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Pulmonary tuberculosis can cause anaemia. Anti-tuberculosis Medications (ATM) are divided into 2 types namely Fixed Dose Combination (FDC) and release. The intensive phase of ATM can cause side effects in mild, moderate, or severe anaemia. This study aims to describe the degree of anaemia in intensive-phase pulmonary TB patients based on the duration of treatment for ATM, type of ATM, and smear status. This research is a retrospective descriptive using secondary data in the form of medical records and the results of the Hb examination in the laboratory. The sampling technique used purposive sampling with inclusion criteria including drug-sensitive pulmonary TB, currently undergoing intensive phase treatment, experiencing anaemia based on the degree of anaemia according to WHO. Exclusion criteria included extrapulmonary TB, drug-resistant TB, and pregnant women. A total of 134 samples and data analysis using univariate analysis. Based on the degree of anaemia, the highest percentage of mild anaemia was during the 2nd week of treatment (60.9%), the type of ATM release (60.0%), and smear-positive (55.3%). The highest percentage of moderate anaemia was in the 6th week (100%), ATM FDC (43.6%), and smear-negative (48.4%). The highest percentage of severe anaemia was at week 8 (50.0%), ATM FDC (6.4%), and smear-negative (6.5%). Worsening of the degree of anaemia as the treatment period progresses, in patients with pulmonary TB who are taking FDC and are smear-negative.

The clinical importance of adhering to the regimen in tuberculosis patients has been widely investigated, but most studies were conducted in controlled settings and in limited populations. We aimed to measure the level of real-world adherence during intensive phase and investigate the predictors and the risk of mortality and health outcomes of intensive phase non-adherence in tuberculosis patients. We conducted a nationwide cohort study by linking the Korean National Tuberculosis Surveillance System and the National Health Information Database. We included all incident drug-susceptible tuberculosis patients who initiated the regimens recommended by the World Health Organization from 2013 to 2018. Adherence was measured using the proportion of days covered (poor [<50%], moderate [50%–79%], and high [≥80%]). We used logistic regression model to assess predictors and the Cox proportional hazard model to evaluate the risk of mortality and health outcomes with intensive phase non-adherence. Of 46,818 patients, there were 8% and 11% with poor and moderate adherent groups, respectively. Age ≥45 years, insulin use, and history of renal failure were predictors of non-adherence. Compared with high adherent group, poor and moderate adherent groups were associated with a substantial risk of mortality (poor: hazard ratio, 2.14 [95% confidence interval, 1.95–2.34]; moderate: 1.76 [1.62–1.92]). Similar trends were observed for health outcomes. Stratified analyses showed a higher risk of mortality in patients with medical aid, low income, and history of renal failure, systematic corticosteroids, and immunomodulators. Non-adherence during intensive phase increased mortality risk by twofold, underscoring targeted intervention for high-risk population, including advanced diabetes, and immunocompromised patients. [ABSTRACT FROM AUTHOR]

Background: The objective of this case series was to evaluate the effectiveness of wearing Mobiderm® Autofit compressive garment as part of the complete decongestive therapy (CDT) of upper limb lymphedema. Materials and Methods: Ten women and men with stage II breast cancer-related lymphedema underwent a CDT intensive phase for 12 days, combining Mobiderm Autofit compression garment with manual lymphatic drainage. Arm volume was calculated with the truncated cone formula using circumferential measurements taken at each appointment. The pressure under the garment and the overall satisfaction of patients and physicians were also assessed. Results: The mean (standard deviation [SD]) age of the patients was 60.50 (11.70) years. The mean (SD) lymphedema excess volume decrease was 343.11 (266.14) mL, which represents a 36.68% decrease between day 1 and day 12, whereas the mean (SD) absolute volume difference was 420.03 (251.27) mL corresponding to a 10.12% decrease during this same period. The mean (SD) device pressure by using the PicoPress® was 30.01 (0.45) mmHg. The majority of patients were satisfied with the ease of use and the comfort of wearing Mobiderm Autofit. Such positive assessment was confirmed by the physicians. During this case series, no adverse event was reported. Conclusion: A lymphedema volume decrease of the upper limb was reported after 12 days of treatment with Mobiderm Autofit during the CDT intensive phase. Moreover, the device was well tolerated, and its use was appreciated by the patients and the physicians. [ABSTRACT FROM AUTHOR]

