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Rahmati S, Nasehi M, Bahrampour A, Mirzazadeh A, Shahesmaeili A. Barriers and gaps in tuberculosis care and treatment in Iran: A multi-center qualitative study. J Clin Tuberc Other Mycobact Dis 2023; 31:100353. [PMID: 36874622 PMCID: PMC9982675 DOI: 10.1016/j.jctube.2023.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Introduction Patients with Tuberculosis (TB) still have barriers in accessing high quality care and treatment services. In this qualitative study, we investigated barriers in accessing TB health services including confirmatory diagnosis, treatment adherence and recurrence of pulmonary TB using patients, physicians, and policy makers point of view. Materials and methods In this qualitative research from November to March 2021, 3 policy makers from the Ministry of Health, 12 provincial TB experts and physicians from the TB control program and 33 patients diagnosed with TB from 4 provinces were enrolled for a semi-structured in-depth interview. All interviews were audio recorded and then transcribed. Framework analysis was done by MAXQDA 2018 software to identify key themes. Results Several barriers reported for TB care and treatment: Poor knowledge of patents about TB symptoms, failure to screen for TB among at-risk patients by physicians, similar symptoms between TB and other lung diseases, low sensitivity of TB diagnostic tests, incomplete case finding and contact-tracing, stigma related to TB, and patients poor adherence due to long TB treatment. In addition, COVID-19 pandemic disrupted TB services and decreased detection, care and treatment services for TB patients. Conclusion Our findings highlight the need for interventions to increase public and healthcare providers awareness about TB symptoms, using more sensitive diagnostic tests, and interventions to reduce stigma, and improve case finding and contact tracing effort. Improving patients' adherence required better monitoring and shorter effective treatment regimes.
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Affiliation(s)
- Shoboo Rahmati
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahshid Nasehi
- Department of Epidemiology, School of Health, Iran University of Medical Sciences, Iran
| | - Abbas Bahrampour
- Modeling in Health Research Center, Institute for Futures Studies in Health, Department of Biostatistics and Epidemiology, Faculty of Health Kerman University of Medical Sciences, Kerman, IRAN. Adjunct Professor of Griffith University, Brisbane, QLD, Australia
| | - Ali Mirzazadeh
- Department of Epidemiology and Biostatistics, University of California San Francisco, California, USA.,HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Tonne EO, Fosbøl MØ, Poulsen A, Nygaard U, Højgaard L, Borgwardt L. Imaging modalities for pulmonary tuberculosis in children: A systematic review. Eur J Radiol Open 2022; 10:100472. [PMID: 36624819 PMCID: PMC9823145 DOI: 10.1016/j.ejro.2022.100472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose The optimal choice of protocol for diagnostic imaging in children with tuberculosis (TB) is a contemporary challenge due to the war in Ukraine, which potentially can create a steep rise in TB cases in Western Europe. We aimed to gather all primary research comparing imaging modalities and their diagnostic accuracies for pulmonary findings in children with suspected or confirmed pulmonary tuberculosis (PTB). Method We searched the databases PubMed and Embase using pre-specified search terms, for English- and non-English published and un-published reports from the period 1972 to 2022. We retrieved reports via citation search in excluded literature reviews and systematic reviews. Studies were eligible if most of the study population was between 0 and 18 years of age with confirmed or suspected PTB, and study participants had described diagnostic images from two or more different imaging modalities. Results A total of 15 studies investigated conventional chest X-Ray (CXR) and computed tomography (CT) in diagnosing PTB in children. Nine studies investigated the number of participants in where CT or CXR confirmed the diagnosis of TB, and all of them, including a total of 1244 patients, reported that findings compatible with TB were more frequently detected on CT than CXR. Only two studies did not include radiological findings as part of their diagnostic criteria for PTB, and combined they showed that CT diagnosed 54/54 (100 %) children with confirmed PTB, while CXR diagnosed 42/54 (78 %). Two studies compared magnetic resonance imaging (MRI) with CXR and showed that MRI diagnosed more children with PTB than CXR. One study reported a higher positive predictive value (PPV), sensitivity and specificity for PTB findings for MRI than CXR. One study compared CXR with high-kilovolt (high-kV) CXR, finding compatible sensitivity and specificity regarding confirmation of PTB. Two studies compared ultrasound (US) with CXR and found that US had a higher diagnostic yield and more often correctly identified consolidations, mediastinal LAP, and pleural effusion. Conclusion CT showed a higher diagnostic accuracy for PTB findings than CXR, MRI and US, and should be the imaging modality of first choice when available. MRI had a higher sensitivity and specificity than CXR for LAP, pleural effusion, and cavitation. US was complimentary in initial diagnostic work-up and follow up. A diagnostic strategy for PTB in children according to local availability and expertise is proposed, as no evidence from this systematic review shows otherwise, in acknowledgement of the expertise in high TB-burdened countries. CT can be performed when in doubt, due to the higher diagnostic yield.
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Key Words
- CT
- CT, computed tomography
- CXR, chest x-ray
- Child
- Diagnostic imaging
- EPTB, extrapulmonary tuberculosis
- LAP, lymphadenopathy
- MRI, magnetic resonance imaging
- NPV, negative predictive value
- PCR, polymerase chain reaction
- PET, positron emission tomography
- PPD, purified protein derivative
- PPV, positive predictive value
- PTB
- PTB, pulmonary tuberculosis
- Pulmonary tuberculosis
- Systematic review
- TB
- TB, tuberculosis
- TST, tuberculin skin test
- US, ultrasound
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Affiliation(s)
- Erle Opdahl Tonne
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Marie Øbro Fosbøl
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, North Zealand Hospital, Hillerød, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Ulrikka Nygaard
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lise Borgwardt
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
- Corresponding author.
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Veisi N, Sharifi H, Shahesmaeili A, Ghaderi E, Rahmati S. An explanation of the 15-year trend and investigation of the tuberculosis cascade in Kurdistan province. J Clin Tuberc Other Mycobact Dis 2022; 28:100323. [PMID: 35813284 PMCID: PMC9263965 DOI: 10.1016/j.jctube.2022.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective This study's objectives were to describe the 15-year trend from 2005 to 2019 and examine the tuberculosis cascade in the Kurdistan province from 21 march 2018–20 march 2019. Methods This retrospective study was in 2744 patients with tuberculosis from 2005 to 2019 who were registered in Kurdistan disease registration centers. For the initial evaluation of demographic data, we utilized SPSS software version 20 and excel. Additionally, to design a care cascade, we utilized draw.io software for registered patients between March 21, 2018, and March 20, 2019. As a result, 2489 new cases of tuberculosis remained in our study. Results The results showed that the mean of age of people with tuberculosis was 58 years and sex distribution were 1441 (57.9) female and 1048 (42.1) male. Additionally, a cascade model showed that in Kurdistan Province, an estimated 112 new cases of smear-positive pulmonary tuberculosis in 2018, of which 90% (101 people) were sent to medical facilities and underwent diagnostic testing, with 80% of these patients (81 people). Infection was identified in 81 individuals, all of whom had their diagnoses recorded in the medical database. 82% (67 patients) of the patients who were enrolled in the treatment system received access to treatment, and 65 patients, or 97 percent, experienced no recurrence for at least a year after treatment. Correct diagnosis and therapy represented the biggest gap. Conclusion Cascade can enhance surveillance program and focus activities to better cases, diagnose, connect to care, and help TB patients survive without recurrence.
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Affiliation(s)
- Nasrollah Veisi
- Zoonoses Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Armita Shahesmaeili
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ebrahim Ghaderi
- Zoonoses Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Shoboo Rahmati
- PhD of Epidemiology, Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
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Shen Y, Qi X, Wu J, Gao Y, Shao L, Zhang W, Wang S. Effect of adjusted cut-offs of interferon-γ release assays on diagnosis of tuberculosis in patients with fever of unknown origin. J Clin Tuberc Other Mycobact Dis 2022; 26:100290. [PMID: 35005253 PMCID: PMC8717605 DOI: 10.1016/j.jctube.2021.100290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) is a leading cause of fever of unknown origin (FUO). In recent years, interferon-γ release assays (IGRAs) have been widely utilized and the cut-off values given by the manufacturers are set in countries where rates of TB are not as high. Methods A prospective cohort study was conducted in a Chinese general hospital to evaluate the diagnostic performance of T-SPOT.TB (T-SPOT) and QuantiFERON-TB Gold (QFT) in detecting active TB (ATB) in a high TB endemic area. Test results were compared with the culture and clinically confirmed diagnosis. Further, we explored an alternative method of interpreting IGRAs by increasing the cut-off values. Results The sensitivity and specificity of T-SPOT in detecting ATB were 85.3% (95% CI 81.6–94.0%) and 71.8% (95% CI 67.3–76.0%), respectively. The sensitivity and specificity of QFT were 72.3% (95% CI 62.8–80.1%) and 77.0% (95% CI 72.7–80.8%), respectively. Receiver operating characteristic analysis was used for evaluation of different cut-off values. When the cut-off values were adjusted as 125 spot-forming cells (SFCs)/ 2.5*105 cells for T-SPOT and 4.0 IU/ml for QFT, the specificity could be improved to > 90.0% (90.3% and 94.1%, respectively), and the sensitivity were 43.1% and 41.6%, respectively. The new adjusted cut-off values were validated in another independent validation cohort. Conclusion The adjusted cut-off values of the two assays considerably improved the diagnostic value when applied to FUO patients in clinical settings.
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Key Words
- ATB, active tuberculosis
- BCG, Bacillus Calmette–Guérin
- CFP-10, culture filtrate protein
- CNS, central nervous system
- EPTB, extrapulmonary tuberculosis
- ESAT-6, early secreted antigenic target 6
- FUO, fever of unknown origin
- IFN-γ, interferon-γ
- IGRAs, interferon-γ release assays
- Interferon-γ release assay
- LTBI, latent tuberculosis infection
- Mtb, Mycobacterium tuberculosis
- PBMCs, peripheral blood mononuclear cells
- PTB, pulmonary tuberculosis
- QFT, QuantiFERON-TB Gold
- QuantiFERON-TB Gold
- ROC, receiver operating characteristic
- SFC, spot-forming cells
- T-SPOT, T-SPOT®.TB
- T-SPOT.TB
- TB, tuberculosis
- TST, Tuberculin skin test
- Tuberculosis
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Affiliation(s)
- Yaojie Shen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiao Qi
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jing Wu
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yan Gao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Lingyun Shao
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.,Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Shanghai 200040, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Wenhong Zhang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.,Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Shanghai 200040, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Sen Wang
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China.,Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Shanghai 200040, China
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Raffali MA, Muhammad SF, Tiau Wei Jyung P, Farouk D, Zohdi A, Che Hassan HH. Disseminated Tuberculosis With Myocarditis and Intracardiac Thrombus in a Previously Young Healthy Woman. JACC Case Rep 2021; 3:1661-1666. [PMID: 34766014 PMCID: PMC8571798 DOI: 10.1016/j.jaccas.2021.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/12/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022]
Abstract
A 33-year-old woman with newly diagnosed disseminated tuberculosis presented with acute heart failure and incidental findings of intracardiac thrombus, demonstrating possible tuberculous myocarditis. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Mohd Asyiq Raffali
- Department of Medicine, University Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Syawal Faizal Muhammad
- Department of Medicine, University Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Patrick Tiau Wei Jyung
- Department of Medicine, University Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Diyana Farouk
- Department of Medicine, University Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Awatif Zohdi
- Department of Medicine, University Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Hamat Hamdi Che Hassan
- Department of Medicine, University Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
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6
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Song S, Gao P, Sun L, Kang D, Kongsted J, Poongavanam V, Zhan P, Liu X. Recent developments in the medicinal chemistry of single boron atom-containing compounds. Acta Pharm Sin B 2021; 11:3035-3059. [PMID: 34729302 PMCID: PMC8546671 DOI: 10.1016/j.apsb.2021.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/25/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022] Open
Abstract
Various boron-containing drugs have been approved for clinical use over the past two decades, and more are currently in clinical trials. The increasing interest in boron-containing compounds is due to their unique binding properties to biological targets; for example, boron substitution can be used to modulate biological activity, pharmacokinetic properties, and drug resistance. In this perspective, we aim to comprehensively review the current status of boron compounds in drug discovery, focusing especially on progress from 2015 to December 2020. We classify these compounds into groups showing anticancer, antibacterial, antiviral, antiparasitic and other activities, and discuss the biological targets associated with each activity, as well as potential future developments.
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Key Words
- ACTs, artemisinin combination therapies
- ADCs, Acinetobacter-derived cephalosporinases
- AML, acute myeloid leukemia
- AMT, aminopterin
- BLs, β-lactamases
- BNCT, boron neutron capture therapy
- BNNPs, boron nitride nanoparticles
- BNNTs, boron nitride nanotubes
- Boron-containing compounds
- CEs, carboxylesterases
- CIA, collagen-induced arthritis
- COVID-19, coronavirus disease 2019
- ClpP, casein protease P
- Covalent inhibitors
- GSH, glutathione
- HADC1, class I histone deacetylase
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- LeuRS, leucyl-tRNA synthetase
- Linker components
- MBLs, metal β-lactamases
- MDR-TB, multidrug-resistant tuberculosis
- MERS, Middle East respiratory syndrome
- MIDA, N-methyliminodiacetic acid
- MM, multiple myeloma
- MTX, methotrexate
- Mcl-1, myeloid cell leukemia 1
- Mtb, Mycobacterium tuberculosis
- NA, neuraminidase
- NS5B, non-nucleoside polymerase
- OBORT, oxaborole tRNA capture
- OPs, organophosphate
- PBA, phenylboronic acid
- PDB, Protein Data Bank
- PPI, protein–protein interaction
- Prodrug
- QM, quinone methide
- RA, rheumatoid arthritis
- ROS, reactive oxygen species
- SARS-CoV-2, syndrome coronavirus 2
- SBLs, serine β-lactamases
- SERD, selective estrogen receptor downregulator
- SHA, salicyl hydroxamic acid
- SaClpP, Staphylococcus aureus caseinolytic protease P
- TB, tuberculosis
- TTR, transthyretin
- U4CR, Ugi 4-component reaction
- cUTI, complex urinary tract infection
- dCTPase, dCTPase pyrophosphatase
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Affiliation(s)
- Shu Song
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
| | - Ping Gao
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
| | - Lin Sun
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
| | - Dongwei Kang
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
| | - Jacob Kongsted
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense M. DK-5230, Denmark
| | - Vasanthanathan Poongavanam
- Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense M. DK-5230, Denmark
- Corresponding authors. Tel./fax: +86 531 88380270.
| | - Peng Zhan
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
- Corresponding authors. Tel./fax: +86 531 88380270.
| | - Xinyong Liu
- Department of Medicinal Chemistry, Key Laboratory of Chemical Biology, Ministry of Education, School of Pharmaceutical Sciences, Shandong University, Ji'nan 250012, China
- Corresponding authors. Tel./fax: +86 531 88380270.
