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Pahuja I, Ghoshal A, Okieh AA, Verma A, Negi K, Agarwal M, Chandra NS, Sharma SK, Bhaskar A, Dwivedi VP. Immunoinhibitory effects of anti-tuberculosis therapy induce the host vulnerability to tuberculosis recurrence. Microbiol Spectr 2024:e0041224. [PMID: 38809023 DOI: 10.1128/spectrum.00412-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/10/2024] [Indexed: 05/30/2024] Open
Abstract
The host immune responses play a pivotal role in the establishment of long-term memory responses, which effectively aids in infection clearance. However, the prevailing anti-tuberculosis therapy, while aiming to combat tuberculosis (TB), also debilitates innate and adaptive immune components of the host. In this study, we explored how the front-line anti-TB drugs impact the host immune cells by modulating multiple signaling pathways and subsequently leading to disease relapse. Administration of these drugs led to a reduction in innate immune activation and also the cytokines required to trigger protective T cell responses. Moreover, these drugs led to activation-induced cell death in the mycobacterial-specific T cell leading to a reduced killing capacity. Furthermore, these drugs stalled the T cell differentiation into memory subsets by modulating the activation of STAT3, STAT4, FOXO1, and NFκB transcription factors and hampering the Th1 and Th17-mediated long-term host protective memory responses. These findings suggest the urgent need to augment directly observed treatment, short-course (DOTS) therapy with immunomodulatory agents to mitigate the adverse effects linked to the treatment.IMPORTANCEAs a central component of TB eradication initiatives, directly observed treatment, short-course (DOTS) therapy imparts immune-dampening effects during the course of treatment. This approach undermines the host immune system by delaying the activation process and lowering the immune response. In our investigation, we have unveiled the impact of DOTS on specific immune cell populations. Notably, the signaling pathways involving STAT3 and STAT4 critical for memory responses and NFκβ associated with pro-inflammation were substantially declined due to the therapy. Consequently, these drugs exhibit limited effectiveness in preventing recurrence of the disease. These observations highlight the imperative integration of immunomodulators to manage TB infection.
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Affiliation(s)
- Isha Pahuja
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
- Department of Molecular Medicine, Jamia Hamdard University, New Delhi, India
| | - Antara Ghoshal
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ahmed Abdallah Okieh
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Akanksha Verma
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Kriti Negi
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Meetu Agarwal
- Department of Molecular Medicine, Jamia Hamdard University, New Delhi, India
| | - Nidhi Subhash Chandra
- Department of Microbiology, Ram Lal Anand College, University of Delhi, New Delhi, India
| | - Saurabh Kumar Sharma
- School of Computer & Systems Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Ashima Bhaskar
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
| | - Ved Prakash Dwivedi
- Immunobiology Group, International Centre for Genetic Engineering and Biotechnology, New Delhi, India
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Polidoro M, de Oliveira DC. Prevalence and Spatial Autocorrelation of Tuberculosis in Indigenous People in Brazil, 2002-2022. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01924-2. [PMID: 38300427 DOI: 10.1007/s40615-024-01924-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/02/2024]
Abstract
Tuberculosis (TB) among indigenous populations in Brazil poses a multifaceted public health challenge influenced by geographical, social, institutional, economic, and cultural factors. This study scrutinized the prevalence and spatial distribution of TB among Brazilian indigenous communities from 2002 to 2022. Employing a cross-sectional and descriptive approach, we analyzed data from the Notifiable Diseases Information System (SINAN) and conducted spatial autocorrelation tests to identify clusters and outliers. The findings uncovered substantial disparities in TB prevalence between the North and Central-West regions, in contrast to the South and Southeast, mirroring social, economic, and cultural inequalities in Brazil. It is concluded that public health strategies should not only consider the epidemiological aspects of TB but also encompass social and environmental determinants, notably the impact of climate change. Holistic and context-sensitive approaches are imperative for addressing TB within indigenous communities, underscoring the need for adaptive and culturally sensitive interventions in the public health landscape.
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Affiliation(s)
- Maurício Polidoro
- Federal Institute of Rio Grande do Sul, Coronel Vicente St., Historic Center, Porto Alegre, Rio Grande do Sul, 90030-041, Brazil.
| | - Daniel Canavese de Oliveira
- Federal University of Rio Grande do Sul, São Manoel St., Rio Branco, Porto Alegre, Rio Grande do Sul, 90620-110, Brazil.
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Patel S, Dadheech M, Maurya AK, Singh J, Purwar S, Rai N, Sarawagi R, Joshi A, Khadanga S. Assessment of the Diagnostic Utility of GeneXpert Mycobacterium tuberculosis/Rifampicin (MTB/RIF) Assay in the Suspected Cases of Tuberculous Meningitis. Cureus 2023; 15:e37761. [PMID: 37213979 PMCID: PMC10193876 DOI: 10.7759/cureus.37761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
INTRODUCTION Tuberculous meningitis (TBM) is a manifestation of extrapulmonary tuberculosis (EPTB) caused by Mycobacterium tuberculosis (MTB). The central nervous system is involved in about 1%-2% of all current tuberculosis (TB) cases and about 7%-8% of all EPTB. if not treated early, TBM leads to a high rate of neurological sequelae and mortality. OBJECTIVE This study aimed to assess the diagnostic performance of the GeneXpert MTB/rifampicin (RIF) assay in patients with TBM. METHODS A total of 100 suspected TBM cases were enrolled from various departments at tertiary care hospital, Bhopal, Madhya Pradesh, India, and classified as definite, possible, or probable TBM. The clinical samples were tested for microbiological and other cerebrospinal fluid (CSF) testing. RESULTS Out of 100 cases, 14 (14%) were classified as definite TBM, 15 (15%) were having probable TBM, and 71 (71%) were having possible TBM. Out of a total of 100 participants, all were negative for acid-fast bacilli (AFB) staining. Of the 100 cases, 11 (11%) were positive by mycobacterium growth indicator tube (MGIT) culture, of which only four (36.36%) were positive by GeneXpert MTB/RIF. GeneXpert MTB/RIF detected three (3%) cases that were negative by MGIT culture. Ten (90.9%) of the 11 MGIT-positive culture isolates were found to be RIF sensitive while one (9.1%) was found to be RIF resistant. Three cases tested positive/sensitive by the GeneXpert MTB/RIF but negative by MGIT culture. Six (85%) of the seven GeneXpert MTB/RIF positive cases were RIF sensitive while one (15%) was RIF resistant. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 36.36% (95% Confidence Interval (CI) (10.93% to 69.21%)), 96.63% (95% CI (90.46% to 99.30%)), 57.14% (95% CI (25.50% to 83.85%)), 92.47% (95% CI (88.70% to 95.06%)) and 90% (95% CI (82.38% to 95.10%)) for GeneXpert MTB/RIF assay, compared with MGIT culture as the reference standard. CONCLUSION Our study found that the sensitivity is lower when compared to culture, so using GeneXpert MTB/RIF alone is not recommended. Overall performance of GeneXpert MTB/RIF assay is noteworthy. The GeneXpert MTB/RIF assay is a potentially accepted test for obtaining an earlier diagnosis, and if it tested positive, the treatment should begin immediately. However, culture must be performed in GeneXpert MTB/RIF negative cases.
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Affiliation(s)
- Sakshi Patel
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Malti Dadheech
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Anand K Maurya
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Jitendra Singh
- Department of Translational Medicine Center, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Shashank Purwar
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Nirendra Rai
- Department of Neurology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Radha Sarawagi
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ankur Joshi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Sagar Khadanga
- Department of General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Vishwakarma D, Bhoi SR, Rannaware A. Latent Tuberculosis in India: An Overview. Cureus 2023; 15:e35706. [PMID: 37009383 PMCID: PMC10065373 DOI: 10.7759/cureus.35706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
Treatment of latent tuberculosis infection (LTBI) is essential for tuberculosis (TB) eradication. LTBI patients serve as a reservoir for active TB cases. The WHO's End TB Strategy now prioritises the detection and treatment of LTBI. A comprehensive approach focused on integrated LTBI control is required to accomplish this goal. This review aims to summarise what we know about LTBI in the existing literature, its prominence, diagnostic strategies, and new interventions to alert people of its occurrence and symptoms. We used Medical Subject Heading (MeSH) phrases to search for published publications on the English language in PubMed, Scopus, and Google Scholar. To provide clarity and impact, we examined several government websites to identify the most effective and current treatment regimens. LTBI is a spectrum of infections, such as intermittent, transitory, or progressive, with early, subclinical, and ultimately active TB cases. The global burden of LTBI cannot be firmly established because no "gold-standard" test exists. Screening is advised for high-risk individuals, such as immigrants, occupants and staff members of congregate living facilities, and those who are HIV-positive. The most reliable form of LTBI screening is still the targeted tuberculin skin test (TST). Although LTBI therapy is challenging, for India to become TB-free, it must first focus on testing and treating LTBI. The government should focus on generalising the new diagnostic criteria and adopting a more specific treatment known to all to eliminate TB once and for all.
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Zhong F, Zhao W, Wang L, Shen Y. Clinical application of Mycobacterium RT-PCR assay using various specimens for the rapid detection of lymph node tuberculosis: A diagnostic accuracy study. Medicine (Baltimore) 2023; 102:e33065. [PMID: 36827006 DOI: 10.1097/md.0000000000033065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
To evaluate the diagnostic accuracy of the Capital Bio Mycobacterium real-time polymerase chain reaction assay Capital Bio assay for lymph node (LN) tuberculosis (LNTB), and to further compare the effect of different types of LN specimens on the detection capability of the test. We retrospectively analyzed the medical records of LNTB patients who met the inclusion criteria. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of Capital Bio assay were calculated to evaluate its diagnostic accuracy compared with the final clinical diagnosis as reference standard. Three hundred sixty-four patients were included in the study. The overall sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of the Capital Bio assay for LNTB were 74.4%, 100.0%, 100.0%, 34.9%, and 0.87, respectively. For the pus specimens, these values for Capital Bio assay were 93.2%, 100.0%, 100.0%, 27.3%, 0.97, respectively. For the core needle biopsy specimens, these values were 65.9%, 100.0%, 100.0%, 33.3%, and 0.83, respectively. For the fine-needle aspiration specimens, these values were 60.0%, 100.0%, 100.0%, 53.9%, and 0.80, respectively. For the tissue, these values were 59.3%, 100.0%, 100.0%, 33.3%, 0.80, respectively. The Capital Bio assay had good effective for the diagnosis of LNTB. Compared to LN fine-needle aspiration and core needle biopsy specimens and tissue specimens, pus specimens were more suitable for molecular testing and had the best diagnostic efficacy.
