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Introduction: HIV/AIDS is one of the most dangerous diseases globally, impacting public health, economics, society, political issues, and communities. As of 2023, the World Health Organization estimates that 40.4 million people are living with HIV/AIDS. This study aimed to identify the determinants of survival time for HIV/AIDS patients in the pastoralist region of Borena at Yabelo General Hospital. Method: The study design was a retrospective cohort study, with a sample size of 293 individuals living with HIV/AIDS, based on recorded data. This research utilized survival model analysis, employing Kaplan-Meier plots, the log-rank test, and Cox proportional hazard model analysis. Result: Out of the total sample size, 179 (61.1%) were female and 114 (38.1%) were male. Among these males, 36 (31.6%) were deceased. The analysis using the Cox proportional hazard model revealed that the following variables were significantly associated with the survival time of HIV/AIDS patients: gender, educational status, area of residence, tuberculosis (TB), and opportunistic infections. Conclusions: We concluded that individuals living with HIV/AIDS in urban areas have a lower risk of death compared to those in rural areas, indicating that rural residents have a reduced survival probability. Therefore, the Borena zone administration should focus on adult patients to enhance life expectancy. [ABSTRACT FROM AUTHOR]

Background Tuberculosis is a leading cause of death worldwide, and food insecurity is known to negatively influence health outcomes through multiple pathways. Few studies have interrogated the relationship between food insecurity and tuberculosis outcomes, particularly independent of nutrition. Methods We conducted a prospective cohort study of adults initiating first-line treatment for clinically suspected or microbiologically confirmed drug-sensitive tuberculosis at a rural referral center in Haiti. We administered a baseline questionnaire, collected clinical data, and analyzed laboratory samples. We used logistic regression models to estimate the relationship between household food insecurity (Household Hunger Scale) and treatment failure or death. We accounted for exclusion of patients lost to follow-up using inverse probability of censoring weighting and adjusted for measured confounders and nutritional status using inverse probability of treatment weighting. Results We enrolled 257 participants (37% female) between May 2020 and March 2023 with a median age (interquartile range) of 35 (25–45) years. Of these, 105 (41%) had no hunger in the household, 104 (40%) had moderate hunger in the household, and 48 (19%) had severe hunger in the household. Eleven participants (4%) died, and 6 (3%) had treatment failure. After adjustment, food insecurity was significantly associated with subsequent treatment failure or death (odds ratio 5.78 [95% confidence interval, 1.20–27.8]; P =.03). Conclusions Household food insecurity at tuberculosis treatment initiation was significantly associated with death or treatment failure after accounting for loss to follow-up, measured confounders, and nutritional status. In addition to the known importance of undernutrition, our findings indicate that food insecurity independently affects tuberculosis treatment outcomes in Haiti. [ABSTRACT FROM AUTHOR]

This paper tackles the complex interplay between Human Immunodeficiency virus (HIV-1) and Mycobacterium tuberculosis (M. tuberculosis) infections, particularly their contribution to immunosenescence, the age-related decline in immune function. Using the current literature, we discuss the immunological mechanisms behind TB and HIV-induced immunosenescence and critically evaluate the BCG (Bacillus Calmette-Guérin) vaccine's role. Both HIV-1 and M. tuberculosis demonstrably accelerate immunosenescence: M. tuberculosis through DNA modification and heightened inflammation, and HIV-1 through chronic immune activation and T cell production compromise. HIV-1 and M. tuberculosis co-infection further hastens immunosenescence by affecting T cell differentiation, underscoring the need for prevention and treatment. Furthermore, the use of the BCG tuberculosis vaccine is contraindicated in patients who are HIV positive and there is a lack of investigation regarding the use of this vaccine in patients who develop HIV co-infection with possible immunosenescence. As HIV does not currently have a vaccine, we focus our review more so on the BCG vaccine response as a result of immunosenescence. We found that there are overall limitations with the BCG vaccine, one of which is that it cannot necessarily prevent re-occurrence of infection due to effects of immunosenescence or protect the elderly due to this reason. Overall, there is conflicting evidence to show the vaccine's usage due to factors involving its production and administration. Further research into developing a vaccine for HIV and improving the BCG vaccine is warranted to expand scientific understanding for public health and beyond. [ABSTRACT FROM AUTHOR]

Introduction: The high morbidity and mortality of tuberculosis has led to the development of numerous therapeutic interventions during the pre-antibiotic era. In 1894, Forlanini proposed the technique of collapse therapy, using spontaneous pneumothorax. In 1926, Bernou developed the oleothorax technique to induce an iatrogenic collapse of the lung through the instillation of oil into the pleural cavity, which was subsequently removed. Nowadays, there are few patients that still represent a living testimony of this historic technique and have been described through traditional radiology. Case Presentation: We report the case of a patient with evidence of a right oleothorax that was investigated not only with traditional radiology but also with the use of chest ultrasonography. Ultrasounds were able to show peculiar characteristics of the oleothorax, including its particular echogenicity, the rigidity and static nature of the collection, the presence of peripheral calcifications, and the negative impact of the collection on diaphragmatic mobility and excursion. Conclusion: To our knowledge, this is the first report of an ultrasound description of oleothorax. We have observed that ultrasound examination, in cases of basal oleothorax, is able to add information regarding its radiological appearance and physiopathological implications on ventilatory mechanics and diaphragmatic distress. Established Facts: Oleothorax is a rare finding in today's clinical practice, demonstrating a historical therapy for pulmonary tuberculosis. Oleothorax has been occasionally described using conventional radiology, such as chest X-ray or chest CT. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary infections, such as tuberculosis, can result in numerous pleural complications including empyemas, pneumothoraces with broncho-pleural fistulas, and persistent air leak (PAL). While definitive surgical interventions are often initially considered, management of these complications can be particularly challenging if a patient has an active infection and is not a surgical candidate. Case Presentation: Autologous blood patch pleurodesis and endobronchial valve placement have both been described in remedying PALs effectively and safely. PALs due to broncho-pleural fistulas in active pulmonary disease are rare, and we present two such cases that were managed with autologous blood patch pleurodesis and endobronchial valves. Conclusion: The two cases presented illustrate the complexities of PAL management and discuss the treatment options that can be applied to individual patients. Established Facts: Persistent air leak (PAL) due to broncho-pleural fistulas (BPFs) can be difficult to treat in patients who are not surgical candidates or have failed prior interventions. Autologous blood patch pleurodesis is a safe and effective treatment for PAL most commonly in the postoperative setting. The use of endobronchial valves has been described to ameliorate PAL due to BPFs, though experience remains limited in pleuropulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Introduction: Spontaneous pneumothorax (SP) commonly presents as continuous, sharp, unilateral chest pain exacerbated by deep inspiration and change of posture. The present study has been undertaken to study the clinical profile of SP among in-patients of a tertiary care hospital in South India. Methodology: A prospective hospital-based study of 100 consecutive cases diagnosed with SP from January 2019 to September 2020. Every patient underwent comprehensive history taking, in-depth clinical examination, and investigations. Data were entered into Excel spreadsheets in 2019. Data were presented using frequency and percentage and descriptive statistics were used. Results: SP was more common in males, Smoking can be considered a significant risk factor for SP, as 54% of all cases had a history of smoking. Dyspnea, accompanied by unilateral chest pain is the most common SP symptom. Tuberculosis is the most common etiological component of SP. Eighty-five percent of cases were successfully treated by tube thoracostomy. Conclusion: SP was more common in males and during the third and fifth decades of life. Secondary SP was more common than primary SP. Smoking history is an important risk factor for SP. Evaluating the clinical profile helps in assessing the etiology of SP. Early screening for risk factors and detection of comorbidities helps in the prevention of SP. [ABSTRACT FROM AUTHOR]

