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Kaewwinud J, Pienchitlertkajorn S, Koomtanapat K, Lumkul L, Wongyikul P, Phinyo P. Diagnostic scoring systems for tuberculous pleural effusion in patients with lymphocyte-predominant exudative pleural profile: A development study. Heliyon 2024; 10:e23440. [PMID: 38332886 PMCID: PMC10851221 DOI: 10.1016/j.heliyon.2023.e23440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 02/10/2024] Open
Abstract
Background Diagnosing tuberculous pleural effusion (TPE) in patients presenting with Lymphocyte-Predominant Exudative pleural effusion (LPE) is challenging, due to the poor clinical utility of TB culture. Adenosine deaminase (ADA) has been recommended for diagnosis, but its high cost and limited availability hinder its clinical utility. We aim to develop diagnostic prediction tools for Thai patients with LPE in scenarios where pleural fluid ADA is available but yields negative results and in situations where pleural fluid ADA is not available. Methods Two diagnostic prediction tools were developed using retrospective data from patients with LPE at Surin Hospital. Model 1 is for ADA-negative results, and Model 2 is for situations where pleural fluid ADA testing is unavailable. The models were derived using multivariable logistic regression and presented as two clinical scoring systems: round-up and count scoring. The score cut-point that achieves a positive predictive value (PPV) comparable to the post-test probability of a pleural fluid ADA at a cut-point of 40 U/L was used as a threshold for initiating anti-TB treatment. Results A total of 359 patients were eligible for analysis, with 166 diagnosed with TPE and 193 diagnosed with non-TPE. Age <40 years, fever, pleural fluid protein ≥5 g/dL, male gender, pleural fluid color, and pleural fluid ADA ≥20 U/L were identified as final predictors. Both models demonstrated excellent discriminative ability (AuROC: 0.85 to 0.89). The round-up scoring demonstrated PPV above 90% at cut-off points of 4 and 4.5, while the count scoring achieved cut-off points of 3 and 4 for Model 1 (Lex-2P2A) and Model 2 (Lex-2P-MAC), respectively. Conclusion These diagnostic tools offer valuable assistance in differentiating between TPE and non-TPE in LPE patients with negative pleural fluid ADA (Lex-2P2A) and in settings where pleural fluid ADA testing is not available (Lex-2P-MAC). Implementing these diagnostic scores may have the potential to improve TPE diagnosis and facilitate prompt initiation of treatment.
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Affiliation(s)
| | | | | | - Lalita Lumkul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Multidisciplinary Technology for Advanced Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pakpoom Wongyikul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Musculoskeletal Science and Translational Research, Chiang Mai University, Chiang Mai, Thailand
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Litvinjenko S, Magwood O, Wu S, Wei X. Burden of tuberculosis among vulnerable populations worldwide: an overview of systematic reviews. THE LANCET. INFECTIOUS DISEASES 2023; 23:1395-1407. [PMID: 37696278 PMCID: PMC10665202 DOI: 10.1016/s1473-3099(23)00372-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/02/2023] [Accepted: 06/07/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Tuberculosis is a communicable disease of public health concern that inequitably impacts the most vulnerable populations worldwide. Vulnerable populations are those with a high risk for tuberculosis disease and whose disadvantaged or marginalised socioeconomic position limits their access to the health system. We conducted an overview of reviews that aimed to assess the burden (ie, prevalence and incidence) of tuberculosis disease among 12 vulnerable populations globally. METHODS We did an overview of reviews using a systematic search in MEDLINE, Embase, and the Cochrane Database for Systematic Reviews for articles published in English, French, and Chinese, from Jan 1, 2010 to March 8, 2023. We did an initial search on Oct 28, 2021, and updated our search on March 8, 2023. We included systematic and scoping reviews reporting on the prevalence or incidence of active tuberculosis among 12 vulnerable populations. Evidence gaps were supplemented with primary or secondary database studies. Study characteristics and outcome data related to tuberculosis burden were tabulated, including prevalence ratios and incidence rate ratios, and evidence was synthesised narratively. This trial is registered with PROSPERO (CRD42022324421). FINDINGS We screened 13 169 citations and included 44 publications (23 reviews and 21 primary or database studies) in the final synthesis. The comprehensiveness and methodological quality of the evidence differed across population groups. Prevalence of more than 1000 cases per 100 000 were reported in all vulnerable populations. On the basis of pooled estimates, prevalence ratios were often more than 25 among people experiencing homelessness, incarcerated populations, refugees, asylum seekers, and people living with HIV compared with the general population. Incidence was infrequently reported, with the best-available incidence rate ratios documented for people who were incarcerated. There was scarce evidence specific to miners, nomadic populations, sex workers, men who have sex with men, and transgender individuals. INTERPRETATION The burden of tuberculosis is substantially higher among vulnerable populations than general populations, suggesting a need for improved integration of these groups, including dedicated efforts for their identification, targeted screening and prevention measures, as well as treatment support. FUNDING WHO.