Background Tuberculosis (TB) is well-known for causing wasting. Patients on treatment gain weight and weight loss is associated with unfavorable treatment outcomes. There is limited description of weight loss and its predictors during intensive treatment phase. The objective of this study was to assess the predictors of weight loss during intensive phase and to see if there is any association exists with sputum conversion at the end of intensive phase of treatment. Methods Data collected as a part of the prospective TB cohort (Regional Prospective Observational Research for TB India Phase 1) conducted in Pondicherry, Cuddalore and Viluppuram districts of Tamil Nadu were used for this study. Sputum smear and body weight comparison were made in the baseline and at the end of second month of treatment. Results In all, 726 participants had weight measurements at the two time points and 18.7% had weight loss; mean weight lost being 2.3 kg (SD 3.05). Mean weight loss was more among males (2.4 kg, SD 3.2), diabetics (2.8 kg, SD 3.9) and alcoholics (2.1 kg, SD 2.4). Alcohol consumption was the only predictor of weight loss after adjusting for age, diabetes, marital status and BMI (aRR 1.52, P 0.02). Weight loss was not associated with sputum conversion at the end of second month. Conclusions Alcohol use emerged as the major predictor for weight loss during intensive phase. [ABSTRACT FROM AUTHOR]

Objective: To estimate the predictors of death during intensive phase of Multidrug resistant tuberculosis treatment according to the weight of patients at the time of diagnosed. Methods: A retrospective study was conducted at three public hospitals in the Lahore, Punjab region, namely Jinnah Hospital, Mayo Hospital and Gulab Devi Hospital on 1,496 patients receiving treatment for MDR-TB from January 2018 to December 2020. Data were collected from electronically nominating and recording system of the hospitals. Data were fitted to Cox proportional hazards regression model with 95% confidence interval (CI) to evaluate the associations between predictors of death and weight of MDR-TB patients during the intensive phase of treatment. Results: This analysis revealed a MDR-TB mortality rate of 30% and the mortality rate due to MDR-TB during the intensive phase of treatment was 23%. The variables related to increased mortality among underweight patients were age more than 60 years (HR: 0.398, 95% CI: 0.314-0.504), diabetes (HR: 1.496, 95% CI: 1.165-1.921), current smoking (HR: 0.465, 95% CI: 0.222-0.973), history of MDR-TB (HR: 0.701, 95% CI: 0.512-0.959) and culture positive at the time of diagnosed (HR: 0.499, 95% CI: 0.379-0.659) during the intensive phase of treatment. Conclusion: The high mortality rate among the underweight MDR-TB patients during the intensive phase of the treatment requires the nutritional support for malnourishment and ensured a close follow-up of the elderly patients with co-morbidities as well as family history of Tuberculosis. [ABSTRACT FROM AUTHOR]

Tuberculosis is an infectious disease caused by the bacteria Mycobacterium Tuberculosis which has a rod shape and is acid-resistant. The prolonged consumption of anti-tuberculosis drugs can cause serious side effects. Side effects from the consumption of anti-tuberculosis drugs, namely the risk of hepatotoxicity, which is marked by an increase in the SGOT / SGPT value. This study aimed to determine the relationship between the duration of use, dosage and side effects of anti-tuberculosis drugs in tuberculosis patients, which had an effect on the SGOT / SGPT value at RSI Sultan Agung Semarang. This research is an analytical observational study with a cross-sectional design. The sample was 96 patients, and data collection was carried out in January-November 2020 at RSI Semarang. The instrument used in this study was patient medic record data. This study uses the Chi-Square test. The Chi-Square test results in 0.000 (p

Background: Conversion status post-intensive phase of treatment in patients with tuberculosis (TB) is an important thing in determining the choice of the next treatment plan. Alternative parameters need to be studied to determine the factors that contribute to this status. Potential parameters thought to have a role are Monocyte Lymphocyte Ratio (MLR) as a hematological marker and Interferon Gamma/Interleukin-4 (IFN-γ/IL-4) as a molecular marker of cytokines and chemokines. Objective: analyzed the association between MLR and IFN-γ/IL-4 ratio on status of sputum conversion in TB patients with post-intensive phase. Method: The design of this study was cross-sectional with consecutive sampling, which was conducted in the period March to July 2021. The data used in this study included MLR, IFN-g /IL-4 ratio, and sputum smear conversion. The statistical tests used included chi-square, fisher's exact test, and logistic regression with p < 0.05. Result: Low MLR (98.2%) and high MLR (55.6%) scores, both had positive sputum conversion (OR = 44.8; CI 4.169 -- 481.452; p = 0.001). Meanwhile, the positive sputum conversion showed low IFN-γ/IL-4 ratio (97.8%) and high IFN-γ/IL-4 ratio (80%; OR = 11.25; CI 1.169 -- 108.280; p = 0.036). There was a significant association between low MLR and sputum conversion positive (OR = 27.103; CI 2.289 -- 320.883; p = 0.009). Meanwhile, IFN-γ/IL-4 ratio and sputum conversion did not have a significant association (OR = 5.248; CI 0.414 -- 66,454; p = 0.201). Conclusion: there is a significant association between MLR, IFN-γ/IL-4 ratio, and the combination of MLR and IFN-γ/ IL-4 ratio on sputum conversion in TB patients with post-intensive phase. [ABSTRACT FROM AUTHOR]