Tuberculosis is caused by Mycobacterium tuberculosis. If the treatment is inadequate or if host defenses are impaired, the apical lesion in primary tuberculosis expands into adjacent lung tissues and may spread via airways, lymphatic channels, or the vascular system. It may also circulate back to the lung and cause miliary pulmonary disease. Systemic miliary tuberculosis occurs when bacteria disseminate through the systemic arterial system to involve any organ. In the present study, we discuss five such cases of systemic miliary tuberculosis wherein the deceased succumbed to the illness. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis and diabetes both diseases are present in large numbers in the country and we are major contributors to both globally. With the objective to understand the various traits of patients having both tuberculosis and diabetes and to ascertain various possible predictors for such occurrence based on the public health database we carried out this study. We seek answers to questions like they have any effects? Are they having any additive role to play? Methods: One-year data from the NIKSHAY portal of both districts were analyzed to look for possible associations and other variable traits. Data were analyzed using standard methods to express data in frequency and percentage. Chi-square test was used to establish association, while step-wise approach was used to calculate univariate and multivariate logistic regression analysis for knowing various predictors. P-value of <0.05 was considered statistically significant. Results: Concurrent diabetes in tuberculosis patients was close to 294 (6%) in the 4933 individuals. In total, 65.2% of the study population were male. Diagnosis of tuberculosis was made most of the time by chest X-ray (49.4%) followed by Microscopy ZN staining and cartridge-based nucleic acid amplification test (CBNAAT). Death was more among diabetics (4.4%) as compared to nondiabetics (3.5%). Conclusion: Diabetes is increasing in tuberculosis patients; improvement in data quality is needed. More research is required to reveal various other reasons that make tuberculosis patients more prone to develop diabetes. [ABSTRACT FROM AUTHOR]

Indonesia is one of the countries with the highest number of tuberculosis (TB) cases globally. Around 10-20% of adolescents with TB infection progress to pulmonary TB, and less than 0.5% develop miliary or central nervous system TB. TB spondylitis occurs in only 5.6% of extrapulmonary TB patients. The clinical manifestations of disseminated and TB spondylitis are heterogeneous and insidious, with several potential risk- and prognostic factors. We report the case of a 16-year-old male admitted with abdominal distension, paraplegia, and urinary retention. He was diagnosed with disseminated TB with TB spondylitis. This case was unique because the patient had no classic symptoms of pulmonary TB. This report focuses on the diagnosis, comprehensive management, and prognosis of TB spondylitis, as well as the risk factors for disseminated TB. The management consisted of antituberculous agents and surgery. The prognosis is influenced by the patient's age, severity of kyphosis deformity, number of vertebrae involved, lesion site, and patient's health status, including nutritional status. [ABSTRACT FROM AUTHOR]

In this study, we report a case of a 34-year-old male presenting with pleuritic chest pain, breathlessness on exertion, and weight loss. His history and initial investigations revealed a right-sided pleural effusion, which required intercostal drainage (ICD) insertion, but the effusion was incompletely drained. Pleural fluid cytology, Adenosine deaminase unit (ADA) levels, and sputum (MTB CBNAAT) testing indicated that the pleural effusion was tuberculous in origin. The patient had been discharged on anti-tubercular drugs two months prior. However, two months later, he presented with the same symptoms, and a repeat HRCT-thorax showed a right-sided pleural effusion, suggestive of a pyo-pneumothorax with pleural thickening. A pigtail catheter was inserted to drain the effusion, and the pus sample was sent for culture, which isolated Klebsiella pneumoniae. The pleural fluid contained a large amount of fibrin, which led to pleural thickening, adhesions, and even calcification. Diffuse pleural thickening (fibrothorax) can result from empyema, hemothorax, or tuberculous pleurisy. Currently, definitive preventive and curative measures are limited, with decortication of pleural fibers or thoracoplasty being feasible when pleural thickness is approximately 0.5 cm, which can significantly reduce adhesions in the visceral pleura and lung tissue. This report aims to raise awareness among clinicians about the importance of early diagnosis, appropriate treatment, and the need for prompt and complete drainage of pleural effusion to prevent pleural thickening, calcification, and severe restrictive ventilation disorders.. [ABSTRACT FROM AUTHOR]

Background Tuberculosis (TB) disease has been associated with pregnancy complications. However, the potential impact of TB infection (TBI) on pregnancy outcome is unknown. To investigate this, we conducted a register-based study in immigrant women screened with QuantiFERON assays for TBI in antenatal care in Sweden. Methods Women with history of immigration from TB-endemic countries were eligible for inclusion if national identification numbers and available QuantiFERON results obtained during pregnancy from 2014 to 2018 were available. QuantiFERON results were linked to data on maternal characteristics and pregnancy outcomes from the national Pregnancy and Patient Registers. TBI was defined as nil-corrected QuantiFERON result ≥0.35 IU/mL, in the absence of TB disease. Pregnancies in women with TB disease or human immunodeficiency virus were excluded, as were multiplex pregnancies, pregnancies resulting in miscarriage, and pregnancies occurring >10 years after immigration. Odds of defined adverse pregnancy outcomes were compared by maternal TBI status using mixed effects logistic regression with adjustment for maternal age and region of origin. Results In total, 7408 women with 12 443 pregnancies were included. In multivariable analysis, stillbirth (adjusted odds ratio [AOR], 1.90; 95% confidence interval [CI], 1.13–3.21; P =.016), severe preeclampsia (AOR, 1.62; 95% CI, 1.03–2.56; P =.036), low birthweight (<2500 g; AOR, 1.38; 95% CI, 1.01–1.88; P =.041), and emergency cesarean section (AOR, 1.28; 95% CI, 1.02–1.63; P =.033) were significantly associated with TBI. Conclusions Among immigrant women seeking antenatal care in Sweden, TBI was independently associated with adverse pregnancy outcomes. Further studies are needed to corroborate these findings and to explore mechanisms involved. [ABSTRACT FROM AUTHOR]