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Affiliation(s)
- Fangming Zhong
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wuchen Zhao
- Zhejiang Tuberculosis Diagnosis and Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Linhua Wang
- Department of Hospital Infection, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi Shen
- Operation Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Chen J, Guo N, Ruan Y, Mai Y, Liao W, Feng Y. Isoniazid improves cognitive performance, clears Aβ plaques, and protects dendritic synapses in APP/PS1 transgenic mice. Front Aging Neurosci 2023; 15:1105095. [PMID: 36743440 PMCID: PMC9892762 DOI: 10.3389/fnagi.2023.1105095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/02/2023] [Indexed: 01/20/2023] Open
Abstract
Background and objective Alzheimer's disease (AD) is characterized by amyloid β (Aβ) aggregation and neuroinflammation. This study aimed to investigate the therapeutic effect of isoniazid (INH) against AD. Methods The APP/PS1 transgenic mouse model of AD was adopted. The APP/PS1 mice received oral INH (45 mg/kg/d) for 14 days. The cognitive capability was assessed by the Morris Water Maze test. Amyloid plaques and Aβ levels were determined by immunohistochemistry and ELISA assay. The dendritic spines were analyzed by DiOlistic labeling. Immunofluorescence staining was used to observe the microglia and astrocytes. Results The Morris Water Maze test suggested that INH administration can effectively attenuate the reference memory deficit and improve the working memory of the APP/PS1 mice compared to the untreated mice (all p < 0.001). INH significantly decreased the Aβ plaques in the hippocampus and cortex and reduced the levels of Aβ1-40 and Aβ1-42 in the brain homogenates, cerebrospinal fluid, and serum (all p < 0.001). INH also inhibited enzyme activities of β-site amyloid precursor protein cleaving enzyme 1 (BACE1, p < 0.05) and monoamine oxidase B (Mao-b, p < 0.01). INH significantly increased the protrusion density in the hippocampus (p < 0.01). Immunofluorescence staining revealed that INH significantly reduced the number of activated microglia and astrocytes around the Aβ plaques (both p < 0.01). Conclusion Isoniazid administration effectively improved cognitive performance, cleared Aβ plaques, protected dendritic synapses, and reduced innate immune cells around the Aβ plaques, suggesting that INH could be a potential drug for AD treatment.
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Affiliation(s)
- Jiacheng Chen
- Department of Neurology, National Key Clinical Department, Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, China
| | - Ning Guo
- Department of Neurosurgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuting Ruan
- Department of Rehabilitation, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yingren Mai
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wang Liao
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China,*Correspondence: Wang Liao, ✉
| | - Yanqing Feng
- Department of Neurology, National Key Clinical Department, Guangdong Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, Guangzhou, China,Yanqing Feng, ✉
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Shleeva MO, Kaprelyants AS. Hypobiosis of Mycobacteria: Biochemical Aspects. BIOCHEMISTRY (MOSCOW) 2023; 88:S52-S74. [PMID: 37069114 DOI: 10.1134/s0006297923140043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Under suboptimal growth conditions, bacteria can transit to the dormant forms characterized by a significantly reduced metabolic activity, resistance to various stress factors, and absence of cell proliferation. Traditionally, the dormant state is associated with the formation of highly differentiated cysts and spores. However, non-spore-forming bacteria can transfer to the dormant-like hypobiotic state with the generation of less differentiated cyst-like forms (which are different from spores). This review focuses on morphological and biochemical changes occurred during formation of dormant forms of mycobacteria in particular pathogenic M. tuberculosis (Mtb) caused latent forms of tuberculosis. These forms are characterized by the low metabolic activity, the absence of cell division, resistance to some antibiotics, marked morphological changes, and loss of ability to grow on standard solid media ("non-culturable" state). Being produced in vitro, dormant Mtb retained ability to maintain latent infection in mice. After a long period of dormancy, mycobacteria retain a number of stable proteins with a potential enzymatic activity which could participate in maintaining of low-level metabolic activity in period of dormancy. Indeed, the metabolomic analysis showed significant levels of metabolites in the dormant cells even after a long period of dormancy, which may be indicative of residual metabolism in dormant mycobacteria. Special role may play intracellularly accumulated trehalose in dormant mycobacteria. Trehalose appears to stabilize dormant cells, as evidenced by the direct correlation between the trehalose content and cell viability during the long-term dormancy. In addition, trehalose can be considered as a reserve energy substrate consumed during reactivation of dormant mycobacteria due to the ATP-dependent conversion of trehalase from the latent to the active state. Another feature of dormant mycobacteria is a high representation of proteins participating in the enzymatic defense against stress factors and of low-molecular-weight compounds protecting cells in the absence of replication. Dormant mycobacteria contain a large number of hydrolyzing enzymes, which, on the one hand, ensure inactivation of biomolecules damaged by stress. On the other hand, the products of these enzymatic reactions can be used for the maintenance of energy state and vital activity of bacterial cells during their long-term survival in the dormant state, i.e., for creating a situation that we propose to refer to as the "catabolic survival". In general, dormant non-replicating mycobacterial cells can be described as morphologically altered forms that contain principal macromolecules and are stabilized and protected from the damaging factors by an arsenal of proteins and low-molecular-weight compounds. Because of the presumable occurrence of metabolic reactions in such cells, this form of survival should be referred to as hypobiosis.
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Affiliation(s)
- Margarita O Shleeva
- A.N. Bach Institute of Biochemistry, Federal Research Centre "Fundamentals of Biotechnology" of the Russian Academy of Sciences, Moscow, 119071, Russia.
| | - Arseny S Kaprelyants
- A.N. Bach Institute of Biochemistry, Federal Research Centre "Fundamentals of Biotechnology" of the Russian Academy of Sciences, Moscow, 119071, Russia
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Atif M, Munir K, Malik I, Al-Worafi YM, Mushtaq I, Ahmad N. Perceptions of healthcare professionals and patients on the role of the pharmacist in TB management in Pakistan: A qualitative study. Front Pharmacol 2022; 13:965806. [PMID: 36588713 PMCID: PMC9798110 DOI: 10.3389/fphar.2022.965806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Globally, tuberculosis (TB) is the second major cause of death from infectious diseases, particularly in developing countries. A multidisciplinary approach to the management of TB may help to curb the disease burden. Objective: The objective of this study was to outline the perceptions of healthcare professionals and patients regarding the potential role of pharmacists in TB management in Pakistan. Method: This was a large-scale qualitative study conducted at the Chest Disease Unit (CDU) of the Bahawal Victoria Hospital (BVH), Punjab, Pakistan. Data were collected through semi-structured interviews with physicians, pharmacists, and patients recruited using a mix of convenient and snowball sampling. The sample size was decided through standard saturation point criteria. All interviews were audio recorded and transcribed verbatim. The data were analyzed to draw conclusions using a thematic analysis approach. Results: Analysis of the data yielded 19 categories and seven themes. Physicians considered pharmacists qualified healthcare professionals, whereas patients considered them merely dispensers. Inventory management and dispensing of medicines were considered as major responsibilities of pharmacists. Physicians were extremely overburdened and wanted to delegate certain duties to pharmacists, subject to their prior extensive trainings. However, most of the physicians were unaware of the legal scope of pharmacy practice in Pakistan. With regard to the potential duties of pharmacists, physicians, pharmacists, and patients (patients-upon explaining the potential roles during the interview) endorsed monitoring, counseling, medicine brand selection, dose adjustment, inventory management, dispensing, and polypharmacy assessment as their potential roles. In view of all stakeholders, the rationale for integrating pharmacists in TB management included overburdened physicians, sub-standard patient care, medication safety issues, and patient dissatisfaction. The healthcare professionals highlighted that the major barriers to integrating pharmacists within the TB management system were limited interest of regulatory authorities and policy makers, followed by inadequate training and experience-driven questionable competency of pharmacists. Conclusion: The study participants acknowledged the potential role of pharmacists in TB management. However, it was emphasized that healthcare policy makers should devise strategies to overcome the underlying barriers before assigning medicine-related clinical roles to pharmacists.
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Affiliation(s)
- Muhammad Atif
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan,*Correspondence: Muhammad Atif,
| | - Kiran Munir
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Iram Malik
- Department of Pharmacy Practice, Faculty of Pharmacy, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Yaser Mohammed Al-Worafi
- Department of Clinical Pharmacy, University of Science and Technology of Fujairah, Fujairah, United Arab Emirates
| | - Irem Mushtaq
- Department of Education, Faculty of Education, The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - Nafees Ahmad
- Department of Pharmacy Practice, Faculty of Pharmacy and Health Sciences, University of Baluchistan, Quetta, Pakistan
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Wang Y, Qu M, Liu Y, Wang H, Dong Y, Zhou X. KLK12 Regulates MMP-1 and MMP-9 via Bradykinin Receptors: Biomarkers for Differentiating Latent and Active Bovine Tuberculosis. Int J Mol Sci 2022; 23:ijms232012257. [PMID: 36293113 PMCID: PMC9603359 DOI: 10.3390/ijms232012257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/24/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
It has been established that kallikrein12 (KLK12) expression is closely related to bovine tuberculosis (bTB) development. Herein, we sought to clarify the regulatory mechanism of KLK12 and its application in tuberculosis diagnosis. KLK12 knockdown macrophages were produced by siRNA transfection. Bradykinin receptors (BR, including B1R and B2R) were blocked with specific inhibitors. Mannose-capped lipoarabinomannan (ManLAM) was extracted from Mycobacterium bovis (M. bovis) and used to study the mechanism of KLK12 activation. In addition, we constructed different mouse models representing the latent and active stages of M. bovis infection. Mouse models and clinical serum samples were used to assess the diagnostic value of biomarkers. Through the above methods, we confirmed that KLK12 regulates MMP-1 and MMP-9 via BR. KLK12 upregulation is mediated by the M. bovis-specific antigen ManLAM. KLK12, MMP-1, and MMP-9 harbor significant value as serological markers for differentiating between latent and active bTB, especially KLK12. In conclusion, we identified a novel signaling pathway, KLK12/BR/ERK/MMPs, in M. bovis-infected macrophages, which is activated by ManLAM. From this signaling pathway, KLK12 can be used as a serological marker to differentiate between latent and active bTB. Importantly, KLK12 also has enormous potential for the clinical diagnosis of human tuberculosis (TB).