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Kusmiati T, Mertaniasih NM, Eko Putranto JN, Suprapti B, Soedarsono, Luthfah N, Koesoemoprodjo W, Sari AP. Correlation of inflammatory cytokines on corrected QT interval in rifampicin-resistant tuberculosis patients. Ann Med Surg (Lond) 2021; 70:102862. [PMID: 34584687 PMCID: PMC8452756 DOI: 10.1016/j.amsu.2021.102862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
Background The cases of Rifampicin-Resistant Tuberculosis (RR-TB) in our country have increased every year and RR-TB deaths are thought to be caused by prolongation of the QTc interval due to side effects of anti-tuberculosis drugs. Thus, cytokines are needed to be used as early markers of prolongation of the QTc interval in RR-TB patients. Objective This study aims to analyze the correlation of inflammatory cytokines on QTc interval in RR-TB patients who received shorter regimens. Methods This study uses a case-control study with a time series conducted in the period September 2019 to February 2020 in one of the referral hospitals for Tuberculosis in Indonesia. Cytokines levels from blood samples were measured using the ELISA method, while QTc intervals were automatically recorded using an electrocardiography machine. The statistical analysis used was the Chi-square test, Man Whitney test, Independence t-test, and Spearman-rank test with p < 0.05. Results There was no significant correlation between inflammatory cytokines and QTc prolongation in intensive phase which TNF-α value (6.8 pg/ml; r = 0.207; p = 0.281), IL-1β (20.13 pg/ml; r = 0.128; p = 0.509), and IL-6 (43.17 pg/ml; r = -0.028; p = 0.886). Meanwhile, in the continuation phase, the values for TNF-α (4.79 pg/ml; r = 0.046; p = 0.865), IL-1β (7.42 pg/ml; r = -0.223; p = 0.406), and IL- 6 (40.61 pg/ml; r = -0.147; p = 0.586). Conclusion inflammatory cytokines (TNF-α, IL-1β, and IL-6) cannot be used to identify QTc interval prolongation in RR-TB patients who received shorter regimens.
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Key Words
- BMI, Body mass index
- Ca, Calcium
- IL-1β
- IL-1β, interleukin-1β
- IL-6
- IL-6, interleukin 6
- K, Potassium
- MDR, multidrug resistance
- QTc prolongation
- RR-TB
- RR-TB, Rifampicin-Resistant Tuberculosis
- TB, tuberculosis
- TNF-α
- TNF-α, Tumor necrosis factor alpha
- WHO, World Health Organization
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Affiliation(s)
- Tutik Kusmiati
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ni Made Mertaniasih
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Johanes Nugroho Eko Putranto
- Department of Vascular and Cardiology Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Suprapti
- Faculty of Pharmacy, Universitas Airlangga - Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Soedarsono
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nadya Luthfah
- Department of Vascular and Cardiology Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Winariani Koesoemoprodjo
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Aryani Prawita Sari
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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8
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Dixon RV, Skaria E, Lau WM, Manning P, Birch-Machin MA, Moghimi SM, Ng KW. Microneedle-based devices for point-of-care infectious disease diagnostics. Acta Pharm Sin B 2021; 11:2344-2361. [PMID: 34150486 PMCID: PMC8206489 DOI: 10.1016/j.apsb.2021.02.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 02/08/2023] Open
Abstract
Recent infectious disease outbreaks, such as COVID-19 and Ebola, have highlighted the need for rapid and accurate diagnosis to initiate treatment and curb transmission. Successful diagnostic strategies critically depend on the efficiency of biological sampling and timely analysis. However, current diagnostic techniques are invasive/intrusive and present a severe bottleneck by requiring specialist equipment and trained personnel. Moreover, centralised test facilities are poorly accessible and the requirement to travel may increase disease transmission. Self-administrable, point-of-care (PoC) microneedle diagnostic devices could provide a viable solution to these problems. These miniature needle arrays can detect biomarkers in/from the skin in a minimally invasive manner to provide (near-) real-time diagnosis. Few microneedle devices have been developed specifically for infectious disease diagnosis, though similar technologies are well established in other fields and generally adaptable for infectious disease diagnosis. These include microneedles for biofluid extraction, microneedle sensors and analyte-capturing microneedles, or combinations thereof. Analyte sampling/detection from both blood and dermal interstitial fluid is possible. These technologies are in their early stages of development for infectious disease diagnostics, and there is a vast scope for further development. In this review, we discuss the utility and future outlook of these microneedle technologies in infectious disease diagnosis.
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Key Words
- AC, alternating current
- APCs, antigen-presenting cells
- ASSURED, affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free and deliverable to end-users
- Biomarker detection
- Biosensor
- CMOS, complementary metal-oxide semiconductor
- COVID, coronavirus disease
- COVID-19
- CSF, cerebrospinal fluid
- CT, computerised tomography
- CV, cyclic voltammetry
- DC, direct current
- DNA, deoxyribonucleic acid
- DPV, differential pulse voltammetry
- EBV, Epstein–Barr virus
- EDC/NHS, 1-ethyl-3-(3-dimethylaminoproply) carbodiimide/N-hydroxysuccinimide
- ELISA, enzyme-linked immunosorbent assay
- GOx, glucose oxidase
- HIV, human immunodeficiency virus
- HPLC, high performance liquid chromatography
- HRP, horseradish peroxidase
- IP, iontophoresis
- ISF, interstitial fluid
- IgG, immunoglobulin G
- Infectious disease
- JEV, Japanese encephalitis virus
- MN, microneedle
- Microneedle
- NA, nucleic acid
- OBMT, one-touch-activated blood multidiagnostic tool
- OPD, o-phenylenediamine
- PCB, printed circuit board
- PCR, polymerase chain reaction
- PDMS, polydimethylsiloxane
- PEDOT, poly(3,4-ethylenedioxythiophene)
- PNA, peptide nucleic acid
- PP, polyphenol
- PPD, poly(o-phenylenediamine)
- PoC, point-of-care
- Point-of-care diagnostics (PoC)
- SALT, skin-associated lymphoid tissue
- SAM, self-assembled monolayer
- SEM, scanning electron microscope
- SERS, surface-enhanced Raman spectroscopy
- SWV, square wave voltammetry
- Skin
- TB, tuberculosis
- UV, ultraviolet
- VEGF, vascular endothelial growth factor
- WHO, World Health Organisation
- cfDNA, cell-free deoxyribonucleic acid
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Affiliation(s)
- Rachael V. Dixon
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - Eldhose Skaria
- Wellcome Trust Centre for Cell-Matrix Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PT, UK
| | - Wing Man Lau
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - Philip Manning
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - Mark A. Birch-Machin
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - S. Moein Moghimi
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
| | - Keng Wooi Ng
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne NE2 4HH, UK
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9
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Gupta P, Thomas SE, Zaidan SA, Pasillas MA, Cory-Wright J, Sebastián-Pérez V, Burgess A, Cattermole E, Meghir C, Abell C, Coyne AG, Jacobs WR, Blundell TL, Tiwari S, Mendes V. A fragment-based approach to assess the ligandability of ArgB, ArgC, ArgD and ArgF in the L-arginine biosynthetic pathway of Mycobacterium tuberculosis. Comput Struct Biotechnol J 2021; 19:3491-3506. [PMID: 34194673 PMCID: PMC8220418 DOI: 10.1016/j.csbj.2021.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 11/23/2022] Open
Abstract
The L-arginine biosynthesis pathway consists of eight enzymes that catalyse the conversion of L-glutamate to L-arginine. Arginine auxotrophs (argB/argF deletion mutants) of Mycobacterium tuberculosis are rapidly sterilised in mice, while inhibition of ArgJ with Pranlukast was found to clear chronic M. tuberculosis infection in a mouse model. Enzymes in the arginine biosynthetic pathway have therefore emerged as promising targets for anti-tuberculosis drug discovery. In this work, the ligandability of four enzymes of the pathway ArgB, ArgC, ArgD and ArgF is assessed using a fragment-based approach. We identify several hits against these enzymes validated with biochemical and biophysical assays, as well as X-ray crystallographic data, which in the case of ArgB were further confirmed to have on-target activity against M. tuberculosis. These results demonstrate the potential for more enzymes in this pathway to be targeted with dedicated drug discovery programmes.
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Affiliation(s)
- Pooja Gupta
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Sherine E. Thomas
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Shaymaa A. Zaidan
- Department of Biological Sciences & Border Biomedical Research Centre, University of Texas at El Paso, El Paso, TX 79968, USA
| | - Maria A. Pasillas
- Department of Biological Sciences & Border Biomedical Research Centre, University of Texas at El Paso, El Paso, TX 79968, USA
| | - James Cory-Wright
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Víctor Sebastián-Pérez
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
- Centro de Investigaciones Biológicas Margarita Salas (CSIC), Ramiro de Maeztu 9, 28040 Madrid, Spain
| | - Ailidh Burgess
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Emma Cattermole
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Clio Meghir
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Chris Abell
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
| | - Anthony G. Coyne
- Yusuf Hamied Department of Chemistry, University of Cambridge, Lensfield Road, Cambridge CB2 1EW, UK
| | - William R. Jacobs
- Department of Microbiology and Immunology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Tom L. Blundell
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
| | - Sangeeta Tiwari
- Department of Biological Sciences & Border Biomedical Research Centre, University of Texas at El Paso, El Paso, TX 79968, USA
| | - Vítor Mendes
- Department of Biochemistry, University of Cambridge, 80 Tennis Court Road, Cambridge CB2 1GA, UK
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10
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Lajin M. EUS-guided gastroenterostomy to treat gastric outlet obstruction in a patient with gastric lymphoma followed by pyloric recanalization using a rendezvous technique. VideoGIE 2021; 6:222-224. [PMID: 34027253 PMCID: PMC8117746 DOI: 10.1016/j.vgie.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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11
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Pennington KM, Vu A, Challener D, Rivera CG, Shweta FNU, Zeuli JD, Temesgen Z. Approach to the diagnosis and treatment of non-tuberculous mycobacterial disease. J Clin Tuberc Other Mycobact Dis 2021; 24:100244. [PMID: 34036184 PMCID: PMC8135042 DOI: 10.1016/j.jctube.2021.100244] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Non-tuberculous mycobacteria (NTM) is a collective name given to a group of more than 190 species of Mycobacterium. The clinical presentation for most NTM infections is non-specific, often resulting in delayed diagnosis. Further complicating matters is that NTM organisms can be difficult to isolate. Medications used to treat NTM infection can be difficult for patients to tolerate, and prolonged courses of anti-mycobacterial therapy are often required for adequate suppression or eradication. Herein, we review different NTM syndromes, appropriate diagnostic tests, and treatment regimens.
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Key Words
- ADR, adverse drug reactions
- AFB, acid fast bacilli
- AST, antimicrobial-susceptibility testing
- ATS, American Thoracic Society
- BCG, Bacille Calmette-Guerin
- CLSI, Clinical and Laboratory Standards Institute
- COPD, chronic obstructive pulmonary disease
- ECG, electrocardiogram
- EMB, ethambutol
- Erm, erythromycin ribosomal methylase
- FDA, Food and Drug Administration
- HIV, human immunodeficiency virus
- HRCT, high resolution computed tomography
- IDSA, Infectious Disease Society of America
- INF-γ, interferon- γ
- INH, isoniazid
- MAC, Mycobacterium avium complex
- MALDI-TOF, matrix-assisted laser desorption ionization time-of-flight mass spectrometry
- MGIT, mycobacteria growth indicator tube
- MIC, minimum inhibitory concentrations
- Mycobacterium abscessus
- Mycobacterium avium
- NTM, non-tuberculous mycobacteria
- Non-tuberculous mycobacteria
- PCR, polymerase chain reaction
- PFT, pulmonary function test
- TB, tuberculosis
- TDM, therapeutic drug monitoring
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Affiliation(s)
- Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Ann Vu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Douglas Challener
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | | | - F N U Shweta
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - John D Zeuli
- Department of Pharmacy, Mayo Clinic Rochester, MN, USA
| | - Zelalem Temesgen
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Rochester, MN, USA
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12
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Putra MD, Rahyussalim AJ, Jusman SWA, Iswanti FC, Sadikin M. Phagocytosis and the antigen-processing abilities of macrophages derived from monocytes in spinal tuberculosis patients. J Clin Tuberc Other Mycobact Dis 2021; 23:100215. [PMID: 33532629 PMCID: PMC7823046 DOI: 10.1016/j.jctube.2021.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study examined the hypothesis that there is an impairment of macrophageal function in spinal TB. We examined macrophageal functions in spinal TB patients. Monocytes were isolated from peripheral blood mononuclear cells (PBMCs) of five spinal TB patients and five healthy persons as control. The isolated monocytes were cultured with stimulation of macrophage colony-stimulating factor (M-CSF) for seven days for maturation. The phagocytic ability of the macrophages derived from monocytes was measured. Also, nitric oxide (NO), myeloperoxidase (MPO), beta-glucuronide, and acid phosphatase activity was investigated. We found that the monocytes collected from patient PBMCs were significantly fewer than those of the control group (2992.103 vs. 6474.103 (cells/mL)). There were also fewer macrophages that had adhered to sheep red blood cells (SRBC) (598.103 vs. 264.103 (cells/mL)). However, NO production (2346 vs. 325.17 (µmol/gram of protein)), and the MPO (570.7 vs. 17.4 (unit/mg), beta-glucuronide (0.149 vs. 0.123 (μmol/hour/100 mg of protein)), and acid phosphatase activities (1776.9 vs. 287.9 (μmol/hour/100 mg of protein)) of the macrophages in the spinal TB group were markedly higher than in the healthy group. Despite the low adhesion to foreign bodies, the intracellular processing of TB macrophages, including oxidative activity and lysosome function, was significantly high. These results suggested the impairment of macrophageal function in spinal TB. Possibly, there is a dominance of innate non-specific immunity in spinal TB infection.