Bullous lung disease caused by tuberculosis is rare, and complications have a poor prognosis with uncertain pathophysiologic mechanisms. We describe a 29-year-old male patient who was admitted to the emergency department due to bilateral tension pneumothorax, which was complicated by bronchopleural fistula. This was managed with the placement of chest tubes, continuity of anti-TB drug treatment, and Heimlich valve placement. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis, which primarily affects the lungs but can also involve other organs, including the kidneys. TB has the potential to result in the development of chronic renal failure and requires prompt diagnosis and treatment for effective management. Renal TB can lead to various complications, including renal failure, perinephritis, perinephric abscesses, fistulae, psoas abscesses, and non-functioning kidneys. Additionally, TB-associated nephropathy is an infrequent variant of glomerulonephritis characterized by the deposition of immune complexes containing TB antigens in the kidney's glomeruli. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a chronic infectious disease caused by airborne transmission of aerosolized droplets of Mycobacterium tuberculosis. TB is one of the top ten causes of death and the leading cause from a single infectious agent, causing an estimated 1.2 million deaths annually. Even with successful treatment patients with TB mostly suffer from long-term pulmonary complications. Objective: To determine the Frequency of Pulmonary Hypertension (PH) in post TB patients. Methodology: This cross-sectional study was carried out at Pulmonology Ward, Ayub Teaching Hospital, Abbottabad over six months from February 4th, 2022 to August 3rd, 2022. A total of 108 patients were included in the study using consecutive sampling technique. The PH patients included those patients who had mean pulmonary arterial pressure (PAPm) ≥ 25 mmHg at rest estimated by echocardiography. Both male and female patients with age between 16 to 80 years having past history of TB were included. Results: Mean age of Post TB patients was 52.1(±7.2) years. Among Post TB patients 46.3% were males and 53.7% were female patients. The frequency of PH in post TB patients was 44.4% (p<0.03). The Post TB PH difference in different age groups was significant (p=0.03) but difference in both genders was not significant in patients (p=0.221). Conclusion: Pulmonary Hypertension is found in a significant number of Post TB patients. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is one of the old diseases with gross mortality and is a serious public health problem all over the world. The disease is more common in some regions of the world and some risk factors like overcrowding, immunocompromised state, and diabetes mellitus (DM) are the well-known risk factors for its development and also associated with delay in sputum conversion and unsuccessful outcome. Objective: To determine the frequency of newly diagnosed Diabetes mellitus (DM) in TB patients. Methodology: The present study was conducted at Department of Pulmonology, Ayub Teaching Hospital, Abbottabad from 2021 to 2022. Patients with age between 16-80 years, who presented with TB were enrolled in this study. TB was diagnosed via detection of MTB in sputum via microscopy, gene expert or culture or when decided by the consultant physician on the basis of clinico-radiological basis. Newly diagnosed DM cases included those whose fasting blood sugar was >126mg/dl or random blood sugar was >200mg/dl. Results: Among study cases, 53.8% were male and 46.2% were female with mean age of 46.1±7.5 years. The difference in age and gender distribution was significant in TB patients. The rate of newly diagnosed DM patients was found to be 25.8%, with 11.0% among male patients and 14.8% among female patients. Positive significant association (P,0.03) was found among DM diagnosis in tuberculosis patients. Conclusion: The present study concluded that among tuberculosis patient occurrence of newly diagnosed Diabetes mellitus was high, therefore, the concerned bodies are required to implement diabetes screening at TB clinics. [ABSTRACT FROM AUTHOR]

Tuberculous (TB) involvement of the vascular system has been reported in the preantibiotic era. We, hereby, report a case involving a teenage boy who presented to us with left upper limb pain followed by gradually progressive motor and sensory deficit over 1 month with preceding history of tuberculosis. Examination revealed a palpable, noncompressible, nonpulsatile swelling superior to the lateral third of the clavicle. Imaging through ultrasonography, computed tomography, and magnetic resonance imaging confirmed the presence of a pseudoaneurysm with compression of the underlying nerves. The child underwent surgical thrombectomy with pseudoaneurysm repair and arteriorrhaphy along with antitubercular medications with complete recovery at 6 months. The tissue staining, nucleic acid amplification tests, and histopathology confirmed TB etiology. Tuberculosis continues to remain a major health concern, especially in the developing world. High index of suspicion is necessary to diagnose such manifestations to avoid catastrophic sequelae. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) triples a person's risk of active tuberculosis (TB) and is associated with increased mortality. It is unclear whether diabetes status and/or the associated renal dysfunction is associated with poor TB outcomes in New Zealand, which has high diabetes screening. Aim: To characterise the population of TB‐DM and TB‐alone to assess the effect of diabetes status and renal function on hospitalisation and mortality. Methods: Clinical records from all adult patients diagnosed with TB in Auckland over a 6‐year period (2010–2015) were reviewed. Baseline demographics, clinical presentation and microbiological data were assessed to compare the rates of hospitalisation and mortality between those with TB‐DM and TB‐alone. Statistical significance was defined as P < 0.05. Results: A total of 701 patients was identified with TB; 120 (17%) had an unknown diabetes status and were excluded, and 135 had co‐existing diabetes. The TB‐DM and TB‐alone groups had similar distribution of TB site and proportions of Mycobacterium tuberculosis culture positivity. Univariate analysis showed TB‐DM patients had statistically significantly higher proportions of acute hospitalisation and mortality. Multivariate logistic regression showed only a reduced estimated glomerular filtration rate (eGFR) accounted for the higher rates of hospitalisation, with the odds of hospitalisation increasing by 2% for every unit decrease in eGFR. The odds of mortality increased by 6% for every year increase in age, and the odds of mortality increased by 3% for every unit reduction in eGFR. Conclusions: Diabetes is associated with higher TB hospitalisation and mortality; however, this is likely mediated by increased age and chronic kidney disease. [ABSTRACT FROM AUTHOR]

Tuberculoma is an uncommon presentation of tuberculosis and is found in regions with a high prevalence of tuberculosis. This is rarely diagnosed during pregnancy. The presentation can mimic other etiologies such as eclampsia or cerebral venous sinus thrombosis so the diagnosis can be challenging, particularly when presenting with seizures in pregnancy. Described here is a woman in her first pregnancy who presented with seizures mimicking eclampsia and was suspected to have a brain tumour on neuroimaging. She was diagnosed to have a intracerebral tuberculoma on histopathological examination following surgical decompression after delivery. [ABSTRACT FROM AUTHOR]

Pulmonary medicine began on tuberculosis wards in the preantibiotic era. Its first practitioners were often themselves physician victims of tuberculosis, observing its effects on their own breathing and that of other patients. Not only were lungs damaged by smoldering tuberculosis itself but by the more radical treatments of the time, including pneumothorax and plombage procedures (methods for collapsing lungs to close cavities) and excisional surgery. Such procedures required pretreatment risk assessment of lung function, resulting in pulmonary function testing, and posttreatment management of often worsened lung function. However, with the introduction of effective chemotherapy in the midtwentieth century, tuberculosis elimination was predicted, and a public health approach focused on making widely available standardized diagnosis, treatment, and bacteriologic assessment of cure. [ABSTRACT FROM AUTHOR]