Background: Pulmonary tuberculosis is associated with local inflammation of the lung tissue andincreases the levels of the inflammatory markers. C - Reactive protein is an important inflammatory marker during pulmonarytuberculosis. The aims of our study were measuringserum CRP level in sputum smear-positive pulmonary tuberculosis patients at the start and end of the intensive phase of anti-tubercular therapy (ATT) along with correlation between sputum smear grading and serumCRP level at the start and end of intensive phase of ATT. Methods: This was aprospective cohort study and60 patientswithsputum smear-positive pulmonary tuberculosiswere taken. Serum CRP level and sputum smear grading wasdone at the start and end of the intensive phase of ATT. Results: SerumCRP level before the start and at end of intensive phase of ATT showed mean of 11.72 ± 5.53 mg/dl (males - 11.01 ± 5.25, females - 12.77 ± 5.89) and 2.69 ± 1.81mg/dl(males -2.66 ± 1.87, females - 2.72 ± 1.75), respectively. On statistical analysis, the p-value was <0.001, thus making it statically significant. There was no correlation found between sputum AFB grading and CRP levels. Conclusion: Serum CRP levels in sputum positive pulmonary tuberculosis patients showed a downward trend at the end of the intensive phase of anti-tubercular therapy; explained that a decrease in the levels due to control in the inflammatory process with treatment. Serum CRP level can be used as a follow-up biomarker in pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Acid fast bacilli (AFB) sputum microscopy is used to diagnose tuberculosis (TB) and to evaluate the effectiveness of anti-tuberculosis drugs in TB eradication program. The AFB sputum microscopy should be performed before treatment, two months after intensive phase and four months after advance phase treatment. The aim of this study was to evaluate the sputum conversion rate of AFB in pulmonary TB patients who received category I of antituberculosis (anti-TB) drugs. Evaluation of sputum conversion was perfomed before initation of anti TB drugs and at the end of the intensive phase. This cohort prospective study was done from February to May, 2018. Nine pulmonary TB patients fulfilled the criteria during the study. This AFB sputum microscopy was evaluated by using Ziehl Neelsen and read by means of International Union Against Tuberculosis and Lung Disease (IUATLD) scale. Nine sputum smear positive were followed for two months. After two months (end of the intensive phase), the smear conversion rate was 100%. All patients received standard dose of anti-TB drugs in fix dose combination (FDC). It can be concluded that the sputum conversion of AFP in pulmonary TB patients who received category I of anti-TB was success at the second month of intensive phase.

Abstract Background Multi-drug resistant Tuberculosis (MDR-TB) is a strain of Mycobacterium tuberculosis that is resistant to at least Rifampicin and Isoniazid drugs. The treatment success rate for MDR-TB cases is lower than for drug susceptible TB. Globally only 55% of MDR-TB patients were successfully treated. Monitoring the early treatment outcome and better understanding of the specific reasons for early unfavorable and unknown treatment outcome is crucial for preventing the emergence of further drug-resistant tuberculosis. However, this information is scarce in Ethiopia. Therefore, this study aimed to determine the intensive phase treatment outcome and contributing factors among patients treated for MDR-TB in Ethiopia. Methods A 6 year retrospective cohort record review was conducted in fourteen TICs all over the country. The records of 751 MDR-TB patients were randomly selected using simple random sampling technique. Data were collected using a pre-tested and structured checklist. Multivariable multinomial logistic regression was undertaken to identify the contributing factors. Results At the end of the intensive phase, 17.3% of MDR-TB patients had an unfavorable treatment outcome, while 16.8% had an unknown outcome with the remaining having a favorable outcome. The median duration of the intensive phase was 9.0 months (IQR 8.04–10.54). Having an unfavorable intensive phase treatment outcome was found significantly more common among older age [ARRR = 1.047, 95% CI (1.024, 1.072)] and those with a history of hypokalemia [ARRR = 0.512, 95% CI (0.280, 0.939)]. Having an unknown intensive phase treatment outcome was found to be more common among those treated under the ambulatory care [ARRR = 3.2, 95% CI (1.6, 6.2)], rural dwellers [ARRR = 0.370, 95% CI (0.199, 0.66)], those without a treatment supporter [ARRR = 0.022, 95% CI (0.002, 0.231)], and those with resistance to a limited number of drugs. Conclusion We observed a higher rate of unfavorable and unknown treatment outcome in this study. To improve favorable treatment outcome more emphasis should be given to conducting all scheduled laboratory monitoring tests, assignment of treatment supporters for each patient and ensuring complete recording and reporting which could be enhanced by quarterly cohort review. Older aged and rural patients need special attention. Furthermore, the sample referral network should be strengthened.

