Search

Induction of mycobacterial efflux pumps is a cause of Mycobacterium tuberculosis (Mtb) drug tolerance, a barrier to shortening antitubercular treatment. Verapamil inhibits Mtb efflux pumps that mediate tolerance to rifampin, a cornerstone of tuberculosis (TB) treatment. Verapamils mycobacterial efflux pump inhibition also limits Mtb growth in macrophages in the absence of antibiotic treatment. These findings suggest that verapamil could be used as an adjunctive therapy for TB treatment shortening. However, verapamil is rapidly and substantially metabolized when co-administered with rifampin. We determined in a dose-escalation clinical trial of persons with pulmonary TB that rifampin-induced clearance of verapamil can be countered without toxicity by the administration of larger than usual doses of verapamil. An oral dosage of 360 mg sustained-release (SR) verapamil given every 12 hours concomitantly with rifampin achieved median verapamil exposures of 903.1 ng.h/mL (area under the curve (AUC)0-12 h ) in the 18 participants receiving this highest studied verapamil dose; these AUC findings are similar to those in persons receiving daily doses of 240 mg verapamil SR but not rifampin. Moreover, norverapamil:verapamil, R:S verapamil, and R:S norverapamil AUC ratios were all significantly greater than those of historical controls receiving SR verapamil in the absence of rifampin. Thus, rifampin administration favors the less-cardioactive verapamil metabolites and enantiomers that retain similar Mtb efflux inhibitory activity to verapamil, increasing overall benefit. Finally, rifampin exposures were 50% greater after verapamil administration, which may also be advantageous. Our findings suggest that a higher dosage of verapamil can be safely used as adjunctive treatment in rifampin-containing treatment regimens.