Key content: Tuberculosis (TB) is an important global cause of maternal and neonatal morbidity and mortality.With increasing migration, cases of tuberculosis in pregnancy or the puerperium are increasing in resource‐rich nations with advanced health care systems.Diagnosis may be delayed given the overlap of some of the symptoms with that of pregnancy.Timely diagnosis is essential to initiate appropriate treatment and prevent maternal and neonatal morbidity and mortality. Learning objectives: To understand the relevant global and UK epidemiology of the disease, including recent goals set by the World Health Organization and the UK.To review the pathophysiology of pulmonary and extrapulmonary TB, and of latent and active TB.To learn how to identify high‐risk women for antenatal assessment and gain an awareness of the screening tests available for latent TB.To gain awareness of the clinical symptoms, diagnosis and therapeutic management of active tuberculosis, including management of any drug resistance.To understand management of the neonate within high‐risk groups and where the mothers have diagnosed latent or active TB. Ethical issues: Pregnant women with TB should be fully counselled about the benefits, risks, and alternate options of management.Should healthcare professionals with high risk of acquiring TB infection be exempt from managing TB infection?Management of TB in HIV‐positive women provides additional challenges.Breastfeeding issues around seropositive mothers should be considered. [ABSTRACT FROM AUTHOR]

Guillain-Barre syndrome (GBS) is one of the common causes for acute flaccid paralysis in adults and mostly preceded by infection. Miller Fisher syndrome (MFS) is a rare variant of GBS with incidence of 1 to 2 in 1,000,000. This syndrome has a triad of ataxia, areflexia, and ophthalmoplegia and diagnosed when two out above three features are present. It usually preceded by viral infection, most commonly Campylobacter jejuni , cytomegalovirus, and Epstein–Barr virus. However, it is very rarely reported in pulmonary tuberculosis. The pathogenesis involves an aberrant immune response due to molecular mimicry against myelin gangliosides. Hereby we are presenting an unusual case of MFS variant of GBS associated with pulmonary tuberculosis. [ABSTRACT FROM AUTHOR]

Tuberculous (TB) involvement of the vascular system has been reported in the preantibiotic era. We, hereby, report a case involving a teenage boy who presented to us with left upper limb pain followed by gradually progressive motor and sensory deficit over 1 month with preceding history of tuberculosis. Examination revealed a palpable, noncompressible, nonpulsatile swelling superior to the lateral third of the clavicle. Imaging through ultrasonography, computed tomography, and magnetic resonance imaging confirmed the presence of a pseudoaneurysm with compression of the underlying nerves. The child underwent surgical thrombectomy with pseudoaneurysm repair and arteriorrhaphy along with antitubercular medications with complete recovery at 6 months. The tissue staining, nucleic acid amplification tests, and histopathology confirmed TB etiology. Tuberculosis continues to remain a major health concern, especially in the developing world. High index of suspicion is necessary to diagnose such manifestations to avoid catastrophic sequelae.

OBJECTIVE: Coronavirus disease 2019 is expected to have a widespread and significant impact on pulmonary tuberculosis services. This study aims to investigate the effect of comprehensive short-term, outpatient pulmonary rehabilitation program among treated pulmonary tuberculosis patients during the coronavirus disease 2019 pandemic. MATERIAL AND METHODS: Forty-five pulmonary tuberculosis patients who completed their tuberculosis treatment were randomly allocated to the outpatient pulmonary rehabilitation group and the other 45 were allocated to the control group for 4 weeks. The pulmonary rehabilitation program comprised supervised endurance and resistance training, breathing techniques, self-management strategies, and patient education. The outcome measures evaluated in both groups were functional capacity assessed by a 6-minute walk test, healthrelated quality of life (short-form 36 questionnaire), pulmonary function (forced expiratory volume in 1 second/forced vital capacity, forced vital capacity, and forced expiratory volume in 1 second), and dyspnea by modified Medical Research Council dyspnea scale. All measurements were performed at enrolment and after completion of 4 weeks protocol in both the groups. RESULTS: There was a significant improvement in 6-minute walk distance in meters (P = .001) and percentage predicted (P = .014) in the pulmonary rehabilitation group compared to the control group. All domains of the short-form 36 questionnaire showed significant improvement post-pulmonary rehabilitation (P < 0.05), and modified Medical Research Council dyspnea scale also significantly improved in the pulmonary rehabilitation group (P < .001). However, no significant differences were observed in any of the pulmonary function measures (P > .05) between the groups after 4 weeks. CONCLUSION: Short-term pulmonary rehabilitation program in pulmonary tuberculosis demonstrated improvement in functional capacity, quality of life, and dyspnea. However, it failed to register changes in pulmonary function. The study results provide motivation to consider the implementation of a short-term pulmonary rehabilitation program after pulmonary tuberculosis treatment to reduce the impairment the patient may suffer even after microbiological cure. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) and tuberculosis (TB) are currently two major causes of death among infectious diseases. Active tuberculosis and a history of tuberculosis appear to be associated with an increased risk of COVID-19. This coinfection, named COVID-TB, was never described in previously healthy children. We report three cases of pediatric COVID-TB. We describe three girls affected by tuberculosis, who tested positive for SARS-CoV-2. The first patient is a 5-year-old girl who was hospitalized for recurrent TB lymphadenopathy. As she never had any complications related to the concomitant infection with SARS-CoV-2, she received TB treatment. The second case is a 13-year-old patient with a history of pulmonary and splenic tuberculosis. She was admitted to the hospital due to deteriorating respiratory dynamics. She was already undergoing treatment for TB, but in the absence of improvement, she also required treatment for COVID-19. Slowly, the general condition improved until discharge. The last patient, a 10-year-old girl, was hospitalized for supraclavicular swelling. The investigations showed disseminated TB characterized by lung and bone involvement without COVID-19-related complications. She was treated with antitubercular and supportive therapy. Based on the data obtained from the adult population and our small experience, a pediatric patient with COVID-TB infection should be considered potentially at risk of worse clinical outcomes; for this reason, we suggest close observation, careful clinical management, and consideration of targeted anti-SARS-CoV-2 therapies. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac dysfunction in pulmonary tuberculosis is relatively more common and underestimated due to lack of suspicion. We have studied prevalence of cardiac dysfunction in pulmonary tuberculosis with special emphasis on echocardiography, serum cortisol and its correlation in cases with unstable cardiorespiratory parameters. Methods: Prospective, observational, complete workup, and one year follow up study conducted during January 2016 to December 2020 included 800 cases of active pulmonary tuberculosis with specified inclusion criteria of disproportionate tachycardia, tachypnea with or without hypoxia and shock. Cases with known risk factor for cardiac disease and taking cardiac medicines, and cases with pericardial effusion were excluded from study. All study cases were undergone protocolized analysis such as chest radiograph, pulse oximetry, ECG, sputum examination, cardiac enzymes (CPK-MB, NTPro- BNP, and cardiac troponins), serum cortisol, and echocardiography at entry point, at two and six months of treatment with anti-tuberculosis medicines as per NTEP. Statistical analysis was carried out by Chi-square test. Observations and analysis: In a study of 800 pulmonary tuberculosis cases, 56.00% (448/800) cases were males, and 44.00% (352/800) cases were females. Cases with BMI<18 was 41.62% (333/800) and BMI>18 was 58.37% (467/800). Radiological patterns as unilateral disease in 33.62% (269/800) & bilateral disease in 66.37% (531/800). Hemoglobin less than 10 gm% were documented in 85.12% (681/800) and above 10 gm% were in 14.87% (119/800) cases. Serum albumin less than 3.5 gm% and more than 3.5 gm% were observed in 48.12% (385/800) and 51.12% (415/800) cases respectively. Hypoxia was documented 26.12% (209/800) cases and normal oxygen saturation in 73.87% (591/800) cases. cases with normal and abnormal serum cortisol were 61.37% (491/800) & 38.62% (309/800) respectively. Sputum examination for AFB observed in 30.00% (240/800) and gene Xpert MTB/RIF documented in 51.37% (411/800) cases respectively. Bronchoscopy guided techniques were used in 149 cases and BAL smear AFB in 44.96% (67/149) cases, gene Xpert MTB/RIF in 97.31% (145/149) cases and MGIT culture in four cases (positive in 100% cases subjected to MGIT culture). We have observed global hypokinesia is predominant cardiac dysfunction documented in 82.21% (171/208) cases, followed by left heart systolic dysfunction in 16.34% (34/208) cases and left heart diastolic dysfunction in 75% (156/208) cases. Right heart dysfunction as dilated right atrium and right ventricle documented in 52.88% (110/208) cases and pulmonary hypertension in 40.38% (84/208) cases. Covariates such as age, gender, hemoglobin, BMI, serum cortisol, serum albumin, oxygen saturation and radiological involvement has significant association with cardiac dysfunction. (p<0.00001) Response to treatment with antituberculosis medicines and steroids has documented as improved in 77.40% cases (161/208) cases, persistent in 13.46% (28/2028) cases and progressive in 9.13% (19/208) cases. Final outcome of cardiac dysfunction in Pulmonary tuberculosis cases has significant association with serum cortisol level (p<0.00086). Conclusion: Cardiac dysfunction is active pulmonary tuberculosis needs prompt workup in presence of disproportionate tachypnea, tachycardia with or without hypoxia and shock. Echocardiography is basic tool to evaluate these cases and global hypokinesis is most common abnormality. Serum cortisol abnormality documented in fair number of cases and very well correlated with left ventricular dysfunction abnormalities. Steroids with antituberculosis treatment backup is mainstay protocol during management of these cases. Cardiac dysfunction is reversible in majority of cases and proportionate number shown complete improvement in cardiac dysfunction. [ABSTRACT FROM AUTHOR]