Introduction: Conventionally, a combination of four separate drugs (ethambutol, isoniazid, rifampicin, and pyrazinamide [EHRZ]) is the first-line pharmacotherapy for pulmonary tuberculosis (TB). In recent years, fixed-dose combination (FDC) formulation, where a single tablet contains the active ingredients of four aforementioned drugs, is gaining popularity due to its ease of administration. Objective: To compare the real-world effectiveness of EHRZ and FDC treatment groups on a cohort registry by investigating the sputum conversion rate and treatment outcomes of both groups. Methods: A total of 11,489 patients' data were extracted from the Sabah TB registry between January 2012 and June 2016, including EHRZ (n = 4188) and FDC (n = 7301) patients. Then, 1:1 propensity score matching was adopted to reduce the baseline bias. Caliper matching was conducted with maximum tolerance score set at 0.001. Confounders included in the propensity score matching were gender, nationality, diabetes, HIV status, smoking status, and chest X-ray status. Successful matching provided 4188 matched pairs (n = 8376) for final analysis. Results: In this matched cohort of 4188 pairs, the 2-month sputum conversion rate of FDC group was significantly higher than the EHRZ group (96.3% vs. 94.3%; P < 0.001) whereas 6-month sputum conversion of both groups showed no significant difference. Treatment outcomes such as noncompliance rate, failure rate, and success rate have no significant difference (P > 0.05) in both the treatment groups. There was an incidental finding of reduced death rate among FDC group compared to the EHRZ group (0.2% vs. 0.5%; P = 0.034). Conclusion: The FDC formulation has better sputum conversion rate at 2 months compared to conventional EHRZ regime as separate-drug formulation. It was also observed that FDC has a slight protective effect against all-cause death among TB patients. This protective effect of FDC, however, still needs to be proven further.

Abstract Background Melioidosis is an infection caused by a facultative intracellular Gram-negative bacterium, Burkholderia pseudomallei. It can present as septicemia, localized infection with/without septicemia, asymptomatic infections, ulcers, pneumonia, visceral abscesses, neurological infection, musculoskeletal infections and can involve any organ. Case presentation A 56 year old Sri Lankan diabetic female presented with fever, chills and rigors for 2 weeks. She also had malaise and loss of appetite, but no other features. On examination, she was febrile (temperature was 101.4 0 F) and rest of the examination was unremarkable. Her blood culture was positive for Burkholderia pseudomallei and she was started on IV antibiotics, on day 3. During her 2nd week of hospital stay, she developed right sided low back pain with buttock pain, right hip joint pain and restricted hip joint movements suggestive of right sacroiliitis. CE CT and MRI scans confirmed the diagnosis of right iliopsoas abscesses and right sacroiliitis. Incision and drainage was performed and a pigtail catheter was left in place for continuous drainage of abscesses. Her intensive phase was initiated with IV ceftazidime 2 g every 6 h for 12 days, then changed over to IV meropenem 2 g every 8 h together with oral co-trimoxazole. 2 weeks later, oral co-trimoxazole was replaced by oral doxycycline for another 6 weeks (due to transient pancytopaenia). She made a complete and uneventful recovery with oral co-trimoxazole for another 6 months, in her eradication phase. We report this case to show the importance in early diagnosis of melioidosis, and to consider it in the differential diagnosis of multiple abscesses and to emphasize the importance in suspecting melioidosis as a causative agent in infective sacroiliitis. Discussion Melioidosis can have 2 major presentations; acute infection (symptoms lasting less than 2 months) and chronic infection (symptoms lasting more than 2 months). Musculoskeletal melioidosis is a well-recognized manifestation of the disease, which can manifest as soft tissue abscesses, septic arthritis, spondylitis, sacroiliitis and osteomyelitis. Management of melioidosis consists of 2 phases. The intensive phase and the eradication phase. These are aimed at the importance of rapidly treating the septicemia, the need of eradication of the persistent disease and the prevention of recurrent infections or relapses. The intensive phase consists of minimum 10–14 days of IV antibiotics: IV ceftazidime or IV carbapenem (meropenem/ imipenem). Eradication phase should be followed by 3–6 months of oral co-trimoxazole alone or in combination with oral doxycycline/ oral amoxiciliin-clavulanic acid.