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Key Words
- Acid phosphatase
- Beta-glucuronidase
- DOTS, directly observed treatment, short-course
- EDTA, Ethylene diamine tetra acetic acid
- HIV, human immunodeficiency virus
- LPS, lipopolysaccharide
- M-CSF, macrophage colony-stimulating factors
- M.tb, Mycobacterium tuberculosis
- MPO, myeloperoxidase
- Macrophage
- Myeloperoxidase
- NO, nitric oxide
- Nitric oxide
- PBMC, peripheral blood mononuclear cell
- PBS, Phosphate buffer saline
- RPMI, Rosewell Park Memorial Institute culture medium
- SRBC, sheep red blood cell
- Spinal tuberculosis
- TB, tuberculosis
- WHO, the World Health Organization
- WST, water-soluble tetrazolium salt
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Affiliation(s)
- Muhamad Dwi Putra
- Master's Programme in Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia.,Faculty of Medicine and Health, Universitas Muhammadiyah Jakarta, 15419, Indonesia
| | - Ahmad Jabir Rahyussalim
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Ciptomangunkusumo Hospital, 10430, Indonesia
| | - Sri Widia A Jusman
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia.,Center of Hypoxia and Oxidative Stress Studies, Indonesia
| | - Febriana Catur Iswanti
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia.,Center of Hypoxia and Oxidative Stress Studies, Indonesia
| | - Mohamad Sadikin
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Universitas Indonesia, 10430, Indonesia.,Center of Hypoxia and Oxidative Stress Studies, Indonesia
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13
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Prasetyo M, Sirath AS, Wicaksono KP, Prihartono J, Setiawan SI. Non-contrast versus contrast-enhanced MR in the diagnosis of spondylitis: A quantitative concordance-analysis. Eur J Radiol Open 2020; 7:100306. [PMID: 33335952 PMCID: PMC7733015 DOI: 10.1016/j.ejro.2020.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/03/2022] Open
Abstract
Introduction : Magnetic Resonance (MR) imaging using gadolinium contrast media is an essential imaging modality in diagnosing spondylitis. However, gadolinium contrast is not widely available in Indonesia and relatively expensive. Many MR studies in Indonesia are performed without contrast administration. It is unclear how confident non-contrast MR can diagnose tuberculous spondylitis in comparison to standard contrast MR. Purposes : This study aims to evaluate the concordance between the contrast MR and non-contrast spine MR in diagnosing tuberculous spondylitis. We also evaluate the interobserver agreement between the general radiologist and musculoskeletal radiologist in interpreting non-contrast MR of spondylitis. Materials and Methods : A cross-sectional study using secondary data was performed to evaluate the concordance between the MR results regarding the usage of contrast media in diagnosing spondylitis. The inclusion criteria were patients over 17 years old who underwent complete sequences of contrast-enhanced MR examination of the spine, referred to radiology with the clinical diagnosis of suspected tuberculous spondylitis, spondylodiscitis, or both. All of the non-contrast and contrast-enhanced MR results were read and interpreted by two independent observers, a musculoskeletal radiologist and a general radiologist, blindly. The interobserver agreement analysis of the MR examination was conducted using Kappa and McNemar test. Results : There was no significant difference between the contrast and non-contrast MR in diagnosing spondylitis (P= 0.368) and no significant difference in the interpretation of MR between the first and the second observer (P = 0.343). The concordance between the contrast and non-contrast spine MR in diagnosing spondylitis (R: 0.88, P < 0.001) and the interpretation of MR between both observers (R: 0.65, P < 0.001) were showed in this study. Conclusion : There is a high concordance between the contrast and non-contrast MR in diagnosing tuberculous spondylitis. Although contrast MR is preferred as the standard imaging method of spondylitis, in case gadolinium contrast is unavailable, non-contrast MR can still provide valuable information in diagnosing spondylitis.
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Affiliation(s)
- Marcel Prasetyo
- Department of Radiology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Aldi Semanta Sirath
- Department of Radiology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Krishna Pandu Wicaksono
- Department of Radiology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Joedo Prihartono
- Departement of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Stefanus Imanuel Setiawan
- Department of Radiology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
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14
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Carmans L, Van Craenenbroeck A, Lagrou K, Deroose CM, Sagaert X, Wolthuis A, Van Wijngaerden E, Kuypers DR. Disseminated histoplasmosis in a kidney liver transplant patient from a non-endemic area: A diagnostic challenge. IDCases 2020; 22:e00971. [PMID: 33088713 PMCID: PMC7566087 DOI: 10.1016/j.idcr.2020.e00971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 12/28/2022] Open
Abstract
Disseminated histoplasmosis is a rare opportunistic infection in non-endemic areas, where the disease is often diagnosed late. The spectrum of clinical manifestations is broad and life-threatening complications occur. We present a detailed case of a kidney liver transplant patient with disseminated histoplasmosis in a non-endemic area. Our case highlights the wide range of pathogens to consider in the immunocompromised patient, the delayed diagnosis of Histoplasmosis Capsulatum in non-endemic areas and the possibility of severe gastrointestinal disease. We also briefly review diagnostic tests and treatment options.
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Affiliation(s)
- L Carmans
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Belgium
| | - A Van Craenenbroeck
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Belgium.,Department of Microbiology and Immunology, Catholic University of Leuven, Belgium
| | - K Lagrou
- Department of Laboratory of Clinical Bacteriology and Mycology, University Hospitals Leuven, Belgium
| | - C M Deroose
- Nuclear Medicine & Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Belgium
| | - X Sagaert
- Department of Pathology, University Hospitals Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Belgium
| | - E Van Wijngaerden
- Department of General Internal Medicine and Infectiology, University Hospitals Leuven, Belgium
| | - D R Kuypers
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Belgium.,Department of Microbiology and Immunology, Catholic University of Leuven, Belgium
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15
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Alende-Castro V, Macía-Rodríguez C, Páez-Guillán E, García-Villafranca A. Miliary pattern, a classic pulmonary finding of tuberculosis disease. J Clin Tuberc Other Mycobact Dis 2020; 20:100179. [PMID: 32904186 PMCID: PMC7452224 DOI: 10.1016/j.jctube.2020.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction The increase in age of the population and in the use of immunosuppressive treatment makes tuberculosis (TB) with hematogenous or lymphatic dissemination a current problem. Methods We collected all the patients diagnosed with tuberculosis with miliary pulmonary pattern at the Santiago de Compostela University Teaching Hospital (NW Spain) from 1 January 2006 to 31 December 2015. Results A total of 27 patients were included, 70.4% women, with a median age of 69.0 years old. A cause of immunosuppression was observed only in 51.9% of patients. The majority of the cases (65.0%) presented pulmonary affectation. The most frequently isolated species was Mycobacterium tuberculosis (88.9%). Multiresistance to first-line antituberculosis drugs was observed only in 3.7%. 92.6% of the patients received treatment with Isoniazid, Rifampicin and Pyrazinamine, associated in 48.1% of them with Ethambutol. Two patients died during admission and there were no recurrences in the 2-years follow-up. Conclusions Miliary tuberculosis remains a current pathology. Most patients do not have a known cause of immunosuppression. The response to the typical treatment is usually good.
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Affiliation(s)
- Vanesa Alende-Castro
- Department of Internal Medicine, Hospital do Salnés, Rúa Hospital do Salnes, 30, 36619 Vilagarcía de Arousa, Pontevedra, Spain
| | | | - Emilio Páez-Guillán
- Department of Internal Medicine, Complexo Hospitalario Universitario de Santiago de Compostela, Travesia da Choupana s/n, Santiago de Compostela, A Coruña, Spain
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16
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Anand AC, Nandi B, Acharya SK, Arora A, Babu S, Batra Y, Chawla YK, Chowdhury A, Chaoudhuri A, Eapen EC, Devarbhavi H, Dhiman R, Datta Gupta S, Duseja A, Jothimani D, Kapoor D, Kar P, Khuroo MS, Kumar A, Madan K, Mallick B, Maiwall R, Mohan N, Nagral A, Nath P, Panigrahi SC, Pawar A, Philips CA, Prahraj D, Puri P, Rastogi A, Saraswat VA, Saigal S, Shalimar, Shukla A, Singh SP, Verghese T, Wadhawan M. Indian National Association for the Study of the Liver Consensus Statement on Acute Liver Failure (Part 1): Epidemiology, Pathogenesis, Presentation and Prognosis. J Clin Exp Hepatol 2020; 10:339-376. [PMID: 32655238 PMCID: PMC7335721 DOI: 10.1016/j.jceh.2020.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/12/2020] [Indexed: 12/12/2022] Open
Abstract
Acute liver failure (ALF) is an infrequent, unpredictable, potentially fatal complication of acute liver injury (ALI) consequent to varied etiologies. Etiologies of ALF as reported in the literature have regional differences, which affects the clinical presentation and natural course. In this part of the consensus article designed to reflect the clinical practices in India, disease burden, epidemiology, clinical presentation, monitoring, and prognostication have been discussed. In India, viral hepatitis is the most frequent cause of ALF, with drug-induced hepatitis due to antituberculosis drugs being the second most frequent cause. The clinical presentation of ALF is characterized by jaundice, coagulopathy, and encephalopathy. It is important to differentiate ALF from other causes of liver failure, including acute on chronic liver failure, subacute liver failure, as well as certain tropical infections which can mimic this presentation. The disease often has a fulminant clinical course with high short-term mortality. Death is usually attributable to cerebral complications, infections, and resultant multiorgan failure. Timely liver transplantation (LT) can change the outcome, and hence, it is vital to provide intensive care to patients until LT can be arranged. It is equally important to assess prognosis to select patients who are suitable for LT. Several prognostic scores have been proposed, and their comparisons show that indigenously developed dynamic scores have an edge over scores described from the Western world. Management of ALF will be described in part 2 of this document.