Background: India has the highest burden of tuberculosis in the world. It is experiencing an increasing burden of non-communicable diseases, thereby facing a dual disease burden. Recent evidence shows an association between TB and non-communicable diseases like diabetes, CVD and chronic respiratory infections. Aims and Objectives: To assess the feasibility of screening for NCDs and risk factors for NCDs among patients with TB in DOTS centers of a medical college in Delhi and ascertain challenges for the same among providers and patients. Methodology: It was a mixed-methods study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data). Results: Among the 139 patients screened, ten new cases of hypertension and six new patients were diagnosed with DM. Out-of-pocket expenditure for tests was a concern of the patients. Health care providers found the screening tool easy to use but were apprehensive about increased workload Conclusion: The study provides useful visions for incorporating NCDs into routine TB care through DOTS centers under RNTCP/NTEP. [ABSTRACT FROM AUTHOR]

Lymphangioleiomyomatosis (LAM) is progressive cystic lung disease that affects premenopausal women with the involvement of many organs of the body including the lungs. It commonly presents with dyspnea and cough, but its clinical course may be complicated by pleural effusions and recurrent pneumothorax. LAM is strongly associated with tuberous sclerosis complex (TSC) and may yield other clinically significant findings such as renal angiomyolipomas (AMLs) and lymphadenopathy. Investigations including radiological imaging, serum testing, and biopsies should be carefully considered when making a diagnosis as symptoms can be mistaken for other lung pathologies. The current mainstay of treatment is immunosuppressants and supportive therapy with bronchodilators and oxygen, while lung transplant is performed for end-stage disease. This case report details an unusual presentation of a 20-year-old female diagnosed with sporadic LAM following a previous pulmonary tuberculosis infection. She had a history of recurrent bilateral pneumothorax following initiation of antitubercular treatment (ATT). Diagnosis was made on the basis of clinical presentation and computed tomography (CT) scans; in addition, histopathological examination of the cervical lymph nodes revealed coexisting extrapulmonary tuberculosis. A brief literature review of the relevant topics is also discussed in this report. [ABSTRACT FROM AUTHOR]

Background: Spontaneous pneumothorax (SP) typically manifests as persistent, intense, one-sided chest pain that worsens with deep breaths and adjustments in body position. It can manifest with breathlessness, or a combination of breathlessness and chest pain. Objective: The objective of this study was to investigate the spontaneous pneumothorax in adult's patients. Methodology: This retrospective study was conducted on 104 spontaneous pneumothorax adults' patients in the Department of Medicine, Shalamar Hospital, Lahore from January 2022 to September 2022. All individuals aged =18 years presented with spontaneous pneumothorax were included. Data regarding demographic characteristics, clinical details, radiological findings, and treatment approaches was collected from medical record. Results: The overall mean age was 44.6±8.2 years. Patients were distributed based on age group as follows: 42 (40.4%) in 18-35 years, 52 (50%) in 36-50 years, and 10 (9.6%) in 51-65 years. Spontaneous pneumothorax (SP) was more prevalent among males. Smoking emerged as a significant risk factor, with 48.1% of all cases having a history of smoking. The most frequent symptom associated with SP was dyspnea, often accompanied by unilateral chest pain. Tuberculosis was identified as the leading cause of SP. Moreover, tube thoracostomy successfully managed 85% of the cases. Conclusion: Spontaneous pneumothorax (SP) exhibited a higher prevalence among males and tended to occur more frequently during the third and fifth decades of life. Assessing the clinical profile of patients with SP was valuable in determining its underlying causes. Early screening for risk factors and identifying comorbidities played a crucial role in SP prevention. [ABSTRACT FROM AUTHOR]