Background: TNF-α plays a role in the occurrence of anorexia and weight loss in pulmonary tubercolusis (TB) patients. Evaluation of treatment response can be done with clinical, microbiological and radiological evaluation. In patients without cough, Body Mass Index (BMI) and TNF-α levels can be used to evaluate clinical treatment response. Objectives: The aim of the study is to measure the Acid Resistant Bacteria (ARB) sputum positivity decrease, TNF-α levels and increased BMI after 2 weeks and 4 weeks intensive treatment of pulmonary TB patients with new case of ARB positive. Methods: The sample size was 14 people with ARB positive pulmonary TB cases, consisting of 9 men and 5 women. It was done sputup smear, BMI and TNF-α examination before treatment, at week 2 and week 4 of intensive phase treatment Result: At the end of the second week, TNF-α levels decreased significantly compared to baseline TNF-α levels with p = 0.015. There was a non significant increase of BMI at the end of the second and fourth week with p = 0.309 and p = 0.270 respectively. The decrease in ARB sputum smear positivity at the end of the second week compared to the fourth week was not statistically significant with p = 0.157. There was a strong correlation between TNF-α and IMT levels before treatment with negative correlation, r = -0.702 and p = 0.005. Conclusion: Levels of TNF-α at the end of the second week decreased significantly compared to baseline TNF-α levels. There was a strong correlation between TNF-α levels and BMI prior to treatment. [ABSTRACT FROM AUTHOR]

Lymphoedema practitioners were surveyed by the Lymphology Association of North America (LANA) in 2019 to provide a snapshot of contemporary practice patterns in the management of patients diagnosed with lymphoedema and related disorders. The State of the Industry Survey respondents (n=860) were physical (47%), occupational (31%), and massage (12%) therapists, physical therapist assistants (6%) and other healthcare professionals. The US Midwest (35.2%) and Northeast (22.1%) geographical regions represented over half of the respondents, while 12.4% were from the West, and the remaining 26.6% were distributed among the Northwest, Southeast, Southwest, and Canada. Most (87%) of the respondents were eligible for the LANA certification examination having earned 135 or more hours of specialty training. Lymphoedema severity was rated severe (21%), moderate (41%), and mild (38%). Treatment frequency in 45% of practitioners was three times per week and 34% reported a treatment duration of 4 weeks. Significant differences in regional practice patterns were found in the time practitioners reported spending in manual lymphatic drainage, multilayered compression bandaging, and intermittent pneumatic compression. These results will inform stakeholders about clinical practice patterns in lymphedema management. [ABSTRACT FROM AUTHOR]

Background: Drug-resistant tuberculosis (DR-TB) continues to be a challenge in developing countries with poor resources. Despite the high prevalence of primary DR-TB, its routine screening prior to the treatment is not performed in public hospitals in Nigeria. Data regarding drug resistance and its genetic determinant among follow-up patients with TB are lacking in Nigeria. Hence, the aim of this study was to determine the prevalence and genetic determinant of drug resistance among the follow-up patients with TB in a tertiary hospital in Nigeria. Materials and Methods: This was a cross-sectional, laboratory-based study conducted on 384 sputum samples collected from consented follow-up patients with TB. Standard microbiology methods (Ziehl–Neelsen staining and microscopy) and polymerase chain reaction (PCR; line probe assay [LIPA]) were used to analyze the collected samples. Pearson's Chi-square test was used to analyze the generated data. Results: Out of 384 sputum samples analyzed for Mycobacterium tuberculosis and DR-TB, 25 (6.5%) tested positive for acid-fast bacilli. These samples were subjected to PCR (LIPA), of which 18 (72%) tested positive for DR-TB. Of these 18 samples, mutations conferring resistance to rifampicin (rpoB) and isoniazid (katG and/or inhA) were detected in 12 (66.7%) and 6 (33.3%) samples, respectively. Transmission dynamics of DR-TB was not significantly (P > 0.05) dependent on demographic characteristics. Conclusion: There is a need to strengthen the laboratory capacity for the diagnosis of TB and drug resistance testing and make these services available, affordable, and accessible to the patients who need them.