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Key Words
- ACLF, acute on chronic liver failure
- AFLP, acute fatty liver of pregnancy
- AKI, Acute kidney injury
- ALF, Acute liver failure
- ALFED, Acute Liver Failure Early Dynamic
- ALT, alanine transaminase
- ANA, antinuclear antibody
- AP, Alkaline phosphatase
- APTT, activated partial thromboplastin time
- ASM, alternative system of medicine
- ASMA, antismooth muscle antibody
- AST, aspartate transaminase
- ATN, Acute tubular necrosis
- ATP, adenosine triphosphate
- ATT, anti-TB therapy
- AUROC, Area under the receiver operating characteristics curve
- BCS, Budd-Chiari syndrome
- BMI, body mass index
- CBF, cerebral blood flow
- CBFV, cerebral blood flow volume
- CE, cerebral edema
- CHBV, chronic HBV
- CLD, chronic liver disease
- CNS, central nervous system
- CPI, clinical prognostic indicator
- CSF, cerebrospinal fluid
- DAMPs, Damage-associated molecular patterns
- DILI, drug-induced liver injury
- EBV, Epstein-Barr virus
- ETCO2, End tidal CO2
- GRADE, Grading of Recommendations Assessment Development and Evaluation
- HAV, hepatitis A virus
- HBV, Hepatitis B virus
- HELLP, hemolysis
- HEV, hepatitis E virus
- HLH, Hemophagocytic lymphohistiocytosis
- HSV, herpes simplex virus
- HV, hepatic vein
- HVOTO, hepatic venous outflow tract obstruction
- IAHG, International Autoimmune Hepatitis Group
- ICH, intracerebral hypertension
- ICP, intracerebral pressure
- ICU, intensive care unit
- IFN, interferon
- IL, interleukin
- IND-ALF, ALF of indeterminate etiology
- INDILI, Indian Network for DILI
- KCC, King's College Criteria
- LC, liver cirrhosis
- LDLT, living donor liver transplantation
- LT, liver transplantation
- MAP, mean arterial pressure
- MHN, massive hepatic necrosis
- MPT, mitochondrial permeability transition
- MUAC, mid-upper arm circumference
- NAPQI, n-acetyl-p-benzo-quinone-imine
- NPV, negative predictive value
- NWI, New Wilson's Index
- ONSD, optic nerve sheath diameter
- PAMPs, pathogen-associated molecular patterns
- PCR, polymerase chain reaction
- PELD, Pediatric End-Stage Liver Disease
- PPV, positive predictive value
- PT, prothrombin time
- RAAS, renin–angiotensin–aldosterone system
- SHF, subacute hepatic failure
- SIRS, systemic inflammatory response syndrome
- SNS, sympathetic nervous system
- TB, tuberculosis
- TCD, transcranial Doppler
- TGF, tumor growth factor
- TJLB, transjugular liver biopsy
- TLR, toll-like receptor
- TNF, tumor necrosis factor
- TSFT, triceps skin fold thickness
- US, ultrasound
- USALF, US Acute Liver Failure
- VZV, varicella-zoster virus
- WD, Wilson disease
- Wilson disease (WD)
- YP, yellow phosphorus
- acute liver failure
- autoimmune hepatitis (AIH)
- drug-induced liver injury
- elevated liver enzymes, low platelets
- sALI, severe acute liver injury
- viral hepatitis
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Affiliation(s)
- Anil C. Anand
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Bhaskar Nandi
- Department of Gastroenterology, Sarvodaya Hospital and Research Centre, Faridababd, Haryana, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Anil Arora
- Institute of Liver Gastroenterology &Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Sethu Babu
- Department of Gastroenterology, Krishna Institute of Medical Sciences, Hyderabad 500003, India
| | - Yogesh Batra
- Department of Gastroenterology, Indraprastha Apollo Hospital, SaritaVihar, New Delhi, 110 076, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Abhijit Chowdhury
- Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, 700020, India
| | - Ashok Chaoudhuri
- Hepatology and Liver Transplant, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
| | - Eapen C. Eapen
- Department of Hepatology, Christian Medical College, Vellore, India
| | - Harshad Devarbhavi
- Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, 560034, India
| | - RadhaKrishan Dhiman
- Department of Hepatology, Post graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Siddhartha Datta Gupta
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Ajay Duseja
- Department of Hepatology, Post graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Dinesh Jothimani
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
| | | | - Premashish Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Mohamad S. Khuroo
- Department of Gastroenterology, Dr Khuroo’ S Medical Clinic, Srinagar, Kashmir, India
| | - Ashish Kumar
- Institute of Liver Gastroenterology &Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Kaushal Madan
- Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, India
| | - Bipadabhanjan Mallick
- Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Rakhi Maiwall
- Hepatology Incharge Liver Intensive Care, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
| | - Neelam Mohan
- Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – the Medicity Hospital, Sector – 38, Gurgaon, Haryana, India
| | - Aabha Nagral
- Department of Gastroenterology, Apollo and Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Preetam Nath
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Sarat C. Panigrahi
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Ankush Pawar
- Liver & Digestive Diseases Institute, Fortis Escorts Hospital, Okhla Road, New Delhi, 110 025, India
| | - Cyriac A. Philips
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, 682028, Kerala, India
| | - Dibyalochan Prahraj
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
| | - Pankaj Puri
- Department of Hepatology and Gastroenterology, Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Hospital, Delhi, India
| | - Amit Rastogi
- Department of Liver Transplantation, Medanta – the MedicityHospital, Sector – 38, Gurgaon, Haryana, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Sanjiv Saigal
- Department of Hepatology, Department of Liver Transplantation, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 29, India
| | - Akash Shukla
- Department of Gastroenterology, LTM Medical College & Sion Hospital, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Thomas Verghese
- Department of Gastroenterology, Government Medical College, Kozikhode, India
| | - Manav Wadhawan
- Institute of Liver & Digestive Diseases and Head of Hepatology & Liver Transplant (Medicine), BLK Super Speciality Hospital, Delhi, India
| | - The INASL Task-Force on Acute Liver Failure
- Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India
- Department of Gastroenterology, Sarvodaya Hospital and Research Centre, Faridababd, Haryana, India
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
- Institute of Liver Gastroenterology &Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
- Department of Gastroenterology, Krishna Institute of Medical Sciences, Hyderabad 500003, India
- Department of Gastroenterology, Indraprastha Apollo Hospital, SaritaVihar, New Delhi, 110 076, India
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
- Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, 700020, India
- Hepatology and Liver Transplant, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
- Department of Hepatology, Christian Medical College, Vellore, India
- Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, 560034, India
- Department of Hepatology, Post graduate Institute of Medical Education and Research, Chandigarh, 160 012, India
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
- Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India
- Gleneagles Global Hospitals, Hyderabad, Telangana, India
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
- Department of Gastroenterology, Dr Khuroo’ S Medical Clinic, Srinagar, Kashmir, India
- Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, India
- Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India
- Hepatology Incharge Liver Intensive Care, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India
- Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta – the Medicity Hospital, Sector – 38, Gurgaon, Haryana, India
- Department of Gastroenterology, Apollo and Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
- Liver & Digestive Diseases Institute, Fortis Escorts Hospital, Okhla Road, New Delhi, 110 025, India
- The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi, 682028, Kerala, India
- Department of Hepatology and Gastroenterology, Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Hospital, Delhi, India
- Department of Liver Transplantation, Medanta – the MedicityHospital, Sector – 38, Gurgaon, Haryana, India
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226 014, India
- Department of Hepatology, Department of Liver Transplantation, India
- Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 29, India
- Department of Gastroenterology, LTM Medical College & Sion Hospital, India
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
- Department of Gastroenterology, Government Medical College, Kozikhode, India
- Institute of Liver & Digestive Diseases and Head of Hepatology & Liver Transplant (Medicine), BLK Super Speciality Hospital, Delhi, India
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Mohammed H, Oljira L, Roba KT, Ngadaya E, Ajeme T, Haile T, Kidane A, Manyazewal T, Fekadu A, Yimer G. Burden of tuberculosis and challenges related to screening and diagnosis in Ethiopia. J Clin Tuberc Other Mycobact Dis 2020; 19:100158. [PMID: 32258437 PMCID: PMC7113623 DOI: 10.1016/j.jctube.2020.100158] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION One-third of tuberculosis (TB) cases in Ethiopia are missing from care for reasons that are not well studied. The aim of this study was to assess TB burden and identify challenges related to TB screening and diagnosis in Ethiopia. METHODS A facility-based cross-sectional study was conducted in seven health facilities selected from two regions and 2 city administrations of Ethiopia using stratified random sampling procedures. The data of 1,059,065 patients were included from outpatient department, HIV clinic, diabetic, and maternal-child health clinics. Data were collected from October to December 2018 using a retrospective review of three years' facility data (2015 to 2017) supplemented by a semi-structured interview with purposively selected health care workers and heads of the health facilities. RESULTS A total of 1,059,065 patients visited the health facilities in three years, of these, 978,480 (92.4%) were outpatients. Of the total, 20,284 (2%) were presumptive TB cases (with 14 days or more cough), 12.2% (2483/20,284) of which had TB. For the type of TB, 604 (24.3%) were smear-positive pulmonary TB (PTB), 789 (31.8%) were smear-negative PTB, 719 (29%) were extra-pulmonary TB, and data were missing for the rest. TB screening was integrated into HIV clinic, outpatient department, diabetic clinic but not with the maternal and child clinics. High patient load, weak TB laboratory specimen referral system, and shortage of TB diagnostic tools including Xpert MTB/RIF assay and chest X-ray, were the major challenges in the screening and diagnosis of TB. CONCLUSION The burden of TB was high in the study setting, and frequent interruption of laboratory reagents and supplies hampered TB screening and diagnostic services. Realizing the END-TB strategy in such resource-limited settings requires sustainable TB diagnostic capacity and improved case detection mechanisms, with national TB programs strongly integrated into the general health care system.
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Key Words
- AFB, acid fast bacilli
- ANC, ant-natal care
- ART, anti-retroviral therapy, DOTS, directly observed treatment, short course
- Diagnosis
- EPTB, extra pulmonary tuberculosis
- Ethiopia
- FMoH, Federal Ministry of Health
- HIV, human immunodeficiency virus
- MDR-TB, multi-drug resistant tuberculosis
- Maternal and child health
- NGOs, non-governmental organizations
- NTB, National TB program
- PFSA, Pharmaceutical Fund and Supply Agency
- PMTCT, prevention mother to child transmission
- PNC, postnatal care
- Screening
- TB, tuberculosis
- Tuberculosis
- WHO, World Health Organization
- Xpert mtb/rif assay
- eHMIS, electronic Health Management Information System
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Affiliation(s)
- Hussen Mohammed
- Department of Public Health, College of Medicine and Health Sciences, Dire Dawa University, Dire Dawa, Ethiopia
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, Dares Saalem, Tanzania
| | - Tigest Ajeme
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
| | - Tewodros Haile
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Achenef Kidane
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
- Ohio State Global One Health initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
| | - Tsegahun Manyazewal
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Getnet Yimer
- Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa University, P.O. Box 1362, Dire Dawa, Ethiopia
- Ohio State Global One Health initiative, Office of International Affairs, The Ohio State University, Addis Ababa, Ethiopia
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18
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Sutherland HS, Tong AST, Choi PJ, Blaser A, Franzblau SG, Cooper CB, Upton AM, Lotlikar M, Denny WA, Palmer BD. Variations in the C-unit of bedaquiline provides analogues with improved biology and pharmacology. Bioorg Med Chem 2019; 28:115213. [PMID: 31810890 DOI: 10.1016/j.bmc.2019.115213] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 11/25/2022]
Abstract
Analogues of the anti-tuberculosis drug bedaquiline, bearing a 3,5-dimethoxy-4-pyridyl C-unit, retain high anti-bacterial potency yet exert less inhibition of the hERG potassium channel, in vitro, than the parent compound. Two of these analogues (TBAJ-587 and TBAJ-876) are now in preclinical development. The present study further explores structure-activity relationships across a range of related 3,5-disubstituted-4-pyridyl C-unit bedaquiline analogues of greatly varying lipophilicity (clogP from 8.16 to 1.89). This broader class shows similar properties to the 3,5-dimethoxy-4-pyridyl series, being substantially more potent in vitro and equally active in an in vivo (mouse) model than bedaquiline, while retaining a lower cardiovascular risk profile through greatly attenuated hERG inhibition.
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Key Words
- CFU, colony-forming units
- HPLC, high-peformance liquid chromatography
- LDA, lithium diisopropylamide
- LORA, low oxygen recovery assay
- LiTMP, lithium tetramethylpiperidide
- M.tb, Mycobacterium tuberculosis
- MABA, microplate alamar blue assay
- MIC(90), minimum concentration for 90% inhibition
- TB, tuberculosis
- hERG, the alpha subunit of a K+ channel that contributes to the electrical activity of the heart
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Affiliation(s)
- Hamish S Sutherland
- Auckland Cancer Society Research Centre, School of Medical Sciences, and Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Amy S T Tong
- Auckland Cancer Society Research Centre, School of Medical Sciences, and Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Peter J Choi
- Auckland Cancer Society Research Centre, School of Medical Sciences, and Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Adrian Blaser
- Auckland Cancer Society Research Centre, School of Medical Sciences, and Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Scott G Franzblau
- Institute for Tuberculosis Research, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, USA
| | | | - Anna M Upton
- Global Alliance for TB Drug Development, 40 Wall St, New York, NY 10005, USA
| | - Manisha Lotlikar
- Global Alliance for TB Drug Development, 40 Wall St, New York, NY 10005, USA
| | - William A Denny
- Auckland Cancer Society Research Centre, School of Medical Sciences, and Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Brian D Palmer
- Auckland Cancer Society Research Centre, School of Medical Sciences, and Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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19
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Cortez de Almeida RF, Cortez Cardoso Penha R, do Nascimento Barbosa L. Two cases of disseminated tuberculosis after negative screening before adalimumab treatment for immune-mediated inflammatory diseases. JAAD Case Rep 2019; 5:1002-1005. [PMID: 31720351 PMCID: PMC6838498 DOI: 10.1016/j.jdcr.2019.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Key Words
- CT, computed tomography
- HS, hidradenitis suppurativa
- IGRA, interferon-γ release assay
- IL, interleukin
- RIPE, rifampicin, isoniazid, pyrazinamide, and ethambutol
- TB, tuberculosis
- TNF, tumor necrosis factor
- TST, tuberculin skin test
- adalimumab
- anergy
- hidradenitis suppurativa
- inflammatory immune-mediated diseases
- psoriasis
- tuberculosis
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Affiliation(s)
- Rita Fernanda Cortez de Almeida
- Dermatology Department, Federal Hospital of Bonsucesso, Rio de Janeiro, Brazil
- Correspondence to: Rita Fernanda Cortez de Almeida, MD, Avenida Londres, 616, 21041-020, Rio de Janeiro, Brazil.
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20
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Chemeda A, Abebe T, Ameni G, Worku A, Mihret A. Utility of urine as a clinical specimen for the diagnosis of pulmonary tuberculosis in people living with HIV in Addis Ababa, Ethiopia. J Clin Tuberc Other Mycobact Dis 2019; 17:100125. [PMID: 31788567 PMCID: PMC6880017 DOI: 10.1016/j.jctube.2019.100125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Tuberculosis is a common cause of mortality and morbidity among people living with HIV/AIDS. Despite the increased prognosis of tuberculosis among HIV infected patients, diagnosis of pulmonary tuberculosis (PTB) smear microscopy has a low sensitivity due to low bacterial load in a sputum specimen of HIV patients. Having alternative specimens for increasing detection of Mycobacterium tuberculosis (Mtb) is very important. Objective The aim of this study was to evaluate the efficacy of urine as clinical specimen for the diagnosis of pulmonary tuberculosis in people living with HIV. Method A total of 117 HIV-seropositive individuals from three public health facilities in Addis Ababa, Ethiopia were enrolled consecutively from December 2013 to July 2014. A total of 117 paired morning sputum and urine samples were simultaneously collected from anti-retroviral therapy (ART) naïve PTB suspected individuals living with HIV. Both sputum and urine samples were processed for culture using Lowenstein-Jensen medium, and the left was subjected to PCR using RD9 primers. Chi-square test and kappa value were used to compare different methods used. Result Out of 117 suspected PTB HIV-infected people, sputum culture alone detected more mycobacterial isolates 33 (28.2%) than the urine specimen alone 17 (14.5%). Of the 33 patients positive for sputum culture, 13 patients were observed as a urine culture positive. Of the 84 individuals negative for mycobacterial by sputum culture, four (4.8%) were urine culture positive and thus, the sensitivity, and the agreement between urine culture as compare to sputum culture were 39.4% and 0.49, respectively. On the other hand, the sensitivity of RD9-based PCR directly on urine was 72.7% by considering sputum culture as a reference standard. Moreover, RD9-based PCR directly on sputum detected 9 (7.7%) individuals who were sputum culture negative for M. Tuberculosis. The detection rate of M. tuberculosis from urine in patients those who couldn't produce sputum were 9(34.6%). Conclusion PCR and culture examination of urine samples also can improve the detection rate of M. tuberculosis in PTB suspected HIV positive individuals.
