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Introduction Methods Results Conclusion The issue of whether integrase inhibitors (INSTIs) may confer a higher risk of paradoxical tuberculosis‐related immune reconstitution inflammatory syndrome (TB‐IRIS) compared with other classes of antiretroviral in people with HIV with a profound level of immunosuppression remains insufficiently explored. We aimed to assess whether such a higher risk exists by examining a cohort of patients with TB‐HIV initiating antiretroviral therapy (ART) in Hong Kong.This was a retrospective review of 133 patients registered in the TB‐HIV Registry of the Department of Health during the period 2014–2021.Sixteen of 70 patients (22.9%; 95% confidence interval [CI] 13.0–32.7) and 14 of 63 patients (22.2%; 95% CI 12.0–32.5) from the INSTI and non‐INSTI groups experienced TB‐IRIS (p = 0.920). The median intervals between ART initiation and IRIS among patients from the two groups were similar (3 weeks [interquartile range IQR 2.0–7.8] vs. 4 weeks [IQR 2.0–5.1], p = 0.620). The proportion of patients requiring steroid therapy were similar, as were the hospitalization rates. There was no IRIS‐related death in either group. The risk of TB‐IRIS with INSTI versus non‐INSTI was also similar in a stratified analysis in a subgroup of patients with a baseline CD4 count of <50 μL (10/33 [30.3%; 95% CI 14.6–46.0] vs. 10/22 [45.5%; 95% CI 24.7–66.3], p = 0.252) and another subgroup of patients with ART initiated within 4 weeks of anti‐TB treatment (10/26 [38.5%; 95% CI 19.8–57.2] vs. 10/23 [43.5%; 95% CI 23.2–63.7], p = 0.721).Our cohort study did not offer support for an increased risk of TB‐IRIS with INSTIs compared with non‐INSTIs, even in severely immunocompromised people with HIV. [ABSTRACT FROM AUTHOR]

Background: Studies in general population reported a positive association between tobacco smoking and airflow obstruction (AFO), a hallmark of chronic obstructive pulmonary disease (COPD). However, this attempt was less addressed in silica dust-exposed workers. Methods: This retrospective cohort study consisted of 4481 silicotic workers attending the Pneumoconiosis Clinic during 1981–2019. The lifelong work history and smoking habits of these workers were extracted from medical records. Spirometry was carried out at the diagnosis of silicosis (n = 4177) and reperformed after an average of 9.4 years of follow-up (n = 2648). AFO was defined as forced expiratory volume in one second (FEV1)/force vital capacity (FVC) less than lower limit of normal (LLN). The association of AFO with smoking status was determined using multivariate logistics regression, and the effect of smoking cessation on the development of AFO was evaluated Cox regression. Results: Smoking was significantly associated with AFO (current smokers: OR = 1.92, 95% CI 1.51–2.44; former smokers: OR = 2.09, 95% CI 1.65–2.66). The risk of AFO significantly increased in the first 3 years of quitting smoking (OR = 1.23, 95% CI 1.02–1.47) but decreased afterwards with increasing years of cessation. Smoking cessation reduced the risk of developing AFO no matter before or after the confirmation of silicosis (pre-silicosis cessation: HR = 0.58, 95% CI 0.46–0.74; post-silicosis cessation: HR = 0.62, 95% CI 0.48–0.79). Conclusions: Smoking cessation significantly reduced the risk of AFO in the workers with silicosis, although the health benefit was not observed until 3 years of abstinence. These findings highlight the importance of early and long-term smoking cessation among silicotic or silica dust-exposed workers. [ABSTRACT FROM AUTHOR]

Weakened circadian activity rhythms (CARs) were associated with mild cognitive impairment (MCI) in the general population. However, it remains unclear among pneumoconiosis patients. We aimed to address this knowledge gap. This cross-sectional study comprised 186 male pneumoconiosis patients (71.3 ± 7.8 years) and 208 healthy community men. Actigraphy was used to determine CARs parameters (percent rhythm, amplitude, MESOR, and acrophase). Values below the corresponding medians of the CARs parameters represented weakened CARs. The Cantonese version of Mini-Mental State Examination (CMMSE) was used to assess cognitive function, MCI, and the composite outcome of MCI plus cognitive impairment. Compared with the community referents, pneumoconiosis patients had worse cognition and dampened CARs. Compared with the community referents or pneumoconiosis patients with robust circadian rhythm, pneumoconiosis patients with weakened circadian rhythm were consistently associated with increased risk of MCI and the composite outcome. However, significant association was only observed between MESOR and the composite outcome (adjusted OR = 1.99, 95%: 1.04–3.81). A delayed phase of CARs was insignificantly associated with MCI and the composite outcome. Our findings showed that weakened CARs were associated with worse cognitive function among male pneumoconiosis workers. Intervention in improving CARs may mitigate cognitive deterioration in male pneumoconiosis workers. [ABSTRACT FROM AUTHOR]