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Du Y, Xin H, Cao X, Liu Z, He Y, Zhang B, Yan J, Wang D, Guan L, Shen F, Feng B, He Y, Liu J, Jin Q, Pan S, Zhang H, Gao L. Association Between Plasma Exosomes S100A9/C4BPA and Latent Tuberculosis Infection Treatment: Proteomic Analysis Based on a Randomized Controlled Study. Front Microbiol 2022; 13:934716. [PMID: 35935235 PMCID: PMC9355536 DOI: 10.3389/fmicb.2022.934716] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundIdentifying host plasma exosome proteins associated with host response to latent tuberculosis infection (LTBI) treatment might promote our understanding of tuberculosis (TB) pathogenesis and provide useful tools for implementing the precise intervention.MethodsBased on an open-label randomized controlled trial (RCT) aiming to evaluate the short-course regimens for LTBI treatment, plasma exosomes from pre- and post-LTBI treatment were retrospectively detected by label-free quantitative protein mass spectrometry and validated by a parallel reaction monitoring method for participants with changed or not changed infection testing results after LTBI treatment. Eligible participants for both screening and verification sets were randomly selected from the based-RCT in a 1:1 ratio by age and gender. Reversion was defined as a decrease in IFN-γ levels from >0.70 IU/ml prior to treatment to 0.20 IU/ml within 1 week of treatment. The predictive ability of the candidate proteins was evaluated by receiver operating characteristic (ROC) analysis.ResultsTotally, two sample sets for screening (n = 40) and validation (n = 60) were included. Each of them included an equal number of subjects with persistent positive or reversed QuantiFERON-TB Gold In-Tube (QFT) results after LTBI. A total of 2,321 exosome proteins were detected and 102 differentially expressed proteins were identified to be associated with QFT reversion. Proteins with high confidence and original values intact were selected to be further verified. Totally, 9 downregulated proteins met the criteria and were validated. After verification, C4BPA and S100A9 were confirmed to be still significantly downregulated (fold change <0.67, p < 0.05). The respective areas under the ROC curve were 0.73 (95% CI: 0.57–0.89) and 0.69 (95% CI: 0.52–0.86) for C4BPA and S100A9, with a combined value of 0.78 (95% CI: 0.63–0.93). The positive and negative predictive values for combined markers were 70.10% (95% CI: 50.22–86.30%) and 55.63% (95% CI: 29.17–61.00%).ConclusionOur findings suggest that downregulated C4BPA and S100A9 in plasma exosomes might be associated with a host positive response to LTBI treatment. Further studies are warranted to verify the findings and potential underlying mechanisms in varied populations with a larger sample size.
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Affiliation(s)
- Ying Du
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Henan Xin
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuefang Cao
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zisen Liu
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Yijun He
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Zhang
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Jiaoxia Yan
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Dakuan Wang
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
| | - Ling Guan
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Fei Shen
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Boxuan Feng
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongpeng He
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianmin Liu
- The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Qi Jin
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shouguo Pan
- Center for Diseases Control and Prevention of Zhongmu, Zhengzhou, China
- Shouguo Pan
| | - Haoran Zhang
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Haoran Zhang
| | - Lei Gao
- National Health Commission of the People's Republic of China (NHC) Key Laboratory of Systems Biology of Pathogens, Center for Tuberculosis Research, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Lei Gao
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11
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Innovations in Molecular Identification of Mycobacterium tuberculosis. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tuberculosis (TB) continues to be a significant public health concern on a global scale. Quick and precise identification of Mycobacterium tuberculosis (MTB) in symptomatic patients is pivotal for worldwide TB eradication initiatives. As an infectious disorder induced by MTB, it remains a critical threat to public health, particularly in poor countries, due to an inadequate diagnostic research laboratory. There is a need for a persistent incentive to reduce response time for effective diagnosis and control of TB infection, which is a benefit that molecular techniques provide over traditional methods. Although there is a tremendous overall prevalence of TB and a relatively poor probability of case identification worldwide. Common screening techniques have focused on tests that have many fundamental shortcomings. Due to the development of antibiotic-resistant Mycobacterium strains, TB is one of the leading contributors to fatalities. It is now possible to examine TB using molecular detection techniques, which are faster and more cost-effective than previous methods, such as standard culture procedures to test and verify antibiotic resistance in patients with TB. Whole genome sequencing (WGS), faster nucleic acid amplification tests, has made it easier to diagnose and treat TB more quickly. This article addresses the genetic approaches for detecting Mycobacterium tuberculosis complex (MTBC) in clinical specimens as well as antibiotic resistance in mycobacterium and discusses the practical limitations of using these methods.
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12
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Swaminathan N, Perloff SR, Zuckerman JM. Prevention of Mycobacterium tuberculosis Transmission in Health Care Settings. Infect Dis Clin North Am 2021; 35:1013-1025. [PMID: 34752218 DOI: 10.1016/j.idc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with tuberculosis (TB) pose a risk to other patients and health care workers, and outbreaks in health care settings occur when appropriate infection control measures are not used. This article discusses strategies to prevent transmission of Mycobacterium tuberculosis within health care settings. All health care facilities should have an operational TB infection control plan that emphasizes the use of a hierarchy of controls (administrative, environmental, and personal respiratory protection). Resources available to clinicians who work in the prevention and investigation of nosocomial transmission of M tuberculosis also are discussed.
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Affiliation(s)
- Neeraja Swaminathan
- Department of Medicine, Einstein Medical Center, Klein Building, Suite 300, 5501 Old York Road, Philadelphia, PA 19141, USA
| | - Sarah R Perloff
- Division of Infectious Disease, Department of Medicine, Einstein Medical Center, Klein Building, Suite 300, 5501 Old York Road, Philadelphia, PA 19141, USA; Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Jerry M Zuckerman
- Department of Patient Safety and Quality, Hackensack Meridian Health, Edison, NJ, USA; Hackensack Meridian School of Medicine, Nutley, NJ, USA.
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13
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Tarmohamed M, Mremi A, Mkwizu E, Paschal J, Sadiq A, Msuya D. Isolated gallbladder tuberculosis in an 84-year old man: A rare case report. Int J Surg Case Rep 2021; 87:106471. [PMID: 34628333 PMCID: PMC8515389 DOI: 10.1016/j.ijscr.2021.106471] [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: 08/23/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Isolated gallbladder tuberculosis is extremely rare even in endemic regions posing diagnostic challenges as the presentation mimics other gallbladder diseases such as cholecystitis and gallbladder carcinoma. Preoperative suspicion index is negligible with most cases being diagnosed postoperatively from resected specimen. CASE PRESENTATION Herein, we report an elderly man who presented with jaundice, and was clinically diagnosed with gallbladder carcinoma. DISCUSSION Histopathology of resected gallbladder revealed gallbladder tuberculosis. No features of tuberculous infection were found elsewhere. CONCLUSION Healthcare providers should have a high index of suspicion particularly for patients in endemic areas presenting with cholecystitis to obtain a pre-operative diagnosis.
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Affiliation(s)
- Murad Tarmohamed
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania.
| | - Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
| | - Elifuraha Mkwizu
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
| | - Joel Paschal
- Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
| | - Adnan Sadiq
- Department of Radiology, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Centre, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University College, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania
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14
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Jiang Y, Li Y, Liu C, Zhang L, Lv D, Weng Y, Cheng Z, Chen X, Zhan J, Zhang H. Isonicotinylation is a histone mark induced by the anti-tuberculosis first-line drug isoniazid. Nat Commun 2021; 12:5548. [PMID: 34545082 PMCID: PMC8452692 DOI: 10.1038/s41467-021-25867-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 09/02/2021] [Indexed: 12/02/2022] Open
Abstract
Isoniazid (INH) is a first-line anti-tuberculosis drug used for nearly 70 years. However, the mechanism underlying the side effects of INH has remained elusive. Here, we report that INH and its metabolites induce a post-translational modification (PTM) of histones, lysine isonicotinylation (Kinic), also called 4-picolinylation, in cells and mice. INH promotes the biosynthesis of isonicotinyl-CoA (Inic-CoA), a co-factor of intracellular isonicotinylation. Mass spectrometry reveals 26 Kinic sites in histones in HepG2 cells. Acetyltransferases CREB-binding protein (CBP) and P300 catalyse histone Kinic, while histone deacetylase HDAC3 functions as a deisonicotinylase. Notably, MNase sensitivity assay and RNA-seq analysis show that histone Kinic relaxes chromatin structure and promotes gene transcription. INH-mediated histone Kinic upregulates PIK3R1 gene expression and activates the PI3K/Akt/mTOR signalling pathway in liver cancer cells, linking INH to tumourigenicity in the liver. We demonstrate that Kinic is a histone acylation mark with a pyridine ring, which may have broad biological effects. Therefore, INH-induced isonicotinylation potentially accounts for the side effects in patients taking INH long-term for anti-tuberculosis therapy, and this modification may increase the risk of cancer in humans. Isoniazid (INH) is an anti-tuberculosis drug; however the underlying cause of its various side effects are not understood. Here the authors identified lysine isonicotinylation as a histone modification on chromatin that is metabolically regulated by INH and its metabolites.
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Affiliation(s)
- Yuhan Jiang
- Program for Cancer and Cell Biology, Department of Human Anatomy, Histology and Embryology, PKU International Cancer Institute, MOE Key Laboratory of Carcinogenesis and Translational Research and State Key Laboratory of Natural and Biomimetic Drugs, Peking University Health Science Center, Beijing, PR China
| | - Yixiao Li
- Program for Cancer and Cell Biology, Department of Human Anatomy, Histology and Embryology, PKU International Cancer Institute, MOE Key Laboratory of Carcinogenesis and Translational Research and State Key Laboratory of Natural and Biomimetic Drugs, Peking University Health Science Center, Beijing, PR China
| | - Cheng Liu
- Program for Cancer and Cell Biology, Department of Human Anatomy, Histology and Embryology, PKU International Cancer Institute, MOE Key Laboratory of Carcinogenesis and Translational Research and State Key Laboratory of Natural and Biomimetic Drugs, Peking University Health Science Center, Beijing, PR China
| | - Lei Zhang
- Program for Cancer and Cell Biology, Department of Human Anatomy, Histology and Embryology, PKU International Cancer Institute, MOE Key Laboratory of Carcinogenesis and Translational Research and State Key Laboratory of Natural and Biomimetic Drugs, Peking University Health Science Center, Beijing, PR China
| | - Danyu Lv
- Program for Cancer and Cell Biology, Department of Human Anatomy, Histology and Embryology, PKU International Cancer Institute, MOE Key Laboratory of Carcinogenesis and Translational Research and State Key Laboratory of Natural and Biomimetic Drugs, Peking University Health Science Center, Beijing, PR China
| | - Yejing Weng
- Jingjie PTM BioLab Co. Ltd., Hangzhou Economic and Technological Development Area, Hangzhou, PR China
| | - Zhongyi Cheng
- Jingjie PTM BioLab Co. Ltd., Hangzhou Economic and Technological Development Area, Hangzhou, PR China
| | - Xiangmei Chen
- Department of Microbiology & Infectious Disease Center, Peking University Health Science Center, Beijing, PR China
| | - Jun Zhan
- Program for Cancer and Cell Biology, Department of Human Anatomy, Histology and Embryology, PKU International Cancer Institute, MOE Key Laboratory of Carcinogenesis and Translational Research and State Key Laboratory of Natural and Biomimetic Drugs, Peking University Health Science Center, Beijing, PR China
| | - Hongquan Zhang
- Program for Cancer and Cell Biology, Department of Human Anatomy, Histology and Embryology, PKU International Cancer Institute, MOE Key Laboratory of Carcinogenesis and Translational Research and State Key Laboratory of Natural and Biomimetic Drugs, Peking University Health Science Center, Beijing, PR China.
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15
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Syahridha S, Massi N, Ahmad A, Djaharuddin I. Associated Factors of the Results of Pulmonary Tuberculosis Treatment During the COVID-19 Pandemic in Makassar City. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: A regimen directly observed treatment-short course is recommended by the World Health Organization as a strategy for controlling tuberculosis (TB).
AIM: This treatment was carried out for 6 months despite the COVID-19 pandemic situation. The purpose of the study was to determine the factors associated with the treatment outcomes of pulmonary TB undergoing treatment during the COVID-19 pandemic, with the research target was Category I pulmonary TB patients.