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Key Words
- AFB, Acid fast bacilli
- CTAB, cetyltrimethylammonium bromide
- DERC, Departmental Ethical Review and Research Committee
- DMIP, Department of Medical Microbiology, Immunology and Parasitology
- Diagnosis
- HIV, human immunodeficiency virus
- L–J, Lowenstein–Jensen
- MTC, Mycobacterium tuberculosis complex
- Mtb, Mycobacterium tuberculosis
- PCR
- PCR, polymerase chain reaction
- PTB, pulmonary tuberculosis
- Pulmonary tuberculosis
- TB, tuberculosis
- TB-HIV infected
- Tuberculosis
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Affiliation(s)
- Alemu Chemeda
- Arbaminch University, College of Natural Science, Department of Biology, Arbaminch, Ethiopia.,Addis Ababa University, School of Medicine, College of Health Science, Department of Medical Microbiology, Immunology and Parasitology, Addis Ababa, Ethiopia
| | - Tamrat Abebe
- Addis Ababa University, School of Medicine, College of Health Science, Department of Medical Microbiology, Immunology and Parasitology, Addis Ababa, Ethiopia
| | - Gobena Ameni
- Aklilu Lema Pathobiology Research Institution, Addis Ababa University, Ethiopia
| | - Adane Worku
- Aklilu Lema Pathobiology Research Institution, Addis Ababa University, Ethiopia
| | - Adane Mihret
- Addis Ababa University, School of Medicine, College of Health Science, Department of Medical Microbiology, Immunology and Parasitology, Addis Ababa, Ethiopia.,Armauer Hansen Research Institute, Immunology Unit, Addis Ababa, Ethiopia
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21
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Whitley MJ, Stout JE, Kapila A, Selim MA, Mansoori P, Marano AL. Papulonecrotic tuberculid and Poncet disease: A case of multisystem delayed-type hypersensitivity in a patient with Mycobacterium tuberculosis infection. JAAD Case Rep 2019; 5:794-797. [PMID: 31517000 PMCID: PMC6728731 DOI: 10.1016/j.jdcr.2019.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Melodi Javid Whitley
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
| | - Jason E Stout
- Division of Infectious Diseases and International Health, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Atul Kapila
- Division of Rheumatology and Immunology, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - M Angelica Selim
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina.,Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Parisa Mansoori
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Anne L Marano
- Department of Dermatology, Duke University Medical Center, Durham, North Carolina
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Abstract
The most preferable mode of drugs administration is via the oral route but physiological barriers such as pH, enzymatic degradation etc. limit the absolute use of this route. Herein lies the importance of nanotechnology having a wide range of applications in the field of nano-medicine, particularly in drug delivery systems. The exclusive properties particularly small size and high surface area (which can be modified as required), exhibited by these nanoparticlesrender these structures more suitable for the purpose of drug delivery. Various nanostructures, like liposomes, dendrimers, mesoporous silica nanoparticles, etc. have been designed for the said purpose. These nanostructures have several advantages over traditional administration of medicine. Apart from overcoming the pharmacokinetic and pharmacodynamics limitations of many potential therapeutic molecules, they may also be useful for advanced drug delivery purposes like targeted drug delivery, controlled release, enhanced permeability and retention (EPR) effect. In this review, we attempt to describe an up-to-date knowledge on various strategically devised nanostructures to overcome the problems related to oral drug administration.
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Key Words
- 5-FU, 5-fluorouracil
- AD, Alzheimer’s disease
- AMCNS, cationic niosome-based azithromycin delivery systems
- AP, acetylpuerarin
- AT1R, angiotensin II receptor type 1
- AmB, amphotericin B
- BCRP, breast cancer resistance protein
- CNL, conventional lipid nanoparticles
- CSC, core shell corona nanolipoparticles
- DCK, N-deoxycholyl-l-lysyl-methylester
- DDS, drug delivery system
- DM, diabetes mellitus
- DOX, doxorubicin
- Drug delivery system
- EPR, enhanced permeability and retention effect
- FRET, Foster resonance energy transfer
- GI, gastrointestinal
- GMO, glyceryl monoolein
- IBD, inflammatory bowel disease
- LG, Lakshadi Guggul
- LNC, Lipid Nanocapsule
- MFS, Miltefosine
- MNBNC, Micronucleated Binucleated Cells
- MSN, mesoporous silica nanoparticle
- MTX, methotrexate
- NP, nanoparticle
- NPC, nanoparticulate carriers
- NSAID, non-steroidal anti-inflammatory drug
- Nanostructures
- OA, osteoarthritis
- OXA, oxaliplatin
- Oral medicine
- PAMAM, poly (amidoamine)
- PD, Parkinson’s disease
- PEG, polyethylene glycol
- PIP, 1-piperoylpiperidine
- PLGA, polylactic-co-glycolic acid
- PNL, PEGylated lipid nanoparticles
- PZQ, praziquantel
- SLN, solid lipid nanoparticle
- SMA, styrene maleic acid
- SMEDD, self microemulsifying drug delivery system
- TB, tuberculosis
- TNBS, trinitrobenzenesulphonic acid
- TPGS, tocopheryl polyethylene glycol succinate
- Tmf, tamoxifen
- WGA, wheat germ agglutinin
- pSi, porous silicon
- pSiO, porous silica oxide
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23
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Sutherland HS, Tong AST, Choi PJ, Blaser A, Conole D, Franzblau SG, Lotlikar MU, Cooper CB, Upton AM, Denny WA, Palmer BD. 3,5-Dialkoxypyridine analogues of bedaquiline are potent antituberculosis agents with minimal inhibition of the hERG channel. Bioorg Med Chem 2019; 27:1292-1307. [PMID: 30803745 PMCID: PMC6467547 DOI: 10.1016/j.bmc.2019.02.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/06/2019] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
Abstract
Bedaquiline is a new drug of the diarylquinoline class that has proven to be clinically effective against drug-resistant tuberculosis, but has a cardiac liability (prolongation of the QT interval) due to its potent inhibition of the cardiac potassium channel protein hERG. Bedaquiline is highly lipophilic and has an extremely long terminal half-life, so has the potential for more-than-desired accumulation in tissues during the relatively long treatment durations required to cure TB. The present work is part of a program that seeks to identify a diarylquinoline that is as potent as bedaquiline against Mycobacterium tuberculosis, with lower lipophilicity, higher clearance, and lower risk for QT prolongation. Previous work led to the identification of compounds with greatly-reduced lipophilicity compounds that retain good anti-tubercular activity in vitro and in mouse models of TB, but has not addressed the hERG blockade. We now present compounds where the C-unit naphthalene is replaced by a 3,5-dialkoxy-4-pyridyl, demonstrate more potent in vitro and in vivo anti-tubercular activity, with greatly attenuated hERG blockade. Two examples of this series are in preclinical development.
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Key Words
- CFU, colony-forming units
- HPLC, high-performance liquid chromatography
- LDA, lithium diisopropylamide
- LORA, low oxygen recovery assay
- LiTMP, lithium tetramethylpiperidide
- M. tb, mycobacterium tuberculosis
- MABA, microplate alamar blue assay
- MDR, multidrug-resistant
- MIC90, minimum concentration for 90% inhibition of growth
- TB, tuberculosis
- hERG (human Ether-a-go-go Related Gene)
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Affiliation(s)
- Hamish S Sutherland
- Auckland Cancer Society Research Centre, School of Medical Sciences, New Zealand
| | - Amy S T Tong
- Auckland Cancer Society Research Centre, School of Medical Sciences, New Zealand
| | - Peter J Choi
- Auckland Cancer Society Research Centre, School of Medical Sciences, New Zealand
| | - Adrian Blaser
- Auckland Cancer Society Research Centre, School of Medical Sciences, New Zealand
| | - Daniel Conole
- Auckland Cancer Society Research Centre, School of Medical Sciences, New Zealand; Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand; Institute for Tuberculosis Research, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, USA; Global Alliance for TB Drug Development, 40 Wall St, NY 10005, USA
| | - Scott G Franzblau
- Institute for Tuberculosis Research, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street, Chicago, IL 60612, USA
| | | | | | - Anna M Upton
- Global Alliance for TB Drug Development, 40 Wall St, NY 10005, USA
| | - William A Denny
- Auckland Cancer Society Research Centre, School of Medical Sciences, New Zealand; Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.
| | - Brian D Palmer
- Auckland Cancer Society Research Centre, School of Medical Sciences, New Zealand; Maurice Wilkins Centre, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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24
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Ahmad A, Agus R, Massi MN, Natzir R, Madhyastha R, Madhyastha HK, Maruyama M. Cloning and expression of MPT83 gene from Mycobacterium tuberculosis in E. coli BL21 as vaccine candidate of tuberculosis: A preliminary study. J Genet Eng Biotechnol 2019; 16:335-340. [PMID: 30733743 PMCID: PMC6353755 DOI: 10.1016/j.jgeb.2018.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 04/03/2018] [Accepted: 04/10/2018] [Indexed: 11/17/2022]
Abstract
The appearance of Mycobacterium tuberculosis strains leading to drug resistance has caused new problems in TB treatment in various parts of the world and forces WHO to declare TB as a global emergency. With the increase of TB drug resistance, it is convinced that a more effective vaccine development will stop the epidemic of TB. Some M. tuberculosis antigens, one of which is MPT83, have been examined as TB vaccine candidate. MPT83 antigen, which is very immunogenic in lipoprotein micro bacteria, is identified as surface cell interrelated to antigen with cytometry circulation. Having TB resistance from BCG vaccine, MPT83 is considered TB vaccine candidate that can protect people against TB at adult age. The purpose of this research is to conduct amplification of MPT83 antigen cloning, and expression of its antigen on E. coli bacteria. From the result of the research, it is expected that raw material to produce TB vaccine as well as a high-quality antigen can be obtained. The band of DNA in PCR product is 660 bp, while the one in pGEMT-Easy-Mpt83 recombinant plasmid is 3678 bp. This is expressed in E. coli BL21 strain and produces 48 kDa protein as well as GST-MPT83 fusion protein.
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Affiliation(s)
- Ahyar Ahmad
- Chemistry Department, Mathematic and Natural Science Faculty, Hasanuddin Univesity, Perintis Kemerdekaan Street km. 10 Tamalanrea, Makassar 90245, Indonesia
- Laboratory of Research Centre and Developing of Sciences, Faculty of Mathematic and Natural Sciences, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Makassar 90245, Indonesia
- Corresponding author at: Chemistry Department, Mathematic and Natural Science Faculty, Hasanuddin Univesity, Perintis Kemerdekaan Street km. 10 Tamalanrea, Makassar 90245, Indonesia.
| | - Rosana Agus
- Biology Department, Mathematic and Natural Science Faculty, Hasanuddin Univesity, Perintis Kemerdekaan Street km. 10 Tamalanrea, Makassar 90245, Indonesia
| | - Muh. Nasrum Massi
- Microbiology Department, Faculty of Medicine, Hasanuddin Univesity, Perintis Kemerdekaan Street km. 10 Tamalanrea, Makassar 90245, Indonesia
| | - Rosdiana Natzir
- Biochemistry Department, Faculty of Medicine, Hasanuddin Univesity, Perintis Kemerdekaan Street km. 10 Tamalanrea, Makassar 90245, Indonesia
| | - Radha Madhyastha
- Dept. of Applied Physiology, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan
| | - Harish Kumar Madhyastha
- Dept. of Applied Physiology, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan
| | - Masugi Maruyama
- Dept. of Applied Physiology, Faculty of Medicine, University of Miyazaki, Miyazaki 889-1692, Japan
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Cruz JN, Costa JFS, Khayat AS, Kuca K, Barros CAL, Neto AMJC. Molecular dynamics simulation and binding free energy studies of novel leads belonging to the benzofuran class inhibitors of Mycobacterium tuberculosis Polyketide Synthase 13. J Biomol Struct Dyn 2018; 37:1616-1627. [PMID: 29633908 DOI: 10.1080/07391102.2018.1462734] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In this work, the binding mechanism of new Polyketide Synthase 13 (Pks13) inhibitors has been studied through molecular dynamics simulation and free energy calculations. The drug Tam1 and its analogs, belonging to the benzofuran class, were submitted to 100 ns simulations, and according to the results obtained for root mean square deviation, all the simulations converged from approximately 30 ns. For the analysis of backbone flotation, the root mean square fluctuations were plotted for the Cα atoms; analysis revealed that the greatest fluctuation occurred in the residues that are part of the protein lid domain. The binding free energy value (ΔGbind) obtained for the Tam16 lead molecule was of -51.43 kcal/mol. When comparing this result with the ΔGbind values for the remaining analogs, the drug Tam16 was found to be the highest ranked: this result is in agreement with the experimental results obtained by Aggarwal and collaborators, where it was verified that the IC50 for Tam16 is the smallest necessary to inhibit the Pks13 (IC50 = 0.19 μM). The energy decomposition analysis suggested that the residues which most interact with inhibitors are: Ser1636, Tyr1637, Asn1640, Ala1667, Phe1670, and Tyr1674, from which the greatest energy contribution to Phe1670 was particularly notable. For the lead molecule Tam16, a hydrogen bond with the hydroxyl of the phenol not observed in the other analogs induced a more stable molecular structure. Aggarwal and colleagues reported this hydrogen bonding as being responsible for the stability of the molecule, optimizing its physic-chemical, toxicological, and pharmacokinetic properties.