Background: This study aims to determine the changes in physical activity and actigraphy-measured rest-activity circadian rhythm among Hong Kong community aged population before and during the outbreak of COVID-19.Methods: This is a three repeated measure population-based cross-sectional study. We recruited community older men aged > 60 years in three periods of the COVID-19 outbreak in Hong Kong, i.e., before the COVID-19 outbreak (2 July 2019-8 January 2020), between the 2nd and 3rd waves of COVID-19 (23 June 2020-9 July 2020), and during the 3rd wave of COVID-19 (15 September 2020-29 September 2020). Participants reported detailed information on their physical activity habits using the International Physical Activity Questionnaire and wore actigraphs continuously for 7 days (168 h). The actigraph data were then transferred to four rest-activity circadian rhythm parameters: midline statistic of rhythm (MESOR), amplitude, acrophase and percent rhythm. Multivariate logistic regression was performed to estimate the association of period effect of COVID-19 on physical activity and rest-activity circadian rhythm parameters.Results: Among the 242 community older men, 106 (43.8%) of them were recruited before the COVID-19 outbreak, 66 (27.3%) were recruited between the 2nd and 3rd waves of COVID-19, and 70 (28.9%) were recruited during the late phase of the 3rd wave of COVID-19. Compared with those recruited before COVID-19, participants recruited between the 2nd and 3rd waves of COVID-19 had lower physical activity (adjusted odds ratio (AOR) = 2.03, 95% confidence interval (95%CI) =1.05-3.93), MESOR (AOR = 2.05, 95%CI = 1.01-4.18), and amplitude (AOR = 1.91, 95%CI = 0.95-3.83). There was no difference in physical activity or circadian rhythm parameters between subjects recruited before and during the late phase of the 3rd wave.Conclusions: This study found that the effect of COVID-19 on physical activity and rest-activity circadian rhythm for the community people may be short-term, indicating strong resilience of the community population. Although maintaining physical activity are encouraged for the older adults to sustain good health, a rebound in their physical activity may be a sign for the next wave of outbreak if insufficient social distancing and population protection are facilitated. [ABSTRACT FROM AUTHOR]

Background and Objective In Hong Kong, neonatal Bacillus Calmette- Guerin ( BCG) vaccination is practiced with 99% coverage. This study was to compare the performance of T- Spot. TB and tuberculin skin test ( TST) in predicting tuberculosis ( TB) among household contacts. Methods From 1 March 2006 to 31 July 2010, 1049 asymptomatic household contacts of smear-positive patients were simultaneously tested with T- Spot. TB and TST, and then followed for up to 5 years for development of TB. Attending clinicians and subjects were blinded to the results of T- Spot. TB. Results T- Spot. TB gave a significantly higher positive rate (32.7% vs 22.1%) and better association with exposure time than TST at the 15 mm cut-off. Agreement between T- Spot. TB and TST using cut-offs of 5, 10 and 15 mm were relatively poor (kappa 0.25-0.41) irrespective of presence or absence of BCG scar. Only T- Spot. TB positivity was negatively associated with BCG scar. Both T- Spot. TB (incidence rate ratio between test-positive and test-negative subjects, IRR: 8.2) and TST ( IRR: 4.1, 6.1 and 2.8, using cut-offs of 5 mm, 10 mm and 15 mm, respectively) helped to predict TB. Using a TST cut-off of 15 mm, 56% of future TB cases and 62.5% of bacteriologically confirmed cases were missed. Lowering the TST cut-off to 10 mm or 5 mm could achieve sensitivity comparable with that of T- Spot. TB, but at the expense of lower specificities, with more positive tests (thus requiring treatment) per case of TB predicted. Conclusions T- Spot. TB outperformed TST in predicting TB among household contacts in a high-income area with widespread BCG vaccination coverage. [ABSTRACT FROM AUTHOR]