Despite the high prevalence of tuberculosis (TB) and the disease burden of osteoporosis and osteoporotic fractures, there is still a lack of well-designed, large-scale studies demonstrating associations among them. We aimed to investigate the effect of TB on the incidence of osteoporosis and osteoporotic fractures. This was a nationwide population–based cohort study. This study was conducted using the National Health Insurance Service Database of South Korea. We included patients with newly diagnosed TB aged >40 years from January 2006 to December 2017. An uninfected control for each TB patient was randomly extracted by frequency matching for sex, age, income level, residence, and registration date at a 2:1 ratio. The primary outcome was the incidence of osteoporosis and osteoporotic fractures between the two groups, adjusted for sex, age, income level, residence, comorbidities, body mass index, blood pressure, laboratory tests, alcohol drinking, and smoking. The risk factors associated with osteoporosis or osteoporotic fractures were also investigated. A total of 164,389 patients with TB and 328,778 matched controls were included (71.9% males). The mean duration of follow-up was 7.00 ± 3.49 years. The incidence of osteoporosis in patients with TB was 6.1 cases per 1000 person-years, which was significantly higher than that in matched controls (adjusted hazard ratio [aHR] 1.349, 95% confidence interval [CI] 1.302–1.398, P < 0.001). The incidence of osteoporotic fractures was also higher in patients with TB than in controls (aHR 1.392, 95% CI 1.357–1.428, P < 0.001). Among fractures, the risk of hip fracture was the highest (aHR 1.703, 95% CI 1.612–1.798, P < 0.001). TB independently contributes to the incidence of osteoporosis and osteoporotic fractures, particularly hip fractures. [ABSTRACT FROM AUTHOR]

Catatonia, a psychomotor disorder, can have underlying psychiatric and medical etiologies. Around 29% of the catatonias with medical etiologies are related to either infectious or immune causes. Benzodiazepines like lorazepam and electroconvulsive therapy are the conventional treatment modalities for catatonia. In this case series, three cases of catatonia secondary to pulmonary tuberculosis, pneumococcal pneumonia, and neurocysticercosis have been described, in which conventional treatment modalities like lorazepam or electroconvulsive therapy either failed or were disadvantageous and were successfully treated with memantine (20–30 mg). [ABSTRACT FROM AUTHOR]

The article focuses on how tuberculosis had a significant and enduring impact on society, particularly in the context of the American West. It discusses the historical prevalence of tuberculosis, its association with social issues, and how the belief in the therapeutic benefits of fresh air led to a massive influx of people to regions like Colorado. This migration, driven by the idea of an environment conducive to health, contributed to the growth of areas in the American West.

Background: Tuberculosis (TB) and chronic obstructive pulmonary disease (COPD) are well-known causes of morbidity and mortality. The relationship between COPD and TB is very complex. A substantial number of post-tuberculosis (Post-TB) patients develop COPD. Objective: The present study was conducted to determine the prevalence of COPD in post-Tuberculosis patients. Methodology: This cross-sectional study was carried out in In Pulmonology unit of Khyber Teaching hospital, Peshawar from 16th October 2021 to 15th April 2022. Post-TB patients of age group 18-70 years and both genders were included in the study. Patients with a current or past history of smoking, diagnosed COPD, exposure to coal or silica, asthma, congestive cardiac failure (CCF), interstitial lung diseases, bronchiectasis and severe anaemic patients were excluded. Written informed consent was taken from all the patients. Each patient underwent spirometry as per the American thoracic society (ATS) protocol and COPD was diagnosed as FVE1/FVC <0.70. COPD was then classified into mild, moderate, severe and very severe according to the GOLD guidelines. Results: Among these 149 patients, 40.9% were male while 59.1% were female. Mean age was 53.17 years ± 12.54 SD. Mean FVC was 59.38 ml ± 20.12 SD and mean FEV1 was 54.77 ml ± 23.46 SD. COPD was found in 51% and stratified among age, gender, FEV1/FVC ratio and time since completion of ATT. Conclusion: This study concludes a high prevalence (51%) of COPD in post-TB patients. COPD causes significant morbidity and proper screening of post-TB patients for COPD will help in the effective management and prevention of complications. [ABSTRACT FROM AUTHOR]

Dynamic contrast-enhanced (DCE) lymphangiography is a novel imaging technique with a potential role in suspected cases of lymphatic leaks. A 15-year-old male with a post operative chylous leak and an 8-year-old male who developed chylous ascites secondary to disseminated tuberculosis are presented. Both children underwent MR lymphangiography. Contribution: The role of DCE-MR lymphangiography in cases of chylous ascites to help guide appropriate management. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the etiology and contributing factors of cavitary pulmonary lesions in HIV infected patients. Methods: In this study, 844 HIV infected patients with a total of 1000 admissions were investigated at Masih Daneshvari Hospital from Aug 2010 to Oct 2019. After excluding the missing data and distorted documentation, 746 cases and 878 admission episodes finally underwent statistical analysis. The CXRs were observed thoroughly and the cavitary lesions were identified. Eventually, demographic data, diagnostic information, and laboratory findings were extracted and analyzed. Results: Of the 878 episodes of hospitalization, cavitary pulmonary lesions were observed in 145 documents. The most prevalent etiology was TB with 105 cases (72.5%). After that, Pneumocystis jiroveci and septic embolism were responsible for a further 7.6% and 5.6% of the total lung cavities, respectively. 58.5% of the cavities were present in a single lobe, with men being affected in 90.2% of the cases. The upper lobes were the most common site of involvement in the lungs [42.9% for Left Upper Lobe (LUL) and 52.3% for Right Upper Lobe (RUL)]. The rate of definitive diagnosis was significantly higher in patients affected with cavitary lesions (82.8%) in comparison with the unaffected (74.8%) (p=0.001). No significant difference in demographics, HIV and ART status, CD4+ cell count, viral load, and mortality was evident between the two groups. Conclusion: The most common etiology of cavitary lesions in HIV positive patients was attributable to TB, PJP, and septic embolism respectively. Cavitary lesions were more prevalent in males and mainly tend to involve the upper zones of pulmonary parenchyma. [ABSTRACT FROM AUTHOR]

Introduction: Identifying areas that the burden of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) disease is concentrated could play an important role in public health. The purpose of the present study was to assess pattern of spatial inequalities in survival in Hamadan Province, and to examine the effect of prognostic factors and trajectory of CD4 on the risk of mortality among HIV-infected patients. Material and methods: This registry-based cohort study was carried in Hamadan Province, Iran, from December 1997 to June 2020, and included 400 patients. Join modeling of longitudinal and spatially clustered survival data was used for analyzing data. Outcomes in longitudinal sub-model was the number of CD4 T-lymphocytes over time and time of HIV diagnosis, and outcomes in survival sub-model was time interval between HIV diagnosis and mortality. Results: According to our results, among all the predictors, there was only a significant relationship between co-infection with tuberculosis and CD4 trajectory. The association for risk of mortality was significant for antiretroviral therapy (ART) and co-infection with tuberculosis. Also, the lower CD4 counts during follow-up were related to a higher risk of mortality. Regarding mapping of our results for risk of mortality, we identified three counties with slightly higher hazards and three counties with rather lower hazards in Hamadan Province. Conclusions: The assessment of spatial pattern of HIV survival is helpful and appears to be dependent on socio-economic characteristics. Furthermore, our results suggest factors of access to ART and prevention of co-infection with tuberculosis, which may be useful to increase the length of patients' life. [ABSTRACT FROM AUTHOR]