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Key Words
- CNPq, National Council for Scientific and Technological Development
- CoA, coenzyme A
- FAS, fatty acid synthase
- GAFF, general amber force field
- GB, generalized born
- HB, hydrogen bonds
- INH, isoniazid
- KatG, catalase-peroxidase
- MD, molecular dynamics
- MDR, multi-drug resistant
- MM/GBSA, molecular mechanics/generalized-born surface area
- NAD, nicotinamide adenine dinucleotide
- NS, nanoseconds
- PCA, acyl carrier protein
- Pks13
- Pks13, polyketide synthase 13
- RESP, restrained electrostatic potential
- RMSD, root mean square deviation
- RMSF, root mean square fluctuations
- TB, tuberculosis
- TE, C-terminal thioesterase
- XDR, extensively drug resistant
- benzofuran
- free energy
- inhibitors
- molecular dynamics
- Δ internal energy
- Δ, Van Der Waals contributions
- Δ, electrostatic contribution
- Δ, electrostatic contributions
- Δ, energy of desolvation
- Δ, energy of the molecular mechanics
- Δ, non-polar contributions
- Δ, polar contributions
- Δ, polar solvation contribution
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Affiliation(s)
- Jorddy N Cruz
- a Laboratory of Preparation and Computation of Nanomaterials , Federal University of Pará , CP 479, 66075-110 Belém , PA , Brazil
| | - José F S Costa
- a Laboratory of Preparation and Computation of Nanomaterials , Federal University of Pará , CP 479, 66075-110 Belém , PA , Brazil
| | - André S Khayat
- b Oncology Research Center , Federal University of Pará , CP 479, 6675-105 Belém , PA , Brazil
| | - Kamil Kuca
- c Biomedical Research Center , University Hospital Hradec Kralove , Sokolska 581, 500 05 Hradec Kralove , Czech Republic
| | - Carlos A L Barros
- d Department of Pharmacy , Federal University of Pará , CP 479, 66050-160 Belém , PA , Brazil
| | - A M J C Neto
- a Laboratory of Preparation and Computation of Nanomaterials , Federal University of Pará , CP 479, 66075-110 Belém , PA , Brazil
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Azadi A, Jafarpour Fard P, Sagharjoghi Farahani M, Khodadadi B, Almasian M. Anal tuberculosis: A non-Healing anal lesion. IDCases 2018; 12:25-28. [PMID: 29942741 PMCID: PMC6010925 DOI: 10.1016/j.idcr.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 02/27/2018] [Accepted: 02/27/2018] [Indexed: 02/07/2023] Open
Abstract
Anal tuberculosis is an extremely rare extrapulmonary presentation of tuberculosis (TB). Less than 1% of the individuals who contract TB manifests as gastrointestinal TB, and anoperineal TB is much less frequently encountered, 1% of the TB cases of the digestive tract. A rare case of anal tuberculosis is reported in a 37-year-old male patient with a recent anal fistula surgery and relapsing anal lesions. AFB were detected by biopsy and culture. In total, the treatment course lasted 6 months and the patient showed signs of recovery in the early stages of the treatment (after 2 weeks), and complete remission was achieved. In conclusion, it is recommended that in case of encountering Non-healing and recurrent anal lesions, especially in regions endemic for TB, should be evaluated for tuberculosis.
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Key Words
- AIDS, acquired immunodeficiency syndrome
- Anal
- CT, computed tomography
- ESR, erythrocyte sedimentation rate
- Fistula surgery
- HB, hemoglobin
- HIV, human immunodeficiency virus
- IV, intravenous
- IgG, immunoglobulin G
- IgM, immunoglobulin M
- MTB, mycobacterium tuberculosis
- TB, tuberculosis
- Tuberculosis
- VDRL, venereal disease research laboratory
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Affiliation(s)
- A. Azadi
- Department of Infectious Diseases, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - P. Jafarpour Fard
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - M. Sagharjoghi Farahani
- Young Researchers and Elite Club, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
| | - B. Khodadadi
- Young Researchers and Elite Club, Khorramabad Branch, Islamic Azad University, Khorramabad, Iran
- Corresponding author at: Lorestan University of Medical Sciences, Kamalvand, Khorramabad, Lorestan, Iran.
| | - M. Almasian
- Department of the English Language, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Kaplan SR, Topal J, Sosa L, Malinis M, Huttner A, Malhotra A, Friedland G. A patient with central nervous system tuberculomas and a history of disseminated multi-drug-resistant tuberculosis. J Clin Tuberc Other Mycobact Dis 2017; 10:9-16. [PMID: 31720380 PMCID: PMC6830180 DOI: 10.1016/j.jctube.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 12/02/2022] Open
Abstract
Tuberculosis (TB) is one of the leading causes of death worldwide, particularly in low- and middle-income countries. The global rates and numbers of drug resistant TB are rising. With increasing globalization, the spread of drug-resistant strains of TB has become a mounting global public health concern. We present a case of a young man previously treated for multi-drug resistant (MDR) TB in India who presented with neurological symptoms and central nervous system TB in the United States. His case highlights unique diagnostic and treatment challenges that are likely to become more commonplace with the increase of patients infected with drug-resistant TB and complicated extrapulmonary disease.
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Key Words
- AFB, acid-fast bacilli
- BAL, bronchoalveolar lavage
- Bedaquiline
- CNS, central nervous system
- CSF, cerebrospinal fluid
- CT, computerized tomography
- Central nervous system (CNS) TB
- DOT, directly observed therapy
- DST, drug susceptibility testing
- Extensively drug-resistant tuberculosis (XDR-TB)
- FDA, Food and Drug Administration
- IV, intravenous
- LUL, left upper lobe
- MDR-TB, multidrug-resistant tuberculosis
- MRI, magnetic resonance imaging
- Multi-drug resistant tuberculosis (MDR-TB)
- TB, tuberculosis
- Tuberculoma
- Tuberculosis (TB)
- WHO, World Health Organization
- XDR-TB, extensively drug-resistant tuberculosis
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Affiliation(s)
- Samantha R Kaplan
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College St, New Haven, CT 06510, United States
| | - Jeffrey Topal
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College St, New Haven, CT 06510, United States
| | - Lynn Sosa
- Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134, United States
| | - Maricar Malinis
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College St, New Haven, CT 06510, United States
| | - Anita Huttner
- Yale School of Medicine, Department of Pathology, 333 Cedar St, New Haven, CT 06510, United States
| | - Ajay Malhotra
- Yale School of Medicine, Department of Radiology, 333 Cedar St, New Haven, CT 06510, United States
| | - Gerald Friedland
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, 135 College St, New Haven, CT 06510, United States
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Van Norman GA. Overcoming the Declining Trends in Innovation and Investment in Cardiovascular Therapeutics: Beyond EROOM's Law. JACC Basic Transl Sci 2017; 2:613-625. [PMID: 30062175 PMCID: PMC6058942 DOI: 10.1016/j.jacbts.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 12/11/2022]
Abstract
Eroom's law (Moore's law spelled backwards), describes adverse trends towards declining innovation and rising costs of drug development over the last several decades. Therapeutics for cardiovascular diseases (CVD) appear to have been particularly sensitive to these trends. Thirty-three percent fewer CVD therapeutics were approved between 2000 and 2009 compared to the previous decade, and the number of CVD drugs starting all clinical trial stages declined in both absolute and relative numbers between 1990 and 2012. In the last 5 years, drugs to treat CVD disease comprised just 6% of all new drug launches. This review discusses the decline in CVD therapeutics, the reasons behind it, and ways in which this trend is being or might be addressed.
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Key Words
- CVD, cardiovascular disease
- Eroom’s law
- FDA, Food and Drug Administration
- NIH, National Institutes of Health
- OD, orphan drug
- PPMD, parent project muscular dystrophy
- R&D, research and development
- RCT, randomized controlled trials
- ROI, return on investment
- SDLT, severely debilitating or life-threatening
- TB, tuberculosis
- drug approval
- innovation
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Affiliation(s)
- Gail A. Van Norman
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
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Lata K, Afsar M, Ramachandran R. Biochemical characterization and novel inhibitor identification of Mycobacterium tuberculosis Endonuclease VIII 2 (Rv3297). Biochem Biophys Rep 2017; 12:20-28. [PMID: 28955788 PMCID: PMC5613217 DOI: 10.1016/j.bbrep.2017.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/10/2017] [Accepted: 07/29/2017] [Indexed: 12/03/2022] Open
Abstract
Nei2 (Rv3297) is a DNA Base Excision Repair (BER) glycosylase that is essential for survival of Mycobacterium tuberculosis in primates. We show that MtbNei2 is a bifunctional glycosylase that specifically acts on oxidized pyrimidine-containing single-stranded, double-stranded, 5’/3’ fork and bubble DNA substrates. MtbNei2 possesses Uracil DNA glycosylase activity unlike E. coli Nei. Mutational studies demonstrate that Pro2 and Glu3 located in the active site are essential for glycosylase activity of MtbNei2. Mutational analysis demonstrated that an unstructured C-terminal zinc finger domain that was important for activity in E. coli Nei and Fpg, was not required for the glycosylase activity of MtbNei2. Lastly, we screened the NCI natural product compound database and identified three natural product inhibitors with IC50 values ranging between 41.8 μM-92.7 μM against MtbNei2 in in vitro inhibition assays. Surface Plasmon Resonance (SPR) experiments showed that the binding affinity of the best inhibitor, NSC31867, was 74 nM. The present results set the stage for exploiting this important target in developing new therapeutic strategies that target Mycobacterial BER. Biochemical characterization of MtbNei2 (Rv3297). Pro2 and Glu3 residues are essential for MtbNei2 activity. Zinc finger domain is dispensable for activity. 3 natural product inhibitors identified against MtbNei2.
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Key Words
- AP, apurinic/apyrimidinic
- BER
- BER inhibitors
- BER, base excision repair
- EcoFpg, E. coli Formamidopyrimidine glycosylase
- EcoNei, E. coli Endonuclease VIII
- Endonuclease VIII 2
- Glycosylases
- MDR, multidrug resistance
- Mtb, Mycobacterium tuberculosis
- MtbNei2, M. tuberculosis Endonuclease VIII 2
- MtbNei2ΔZNF, M. tuberculosis zinc finger domain deleted mutant
- NSC250430 (Pubchem CID: 317611)
- NSC31867 (Pubchem CID: 233380)
- NSC345647 (Pubchem CID: 53277)
- ROS
- ROS, reactive oxygen species
- SEC, size exclusion chromatography
- TB, tuberculosis
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Affiliation(s)
- Maeve Lynch
- Dermatology Department, University Hospital Limerick, Limerick, Ireland
| | - Lisa Roche
- Dermatology Department, University Hospital Limerick, Limerick, Ireland
| | - Mary Horgan
- Medical School, University College Cork, Cork, Ireland
| | - Kashif Ahmad
- Dermatology Department, University Hospital Limerick, Limerick, Ireland
| | - Caitriona Hackett
- Dermatology Department, University Hospital Limerick, Limerick, Ireland
| | - Bart Ramsay
- Dermatology Department, University Hospital Limerick, Limerick, Ireland
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Watanabe S, Kaneko Y, Kawamoto H, Maehara T, Baba Y, Fujisaki I, Saito N, Ryu K, Seki A, Horikiri T, Kinoshita A, Takeda H, Saito K, Kuwano K. Paradoxical response with increased tumor necrosis factor-α levels to anti-tuberculosis treatment in a patient with disseminated tuberculosis. Respir Med Case Rep 2017; 20:201-204. [PMID: 28331797 PMCID: PMC5345969 DOI: 10.1016/j.rmcr.2017.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 11/30/2022] Open
Abstract
It has been reported that tuberculosis (TB) worsens after cessation of tumor necrosis factor-α inhibitors and starting anti-TB treatment. Little is known about the immunological pathogenesis of this paradoxical response (PR). We report the first case of a TB patient in whom PR occurred concurrently with elevation of circulating tumor necrosis factor-α (TNFα) levels. A 75-year-old woman, who had been treated with adalimumab for SAPHO syndrome, developed disseminated TB. Soon after administration of anti-TB treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol), and after discontinuation of adalimumab, a PR occurred. Serial testing of serum cytokine levels revealed a marked increase in TNFα, and a decline in interferon-γ levels. Despite intensive treatment with antibiotics, prednisolone, noradrenaline, and mechanical ventilation, acute respiratory distress syndrome developed and she died. Thus, overproduction of TNFα after cessation of TNFα inhibitors may partially account for the pathogenesis of a PR. This supports preventative or therapeutic reinitiation of TNFα inhibitors when PR occurs. Serial monitoring of circulating inflammatory cytokine levels could lead to earlier identification of a PR.
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Affiliation(s)
- Sho Watanabe
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Yugo Kaneko
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Hironori Kawamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Tomoki Maehara
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Yuri Baba
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Ikumi Fujisaki
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Nayuta Saito
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Kai Ryu
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Aya Seki
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Tsugumi Horikiri
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Akira Kinoshita
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Hiroshi Takeda
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Keisuke Saito
- Division of Respiratory Medicine, Department of Internal Medicine, Jikei Daisan Hospital, 11-1, Izumihoncho 4, Komae City, Tokyo, Japan
| | - Kazuyosi Kuwano
- Department of Respiratory Medicine, Jikei University School of Medicine, 19-18, Nishishinbashi 3, Minato-ku, Tokyo, Japan
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Ratsavong K, Quet F, Nzabintwali F, Diendéré J, Sebert J, Strobel M, Buisson Y. Usefulness and limits of Ziehl-Neelsen staining to detect paragonimiasis in highly endemic tuberculosis areas. Parasite Epidemiol Control 2017; 2:1-7. [PMID: 29774276 DOI: 10.1016/j.parepi.2016.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 12/04/2022] Open
Key Words
- AFB, acid-fast bacilli
- ELISA, enzyme-linked immunosorbent assay
- ID, intradermal
- IFMT, Institut de la Francophonie pour la Médecine Tropicale
- Lao PDR, Lao People's Democratic Republic
- NTC, National Tuberculosis Centre
- PP, pulmonary paragonimiasis
- TB, tuberculosis
- WHO, World Health Organization
- ZN, Ziehl-Neelsen
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Dueñas MA, Bisceglio I. Funding Research Through the Online Partnership to Accelerate Research (OnPAR). JACC Basic Transl Sci 2016; 1:536-540. [PMID: 30167536 PMCID: PMC6113420 DOI: 10.1016/j.jacbts.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 11/22/2022]
Abstract
OnPAR-the Online Partnership to Accelerate Research-seeks to provide a second opportunity for funding of high-quality, unfunded applications originally submitted to the National Institutes of Health and other national and international funding agencies. OnPAR will match applicable, unfunded applications with the research priorities of nongovernment organizations such as private biomedical foundations, pharmaceutical companies, venture capital funds, and other private funds. Funding organization members will review and make final funding decisions through a simple, 2-step process whereby applicants can submit public abstracts directly to OnPAR. If a member requests additional information, then, by invitation only, an applicant can submit their original unfunded application and their peer review summary statement. Advancing research discovery and drug development to improve clinical outcomes for patients afflicted with or at risk for disease is the primary goal of OnPAR. OnPAR invites the scientific community to fully participate in this new funding paradigm by submitting their National Institutes of Health public abstracts so that funding members can review and potentially support these high-quality, unfunded applications.