METHOD: The type of research was observational analytic with a cohort study design. This research was conducted at the Pulmonary Center in October 2020-May 2021 involved 62 samples.
RESULTS: About 75.8% (47 respondents) successfully treated and 24.2% (15 respondents) decided unsuccessful. There was a significant association between diabetes status (p = 0.014), anemia status (p = 0.035), knowledge of TB (p = 0.009), knowledge of COVID-19 (p = 0.014), and family history of COVID-19 exposure (p = 0.011) to the treatment outcomes of pulmonary TB treatment during the pandemic.
CONCLUSION: Associated factors to the outcome of treatment for pulmonary TB patients undergoing TB treatment during a pandemic included diabetes mellitus status, anemia status, knowledge of TB, knowledge of COVID-19, and family history of exposure to COVID-19.
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16
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Alene KA, Xu Z, Bai L, Yi H, Tan Y, Gray DJ, Viney K, Clements ACA. Spatiotemporal Patterns of Tuberculosis in Hunan Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136778. [PMID: 34202504 PMCID: PMC8297355 DOI: 10.3390/ijerph18136778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/04/2021] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB) is the leading cause of death from a bacterial pathogen worldwide. China has the third highest TB burden in the world, with a high reported burden in Hunan Province (amongst others). This study aimed to investigate the spatial distribution of TB and identify socioeconomic, demographic, and environmental drivers in Hunan Province, China. Numbers of reported cases of TB were obtained from the Tuberculosis Control Institute of Hunan Province, China. A wide range of covariates were collected from different sources, including from the Worldclim database, and the Hunan Bureau of Statistics. These variables were summarized at the county level and linked with TB notification data. Spatial clustering of TB was explored using Moran’s I statistic and the Getis–Ord statistic. Poisson regression models were developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using a Bayesian approach with Markov chain Monte Carlo (MCMC) simulation. A total of 323,340 TB cases were reported to the Hunan TB Control Institute from 2013 to 2018. The mean age of patients was 51.7 years (SD + 17.6 years). The majority of the patients were male (72.6%, n = 234,682) and had pulmonary TB (97.5%, n = 315,350). Of 319,825 TB patients with registered treatment outcomes, 306,107 (95.7%) patients had a successful treatment outcome. The annual incidence of TB decreased over time from 85.5 per 100,000 population in 2013 to 76.9 per 100,000 population in 2018. TB case numbers have shown seasonal variation, with the highest number of cases reported during the end of spring and the beginning of summer. Spatial clustering of TB incidence was observed at the county level, with hotspot areas detected in the west part of Hunan Province. The spatial clustering of TB incidence was significantly associated with low sunshine exposure (RR: 0.86; 95% CrI: 0.74, 0.96) and a low prevalence of contraceptive use (RR: 0.88; 95% CrI: 0.79, 0.98). Substantial spatial clustering and seasonality of TB incidence were observed in Hunan Province, with spatial patterns associated with environmental and health care factors. This research suggests that interventions could be more efficiently targeted at locations and times of the year with the highest transmission risk.
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Affiliation(s)
- Kefyalew Addis Alene
- Faculty of Health Sciences, Curtin University, Perth 6102, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth 6009, Australia
| | - Zuhui Xu
- Department of Tuberculosis Control, Tuberculosis Control Institute of Hunan Province, Changsha 410000, China
| | - Liqiong Bai
- Department of Director's Office, Hunan Chest Hospital, Changsha 410013, China
| | - Hengzhong Yi
- Department of MDR-TB, Internal Medicine, Hunan Chest Hospital, Changsha 410013, China
| | - Yunhong Tan
- Department of MDR-TB, Internal Medicine, Hunan Chest Hospital, Changsha 410013, China
| | - Darren J Gray
- Research School of Population Health, the Australian National University, Canberra 2601, Australia
| | - Kerri Viney
- Research School of Population Health, the Australian National University, Canberra 2601, Australia
- Department of Global Public Health, Karolinska Institutet, 141 83 Stockholm, Sweden
- School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth 6102, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth 6009, Australia
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17
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Pathak L, Das B. Initiation of Post-Primary Tuberculosis of the Lungs: Exploring the Secret Role of Bone Marrow Derived Stem Cells. Front Immunol 2021; 11:594572. [PMID: 33584661 PMCID: PMC7873989 DOI: 10.3389/fimmu.2020.594572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/03/2020] [Indexed: 01/01/2023] Open
Abstract
Mycobacterium tuberculosis (Mtb), the causative organism of pulmonary tuberculosis (PTB) now infects more than half of the world population. The efficient transmission strategy of the pathogen includes first remaining dormant inside the infected host, next undergoing reactivation to cause post-primary tuberculosis of the lungs (PPTBL) and then transmit via aerosol to the community. In this review, we are exploring recent findings on the role of bone marrow (BM) stem cell niche in Mtb dormancy and reactivation that may underlie the mechanisms of PPTBL development. We suggest that pathogen's interaction with the stem cell niche may be relevant in potential inflammation induced PPTBL reactivation, which need significant research attention for the future development of novel preventive and therapeutic strategies for PPTBL, especially in a post COVID-19 pandemic world. Finally, we put forward potential animal models to study the stem cell basis of Mtb dormancy and reactivation.
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Affiliation(s)
- Lekhika Pathak
- Department of Stem Cell and Infectious Diseases, KaviKrishna Laboratory, Guwahati Biotech Park, Indian Institute of Technology, Guwahati, India
- KaviKrishna Telemedicine Care, Sualkuchi, India
| | - Bikul Das
- Department of Stem Cell and Infectious Diseases, KaviKrishna Laboratory, Guwahati Biotech Park, Indian Institute of Technology, Guwahati, India
- KaviKrishna Telemedicine Care, Sualkuchi, India
- Department of Stem Cell and Infection, Thoreau Laboratory for Global Health, M2D2, University of Massachusetts, Lowell, MA, United States
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18
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Byrne AS, Goudreau A, Bissonnette N, Shamputa IC, Tahlan K. Methods for Detecting Mycobacterial Mixed Strain Infections-A Systematic Review. Front Genet 2020; 11:600692. [PMID: 33408740 PMCID: PMC7779811 DOI: 10.3389/fgene.2020.600692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/19/2020] [Indexed: 12/22/2022] Open
Abstract
Mixed strain infection (MSI) refers to the concurrent infection of a susceptible host with multiple strains of a single pathogenic species. Known to occur in humans and animals, MSIs deserve special consideration when studying transmission dynamics, evolution, and treatment of mycobacterial diseases, notably tuberculosis in humans and paratuberculosis (or Johne's disease) in ruminants. Therefore, a systematic review was conducted to examine how MSIs are defined in the literature, how widespread the phenomenon is across the host species spectrum, and to document common methods used to detect such infections. Our search strategy identified 121 articles reporting MSIs in both humans and animals, the majority (78.5%) of which involved members of the Mycobacterium tuberculosis complex, while only a few (21.5%) examined non-tuberculous mycobacteria (NTM). In addition, MSIs exist across various host species, but most reports focused on humans due to the extensive amount of work done on tuberculosis. We reviewed the strain typing methods that allowed for MSI detection and found a few that were commonly employed but were associated with specific challenges. Our review notes the need for standardization, as some highly discriminatory methods are not adapted to distinguish between microevolution of one strain and concurrent infection with multiple strains. Further research is also warranted to examine the prevalence of NTM MSIs in both humans and animals. In addition, it is envisioned that the accurate identification and a better understanding of the distribution of MSIs in the future will lead to important information on the epidemiology and pathophysiology of mycobacterial diseases.
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Affiliation(s)
| | - Alex Goudreau
- Science & Health Sciences Librarian, University of New Brunswick, Saint John, NB, Canada
| | - Nathalie Bissonnette
- Sherbrooke Research and Development Center, Agriculture and Agri-Food Canada, Sherbrooke, QC, Canada
| | - Isdore Chola Shamputa
- Department of Nursing & Health Sciences, University of New Brunswick, Saint John, NB, Canada
| | - Kapil Tahlan
- Department of Biology, Memorial University of Newfoundland, St. John's, NL, Canada
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19
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Guevara Salazar JA, Morán Díaz JR, Ramírez Segura E, Trujillo Ferrara JG. What are the origins of growing microbial resistance? Both Lamarck and Darwin were right. Expert Rev Anti Infect Ther 2020; 19:563-569. [PMID: 33073640 DOI: 10.1080/14787210.2021.1839418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Microorganisms of clinical importance frequently develop resistance to drug therapy, now a growing problem. The experience with Mycobacterium tuberculosis is a representative example of increasing multi-drug resistance. To avoid reaching a crisis in which patients could be left without adequate treatment, a new strategy is needed. Anti-microbial therapy has historically targeted the mechanisms rather than origin of drug resistance, thus allowing microorganisms to adapt and survive. AREAS COVERED This contribution analyses the historical development (1943-2020) of the evolution of multi-drug resistance by M. tuberculosis strains in light of Darwin's and Lamarck's theories of evolution. EXPERT OPINION Regarding the molecular origin of microbial drug resistance, genetic mutations and epigenetic modifications are known to participate. The analysis of the history of drug resistance by M. tuberculosis evidences a gradual development of resistance to some antibiotics, undoubtedly due to random mutations together with natural selection based on environmental pressures (e.g., antibiotics), representing Darwin's idea. More rapid adaptation of M. tuberculosis to new antibiotic treatments has also occurred, probably because of heritable acquired characteristics, evidencing Lamarck's proposal. Therefore, microbial infections should be treated with an antibiotic producing null or low mutagenic activity along with a resistance inhibitor, preferably in a single medication.
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Affiliation(s)
- Juan Alberto Guevara Salazar
- Departamento De Farmacología, Escuela Superior De Medicina, Instituto Politécnico Nacional, Ciudad De México, CDMX, Mexico
| | - Jessica Rubí Morán Díaz
- Departamento De Farmacología, Escuela Superior De Medicina, Instituto Politécnico Nacional, Ciudad De México, CDMX, Mexico
| | - Enrique Ramírez Segura
- Laboratorio De Bioquímica Médica, Escuela Superior De Medicina, Instituto Politécnico Nacional, Ciudad De México, CDMX, Mexico
| | - José Guadalupe Trujillo Ferrara
- Laboratorio De Bioquímica Médica, Escuela Superior De Medicina, Instituto Politécnico Nacional, Ciudad De México, CDMX, Mexico
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20
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Imam F, Sharma M, Khayyam KU, Khan MR, Ali MD, Qamar W. Determination of isoniazid acetylation patterns in tuberculosis patients receiving DOT therapy under the Revised National tuberculosis Control Program (RNTCP) in India. Saudi Pharm J 2020; 28:641-647. [PMID: 32550793 PMCID: PMC7292862 DOI: 10.1016/j.jsps.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/07/2020] [Indexed: 11/25/2022] Open
Abstract
Monitoring of liver function tests is very important in patient receiving DOT therapy. There was no significance difference reported in the differential leucocytes count. We define mechanisms underlying the adverse drug reactions observed following DOTS. The plasma INH concentration was reported to be high in slow acetylation. Plasma INH concentration greater than the antimode are slow acetylator.