Pyroptosis is a programmed cell death caused by inflammation. Multiple studies have suggested that Mycobacterium tuberculosis infection causes tissue pyroptosis. However, there are currently no protective drugs against the inflammatory damage caused by pyroptosis. In this study, anti-pyroptotic effects of the natural compound astaxanthin (ASTA) were explored in a simulated pulmonary tuberculosis-associated inflammatory environment. The results showed that ASTA maintained the stability of MLE-12 lung epithelial cell numbers in the inflammatory environment established by lipopolysaccharide. The reason is not to promote cell proliferation but to inhibit lipopolysaccharide-induced pyroptosis. The results showed that ASTA significantly inhibited the expression of key proteins in the caspase 4/11-gasdermin D pathway and the release of pyroptosis-related inflammatory mediators. Therefore, ASTA inhibits inflammation-induced pyroptosis by inhibiting the caspase 4/11-gasdermin D pathway and has the potential to protect lung tissue from tuberculosis-related inflammatory injury. ASTA, a functional food component, is a promising candidate for protection against tuberculosis-associated inflammatory lung injury. [ABSTRACT FROM AUTHOR]

BACKGROUND Tuberculosis (TB) is a common cause of intraocular inflammation in Indonesia. As no accurate biomarker can confirm the diagnosis, ophthalmologists often rely on systemic findings, such as tuberculin skin test, interferon-gamma release assay (IGRA), and chest X-ray (CXR) for TB suspicion. This study aimed to evaluate IGRA and CXR in classifying intraocular TB among patients with a clinically undifferentiated cause of uveitis. METHODS This cross-sectional study included 116 patients (a total of 163 affected eyes) with a clinically undifferentiated cause of uveitis. IGRA and CXR were performed as part of the workup. Data on visual acuity, anterior chamber inflammation grade, and anatomical classification of uveitis were recorded. As there were no confirmed ocular tuberculosis (OTB) in our cases, eyes were classified into probable OTB, possible OTB, and unclassified. RESULTS Overall, 93 patients (80.2%) with a clinically undifferentiated cause of uveitis had positive IGRA, whereas 10 (8.6%) had CXR results suggestive of TB. More than one- third of the patients were blind (visual acuity <3/60), and panuveitis was the commonest anatomical classification. A trend was identified in patients with panuveitis, who often showed ≥2+ cell anterior chamber inflammation (p for trend = 0.023), according to OTB criteria (probable OTB = 3/4, 75.0%; possible OTB = 44/67, 65.7%; unclassified = 2/9, 22.2%). Furthermore, the clinically undifferentiated uveitis cases were eligible to be stratified into probable (8.6%) and possible (75.0%) OTB categories after IGRA and CXR examinations. CONCLUSIONS The combination of IGRA and CXR is valuable for classifying and diagnosing TB-related uveitis. A multidisciplinary approach is essential when the cause of uveitis is unknown. [ABSTRACT FROM AUTHOR]

Background: Considering the high prevalence of tuberculosis (TB) in developing countries and the fact that comorbidity with diabetes mellitus (DM) imposes a higher burden on the society, this study was carried out to assess the prevalence of diabetes and its related factors in patients with TB in Mashhad, Iran. Methods: In this study, we enrolled 405 patients over the age of 18 who had been diagnosed with TB between the years 2015 and 2016 according to the documents of the ministry of health. The participants were selected randomly from five health center domains based on the stratified sampling method. The patients were screened for diabetes according to HbA1c over 6.5% or a fasting blood sugar (FBS) level over 126 mg/dL at different time points and the patient's self-report of having DM. Results: The mean age of participants was 51.14 ± 20.52 (19-92 years). The prevalence of DM in patients with TB was 21.2%, of whom 3.5% were newly diagnosed. Among potential factors, age with OR = 3.786 (1.183, 12.113), body mass index with OR = 9.149 (3.182, 26.302), nationality with OR = 2.149 (1.122, 4.117) and TB type with 3.328 (1.44, 7.689) were associated with DM in patients with TB. Conclusion: The prevalence of DM in our study was higher than that observed in other countries. Our study showed associated factors like age, body mass index, and TB type to be very important. Also, the prevalence of DM was different in patients with different nationality. [ABSTRACT FROM AUTHOR]

Tuberculosis-associated hemophagocytic lymphohistiocytosis (TB-HLH) is a rare and life-threatening complication of tuberculosis infection. Early recognition and treatment of TB-HLH is crucial for improving outcomes. Treatment typically involves a combination of antituberculosis therapy and immunosuppressive therapy to control the immune system's overreaction. In this report, we present the case of a 53-year-old ambulance driver who was diagnosed with TB-HLH. His CT scan revealed splenic abscesses, hepatomegaly and bilateral lung consolidation. He subsequently developed multiorgan failure, including acute respiratory distress syndrome (ARDS), transaminitis and bone marrow dysfunction. The clinical course and simultaneous increase in serum ferritin raised the suspicion of HLH. His Hscore was 254, indicating a high probability of hemophagocytic syndrome. TB diagnosis was confirmed by positive endotracheal TB GeneXpert and bone marrow aspiration (BMA) which detected acid-fast bacilli organisms. The patient was promptly started on anti-TB, dexamethasone and IVIG. The patient responded well to treatment and made a full recovery without any lasting complications. This case highlights the importance of promptly recognising HLH and identifying the underlying cause. In critically ill patients, it is crucial not to delay HLH-specific treatment while working up for differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: There is ample evidence indicating that immunosuppressive therapy or immune dysregulation in systemic lupus erythematosus increases the risk for tuberculosis. Interestingly, a few case reports suggest that tuberculosis could also be a risk factor for systemic lupus erythematosus and other autoimmune diseases.Case Presentation: We report the case of a 32-year-old Indian patient who was co-diagnosed with tuberculosis, systemic lupus erythematosus, and autoimmune hepatitis without any history of prior immunosuppression. This stresses the complex relationship between tuberculosis and autoimmune diseases.Conclusion: Further research is warranted in this field to unfold the complex relationship between tuberculosis and systemic lupus erythematosus. It is essential to establish clear guidelines for the management of coexisting tuberculosis and systemic lupus erythematosus to promote individualized treatment. [ABSTRACT FROM AUTHOR]