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Key Words
- ALS, amyotrophic lateral sclerosis
- CDA, Confidential Disclosure Agreement
- COPD, chronic obstructive pulmonary disease
- HIV/AIDS, human immunodeficiency virus/ acquired immune deficiency syndrome
- NCI, National Cancer Institute
- NHLBI, National Heart, Lung, and Blood Institute
- NIAID, National Institute of Allergy and Infectious Disease
- NIGMS, National Institute of General Medicine Sciences
- NIH, National Institutes of Health
- NINDS, National Institute of Neurological Disorders and Stroke
- OnPAR, Online Partnership to Accelerate Research
- TB, tuberculosis
- funding
- grants
- research
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Wang P, Pradhan K, Zhong XB, Ma X. Isoniazid metabolism and hepatotoxicity. Acta Pharm Sin B 2016; 6:384-92. [PMID: 27709007 DOI: 10.1016/j.apsb.2016.07.014] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/09/2016] [Accepted: 06/27/2016] [Indexed: 12/17/2022] Open
Abstract
Isoniazid (INH) is highly effective for the management of tuberculosis. However, it can cause liver injury and even liver failure. INH metabolism has been thought to be associated with INH-induced liver injury. This review summarized the metabolic pathways of INH and discussed their associations with INH-induced liver injury.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AcHz, acetylhydrazine
- AcINH, acetylisoniazid
- Amidase
- Anti-tuberculosis
- DiAcHz, diacetylhydrazine
- GSH, glutathione
- GST, glutathione S-transferase
- Hepatotoxicity
- Hz, hydrazine
- INA, isonicotinic acid
- INH, isoniazid
- Isoniazid
- MPO, myeloperoxidase
- Metabolism
- N-Acetyltransferase 2
- NAD+, nicotinamide adenine dinucleotide
- NAT, N-acetyltransferase
- P450, cytochrome P450
- R.M., reactive metabolite
- TB, tuberculosis
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Zhang Y, Feng L, Li L, Wang D, Li C, Sun C, Li P, Zheng X, Liu Y, Yang W, Niu X, Zhong N, Chen L. Effects of the fusion design and immunization route on the immunogenicity of Ag85A-Mtb32 in adenoviral vectored tuberculosis vaccine. Hum Vaccin Immunother 2016; 11:1803-13. [PMID: 26076321 DOI: 10.1080/21645515.2015.1042193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Vaccines containing multiple antigens may induce broader immune responses and provide better protection against Mycobacterium tuberculosis (Mtb) infection as compared to a single antigen. However, strategies for incorporating multiple antigens into a single vector and the immunization routes may affect their immunogenicity. In this study, we utilized recombinant adenovirus type 5 (rAd5) as a model vaccine vector, and Ag85A (Rv3804c) and Mtb32 (Rv0125) as model antigens, to comparatively evaluate the influence of codon usage optimization, signal sequence, fusion linkers, and immunization routes on the immunogenicity of tuberculosis (TB) vaccine containing multiple antigens in C57BL/6 mice. We showed that codon-optimized Ag85A and Mtb32 fused with a GSG linker induced the strongest systemic and pulmonary cell-mediated immune (CMI) responses. Strong CMI responses were characterized by the generation of a robust IFN-γ ELISPOT response as well as antigen-specific CD4(+) T and CD8(+) T cells, which secreted mono-, dual-, or multiple cytokines. We also found that subcutaneous (SC) and intranasal (IN)/oral immunization with this candidate vaccine exhibited the strongest boosting effects for Mycobacterium bovis bacille Calmette-Guérin (BCG)-primed systemic and pulmonary CMI responses, respectively. Our results supported that codon optimized Ag85A and Mtb32 fused with a proper linker and immunized through SC and IN/oral routes can generate the strongest systemic and pulmonary CMI responses in BCG-primed mice, which may be particularly important for the design of TB vaccines containing multiple antigens.
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Key Words
- APC, Allophycocyanin
- BCG, Mycobacterium bovis bacille Calmette-Guérin
- BSA, bovine serum album
- CMI, cell-mediated immune responses
- DAPI, 4′,6-diamidino-2-phenylindole
- DMSO, Dimethyl sulfoxide
- ELISPOT, Enzyme-linked immune-sorbent spot
- FACS, Fluorescence Activated Cell Sorter
- FBS, fetal bovine serum
- FITC, fluorescein isothiocyanate
- HA tag, hemagglutinin tag
- HEK, human embryo kidney
- ICS, Intracellular cytokine staining
- IFN-γ, interferon gamma
- IL-2, Interleukin 2
- IM, intramuscular
- IN, intranasal
- Mtb, Mycobacterium tuberculosis
- NBT/BCIP, Nitro blue tetrazolium/ 5-Bromo-4-chloro-3-indolyl phosphate
- PBS, Phosphate Buffered Saline
- PCR, polymerase chain reaction
- PE, Phycoerythrin
- PerCP, Peridinin-ChlorophylL-Protein Complex
- RPMI, Roswell Park Memorial Institute
- SC, subcutaneous
- SDS-PAGE, sodium dodecyl sulfate polyacrylamide gel electrophoresis
- SFC, spot-forming cells
- TB, tuberculosis
- TNF-α, tumor necrosis factor α
- fusion strategies
- immunization routes
- immunogenicity
- multiple antigens
- mycobacterium tuberculosis
- rAd5, recombinant adenovirus type 5
- tPA, tissue plasminogen activator
- vp, viral particles
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Affiliation(s)
- Yiling Zhang
- a State Key Laboratory of Respiratory Diseases; The First Affiliated Hospital of Guangzhou Medical University ; Guangzhou , China
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Sharan LA, Price TP, Hehn B, Manoff D, Cowan SW. A 22-year-old man with pleural tuberculosis associated hydropneumothorax: Case report and literature review. Respir Med Case Rep 2016; 18:27-30. [PMID: 27144114 PMCID: PMC4840424 DOI: 10.1016/j.rmcr.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/25/2022] Open
Abstract
A 22-year-old Asian male presented with fever, non-productive cough, right-sided pleuritic chest pain and was found to have a large right hydropneumothorax. A chest tube was placed. Pleural fluid analysis revealed a lymphocytic predominant exudate and he was subsequently started on four-drug daily anti-tuberculosis therapy (isoniazid, ethambutol, rifampin, pyrazinamide). Pleural biopsy revealed acid-fast bacilli. Given his persistent pleural effusion, he was given four doses of intrapleural tissue plasminogen activator (tPA) and dornase alpha (DNase) via his chest tube over a period of 6 days resulting in clinical and radiologic improvement. Pleural biopsy and pleural fluid culture specimens later revealed Mycobacterium tuberculosis. Intrapleural tPA-DNase therapy has demonstrated improved resolution of infections and shortened hospitalizations for parapneumonic infectious effusions. However, there is little literature on the use of intrapleural fibrinolytics specifically for pleural tuberculosis associated effusions. Furthermore, the American Thoracic Society does not comment on therapeutic thoracentesis or intrapleural fibrinolytic therapy in their recommendations for treatment of pleural tuberculosis. In our case of pleural TB-associated hydropneumothorax, the use of intrapleural tPA-DNase therapy facilitated pleural fluid drainage and resulted in near-complete resolution of the effusion.
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Key Words
- ADA, adenosine deaminase
- AFB, acid fast bacilli
- CT, chest tube
- CXR, chest radiograph
- EMB, ethambutol
- Fibrinolytic therapy
- HD, hospital day
- INH, isoniazid
- PZA, pyrazinamide
- Pleural effusion
- Pleural tuberculosis
- RIF, rifampin
- TB, tuberculosis
- Tuberculosis
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Affiliation(s)
- Lauren A. Sharan
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Thea P. Price
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Boyd Hehn
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Manoff
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Scott W. Cowan
- Department of Surgery, Division of Thoracic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
- Corresponding author. Thoracic Surgery, Thomas Jefferson University Hospital, 1025 Walnut Street, Suite 607, Philadelphia, PA 19107, USA.Thoracic SurgeryThomas Jefferson University Hospital1025 Walnut StreetSuite 607PhiladelphiaPA19107USA
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Ponte C, Peres L, Marinho S, Lima J, Siqueira M, Pedro T, De Luca P, Cascabulho C, Castello-Branco LR, Antas PRZ. In vitro T-cell profile induced by BCG Moreau in healthy Brazilian volunteers. Hum Vaccin Immunother 2015; 11:450-7. [PMID: 25483636 DOI: 10.4161/21645515.2014.970954] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Tuberculosis (TB) remains the world's leading cause of morbidity and mortality. Although Mycobacterium bovis bacillus Calmette-Guérin (BCG) is the only vaccine currently in use, its efficacy is highly variable. It has been suggested that early antigenic presentation is a pivotal event leading to a better immune response in TB vaccine models. To investigate this further, we compared in vitro cell-mediated immune responses in the context of early sensitization with TB (i.e. healthy adults vaccinated with BCG when they were young, HD; n = 25) to those in its absence (i.e., newborns with naïve immunity to TB, UV; n = 10) by challenging mononuclear cells with BCG Moreau. After 48 hours, CD4+ and CD8+ T cells were harvested from both groups and stained for PD-1/CD25/ FOXP3. In addition, supernatants were assayed for a broad range of cytokines using an array system. The HD group showed robust reactivity to Protein Purified Derivative and BCG while the naïve, UV group did not. Similarly, in terms of PD-1 expression and Treg cells (CD4+/CD25high(+)/FOXP3+), only the HD group showed higher levels in CD4 lymphocytes. Otherwise, only the UV group showed expression of CD25dim+ as an activation marker dependent on BCG infection. In terms of cytokines, the HD group showed higher levels of Th1 (IL-2/TNF-α/IFN-γ) and regulatory (IL-10) profiles, with monocytes, but not Tr1 cells, acting as the main source of IL-10. Taken together, our results highlight critical roles of early sensitization with TB in mounting cell-mediated immune responses.
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Key Words
- BCG vaccine
- BCG, bacillus calmette-guérin
- CBA, cytometric beads array kit
- CBMC, cord blood mononuclear cells
- ELISA, enzyme-linked immunosorbent assay
- ELISPOT, enzyme linked immunospot
- FACS, fluorescence activating cell sorting
- HD, healthy donor
- HIV, human immunodeficiency virus
- HLA, human leukocyte antigen
- PBMC, peripheral blood mononuclear cells
- PHA, phytohaemaglutinin
- PPD, protein purified derivative
- TB, tuberculosis
- UV, umbilical vein
- cytokine
- iNKT, invariant natural killer T cells
- lymphocyte
- phenotyping
- tuberculosis
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Affiliation(s)
- C Ponte
- a Laboratório de Imunologia Clínica; Instituto Oswaldo Cruz ; Fiocruz , Rio de Janeiro , Brazil
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Rovetta AI, Peña D, Hernández Del Pino RE, Recalde GM, Pellegrini J, Bigi F, Musella RM, Palmero DJ, Gutierrez M, Colombo MI, García VE. IFNG-mediated immune responses enhance autophagy against Mycobacterium tuberculosis antigens in patients with active tuberculosis. Autophagy 2015; 10:2109-21. [PMID: 25426782 DOI: 10.4161/15548627.2014.981791] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Protective immunity against Mycobacterium tuberculosis (Mtb) requires IFNG. Besides, IFNG-mediated induction of autophagy suppresses survival of virulent Mtb in macrophage cell lines. We investigated the contribution of autophagy to the defense against Mtb antigen (Mtb-Ag) in cells from tuberculosis patients and healthy donors (HD). Patients were classified as high responders (HR) if their T cells produced significant IFNG against Mtb-Ag; and low responders (LR) when patients showed weak or no T cell responses to Mtb-Ag. The highest autophagy levels were detected in HD cells whereas the lowest quantities were observed in LR patients. Interestingly, upon Mtb-Ag stimulation, we detected a positive correlation between IFNG and MAP1LC3B-II/LC3-II levels. Actually, blockage of Mtb-Ag-induced IFNG markedly reduced autophagy in HR patients whereas addition of limited amounts of IFNG significantly increased autophagy in LR patients. Therefore, autophagy collaborates with human immune responses against Mtb in close association with specific IFNG secreted against the pathogen.
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Key Words
- AG, antigen
- ATG, autophagy-related
- FBS, fetal bovine serum
- GAPDH, glyceraldehyde-3-phosphate dehydrogenase
- GTP, guanosine triphosphate
- HD, healthy donors
- HR TB, high-responder tuberculosis patient
- IFNG
- IFNG, interferon gamma
- IL, Interleukin
- LC3, microtubule-associated protein 1A/1B-light chain 3
- LR TB, low-responder tuberculosis patients
- Mtb-Ag, Mycobacterium tuberculosis antigen
- PBMC, peripheral blood mononuclear cells
- PBS, phosphate-buffered saline
- SLAM, signaling lymphocytic activation molecule
- TB, tuberculosis
- Th, T helper
- autophagy
- cytokines
- defense
- immune response
- mAb, monoclonal antibody
- patients
- rIFNG, recombinant IFNG
- tuberculosis
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Affiliation(s)
- Ana I Rovetta
- a Departamento de Química Biológica; Facultad de Ciencias Exactas y Naturales; Universidad de Buenos Aires (UBA) ; Buenos Aires , Argentina
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Abstract
As the liver transplant journey in India reaches substantial numbers and suggests quality technical expertise, it is time to dispassionately look at the big picture, identify problems, and consider corrective measures for the future. Several features characterize the current scenario. Although the proportion of deceased donor liver transplants is increasing, besides major regional imbalances, the activity is heavily loaded in favor of the private sector and live donor transplants. The high costs of the procedure, the poor participation of public hospitals, the lack of a national registry, and outcomes reporting are issues of concern. Organ sharing protocols currently based on chronology or institutional rotation need to move to a more justiciable severity-based system. Several measures can expand the deceased donor pool. The safety of the living donor continues to need close scrutiny and focus. Multiple medical challenges unique to the Indian situation are also being thrown up. Although many of the deficits demand state intervention and policy changes the transplant community needs to take notice and highlight them. The future of liver transplantation in India should move toward a more accountable, equitable, and accessible form. We owe this to our citizens who have shown tremendous faith in us by volunteering to be living donors as well as consenting for deceased donation.