Isoniazid is the most commonly used drug for treatment of tuberculosis, and is administered individually or in combination with other drugs as standard first line therapy. Offsetting its efficacy, severe adverse effects, especially peripheral neuropathy and hepatotoxicity, are associated with isoniazid therapy, limiting its use in tuberculosis. Isoniazid is acetylated in vivo producing hydrazine and acetyl hydrazine, which are responsible for hepatotoxicity. Marked pharmacogenetic differences in acetylation have been reported among different population across the globe. This study evaluates isoniazid acetylation patterns in tuberculosis patients receiving DOT therapy under the Revised National Tuberculosis Control Program (RNTCP) in a specialized tuberculosis hospital in north India. Of 351 patients from whom samples were taken for biochemical analysis of adverse events, 36 were assessed for acetylation patterns. Blood samples were taken 1 h after administration of a 600 mg dose of isoniazid, and plasma concentrations of isoniazid were determined using a validated HPLC method. Of these 36 patients, 20 (55.56%) were slow acetylators and 16 (44.44%) were fast acetylators. Our results are consistent with those of an earlier study conducted in a different region of India. Most biochemical changes produced during long-term isoniazid therapy resolve after therapy is terminated.
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Affiliation(s)
- Faisal Imam
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Hamdard University, New Delhi 110062, India
| | - Khalid Umer Khayyam
- Department of Epidemiology & Public Health, National Institute of Tuberculosis & Respiratory Diseases, New Delhi 110030, India
| | - Mohammad Rashid Khan
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, P.O. Box: 2457, Riyadh 11451, Saudi Arabia
| | - Mohammad Daud Ali
- Mohammed Al-Mana College for Medical Sciences, Abdulrazaq Bin Hammam Street, As Safa, Dammam 34222, Saudi Arabia
| | - Wajhul Qamar
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Central Laboratory Research Center, P.O. Box 2457, Riyadh 11451, Saudi Arabia
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21
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Moriguchi M, Koh H, Hayashi T, Okamura H, Nanno S, Nakashima Y, Nakane T, Imoto W, Yamada K, Kakeya H, Hino M, Nakamae H. Clinical usefulness of very high serum soluble interleukin-2 receptor levels for the detection of tuberculous peritonitis in a patient with chronic myelogenous leukemia. J Infect Chemother 2020; 26:1054-1057. [PMID: 32505444 DOI: 10.1016/j.jiac.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/15/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
Abstract
Tuberculous peritonitis is difficult to diagnose due to the disadvantages of ascitic culture and peritoneal biopsy. Although previous reports suggested that very high serum soluble interleukin-2 receptor (sIL-2R) levels may reflect the clinical activity of tuberculosis, little is known about the diagnostic utility of serum sIL-2R for tuberculous peritonitis. We describe a case of tuberculous peritonitis with chronic myelogenous leukemia. The abnormally high serum sIL-2R value and negative findings for other possible causes including lymphoma suggested tuberculous peritonitis and we administered anti-tuberculosis treatment before definitive diagnosis. Abnormally high serum sIL-2R levels may contribute to earlier diagnosis of tuberculous peritonitis, along with ruling out other potential differential diagnoses.
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Affiliation(s)
- Makoto Moriguchi
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hideo Koh
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
| | - Tetsuya Hayashi
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroshi Okamura
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Satoru Nanno
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yasuhiro Nakashima
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Takahiko Nakane
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Waki Imoto
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan; Research Center for Infectious Disease Sciences (RCIDS), Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Koichi Yamada
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan; Research Center for Infectious Disease Sciences (RCIDS), Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Graduate School of Medicine, Osaka City University, Osaka, Japan; Research Center for Infectious Disease Sciences (RCIDS), Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Masayuki Hino
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hirohisa Nakamae
- Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan
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22
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Zhong H, Wu H, Yu Z, Zhang Q, Huang Q. Clinical evaluation of the T-SPOT.TB test for detection of tuberculosis infection in northeastern Guangdong Province, China. J Int Med Res 2020; 48:300060520923534. [PMID: 32475200 PMCID: PMC7263121 DOI: 10.1177/0300060520923534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 04/09/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We evaluated clinical performance of the T-SPOT.TB test for detecting tuberculosis (TB) infection in Meizhou, China. METHODS We enrolled 2,868 patients who underwent T-SPOT.TB, smear, and TB-DNA at the same time. The tests' sensitivity and specificity were evaluated and compared in different groups, and in pulmonary TB (PTB) and extrapulmonary TB (EPTB) subgroups. Receiver operator characteristic (ROC) curve analysis was used to evaluate T-SPOT.TB's diagnostic value and determine its cutoff value. RESULTS T-SPOT.TB, TB-DNA, and sputum smear sensitivity was 61.44%, 37.12%, and 14.02%; and specificity was 76.49%, 99.20% and 99.60%, respectively. The T-SPOT.TB positive rate was higher in the PTB and EPTB subgroups than in patients with other pulmonary diseases (61.38% and 61.76% vs. 23.34%). The T-SPOT.TB test had better diagnostic accuracy and sensitivity when the positive cutoff value of marker ESAT-6 was 2.5 [area under ROC curve = 0.701, 95%CI 0.687-0.715] and marker CFP-10 was 6.5 [area under ROC curve = 0.669, 95%CI 0.655-0.683]. CONCLUSION T-SPOT.TB sensitivity was higher than that of TB-DNA or sputum smear, but the specificity was lower. T-SPOT.TB had moderate sensitivity and specificity for diagnosing TB. T-SPOT.TB's new positive cutoff value may be clinically valuable according to ROC analysis.
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Affiliation(s)
- Hua Zhong
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Heming Wu
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Zhikang Yu
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Qunji Zhang
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Qingyan Huang
- Center for Precision Medicine, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
- Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People’s Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
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Lakoh S, Jiba DF, Adekanmbi O, Poveda E, Sahr F, Deen GF, Foray LM, Gashau W, Hoffmann CJ, Salata RA, Yendewa GA. Diagnosis and treatment outcomes of adult tuberculosis in an urban setting with high HIV prevalence in Sierra Leone: A retrospective study. Int J Infect Dis 2020; 96:112-118. [PMID: 32339724 DOI: 10.1016/j.ijid.2020.04.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess the diagnosis, treatment outcomes, and predictors of mortality in adult tuberculosis (TB) patients in an urban setting with a high HIV prevalence. METHODS A retrospective study was conducted of adult TB patients aged ≥15 years who were treated at Connaught Hospital in Freetown, Sierra Leone from January through December 2017. Multivariate logistic regression was used to identify predictors of mortality. RESULTS Of 1127 TB cases notified in 2017, 1105 (98%) were tested for HIV, yielding a TB/HIV co-infection rate of 32.0%. Only HIV-tested cases (n=1105) were included in the final analysis. The majority were male (69.3%), aged 25-34 years (29.2%), and had pulmonary TB (96.3%). Treatment outcomes were as follows: 29.0% cured, 29.0% completed, 0.5% treatment failure, 24.2% lost to follow-up, 12.8% transferred/not evaluated, and 4.5% died. The majority of deaths (80.0%, 40/50) occurred within 2 months of TB treatment initiation. Age 65 years or older (adjusted odds ratio 3.48, 95% confidence interval 1.15-10.56; p=0.027) and HIV-positive status (adjusted odds ratio 3.50, 95% confidence interval 1.72-7.12; p=0.001) were independent predictors of mortality. CONCLUSIONS Suboptimal TB treatment outcomes were observed in Sierra Leone in 2017. More local and international action is warranted to help achieve the 2035 global TB elimination targets.
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Affiliation(s)
- Sulaiman Lakoh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone.
| | - Darlinda F Jiba
- Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Olukemi Adekanmbi
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute, Complexo Hospitalario Universitario de Vigo, SERGAS-Vigo, Vigo, Spain
| | - Foday Sahr
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Gibrilla F Deen
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Department of Medicine, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Lynda M Foray
- National TB and Leprosy Control Programme, Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Wadzani Gashau
- College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | | | - Robert A Salata
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - George A Yendewa
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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24
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Erawati M, Andriany M. The Prevalence and Demographic Risk Factors for Latent Tuberculosis Infection (LTBI) Among Healthcare Workers in Semarang, Indonesia. J Multidiscip Healthc 2020; 13:197-206. [PMID: 32110034 PMCID: PMC7038397 DOI: 10.2147/jmdh.s241972] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose To determine the prevalence and demographic risk factors for latent tuberculosis infection (LTBI) among healthcare workers in Semarang, Indonesia. Methods A cross-sectional study involving 195 healthcare workers from 34 primary health centers was conducted from August to October 2019. The relationship between independent variables and dependent variables was analyzed using a multivariable logistic regression analysis. Results The prevalence of LTBI among healthcare workers in this study was 23.6%. Comorbidities were the only risk factor for LTBI identified among other risk factors (OR=3.39, 95% CI: 0.99–11.62, p=0.04). Other demographic factors such as age (OR=0.93, 95% CI: 0.45–1.92, p=0.839), gender (OR=0.79, 95% CI: 0.23–2.72, p=0.708, smoking habits (OR=2.54, 95% CI: 0.52–12.38, p=0.247), and length of work (OR=1.43, 95% CI: 0.70–2.91, p=0.331) were not significant risk factors for LTBI. Conclusion Healthcare workers suffering from comorbidity have a high risk for tuberculosis infection, and should not work in areas where they would be exposed to patients with tuberculosis. Healthcare workers need to apply occupational safety standards during contact with TB patients or specimens to minimize the disease transmission.
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Affiliation(s)
- Meira Erawati
- Department of Nursing, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Megah Andriany
- Department of Nursing, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
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25
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Di Renzo C, Tabrizian P, Kozuch DE, Fiel MI, Schwartz ME. Abdominal Tuberculosis Mimicking Cancer Clinically and on Fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) Imaging: A Two-Case Series. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e918901. [PMID: 32019906 PMCID: PMC7020736 DOI: 10.12659/ajcr.918901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Case series Patients: Male, 76-year-old • Male, 53-year-old Final Diagnosis: Disseminate tuberculosis and liver tuberculoma Symptoms: Fatigue Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Chiara Di Renzo
- Liver Surgery at Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.,Hepatobiliary and Liver Transplant Unit, Padova University Hospital, Padova, Italy
| | - Parissa Tabrizian
- Liver Surgery at Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - David E Kozuch
- Liver Surgery at Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Maria Isabel Fiel
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Myron E Schwartz
- Liver Surgery at Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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26
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Ali AOA, Prins MH. Mobile health to improve adherence to tuberculosis treatment in Khartoum state, Sudan. J Public Health Afr 2019; 10:1101. [PMID: 32257081 PMCID: PMC7118426 DOI: 10.4081/jphia.2019.1101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/21/2019] [Indexed: 11/22/2022] Open
Abstract
Although tuberculosis is a treatable disease, the high frequency of treatment default remains a challenge. The use of mobile phones structurally in a TB program has the potential to lower the frequency of default. However, it's impact on treatment outcome in Sudan has not yet been evaluated. The aim is to evaluate the potential use of cell phones for lowering treatment default. We conducted a controlled intervention pilot study during the period from 1st of May 2017 to 31st of March 2018, in eight TB treatment units in Khartoum state, Sudan. Newly diagnosed patient with positive sputum smear on DOTS therapy were enrolled in intervention and control groups. SMS reminder were sent to the intervention group.Assessments were done at the beginning and at the end of the treatment. One hundred and forty-eight patients were enrolled, seventy-four patients in each group.The participants in the two groups were similar in demographic characteristics and behavioral and knowledge related factors about TB disease at baseline. The patients in the intervention group had a lower default rate (6.8%), higher documented cure rate (78.4%), better knowledge compared to control group. SMS reminder was useful and facilitated good interaction between patients and health personnel. Mobile texting seemed useful and was highly accepted by participants. Further evaluation of it's potential benefit was warranted.