Objective To identify literature on health literacy levels and examine its association with tuberculosis treatment adherence and treatment outcomes. Methods Two authors independently searched Pubmed[R], Embase, CINAHL, PsycINFO, Scopus, LILACS, Global Health Medicus and ScienceDirect for articles reporting on health literacy levels and tuberculosis that were published between January 2000 and September 2023. We defined limited health literacy as a person's inability to understand, process, and make decisions from information obtained concerning their own health. Methodological quality and the risk of bias was assessed using the JBI critical appraisal tools. We used a random effects model to assess the pooled proportion of limited health literacy, the association between health literacy and treatment adherence, and the relationship between health literacy and tuberculosis-related knowledge. Findings Among 5813 records reviewed, 22 studies met the inclusion criteria. The meta-analysis revealed that 51.2% (95% confidence interval, CI: 48.0-54.3) of tuberculosis patients exhibit limited health literacy. Based on four studies, patients with lower health literacy levels were less likely to adhere to tuberculosis treatment regimens (pooled odds ratio: 1.95; 95% CI: 1.37-2.78). Three studies showed a significant relationship between low health literacy and inadequate knowledge about tuberculosis (pooled correlation coefficient: 0.79; 95% CI: 0.32-0.94). Conclusion Health literacy is associated with tuberculosis treatment adherence and care quality. Lower health literacy might hamper patients' ability to follow treatment protocols. Improving health literacy is crucial for enhancing treatment outcomes and is a key strategy in the fight against tuberculosis. Objectif Identifier la litterature consacree aux niveaux d'education a la sante et etudier ses liens avec l'adhesion au traitement de la tuberculose ainsi qu'avec l'issue de ce traitement. Methodes Deux auteurs ont explore Pubmed[R], Embase, CINAHL, PsyclNFO, Scopus, LILACS, Global Health Medicus et ScienceDirect, independamment l'un de l'autre, a la recherche d'articles portant sur les niveaux d'education a la sante et la tuberculose, publies entre janvier 2000 et septembre 2023. Nous avons defini qu'un faible niveau d'education a la sante signifiait qu'une personne etait incapable de comprendre, d'assimiler et de prendre des decisions sur la base des informations qui lui etaient communiquees concernant sa sante. Nous avons utilise les outils devaluation critique du JBI pour determiner la qualite methodologique et le risque de biais. Enfin, nous avons applique un modele a effets aleatoires pour calculer la proportion groupee correspondant a un faible niveau d'education a la sante, le rapport entre l'education a la sante et l'adhesion au traitement, et celui entre l'education a la sante et les connaissances liees a la tuberculose. Resultats Sur 5813 documents examines, 22 correspondaient aux criteres d'inclusion. La meta-analyse a revele que 51,2% (intervalle de confiance de 95%, IC: 48,0-54,3) des patients tuberculeux affichaient un faible niveau d'education a la sante. D'apres quatre etudes, les patients avec un niveau d'education a la sante moins eleve avaient moins tendance a suivre les traitements contre la tuberculose (odds ratio groupe: 1,95; IC de 95%: 1,37-2,78). Trois etudes ont montre un lien significatif entre un faible niveau d'education a la sante et des connaissances insuffisantes sur la tuberculose (coefficient de correlation groupe: 0,79; IC de 95%: 0,32-0,94). Conclusion L'education a la sante a un impact sur l'adhesion au traitement contre la tuberculose et la qualite des soins. Un niveau d'education moindre peut entraver la capacite des patients a suivre les protocoles therapeutiques. Promouvoir l'education a la sante est essentiel pour ameliorer les resultats du traitement et constitue un element cle de la strategie de lutte contre la tuberculose. Objetivo Identificar la bibliografia sobre los niveles de alfabetizacion sanitaria y examinar su asociacion con el cumplimiento terapeutico de la tuberculosis y los resultados del tratamiento. Metodos Dos autores buscaron de manera independiente en Pubmed[R], Embase, CINAHL, PsycINFO, Scopus, LILACS, Global Health Medicus y ScienceDirect articulos que informaran sobre los niveles de alfabetizacion sanitaria y de tuberculosis publicados entre enero de 2000 y septiembre de 2023. Se definio la alfabetizacion sanitaria limitada como la incapacidad de una persona para comprender, procesar y tomar decisiones a partir de la informacion obtenida en relacion con su propia salud. La calidad metodologica y el riesgo de sesgo se evaluaron mediante las herramientas de evaluacion critica de JBI. Se utilizo un modelo de efectos aleatorios para evaluar el porcentaje agrupado de alfabetizacion sanitaria limitada, la asociacion entre la alfabetizacion sanitaria y el cumplimiento del tratamiento y la relacion entre la alfabetizacion sanitaria y los conocimientos relacionados con la tuberculosis. Resultados De los 5813 registros revisados, 22 estudios cumplieron los criterios de inclusion. El metanalisis revelo que el 51,2% (intervalo de confianza del 95%, IC: 48,0-54,3) de los pacientes con tuberculosis presentan conocimientos sanitarios limitados. Segun cuatro estudios, los pacientes con niveles mas bajos de conocimientos sanitarios tenian menos probabilidades de cumplir los regimenes de tratamiento de la tuberculosis (razon de posibilidades acumulada: 1,95; IC del 95%: 1,37-2,78). Tres estudios mostraron una relacion significativa entre los bajos conocimientos sanitarios y los conocimientos insuficientes sobre la tuberculosis (coeficiente de correlacion agrupado: 0,79; IC del 95%: 0,32-0,94). Conclusion La alfabetizacion sanitaria esta asociada al cumplimiento del tratamiento de la tuberculosis y a la calidad de la atencion. Una alfabetizacion sanitaria baja podria dificultar la capacidad de los pacientes para seguir los protocolos de tratamiento. Mejorar la alfabetizacion sanitaria es crucial para mejorar los resultados del tratamiento y constituye una estrategia clave en la lucha contra la tuberculosis. [phrase omitted], Introduction Health literacy is the ability to apply various skills--like reading, counting and problem-solving--to obtain, understand and use health-related information. Such knowledge and skills support informed decision-making, facilitate greater health-care [...]

This study investigated the major pathogens in fever patients’ blood in a rural cohort and characterized its virulence. A total of 718 blood samples received from IPD/OPD (inpatient department/outpatient department) patients with H/O (history of) fever were cultured, and 73 out of 83 culture-positive samples were identified as Staphylococcus aureus. The isolates showed higher resistance to penicillin, most being multidrug resistant. They formed biofilm in vitro, and 27.4% of the isolates were strong biofilm producers. They were sensitive towards linezolid, gentamicin, and tetracycline. The findings emphasize the necessity of preventing and managing staphylococcal infection and regular antimicrobial surveillance in rural areas.