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Key Words
- ALF, acute liver failure
- CMV, cytomegalovirus
- CT, computerized tomography
- DBD, donation after brain death
- DCD, donation after cardiac death
- DDLT, deceased donor liver transplant
- DNA, deoxyribonucleic acid
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HOTA, Human Organs Transplant Act
- ICU, intensive care unit
- INASL, Indian Association for Study of the Liver
- ISOT, Indian Society of Organ Transplantation
- India
- KCH, King's College Hospital
- LDLT, live donor liver transplantation
- LT, liver transplantation
- MELD, model for end stage liver disease
- NASH, non-alcoholic steatohepatitis
- NGO, non-governmental organizations
- NOTTO, National Organ and Tissue Transplant Organization
- NTORC, non transplant organ retrieval center
- OPTN, Organ Procurement Transplant Network
- RGJAY, Rajiv Gandhi JeevandayeeArogyaYojana
- ROTTO, Regional Organ and Tissue Transplant Organization
- SOTTO, State Organ and Tissue Transplant Organization
- SRTR, Scientific Registry of Transplant Recipients
- TB, tuberculosis
- UCSF, University of California San Francisco
- UK, United Kingdom
- UKELD, United Kingdom End stage Liver Disease
- UKNHSBT, UK the National Health Services Blood and Transplant Authority
- UNOS, United Network for Organ Sharing
- USA, United States of America
- ZTCC, Zonal Transplant Coordination Centre
- donation after brain death
- liver transplantation
- living donor liver transplant
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Affiliation(s)
- Sanjay Nagral
- Department of Surgical Gastroenterology, Jaslok Hospital and Research Centre, India
| | - Aditya Nanavati
- Department of General Surgery, K.B. Bhabha Municipal General Hospital, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital and Research Centre, India
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Abstract
We describe the case of a 79-year-old man who presented with an enlarging mass on his chest wall. He had a history of thoracoplasty performed 55 years ago for treatment of pulmonary tuberculosis. The mass was subsequently proven to be the result of empyema neccesitans caused by reactivation tuberculosis. Empyema neccesitans is a well described entity in which an empyema spontaneously decompresses by dissecting into the chest wall and extrathoracic soft tissues. This can occur following necrotizing pneumonia, including pyogenic or tuberculus, or pulmonary abscess. Complications from collapse therapy for tuberculosis can be encountered decades following the surgery, however, empyema necessitans due to reactivation tuberculosis is rare. This case affords the opportunity to review the goals, techniques, and radiologic appearance of thoracoplasty.
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Abstract
Portal vein thrombosis is an important cause of portal hypertension. PVT occurs in association with cirrhosis or as a result of malignant invasion by hepatocellular carcinoma or even in the absence of associated liver disease. With the current research into its genesis, majority now have an underlying prothrombotic state detectable. Endothelial activation and stagnant portal blood flow also contribute to formation of the thrombus. Acute non-cirrhotic PVT, chronic PVT (EHPVO), and portal vein thrombosis in cirrhosis are the three main variants of portal vein thrombosis with varying etiological factors and variability in presentation and management. Procoagulant state should be actively investigated. Anticoagulation is the mainstay of therapy for acute non-cirrhotic PVT, with supporting evidence for its use in cirrhotic population as well. Chronic PVT (EHPVO) on the other hand requires the management of portal hypertension as such and with role for anticoagulation in the setting of underlying prothrombotic state, however data is awaited in those with no underlying prothrombotic states. TIPS and liver transplant may be feasible even in the setting of PVT however proper selection of candidates and type of surgery is warranted. Thrombolysis and thrombectomy have some role. TARE is a new modality for management of HCC with portal vein invasion.
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Key Words
- ACLA, anti-cardiolipin antibody
- AFP, alpha feto protein
- BCS, Budd-Chiari syndrome
- CDUS, color doppler ultrasonography
- CT, computed tomography
- CTP, Child Turcotte Pugh
- EHPVO, extra hepatic portal venous obstruction
- EST, endoscopic sclerotherapy
- HCC, hepatocellular carcinoma
- HVPG, hepatic venous pressure gradient
- IGF-1, insulin like growth factor-1
- IGFBP-3, insulin like growth factor binding protein-3
- INR, international normalized ratio
- JAK-2, Janus kinase 2
- LA, lupus anticoagulant
- LMWH, low molecular weight heparin
- MELD, model for end stage liver disease
- MPD, myeloproliferative disorder
- MRI, magnetic resonance imaging
- MTHFR, methylenetetrahydrofolate reductase
- MVT, mesenteric vein thrombosis
- OCPs, oral contraceptive pills
- PAI-1 4G-4G, plasminogen activator inhibitor type 1- 4G/4G genotype
- PNH, paroxysmal nocturnal hemoglobinuria
- PV, portal vein
- PVT
- PVT, portal vein thrombosis
- PWUS, Pulsed Wave ultrasonography
- RFA, radio frequency ablation
- SMA, superior mesenteric artery
- SMV, superior mesenteric vein
- TAFI, thrombin activatable fibrinolysis inhibitor
- TARE, Trans arterial radioembolization
- TB, tuberculosis
- TIPS, transjugular intrahepatic portosystemic shunt
- UFH, unfractionated heparin
- acute and chronic
- anticoagulation
- imaging
- prothrombotic
- rtPA, recombinant tissue plasminogen activator
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Affiliation(s)
- Yogesh K. Chawla
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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Abstract
Molecular oxygen (O2) and nitric oxide (NO) are diatomic gases that play major roles in infection. The host innate immune system generates reactive oxygen species and NO as bacteriocidal agents and both require O2 for their production. Furthermore, the ability to adapt to changes in O2 availability is crucial for many bacterial pathogens, as many niches within a host are hypoxic. Pathogenic bacteria have evolved transcriptional regulatory systems that perceive these gases and respond by reprogramming gene expression. Direct sensors possess iron-containing co-factors (iron–sulfur clusters, mononuclear iron, heme) or reactive cysteine thiols that react with O2 and/or NO. Indirect sensors perceive the physiological effects of O2 starvation. Thus, O2 and NO act as environmental cues that trigger the coordinated expression of virulence genes and metabolic adaptations necessary for survival within a host. Here, the mechanisms of signal perception by key O2- and NO-responsive bacterial transcription factors and the effects on virulence gene expression are reviewed, followed by consideration of these aspects of gene regulation in two major pathogens, Staphylococcus aureus and Mycobacterium tuberculosis.
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Key Words
- AIP, autoinducer peptide
- Arc, Aerobic respiratory control
- FNR
- FNR, fumarate nitrate reduction regulator
- GAF, cGMP-specific phosphodiesterase-adenylyl cyclase-FhlA domain
- Isc, iron–sulfur cluster biosynthesis machinery
- Mycobacterium tuberculosis
- NOX, NADPH oxidase
- PAS, Per-Amt-Sim domain
- RNS, reactive nitrogen species
- ROS, reactive oxygen species
- Staphylococcus aureus
- TB, tuberculosis
- WhiB-like proteins
- iNOS, inducible nitric oxide synthase
- iron–sulfur cluster
- nitric oxide sensors
- oxygen sensors
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Affiliation(s)
- Jeffrey Green
- a Krebs Institute; Molecular Biology & Biotechnology; University of Sheffield ; Western Bank , Sheffield , UK
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Ramappa V, Aithal GP. Hepatotoxicity Related to Anti-tuberculosis Drugs: Mechanisms and Management. J Clin Exp Hepatol 2013; 3:37-49. [PMID: 25755470 DOI: 10.1016/j.jceh.2012.12.001] [Citation(s) in RCA: 255] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 12/12/2012] [Indexed: 02/07/2023] Open
Abstract
Development of idiosyncratic hepatotoxicity is an intricate process involving both concurrent as well as sequential events determining the direction of the pathways, degree of liver injury and its outcome. Decades of clinical observation have identified a number of drug and host related factors that are associated with an increased risk of antituberculous drug-induced hepatotoxicity, although majority of the studies are retrospective with varied case definitions and sample sizes. Investigations on genetic susceptibility to hepatotoxicity have so far focused on formation and accumulation reactive metabolite as well as factors that contribute to cellular antioxidant defense mechanisms and the environment which can modulate the threshold for hepatocyte death secondary to oxidative stress. Recent advances in pharmacogenetics have promised the development of refined algorithms including drug, host and environmental risk factors that allow better tailoring of medications based on accurate estimates of risk-benefit ratio. Future investigations exploring the pathogenesis of hepatotoxicity should be performed using human tissue and samples whenever possible, so that the novel findings can be translated readily into clinical applications.
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Key Words
- ALT, alanine transaminase
- ART, anti-retroviral therapy
- AST, aspartate transaminase
- ATP, adenosine triphosphate
- ATS, American Thoracic Society
- BSEP, bile salt exporter pump
- BTB, broad complex, tramtrack, bric-a-brac domain
- BTS, British Thoracic Society
- CNC, cap‘n’collar type of basic region
- CYP, cytochrome P450
- DILI, drug-induced liver injury
- DOTS, directly observed short-course therapy
- FDA, Food and Drug Administration
- GST, glutathione S-transferase
- HAART, highly active anti-retroviral therapy
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- HLA, human leukocyte antigen
- INH, isoniazid
- MHC, major histocompatibility complex
- MPT, mitochondrial permeability transition
- MnSOD, manganese superoxide dismutase
- NAC, N-acetyl cysteine
- NAT2, N-acetyltransferase 2
- NICE, National Institute for Clinical Excellence
- Nrf2, nuclear factor erythroid 2-related factor-2
- OR, odds ratio
- PXR, pregnane X receptor
- ROS, reactive oxygen species
- SH, sulfhydryl
- SNP, single-nucleotide polymorphism
- TB, tuberculosis
- ULN, upper limit of normal range
- WHO, World Health Organization
- drug-induced liver injury
- genetic
- hepatotoxicity
- pathogenesis
- tuberculosis
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Varghese J, Gomathy N, Rajashekhar P, Venugopal K, Olithselvan A, Vivekanandan S, Naresh S, Sujatha C, Vijaya S, Jayanthi V, Rela M. Perioperative bacterial infections in deceased donor and living donor liver transplant recipients. J Clin Exp Hepatol 2012; 2:35-41. [PMID: 25755404 PMCID: PMC3940144 DOI: 10.1016/s0973-6883(12)60081-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 02/24/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Deceased donor (DDLT) and living donor (LDLT) liver transplant (LT) is in vogue in several centers in India. Most centers are resorting to LDLT as a preferred surgery due to shortage of deceased donor liver. The risk of infection and its effect on survival in both groups of recipients from the Indian subcontinent are not known. The study was conducted to compare the bacterial infection rates among LDLT and DDLT recipients and their impact on survival at a tertiary referral center. METHODS Retrospective data on 67 LT recipients were reviewed. Data on pre-, per-, and postoperative bacterial infection rates and the common isolates were obtained. RESULTS Thirty-five patients had LDLT and 32 had DDLT. The prevalence of pre-operative bacterial infection and the isolates was similar in both groups. The perioperative bacterial infection rates were significantly higher in DDLT recipients (P < 0.01) (relative risk: 1.44 95% confidence interval 1.04-1.9). In both LDLT and DDLT, the common source was urinary tract followed by bloodstream infection. The common bacterial isolates in either transplant were Klebsiella followed by Escherichia coli, Pseudomonas spp. and nonfermenting gram-negative bacteria. Six patients (four LDLT; two DDLT) were treated for tuberculosis. Among the risk factors, cold ischemic time, and duration of stay in the intensive care unit was significantly higher for DDLT (p < 0.01). The death rates were not significantly different in the two groups. However, the odds for death were significantly high at 26.8 (p < 0.05) for postoperative bacterial infection and 1.8 (p < 0.001) for past alcohol. CONCLUSION Liver transplant recipients are at high-risk for bacterial infection irrespective of type of transplant, more so in DDLT.
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Key Words
- AFB, acid fast bacilli
- ATT, anti-tuberculous treatment
- BAL, bronchoalveolar lavage
- BSI, bloodstream infections
- Bacteria
- CIT, cold ischemic time
- CLSI, Clinical and Laboratory Standards Institute
- CRP, C-reactive protein
- DDLT, deceased donor liver transplant
- E. coli, Escherichia coli
- ET, endotracheal
- ICU, intensive care unit
- K. pneumonia, Klebsiella pneumonia
- LDLT, living donor liver transplant
- LT, liver transplant
- MELD, model for end-stage liver disease
- MRSA, methicillin-resistant Staphylococcus aureus
- NFGNB, nonfermenting gram-negative bacilli
- P. aeruginosa, Pseudomonas aeruginosa
- RFA, radiofrequency ablation
- RR, relative risk
- TACE, transarterial chemoembolization
- TB, tuberculosis
- infection
- liver transplant
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Affiliation(s)
- Joy Varghese
- Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai, India,Address for correspondence: Joy Varghese, Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai, India
| | - Narasimhan Gomathy
- Institute of Hepatopancreaticbiliary and Transplant Unit, Global Hospitals and Health City, Chennai, India
| | - Perumalla Rajashekhar
- Institute of Hepatopancreaticbiliary and Transplant Unit, Global Hospitals and Health City, Chennai, India
| | - Kota Venugopal
- Institute of Hepatopancreaticbiliary and Transplant Unit, Global Hospitals and Health City, Chennai, India
| | - Arikichenin Olithselvan
- Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai, India
| | - Shanmugam Vivekanandan
- Institute of Hepatopancreaticbiliary and Transplant Unit, Global Hospitals and Health City, Chennai, India
| | - Shanmugam Naresh
- Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai, India
| | | | - Srinivasan Vijaya
- Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai, India
| | - Venkataraman Jayanthi
- Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai, India
| | - Mohamed Rela
- Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai, India,Institute of Hepatopancreaticbiliary and Transplant Unit, Global Hospitals and Health City, Chennai, India
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