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Affiliation(s)
| | - Martin H. Prins
- Maastricht University Medical Centre, Maastricht, The Netherlands
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27
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Abstract
Infectious diseases are one of the main causes of morbidity and mortality worldwide. With new pathogens continuously emerging, known infectious diseases reemerging, increasing microbial resistance to antimicrobial agents, global environmental change, ease of world travel, and an increasing immunosuppressed population, recognition of infectious diseases plays an ever-important role in surgical pathology. This becomes particularly significant in cases where infectious disease is not suspected clinically and the initial diagnostic workup fails to include samples for culture. As such, it is not uncommon that a lung biopsy becomes the only material available in the diagnostic process of an infectious disease. Once the infectious nature of the pathological process is established, careful search for the causative agent is advised. This can often be achieved by examination of the hematoxylin and eosin-stained sections alone as many organisms or their cytopathic effects are visible on routine staining. However, ancillary studies such as histochemical stains, immunohistochemistry, in situ hybridization, or molecular techniques may be needed to identify the organism in tissue sections or for further characterization, such as speciation.
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Affiliation(s)
- Annikka Weissferdt
- Associate Professor, Department of Pathology, Division of Pathology and Laboratory Medicinec, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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28
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Khan SR, Manialawy Y, Siraki AG. Isoniazid and host immune system interactions: A proposal for a novel comprehensive mode of action. Br J Pharmacol 2019; 176:4599-4608. [PMID: 31517993 DOI: 10.1111/bph.14867] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/16/2019] [Accepted: 09/04/2019] [Indexed: 12/19/2022] Open
Abstract
The known mode of action of isoniazid (INH) is to inhibit bacterial cell wall synthesis following activation by the bacterial catalase-peroxidase enzyme KatG in Mycobacterium tuberculosis (Mtb). This simplistic model fails to explain (a) how isoniazid penetrates waxy granulomas with its very low lipophilicity, (b) how isoniazid kills latent Mtb lacking a typical cell wall, and (c) why isoniazid treatment time is remarkably long in contrast to most other antibiotics. To address these questions, a novel comprehensive mode of action of isoniazid has been proposed here. Briefly, isoniazid eradicates latent tuberculosis (TB) by prompting slow differentiation of pro-inflammatory monocytes and providing protection against reactive species-induced "self-necrosis" of phagocytes. In the case of active TB, different immune cells form INH-NAD+ adducts to inhibit Mtb's cell wall biosynthesis. This additionally suggests that the antibacterial properties of INH do not rely on KatG of Mtb. As such, isoniazid-resistant TB needs to be re-evaluated.
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Affiliation(s)
- Saifur R Khan
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Advanced Diagnostics, Metabolism, Toronto General Research Institute, Ontario, Canada
| | - Yousef Manialawy
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Advanced Diagnostics, Metabolism, Toronto General Research Institute, Ontario, Canada
| | - Arno G Siraki
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada
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29
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Ali MH, Alrasheedy AA, Kibuule D, Hassali MA, Godman B, Abdelwahab MF, Abbadi RY. Isoniazid acetylation phenotypes in the Sudanese population; findings and implications. J Clin Tuberc Other Mycobact Dis 2019; 17:100120. [PMID: 31788562 PMCID: PMC6879993 DOI: 10.1016/j.jctube.2019.100120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Isoniazid (INH) is the mainstay antimicrobial in the treatment of tuberculosis (TB). It is acetlylated in the liver to acetyl-INH. However, there is variation in rate of acetylation of INH among TB patients (i.e. fast, intermediate or slow acetylators) which impacts on the treatment outcomes. Aim The isoniazid acetylation phenotypes in the expatriate Sudanese population were determined to provide future guidance since TB is prevalent in Sudan. Methods A community-based trial among Sudanese expatriates in Saudi Arabia was undertaken to identify INH-acetylation phenotypes. After overnight fasting, a single dose of 200 mg of INH was given to the volunteers. Three hours later, 5 ml of blood were drawn from each volunteer and prepared for High-Performance Liquid Chromatography (HPLC) analysis. The main outcomes were INH and Acetyl-INH concentrations in plasma and the subsequent Acetyl-INH/INH metabolic ratio (MR). Results The findings suggest that slow acetylation is highly prevalent among the study participants (n = 43; 84.31%). Moreover, there was no statistically significant correlation between age and the MR (r = −0.18, P = 0.20). Further, there was no significant association between gender and the MR (P = 0.124). Similarly, no significant association was found between smoking habits and MR (P = 0.24). Conclusion Isoniazid phenotyping suggests predominantly slow acetylation among the Sudanese in this sample. The study found no statistically significant associations between the MR and age or gender or smoking.
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Affiliation(s)
- Monadil H Ali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.,Faculty of Pharmacy, Northern Border University, Saudi Arabia
| | | | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia
| | - Brian Godman
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang, Malaysia.,Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | - Raef Y Abbadi
- Faculty of Pharmacy, Northern Border University, Saudi Arabia
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30
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Singh AP, Biswas A, Shukla A, Maiti P. Targeted therapy in chronic diseases using nanomaterial-based drug delivery vehicles. Signal Transduct Target Ther 2019; 4:33. [PMID: 31637012 PMCID: PMC6799838 DOI: 10.1038/s41392-019-0068-3] [Citation(s) in RCA: 242] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023] Open
Abstract
The application of nanomedicines is increasing rapidly with the promise of targeted and efficient drug delivery. Nanomedicines address the shortcomings of conventional therapy, as evidenced by several preclinical and clinical investigations indicating site-specific drug delivery, reduced side effects, and better treatment outcome. The development of suitable and biocompatible drug delivery vehicles is a prerequisite that has been successfully achieved by using simple and functionalized liposomes, nanoparticles, hydrogels, micelles, dendrimers, and mesoporous particles. A variety of drug delivery vehicles have been established for the targeted and controlled delivery of therapeutic agents in a wide range of chronic diseases, such as diabetes, cancer, atherosclerosis, myocardial ischemia, asthma, pulmonary tuberculosis, Parkinson's disease, and Alzheimer's disease. After successful outcomes in preclinical and clinical trials, many of these drugs have been marketed for human use, such as Abraxane®, Caelyx®, Mepact®, Myocet®, Emend®, and Rapamune®. Apart from drugs/compounds, novel therapeutic agents, such as peptides, nucleic acids (DNA and RNA), and genes have also shown potential to be used as nanomedicines for the treatment of several chronic ailments. However, a large number of extensive clinical trials are still needed to ensure the short-term and long-term effects of nanomedicines in humans. This review discusses the advantages of various drug delivery vehicles for better understanding of their utility in terms of current medical needs. Furthermore, the application of a wide range of nanomedicines is also described in the context of major chronic diseases.
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Affiliation(s)
- Akhand Pratap Singh
- School of Materials Science and Technology, Indian Institute of Technology (BHU), Varanasi, 221005 India
| | - Arpan Biswas
- School of Materials Science and Technology, Indian Institute of Technology (BHU), Varanasi, 221005 India
| | - Aparna Shukla
- School of Materials Science and Technology, Indian Institute of Technology (BHU), Varanasi, 221005 India
| | - Pralay Maiti
- School of Materials Science and Technology, Indian Institute of Technology (BHU), Varanasi, 221005 India
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31
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Abdelghany S, Parumasivam T, Pang A, Roediger B, Tang P, Jahn K, Britton WJ, Chan HK. Alginate modified-PLGA nanoparticles entrapping amikacin and moxifloxacin as a novel host-directed therapy for multidrug-resistant tuberculosis. J Drug Deliv Sci Technol 2019. [DOI: 10.1016/j.jddst.2019.05.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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32
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Bio-nanobactericides: an emanating class of nanoparticles towards combating multi-drug resistant pathogens. SN APPLIED SCIENCES 2019. [DOI: 10.1007/s42452-019-0715-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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33
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Babu D, Morgan AG, Reiz B, Whittal RM, Almas S, Lacy P, Siraki AG. Eosinophil peroxidase oxidizes isoniazid to form the active metabolite against M. tuberculosis, isoniazid-NAD . Chem Biol Interact 2019; 305:48-53. [PMID: 30922765 DOI: 10.1016/j.cbi.2019.03.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/14/2019] [Accepted: 03/21/2019] [Indexed: 11/24/2022]
Abstract
The formation of isonicotinyl-nicotinamide adenine dinucleotide (INH-NAD+) by the mycobacterial catalase-peroxidase enzyme, KatG, was known to be the major component of the mode of action of isoniazid (INH), an anti-tuberculosis drug. However, there are other enzymes that may catalyze this reaction. We have previously reported that neutrophil myeloperoxidase (MPO) is capable of metabolizing INH through the formation of INH-NAD+ adduct, which could be attributed to being a possible mode of action of INH. However, eosinophilic infiltration of the lungs is more pronounced and characteristic of granulomas in Mycobacterium tuberculosis-infected patients. Thus, the aim of the present study is to investigate the role of eosinophil peroxidase (EPO), a key eosinophil enzyme, during INH metabolism and the formation of its active metabolite, INH-NAD+ using purified EPO and eosinophils isolated from asthmatic donors. UV-Vis spectroscopy revealed INH oxidation by EPO led to a new product (λmax = 326 nm) in the presence of NAD+. This adduct was confirmed to be INH-NAD+ using LC-MS analysis where the intact adduct was detected (m/z = 769). Furthermore, EPO catalyzed the oxidation of INH and formed several free radical intermediates as assessed by electron paramagnetic resonance (EPR) spin-trapping; a carbon-centred radical, which is considered to be the reactive metabolite that binds with NAD+, was found when superoxide dismutase was included in the reaction. Our findings suggest that eosinophilic EPO may also play a role in the pharmacological activity of INH through the formation of INH-NAD+ adduct, and supports further evidence that human cells and enzymes are capable of producing the active metabolite involved in tuberculosis treatment.