Background: Antituberculosis drugs (ATDs) efficiently combat Mycobacterium tuberculosis either through direct molecular interactions or those of its metabolites. However, a variety of adverse effects have been reported, leading to frequent interruptions of treatment. To investigate the possible metabolic disturbances resulting from antituberculosis (TB) treatment, the uric acid (UA) level of patients on ATDs was measured in the southwest region of Cameroon. Methods: This hospital-based cross-sectional study involved 96 TB patients on ATDs and 32 controls who were neither on ATDs nor any other treatment that could increase UA levels. The hospital records of consenting participants were reviewed for medical history and questionnaires were issued. About 2 ml venous blood was collected and analyzed using spectrophotometers to determine UA levels. Results: Hyperuricemia was observed in 56/96 (58.3%) of the studied group as compared with 4/32 (12.5%) in the control group (P < 0.001). Our results indicated that treatment duration was significantly associated with hyperuricemia (P = 0.0016) while gender (P = 0.1275) was not. Conclusion: Hyperuricemia is associated with ATDs, with treatment duration being a significant factor. The disorder should be closely monitored, especially during the intensive phase of treatment.

Introduction: Conventionally, a combination of four separate drugs (ethambutol, isoniazid, rifampicin, and pyrazinamide [EHRZ]) is the first-line pharmacotherapy for pulmonary tuberculosis (TB). In recent years, fixed-dose combination (FDC) formulation, where a single tablet contains the active ingredients of four aforementioned drugs, is gaining popularity due to its ease of administration. Objective: To compare the real-world effectiveness of EHRZ and FDC treatment groups on a cohort registry by investigating the sputum conversion rate and treatment outcomes of both groups. Methods: A total of 11,489 patients' data were extracted from the Sabah TB registry between January 2012 and June 2016, including EHRZ (n = 4188) and FDC (n = 7301) patients. Then, 1:1 propensity score matching was adopted to reduce the baseline bias. Caliper matching was conducted with maximum tolerance score set at 0.001. Confounders included in the propensity score matching were gender, nationality, diabetes, HIV status, smoking status, and chest X-ray status. Successful matching provided 4188 matched pairs (n = 8376) for final analysis. Results: In this matched cohort of 4188 pairs, the 2-month sputum conversion rate of FDC group was significantly higher than the EHRZ group (96.3% vs. 94.3%; P < 0.001) whereas 6-month sputum conversion of both groups showed no significant difference. Treatment outcomes such as noncompliance rate, failure rate, and success rate have no significant difference (P > 0.05) in both the treatment groups. There was an incidental finding of reduced death rate among FDC group compared to the EHRZ group (0.2% vs. 0.5%; P = 0.034). Conclusion: The FDC formulation has better sputum conversion rate at 2 months compared to conventional EHRZ regime as separate-drug formulation. It was also observed that FDC has a slight protective effect against all-cause death among TB patients. This protective effect of FDC, however, still needs to be proven further. [ABSTRACT FROM AUTHOR]

Background: Lymphoedema is a chronic disease that requires a lifelong management. Complex decongestive therapy is the recommended treatment, which consists of intensive and of long-term management phases. The goals of treatment can be different for the therapist or for the person who lives with lymphoedema. No study has examined the perception of treatment success of those who experience lymphoedema. Therefore, the aims of the study were to understand what people with lymphoedema consider to be the meaning of success in the intensive phase and in the long-term phase of lymphoedema management. Method: The biopsychosocial model for lymphoedema was used as a conceptual framework for this study. A phenomenological method, with semi-structured interviews and open-ended questions, was applied. Purposeful sampling was used to recruit people who live with lymphoedema of different aetiologies, stages and severities. The interviews were conducted in the long-term management phase for each participant. Content analysis was conducted using value and affective methods for the first cycle coding and axial coding for the second cycle. The most common themes that emerged from the data were hope; lack of-clarity as to moving to the long-term phase of treatment; and empowerment and maintenance versus back to normal (acceptance versus hope). Conclusion: In the intensive phase of treatment, success means disappearance or improvement of the swelling and pain, and better function. In the maintenance phase, success was deemed as stability and not getting worse, but also, for some participants, disappearance of the swelling. [ABSTRACT FROM AUTHOR]