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Affiliation(s)
- Stefan Litvinjenko
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Olivia Magwood
- Bruyère Research Institute, Ottawa, ON, Canada; Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Shishi Wu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Pastana LF, Silva TA, Gellen LPA, Vieira GM, de Assunção LA, Leitão LPC, da Silva NM, Coelho RDCC, de Alcântara AL, Vinagre LWMS, Rodrigues JCG, Borges Leal DFDV, Fernandes MR, de Souza SJ, Kroll JE, Ribeiro-dos-Santos AM, Burbano RMR, Guerreiro JF, de Assumpção PP, Ribeiro-dos-Santos ÂC, dos Santos SEB, dos Santos NPC. The Genomic Profile Associated with Risk of Severe Forms of COVID-19 in Amazonian Native American Populations. J Pers Med 2022; 12:jpm12040554. [PMID: 35455670 PMCID: PMC9027999 DOI: 10.3390/jpm12040554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/11/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022] Open
Abstract
Genetic factors associated with COVID-19 disease outcomes are poorly understood. This study aimed to associate genetic variants in the SLC6A20, LZTFL1, CCR9, FYCO1, CXCR6, XCR1, and ABO genes with the risk of severe forms of COVID-19 in Amazonian Native Americans, and to compare the frequencies with continental populations. The study population was composed of 64 Amerindians from the Amazon region of northern Brazil. The difference in frequencies between the populations was analyzed using Fisher’s exact test, and the results were significant when p ≤ 0.05. We investigated 64 polymorphisms in 7 genes; we studied 47 genetic variants that were new or had impact predictions of high, moderate, or modifier. We identified 15 polymorphisms with moderate impact prediction in 4 genes (ABO, CXCR6, FYCO1, and SLC6A20). Among the variants analyzed, 18 showed significant differences in allele frequency in the NAM population when compared to others. We reported two new genetic variants with modifier impact in the Amazonian population that could be studied to validate the possible associations with COVID-19 outcomes. The genomic profile of Amazonian Native Americans may be associated with protection from severe forms of COVID-19. This work provides genomic data that may help forthcoming studies to improve COVID-19 outcomes.
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Affiliation(s)
- Lucas Favacho Pastana
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Thays Amâncio Silva
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Laura Patrícia Albarello Gellen
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Giovana Miranda Vieira
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Letícia Almeida de Assunção
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Luciana Pereira Colares Leitão
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Natasha Monte da Silva
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Rita de Cássia Calderaro Coelho
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Angélica Leite de Alcântara
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Lui Wallacy Morikawa Souza Vinagre
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Juliana Carla Gomes Rodrigues
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Diana Feio da Veiga Borges Leal
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Marianne Rodrigues Fernandes
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Sandro José de Souza
- Instituto do Cérebro, Universidade Federal do Rio Grande do Norte, Natal 59076-550, Brazil; (S.J.d.S.); (J.E.K.)
- BioME, Universidade Federal do Rio Grande do Norte, Natal 59078-400, Brazil
- Institute of Systems Genetics, West China Hospital, University of Sichuan, Chengdu 610041, China
| | - José Eduardo Kroll
- Instituto do Cérebro, Universidade Federal do Rio Grande do Norte, Natal 59076-550, Brazil; (S.J.d.S.); (J.E.K.)
| | - André Mauricio Ribeiro-dos-Santos
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém 66075-110, Brazil; (A.M.R.-d.-S.); (J.F.G.); (Â.C.R.-d.-S.)
| | - Rommel Mario Rodríguez Burbano
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - João Farias Guerreiro
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém 66075-110, Brazil; (A.M.R.-d.-S.); (J.F.G.); (Â.C.R.-d.-S.)
| | - Paulo Pimentel de Assumpção
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Ândrea Campos Ribeiro-dos-Santos
- Laboratório de Genética Humana e Médica, Universidade Federal do Pará, Belém 66075-110, Brazil; (A.M.R.-d.-S.); (J.F.G.); (Â.C.R.-d.-S.)
| | - Sidney Emanuel Batista dos Santos
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
| | - Ney Pereira Carneiro dos Santos
- Laboratório do Núcleo de Pesquisa em Oncologia, Universidade Federal do Pará, Belém 66073-000, Brazil; (L.F.P.); (T.A.S.); (L.P.A.G.); (G.M.V.); (L.A.d.A.); (L.P.C.L.); (N.M.d.S.); (R.d.C.C.C.); (A.L.d.A.); (L.W.M.S.V.); (J.C.G.R.); (D.F.d.V.B.L.); (M.R.F.); (R.M.R.B.); (P.P.d.A.); (S.E.B.d.S.)
- Correspondence: ; Tel.: +55-(91)-98107-0850
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