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Affiliation(s)
- Dinesh Babu
- Faculty of Pharmacy and Pharmaceutical Sciences, Katz Group Centre for Pharmacy & Health Research, University of Alberta, Edmonton, AB, Canada
| | - Andrew G Morgan
- Faculty of Pharmacy and Pharmaceutical Sciences, Katz Group Centre for Pharmacy & Health Research, University of Alberta, Edmonton, AB, Canada
| | - Béla Reiz
- Department of Chemistry, Faculty of Sciences, University of Alberta, Edmonton, AB, Canada
| | - Randy M Whittal
- Department of Chemistry, Faculty of Sciences, University of Alberta, Edmonton, AB, Canada
| | - Sarah Almas
- Pulmonary Research Group, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Paige Lacy
- Pulmonary Research Group, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Arno G Siraki
- Faculty of Pharmacy and Pharmaceutical Sciences, Katz Group Centre for Pharmacy & Health Research, University of Alberta, Edmonton, AB, Canada.
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Almeida S, Valentim M, Neto C, Cerol M, Boticário M, Santos MI, Gameiro A. Extrapulmonary Tuberculosis Presenting as a Suspected Case of Metastatic Breast Cancer. Eur J Case Rep Intern Med 2019; 6:001062. [PMID: 30931280 PMCID: PMC6438115 DOI: 10.12890/2019_001062] [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: 01/29/2019] [Accepted: 02/13/2019] [Indexed: 11/05/2022] Open
Abstract
Extrapulmonary tuberculosis (TB) represents a diagnostic challenge. Bone TB is an uncommon and important presentation of extrapulmonary TB, which can lead to bone destruction, deformity and even paraplegia. Breast TB is rare and often confused with neoplasia, since the clinical and imaging presentations are not specific. Any of these extrapulmonary TB presentations, in the absence of cultural isolation of mycobacteria, oblige the exclusion of other diseases (secondary or infectious diseases). The authors report a case of multifocal extrapulmonary TB, as an example of the problem with the differential diagnosis of the disease. LEARNING POINTS Extrapulmonary TB remains a diagnostic challenge.Consider breast TB as a differential diagnosis of mammary nodules.A high level of suspicion is necessary to make an early diagnosis and start appropriate treatment before irreversible damage takes place.
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Affiliation(s)
- Sonia Almeida
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
| | - Marta Valentim
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
| | - Catarina Neto
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
| | - Marta Cerol
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
| | | | | | - Ana Gameiro
- Hospital Distrital De Santarem E.P.E., Santarém, Portugal
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Isoniazid induces a monocytic-like phenotype in HL-60 cells. Arch Biochem Biophys 2019; 664:15-23. [DOI: 10.1016/j.abb.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 12/31/2018] [Accepted: 01/06/2019] [Indexed: 02/08/2023]
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Hwang E, Szabo J, Federman A, Margolies LR. Reactivation tuberculosis presenting with unilateral axillary lymphadenopathy. Radiol Case Rep 2018; 13:1188-1191. [PMID: 30233757 PMCID: PMC6141701 DOI: 10.1016/j.radcr.2018.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 07/08/2018] [Indexed: 11/25/2022] Open
Abstract
Unilateral axillary lymphadenopathy has various benign and malignant etiologies. Although benign causes are more common, it is important to exclude malignant causes, including metastasis from primary breast carcinoma. Benign etiologies include reactive adenopathy, granulomatous disease, and collagen vascular disease. We present a case of unilateral right axillary lymphadenopathy in a patient with rheumatoid arthritis. The pathologic diagnosis of granulomatous lymphadenitis and interval discovery of patient's history of latent tuberculosis led to a second biopsy for special mycobacterial staining and cultures with a final diagnosis of reactivation tuberculosis. The extrapulmonary manifestation of reactivation tuberculosis with tuberculous lymphadenitis is uncommon and particularly rare in the axillary lymph nodes.
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Filate M, Mehari Z, Alemu YM. Longitudinal body weight and sputum conversion in patients with tuberculosis, Southwest Ethiopia: a retrospective follow-up study. BMJ Open 2018; 8:e019076. [PMID: 30185566 PMCID: PMC6129038 DOI: 10.1136/bmjopen-2017-019076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To describe the association between change in body weight and sputum smear conversion and to identify factors linked with body weight and sputum smear conversion in Jimma University Specialized Hospital, Southwest Ethiopia. DESIGN A retrospective follow-up study. SETTING Teaching hospital in Southwest Ethiopia. PARTICIPANTS A total of 450 patients with tuberculosis (TB) were included in the follow-up between 2011 and 2013. MAIN OUTCOME MEASURES The association between body weight and sputum conversion was measured using joint modelling. RESULTS The association between change in body weight and change in sputum conversion was -0.698 (p<0.001). A strong inverse association between change in body weight and change in sputum conversion was observed. The study variables sex, age, type of TB, HIV status, dose of anti-TB drug and length of enrolment to TB treatment were significantly associated with change in body weight of patients with TB. The study variables age, type of TB, dose of anti-TB drug and length of enrolment were significantly associated with change in sputum status of patients with TB. CONCLUSIONS Among patients with TB who were on anti-TB treatment, increase in body weight and positive sputum status were inversely related over time. TB prevention and control strategies should give emphasis on factors such as female sex, older age, non-pulmonary positive type of TB, HIV-positive, lower dose of anti-TB drug and length of enrolment to TB treatment during monitoring of trends in body weight and sputum status.
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Affiliation(s)
- Mersha Filate
- Department of Statistics, Jimma University, Jimma, Ethiopia
| | - Zelalem Mehari
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yihun Mulugeta Alemu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Tuberculosis at Raffic Hariri University Hospital (RHUH) during 10 years period 2005-2015, cross sectional, observational study. Indian J Tuberc 2018; 65:225-232. [PMID: 29933864 DOI: 10.1016/j.ijtb.2017.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/18/2017] [Accepted: 08/08/2017] [Indexed: 11/23/2022]
Abstract
AIM Tuberculosis is a contagious disease caused by Mycobacterium tuberculosis. It represents, according to WHO, one of the most leading causes of death worldwide.1 BACKGROUND: Based on our regional conditions, such as Syrian immigration, poor nutritional status, are contributors for the development of the disease. METHODS This was a retrospective analytical cross sectional study done to review all cases of tuberculosis newly diagnosed at RHUH during 10 years period (2005-2015). 128 TB labeled patients were retrieved. A standardized checklist was used to collect data. Patients were then classified as TB diseased and TB infected. RESULTS The total number of TB suspected patients was 128 over 10 years which represents 1.77% of all patients admitted to the medical floor. Among these, the total number of PPD positive patients was 40.6% from our study population (2005-2015), 48% were TB infected and 52% had positive CXR. Among those with positive CXR, 41% were confirmed TB disease and 59% not confirmed TB disease. There was significant variation in evolution through years (2005-2015). By comparing the socio-demographic findings between TB disease, TB infection and non-TB group no statistical significance was found. Same analysis were repeated between TB infection and TB disease groups showed one significant association between age and TB disease vs. TB infection (p=0.034), where the younger population belongs to TB infected group (42%), while 50% of TB diseased group were older. As for scoring severity index, ANOVA in the three groups showed a significant association with a p value of 0.046. The TB diseased patients have the highest severity score index. CONCLUSION TB disease is still present in Lebanon with fluctuating level with the highest peak found in 2013 explained by the influx of Syrian refugee population. Followed by a gradual drop in the following years. The younger population belongs to TB infected group, while TB disease patients had the most severe clinical course compared to TB infected and non TB patients.
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Abdel-Ghaf O, Abdel-Mone A, Abdel-Mohs S. Protective Effect of Naringenin Against Isoniazid-induced Adverse Reactions in Rats. INT J PHARMACOL 2018. [DOI: 10.3923/ijp.2018.667.680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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40
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Wirunsawanya K, Bolger DT. Surprising pathological and clinical manifestations of miliary tuberculosis. BMJ Case Rep 2018; 2018:bcr-2017-223360. [PMID: 29754134 DOI: 10.1136/bcr-2017-223360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a surprising pathological finding of miliary tuberculosis (TB) in a 49-year-old Chuukese, immunocompetent woman who was initially admitted to the hospital for a 1-month duration of chronic abdominal pain and intermittent fevers. Her clinical symptoms did not improve despite treatment with vancomycin and piperacillin-tazobactam. Based on the primary abdominal CT findings suggesting advanced ovarian cancer with omental metastatic disease, further workup with omental core biopsy was performed and demonstrated acute neutrophilic necrosis without malignant cells or granulomata. Within the omental tissue, however, many organisms stained positive for acid-fast bacilli despite lack of typical granulomata. The diagnosis of genitourinary TB was confirmed by urine Mycobacterium tuberculosis/rifampin automated molecular rapid nucleic acid amplification test. The chest CT showed a millet seed pattern of infiltration which is a hallmark for miliary TB. After initiation of multidrug TB therapy, her fever and abdominal pain drastically improved.
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Affiliation(s)
| | - Dennis Thomas Bolger
- Department of Medicine, University of Hawaii, Honolulu, Hawaii, USA.,Hospitalist Program, Queen's Medical Center, Honolulu, Hawaii, USA
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Automated real-time detection of drug-resistant Mycobacterium tuberculosis on a lab-on-a-disc by Recombinase Polymerase Amplification. Anal Biochem 2018; 544:98-107. [DOI: 10.1016/j.ab.2017.12.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/26/2017] [Accepted: 12/29/2017] [Indexed: 12/12/2022]
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Nurwidya F, Handayani D, Burhan E, Yunus F. Molecular Diagnosis of Tuberculosis. Chonnam Med J 2018; 54:1-9. [PMID: 29399559 PMCID: PMC5794472 DOI: 10.4068/cmj.2018.54.1.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/19/2017] [Accepted: 12/20/2017] [Indexed: 12/13/2022] Open
Abstract
Tuberculosis (TB) is one of the leading causes of adult death in the Asia-Pacific Region, including Indonesia. As an infectious disease caused by Mycobacterium tuberculosis (MTB), TB remains a major public health issue especially in developing nations due to the lack of adequate diagnostic testing facilities. Diagnosis of TB has entered an era of molecular detection that provides faster and more cost-effective methods to diagnose and confirm drug resistance in TB cases, meanwhile, diagnosis by conventional culture systems requires several weeks. New advances in the molecular detection of TB, including the faster and simpler nucleic acid amplification test (NAAT) and whole-genome sequencing (WGS), have resulted in a shorter time for diagnosis and, therefore, faster TB treatments. In this review, we explored the current findings on molecular diagnosis of TB and drug-resistant TB to see how this advancement could be integrated into public health systems in order to control TB.