Background: Drug-resistant tuberculosis (DR-TB) continues to be a challenge in developing countries with poor resources. Despite the high prevalence of primary DR-TB, its routine screening prior to the treatment is not performed in public hospitals in Nigeria. Data regarding drug resistance and its genetic determinant among follow-up patients with TB are lacking in Nigeria. Hence, the aim of this study was to determine the prevalence and genetic determinant of drug resistance among the follow-up patients with TB in a tertiary hospital in Nigeria. Materials and Methods: This was a cross-sectional, laboratory-based study conducted on 384 sputum samples collected from consented follow-up patients with TB. Standard microbiology methods (Ziehl-Neelsen staining and microscopy) and polymerase chain reaction (PCR; line probe assay [LIPA]) were used to analyze the collected samples. Pearson's Chi-square test was used to analyze the generated data. Results: Out of 384 sputum samples analyzed for Mycobacterium tuberculosis and DR-TB, 25 (6.5%) tested positive for acid-fast bacilli. These samples were subjected to PCR (LIPA), of which 18 (72%) tested positive for DR-TB. Of these 18 samples, mutations conferring resistance to rifampicin (rpoB) and isoniazid (katG and/or inhA) were detected in 12 (66.7%) and 6 (33.3%) samples, respectively. Transmission dynamics of DR-TB was not signiicantly (P > 0.05) dependent on demographic characteristics. Conclusion: There is a need to strengthen the laboratory capacity for the diagnosis of TB and drug resistance testing and make these services available, affordable, and accessible to the patients who need them. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a communicable disease. Financial risk protection is a key target to achieve in end TB strategy. Out-Of-Pocket Expenditure (OOPE) consisted of expenses bore by patients for their illnesses after subtracting third-party payments such as insurance. Despite the free health care in Sri Lanka, TB patients have to pay for various expenses (e.g., expenses for travel, food, drugs, medical investigations, and cost of accompanied person/bystander)., Objectives: The main objective of this study was to estimate direct OOPE and find the association between direct OOPE and noncompliance to TB treatment in intensive phase., Methods: A cross-sectional study was conducted with TB patients who were registered in Kalutara-district chest clinic for period of six months (n = 267). Interviewer-administered questionnaire (consisted of sections on socio-demographic characteristics, treatment compliance, sources and amount of OOPE, etc.) was used to collect data. Mean median, minimum, maximum and interquartile range were calculated in each component of OOPE., Results: Questionnaire were administered for 252 patients (male = 160, 63.5%). Mean total direct non-medical cost for one DOTS visit (without accompanied person) was 435.40 (IQR = 420.00) Sri Lankan Rupees (SLR) (i.e., 2.45 United State Dollars (USD)). A patient without an accompanying person spent 26124.00 SLR (435.40 per day into 60 days) (i.e., 146.76 USD) for transport and food during the intensive phase. During the intensive phase, the mean medical cost for one patient was 6444.66 LKR (IQR = 6400) (i.e., 36.21 USD). OOPE was not associated with noncompliance to TB treatment in intensive phase (p = 0.29)., Conclusions: There was no association between OOPE and noncompliance. The direct OOPE for TB treatment in the intensive phase was high. Therefore, it is necessary to develop strategies to reduce OOPE during TB treatment especially in intensive phase., Competing Interests: Conflicts of interest The authors have none to declare., (Copyright © 2022 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: This article is to review cervical lymphadenitis due to tuberculosis (TB), their presentation, their aetiology, the methods used to diagnose them, the treatment modalities offered and the response to treatment., Methods: 1019 patients were diagnosed and treated for TB of the lymph nodes of the neck from 1st November 2001 to 31st August 2020 at a tertiary ENT hospital, Nadiad, Gujarat, India. Study consisted about 61% males and 39% females with the mean age being 37.3 years., Result: Commonest factor or habit among those diagnosed for tuberculous cervical lymphadenitis was consumption of unpasteurized milk. HIV and diabetes were the most common co-morbid conditions found with this disease. Swelling in the neck was most common clinical feature followed by loss of weight, formation of abscess, fever and fistula. Rifampicin resistance was found in 1.5% of patients among those tested for the same., Conclusion: The most commonly affected site for extra pulmonary TB is posterior triangle of neck than the anterior triangle. Patients with HIV and diabetes are at higher risk for the same. Testing for drug susceptibility has to be done due to increased resistant of drugs for extra pulmonary TB. GeneXpert and histopathological examination are important for its confirmation., Competing Interests: Conflict of interests All authors have none to declare., (Copyright © 2022 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Background: Tuberculosis (TB) treatment may present significant hematological disorder and some anti-TB drugs also have serious side effects. Although many other diseases may be reflected by the blood and its constituents, the abnormalities of red cells, white cells, platelets, and clotting factors are considered to be primary hematologic disorder as a result of tuberculosis treatment. The aim of this study was to determine hematological profiles of TB patients before and after intensive phase treatment. Objective: The aim of this study was to determine hematological profiles of TB patients before and after intensive phase treatment. Methods: Smear positive new TB patients were recruited successively and socio-demographic characteristics were collected using pre-tested questionnaire. About 5 ml of venous blood was collected from each patient and the hematological profiles were determined using Mindry BC 3000 plus automated hematology analyzer. Result: The hematological profiles of TB patients showed statistically significant difference in hematocrit (38.5 % versus 35.7 %), hemoglobin (12.7 g/lversus11.8 g/l) and platelet (268 x 10³ /µlversus239 x 10³ /µl) values of patients before initiation of treatment and after completion of the intensive phase of tuberculosis treatment, respectively (P < 0.05). The red cell distribution width (RDW) of treatment naïve TB patients was by far lower (17.6 ± 7.09 %) than the corresponding RDW (31.9 ± 5.19 %) of intensive phase treatment completed patients. Among TB patients that had high platelet distribution width (PDW) (n = 11) before initiation of TB treatment, 10 demonstrated lower PDW values after completion of the intensive phase. There was no significant difference on total white blood cell count among TB patients before and after completion of the 2 month treatment. Conclusion: The levels of hemoglobin, hematocrit and platelet count of the TB patients were significantly lowered after completion of the intensive phase of TB treatment. Significant variation of the RDW and PDW were also observed among treatment naïve and treatment completed patients. Hematological abnormalities resulted from TB treatment should be assessed continuously throughout the course of tuberculosis therapy. [ABSTRACT FROM AUTHOR]