Objective: Urogenital tuberculosis and disseminated tuberculosis affecting urogenital system are more frequent in developing countries but are often overlooked in developed ones. We aimed to compare clinical characteristics and outcomes of urogenital tuberculosis and disseminated tuberculosis affecting the urogenital system. Material and methods: We retrospectively reviewed data from patients with tuberculosis in the urogenital system, diagnosed in a tertiary center in a European country, from 2008 to 2018. Cases were divided into urogenital tuberculosis and disseminated tuberculosis affecting the urogenital system and compared. Results: We included 172 patients, 31 with urogenital tuberculosis and 141 with disseminated tuberculosis affecting urogenital system. Patients with disseminated tuberculosis affecting the urogenital system were younger (median 45 vs. 64 years, P = .001), more likely to be male (80 vs. 55%, P = .005), or having risk factors for the disease (84 vs. 23%, P = .005) than patients with urogenital tuberculosis. Patients with urogenital tuberculosis presented most commonly with symptoms related to the urinary tract, with 52% complaining of lower urinary tract symptoms attributed to urinary tract infections and 48% of dysuria, while patients with disseminated tuberculosis affecting the urogenital system presented mainly with systemic symptoms, with 89% complaining of malaise, 62% of fever, and 57% of anorexia. Patients with urogenital tuberculosis were more likely to need urological surgery as part of their treatment (71 vs. 5%, P < .001) and patients with disseminated tuberculosis affecting the urogenital system were more likely to die due to tuberculosis (10 vs. 21%, P < .001). Conclusion: Tuberculosis of the urogenital system can have multiple clinical presentations, and a simple diagnostic algorithm does not exist. In the presence of urogenital tuberculosis in injected drug users, immunosuppressed individuals, or patients with systemic symptoms, we should think of disseminated tuberculosis affecting the urogenital system and remember these patients less frequently need surgery but entail a worst outcome. [ABSTRACT FROM AUTHOR]

The purpose of this study is to find out the risk factors of poor wound healing (PWH) in spinal tuberculosis (STB) patients. A total of 232 STB patients who underwent debridement surgery between January 2012 to June 2020 were included in this retrospective study. The study cohort was divided into two groups according to the presence or absence of PWH. The clinical characteristics of STB patients who developed PWH were evaluated, and risk factors were found using logistic regression analysis. Of the 232 patients, 30 developed PWH. Multivariate binary logistic regression analysis showed that pulmonary tuberculosis, long operation time and low postoperative albumin level were independent risk factors for PWH in STB patients. Receiver operating characteristic curve analysis showed that the optimal cutoff value of PWH in operation time and postoperative albumin are 200 minutes and 30 g/L, respectively. Pulmonary tuberculosis, long operation time and low postoperative albumin level are independent risk factors for PWH following surgery for STB. Curing pulmonary tuberculosis, controlling operation time and supervising postoperative serum albumin may decrease the risk of PWH among STB patients. [ABSTRACT FROM AUTHOR]

Background and Objective: Childhood tuberculosis remains a global public health threat despite being preventable and curable. Childhood tuberculosis prevention using strategies including isoniazid preventive therapy is evidence based and cost effective. This study aimed to determine the isoniazid preventive therapy completion rate and predictors of hepatotoxicity of isoniazid among children who sought human immunodeficiency virus (HIV)/acquired immune deficiency syndrome care in public hospitals in Sokoto, Nigeria. Methods: This was a 4-year (2016–19) retrospective chart review of 429 paediatric patients with HIV/acquired immune deficiency syndrome aged ≤18 years, accessing isoniazid preventive therapy from Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital, Sokoto, Nigeria. The study commenced in January 2020 and lasted for 6 months. Regression models were used to determine predictors of the isoniazid preventive therapy completion rate and the development of hepatotoxicity. Results: Of the 429 HIV-infected children initiated on isoniazid preventive therapy, 244 (56.9%) successfully completed isoniazid preventive therapy. Young age and low socioeconomic status were the strongest predictors of the isoniazid preventive therapy completion rate. Only 37 (18.0%; 37/205) were found to have their alanine transaminase raised to a grade 1 level (47.5–95.0 U/L) with the median (interquartile range) being 71 (53–87) U/L. Advanced HIV (HIV clinical stages 3 and 4) predicted isoniazid-induced hepatotoxicity. Conclusions: The isoniazid preventive therapy completion rate was sub-optimal and the incidence rate of developing grade 1 liver injury was low among the study cohort. We recommend community-appropriate and tailored strategies to promote the isoniazid preventive therapy completion rate and that their liver enzymes be monitored especially for children with advanced HIV disease. Plain Language Summary: The burden of childhood tuberculosis continues to remain unacceptably high in developing countries despite the preventability and curability of the disease. Tuberculosis and human immunodeficiency virus (HIV) often coexist and impact each other and thus form a highly lethal partnership. Consequently, measures such as isoniazid preventive therapy (IPT) that can prevent such coexistence is highly warranted. However, low uptake and completion rate, and hepatotoxicity threaten the beneficial effects of IPT. The study investigated the completion rate of a 6-month course of IPT among HIV/acquired immune deficiency syndrome-infected children on antiretroviral drugs and the predictors of hepatotoxicity of the IPT. The 4-year retrospective chart review revealed a less-than-adequate IPT completion rate of 56.9% (244/429) that was predicted by young age (≤10 years) and low socioeconomic status of the children. A grade 1 level elevation of alanine transaminase (47.5–95.0 U/L: mild hepatotoxicity) was also recorded among 18.0% (37/205) of the children and this was predicted by HIV clinical stage. The alanine transaminase levels of the remaining children (82.0%; 168/205) were within the normal range. Interventions designed to improve the IPT completion rate and periodic measurement of alanine transaminase for those with advanced HIV (HIV clinical stages 3 and 4) were recommended. [ABSTRACT FROM AUTHOR]

Introduction: Human immunodeficiency virus (HIV) increases epidemiology of tuberculosis (TB) cases worldwide, particularly in sub-Saharan Africa, with a significant increase in TB incidence. In many countries, HIV prevalence in TB patients is a sensitive indicator of the spread of HIV into general population. Therefore, the objective of this study was to determine trends and HIV prevalence among TB patients in two public hospitals in Bale Zone, Southeast Ethiopia. Material and methods: A five-year retrospective data (from July 2013 to June 2018) of TB patients registered in TB clinics of two randomly selected public hospitals in Bale Zone were retrieved. HIV testing and tuberculosis diagnosis were performed according to national HIV/TB co-infection control program guidelines. Data were extracted from a registry of TB patients and analyzed using SPSS version 23. Bivariable and multivariable logistic regression analysis were used to identify factors associated with HIV infection among TB patients. Results: Among 1,281 TB patients, 98.1% (1,257) have been tested for HIV, of whom 246 (19.6%) were HIV co-infected. A slightly declining trend of HIV infection among TB patients was observed during the study period, from 3.1% in 2013 to 2.5% in 2018 (Χ² = 13.4, p = 0.02). Females (AOR = 1.47, 95% CI: 1.09-1.97%), previously treated TB patients, and age between 25 and 44 were found to have a statistically significant association with HIV infection among TB patients. Conclusions: In this study, around one-fifth of TB patients who followed treatment in the past five years was found HIV co-infected. [ABSTRACT FROM AUTHOR]