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Affiliation(s)
- Fariz Nurwidya
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia Faculty of Medicine, Persahabatan Hospital, Jakarta, Indonesia
| | - Diah Handayani
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia Faculty of Medicine, Persahabatan Hospital, Jakarta, Indonesia
| | - Erlina Burhan
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia Faculty of Medicine, Persahabatan Hospital, Jakarta, Indonesia
| | - Faisal Yunus
- Department of Pulmonology and Respiratory Medicine, Universitas Indonesia Faculty of Medicine, Persahabatan Hospital, Jakarta, Indonesia
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Agarwal M, Shrivastav A, Waris A. Tubercular retinal vasculitis mimicking frosted branch angiitis: a case report. J Ophthalmic Inflamm Infect 2018; 8:3. [PMID: 29356903 PMCID: PMC5777968 DOI: 10.1186/s12348-018-0145-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tubercular vasculitis is an important manifestation of ocular tuberculosis and this report highlights the mimicking nature of the disease with frosted branch angiitis. RESULTS A patient presented with a severe form of retinal vasculitis in both eyes and a branch retinal vein occlusion in the left eye. He had a positive tuberculin skin test (TST) and a raised erythrocyte sedimentation rate (ESR) and serum angiotensin-converting enzyme (ACE) levels. Radiological investigations revealed a sub-pleural nodule and mediastinal lymph nodes, which on histopathological evaluation confirmed a granulomatous etiology. CONCLUSION Retinal vasculitis secondary to tubercular etiology may mimic a viral vasculitis; however, a clinical suspicion with a timely diagnosis and management helps in preventing loss of vision and the eye.
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Affiliation(s)
- Manisha Agarwal
- Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, 110002, India.
| | - Ankita Shrivastav
- Dr. Shroff's Charity Eye Hospital, 5027, Kedarnath Road, Daryaganj, New Delhi, 110002, India
| | - Abdul Waris
- Institute of Ophthalmology, Aligarh Muslim University, Aligarh, India
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Wondale B, Medihn G, Teklu T, Mersha W, Tamirat M, Ameni G. A retrospective study on tuberculosis treatment outcomes at Jinka General Hospital, southern Ethiopia. BMC Res Notes 2017; 10:680. [PMID: 29202880 PMCID: PMC5715540 DOI: 10.1186/s13104-017-3020-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/29/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Information on tuberculosis (TB) treatment outcomes would be useful for the improvement of the TB control program. The aim of the present study was to evaluate treatment outcomes of TB and identify associated factors in TB patients at the Jinka General Hospital (JGH), remote Zone of Ethiopia. RESULT The result showed that 13.1% (154/1172) of the cases were cured, 60.9% treatment completed, 10.2% died and 9.1% were lost to follow-up. Thus, the overall treatment success rate was 74%. Male patients [AOR = 0.70 (0.52-0.93)] and HIV co-infected patients [AOR = 0.67 (0.45-0.98)] were associated with unsuccessful treatment outcomes.
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Affiliation(s)
- Biniam Wondale
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Biology, Arba Minch University, Arba Minch, Ethiopia
| | - Girmay Medihn
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Takele Teklu
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Immunology and Molecular Biology, University of Gonder, Gonder, Ethiopia
| | | | | | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Rawal T, Kremer L, Halloum I, Butani S. Dry-Powder Inhaler Formulation of Rifampicin: An Improved Targeted Delivery System for Alveolar Tuberculosis. J Aerosol Med Pulm Drug Deliv 2017; 30:388-398. [DOI: 10.1089/jamp.2017.1379] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Tejal Rawal
- Institute of Pharmacy, Nirma University, Gujarat, Ahmedabad, India
| | - Laurent Kremer
- Centred'étude des Pathogènes et Biotechnologies pour la Santé, Montpellier, France
| | - Iman Halloum
- Centred'étude des Pathogènes et Biotechnologies pour la Santé, Montpellier, France
| | - Shital Butani
- Institute of Pharmacy, Nirma University, Gujarat, Ahmedabad, India
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46
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Ali MK, Karanja S, Karama M. Factors associated with tuberculosis treatment outcomes among tuberculosis patients attending tuberculosis treatment centres in 2016-2017 in Mogadishu, Somalia. Pan Afr Med J 2017; 28:197. [PMID: 29610635 PMCID: PMC5878850 DOI: 10.11604/pamj.2017.28.197.13439] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/29/2017] [Indexed: 11/20/2022] Open
Abstract
Introduction World Health Organization (WHO) reported that tuberculosis (TB) was a major health problem and the second leading cause of mortality globally. An estimated 1.8 million TB deaths were reported in 2015. In Somalia, the average TB incidence was 274 cases per 100,000 people in 2014; prevalence was 513 per 100,000 population; and mortality rate excluding human immune deficiency virus (HIV)/TB co-infection was 64/100,000. In addition, the prevalence rates of multi-drug resistant (MDR)-TB are still high, 5.2% among new cases and 40.7% for retreatment cases. The objective of this study was to determine individual and institutional level factors associated with TB treatment outcomes (TB-TOs) among patients attending TBTCs in Mogadishu. Methods The study design was cross-sectional, using quantitative and qualitative methods. Data was collected using interviewer administered semi-structured questionnaires and key in-depth interviews in 2016/2017. Qualitative data was coded using NVIVO8 and quantitative data analyzed using descriptive and inferential statistics at 95% confidence interval using SPSS20 software. Results The study used a sample of 385 TB patients. There were 315(81.8%) successful TB-TOs. Individual level factors-marital status, education level, HIV status, treatment category and knowledge on TB influenced TB-TOs (p-value < 0.05). Being married, educated, HIV-negative, new treatment case and knowledgeable on TB increased odds of successful TB-TOs (OR > 0, p value < 0.05) compared to other patients. TBTCs factors did not influence TB-TOs (p-value > 0.05). Conclusion TB-TOs were mainly affected by patient individual factors. There was need for patient education on TB management and treatment; and improved patient-health provider relationship.
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Affiliation(s)
- Marian Khalif Ali
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Simon Karanja
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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47
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Peritoneale Tuberkulose. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0145-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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48
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Ureidopyrazine Derivatives: Synthesis and Biological Evaluation as Anti-Infectives and Abiotic Elicitors. Molecules 2017; 22:molecules22101797. [PMID: 29065539 PMCID: PMC6151446 DOI: 10.3390/molecules22101797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) caused by Mycobacterium tuberculosis (Mtb) has become a frequently deadly infection due to increasing antimicrobial resistance. This serious issue has driven efforts worldwide to discover new drugs effective against Mtb. One research area is the synthesis and evaluation of pyrazinamide derivatives as potential anti-TB drugs. In this paper we report the synthesis and biological evaluations of a series of ureidopyrazines. Compounds were synthesized by reacting alkyl/aryl isocyanates with aminopyrazine or with propyl 5-aminopyrazine-2-carboxylate. Reactions were performed in pressurized vials using a CEM Discover microwave reactor with a focused field. Purity and chemical structures of products were assessed, and the final compounds were tested in vitro for their antimycobacterial, antibacterial, and antifungal activities. Propyl 5-(3-phenylureido)pyrazine-2-carboxylate (compound 4, MICMtb = 1.56 μg/mL, 5.19 μM) and propyl 5-(3-(4-methoxyphenyl)ureido)pyrazine-2-carboxylate (compound 6, MICMtb = 6.25 μg/mL, 18.91 μM) had high antimycobacterial activity against Mtb H37Rv with no in vitro cytotoxicity on HepG2 cell line. Therefore 4 and 6 are suitable for further structural modifications that might improve their biological activity and physicochemical properties. Based on the structural similarity to 1-(2-chloropyridin-4-yl)-3-phenylurea, a known plant growth regulator, two selected compounds were evaluated for similar activity as abiotic elicitors.
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Childs DS, Tracy SI, Thanarajasingam U. 46-Year-Old Man With Lower Back Pain. Mayo Clin Proc 2017; 92:e133-e137. [PMID: 28844304 DOI: 10.1016/j.mayocp.2017.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/11/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel S Childs
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Sean I Tracy
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Uma Thanarajasingam
- Advisor to residents and Consultant in Rheumatology, Mayo Clinic, Rochester, MN.
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50
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Mittal R, Sharma S, Rath S, Barik MR, Tripathy D. Orbital tuberculosis: Clinicopathological correlation and diagnosis using PCR in formalin-fixed tissues. Orbit 2017; 36:264-272. [PMID: 28678592 DOI: 10.1080/01676830.2017.1337169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 05/28/2017] [Indexed: 06/07/2023]
Abstract
This article describes the clinicopathological correlation and challenges encountered in the diagnosis of orbital tuberculosis (TB). Retrospective, interventional case series. A chart review of six patients who underwent biopsy for an orbital mass between January 2012 and December 2013 was performed. Institutional review board approval was obtained for the study. Clinical, radiological, and laboratory findings were documented, and response to antitubercular therapy (ATT) was noted. Age at presentation ranged from 18 to 64 years and duration of complaints varied from 2 weeks to 2 months. Pain, redness, and swelling with an orbital mass on computerized tomography (CT) were the common features. None of the patients was clinically suspected to have orbital TB at presentation. History of prior contact with a patient of TB and history of prior TB were present in one case each. Chest radiography (CXR) showed pulmonary consolidation in one case. Tuberculin skin test (TST) readings ranged from nonreactive to 23 mm. The presence of sputum acid fast bacilli (AFB) was tested in three cases and was negative. Polymerase chain reaction (PCR) for MPB64 gene was positive in all six cases. All cases responded to ATT. Clinical presentation of orbital TB can be variable and can simulate conditions like inflammatory disease and malignancy. Biopsy with histopathology plays a key role in diagnosis. Supportive laboratory investigations are necessary to clinch the diagnosis in cases where histopathology is suggestive of TB. In this regard, PCR for Mycobacterium tuberculosis (MTB) on tissue biopsy specimens may be a sensitive diagnostic tool.
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MESH Headings
- Adolescent
- Adult
- Antigens, Bacterial/genetics
- Antitubercular Agents/therapeutic use
- Bacterial Proteins/genetics
- DNA, Bacterial/genetics
- Eye Infections, Bacterial/diagnosis
- Eye Infections, Bacterial/drug therapy
- Eye Infections, Bacterial/genetics
- Female
- Fixatives
- Formaldehyde
- Humans
- Male
- Middle Aged
- Mycobacterium tuberculosis/isolation & purification
- Orbital Diseases/diagnosis
- Orbital Diseases/drug therapy
- Orbital Diseases/genetics
- Polymerase Chain Reaction
- Radiography, Thoracic
- Retrospective Studies
- Sputum/microbiology
- Tissue Fixation
- Tomography, X-Ray Computed
- Tuberculin Test
- Tuberculosis, Ocular/diagnosis
- Tuberculosis, Ocular/drug therapy
- Tuberculosis, Ocular/genetics
- Tuberculosis, Pulmonary/diagnosis
- Young Adult
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Affiliation(s)
- Ruchi Mittal
- a Ophthalmic Pathology Services , LV Prasad Eye Institute , Bhubaneswar , Odisha , India
| | - Savitri Sharma
- b Ocular Microbiology Services , LV Prasad Eye Institute , Bhubaneswar , Odisha , India
| | - Suryasnata Rath
- c Oculoplastics, Orbit and Ocular Oncology Services , LV Prasad Eye Institute , Bhubaneswar , Odisha , India
| | - Manas Ranjan Barik
- b Ocular Microbiology Services , LV Prasad Eye Institute , Bhubaneswar , Odisha , India
| | - Devjyoti Tripathy
- c Oculoplastics, Orbit and Ocular Oncology Services , LV Prasad Eye Institute , Bhubaneswar , Odisha , India
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