Background: Antituberculosis drugs (ATDs) efficiently combat Mycobacterium tuberculosis either through direct molecular interactions or those of its metabolites. However, a variety of adverse effects have been reported, leading to frequent interruptions of treatment. To investigate the possible metabolic disturbances resulting from antituberculosis (TB) treatment, the uric acid (UA) level of patients on ATDs was measured in the southwest region of Cameroon. Methods: This hospital-based cross-sectional study involved 96 TB patients on ATDs and 32 controls who were neither on ATDs nor any other treatment that could increase UA levels. The hospital records of consenting participants were reviewed for medical history and questionnaires were issued. About 2 ml venous blood was collected and analyzed using spectrophotometers to determine UA levels. Results: Hyperuricemia was observed in 56/96 (58.3%) of the studied group as compared with 4/32 (12.5%) in the control group (P < 0.001). Our results indicated that treatment duration was significantly associated with hyperuricemia (P = 0.0016) while gender (P = 0.1275) was not. Conclusion: Hyperuricemia is associated with ATDs, with treatment duration being a significant factor. The disorder should be closely monitored, especially during the intensive phase of treatment. [ABSTRACT FROM AUTHOR]

Objective/background: To study whether interleukin (IL)-10 gene polymorphism is associated with multi-drug resistant tuberculosis (MDR TB) during the intensive phase of standard chemotherapy. Methods: The study comprised 170 individuals in Kharkiv region of Ukraine including 74 patients with pulmonary MDR TB (Group 1), 66 patients without MDR TB (Group 2), and 30 healthy donors (Group 3). Serum level of IL-10 was evaluated by enzyme-linked immunosorbent assay (pg/L). Measurements of serum samples were conducted before or during the initial days after hospital admission and after 2 months on antituberculous therapy. Investigations of IL-10 gene polymorphism were performed using restriction analysis of the amplification products of specific regions of the genome. The method of investigation (for the sets real-time) — an allele-specific PCR using intercalating coloring Sybr Green. Polymorphism G1082A of gene IL-10 rs1800896 were genotyped with amplification-refractory mutation system-polymerase chain reaction. Results: In Group 1, the level of IL-10 was (38.01 ± 0.78) pg/L, compared with 43.88 ± 0.70 in Group 2, and 50.25 ± 1.26 in Group 3 (p