling immune dysregulation and the clinical manifestation of the disease. To accomplish this goal, it is crucial to predict the effects of introducing specific phage mixtures into the intricate ecology of the airways and devise suitable interventions.
PubMed: 38814533
DOI: 10.1007/s41030-024-00261-3