3,071 research outputs found
Serelaxin - from basic research to clinical practice in acute heart failure [invited speaker]
No full textMissed opportunities for tuberculosis diagnosis.
No full textBACKGROUND: In high tuberculosis (TB) burden, resource-poor countries, sputum smear microscopy remains the mainstay of diagnosis. The low sensitivity of this test means that patients with smear-negative but culture-positive TB pass undetected through the health care system. Such clinical episodes are missed opportunities for diagnosis and interruption of transmission, which might be averted through the application of more sensitive diagnostic tests. OBJECTIVES: To estimate the proportion of incident TB cases that might have been detected earlier than the actual date of diagnosis if a test more sensitive than smear microscopy had been used at an earlier presentation episode. METHOD: Retrospective cohort study in urban Peru, investigating health care facility interactions for symptoms suggestive of TB prior to TB diagnosis through patient interviews and a review of clinical records. RESULTS: Of 212 participants enrolled, 58% had one or more clinical interactions prior to their diagnostic episode. Of those with a prior episode, the median number of episodes was three. The median delay to diagnosis from first presentation was 26 days. CONCLUSION: There are clear missed opportunities for earlier TB diagnosis, delaying treatment initiation and continued spread of Mycobacterium tuberculosis to the community. The implementation of sensitive diagnostic tests appropriate to resource-poor settings should be given high priority
Diabetes is a Strong Predictor of Mortality During Tuberculosis Treatment: A Prospective Cohort Study Among Tuberculosis Patients from Mwanza, Tanzania.
No full textStrong evidence suggests diabetes may be associated with tuberculosis (TB) and could influence TB treatment outcomes. We assessed the role of diabetes on sputum culture conversion and mortality among patients undergoing TB treatment. A total of 1250 Tanzanian TB patients were followed prospectively during TB treatment with sputum culture after 2 and 5 months. Survival status was assessed at least 1 year after initiation of treatment. At baseline, all participants underwent testing for diabetes and HIV, and the serum concentration of the acute phase reactant alpha-1 glycoprotein (AGP) was determined. There were no differences between participants with and without diabetes regarding the proportion of positive cultures at 2 (3.8% vs. 5.8%) and 5 (1.3% vs. 0.9%) months (P > 0.46). However, among patients with a positive TB culture, relatively more patients with diabetes died before the 5-month follow-up. Within the initial 100 days of TB treatment, diabetes was associated with a fivefold increased risk of mortality (RR 5.09, 95% CI 2.36; 11.02, P < 0.001) among HIV uninfected, and a twofold increase among HIV co-infected patient (RR 2.33 95% CI 1.20; 4.53, P = 0.012), while diabetes was not associated with long-term mortality. Further adjustment with AGP did not change the estimates. Diabetes considerably increases risk of early mortality during TB treatment. The effect may not be explained by increased severity of TB, but could be due to impaired TB treatment response. Research is needed to clarify the mechanism and to assess whether glycaemic control improves survival
Accurate diagnosis of latent tuberculosis in children, people who are immunocompromised or at risk from immunosuppression and recent arrivals from countries with a high incidence of tuberculosis: systematic review and economic evaluation
No full textBackground - Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB) [(Zopf 1883) Lehmann and Neumann 1896], is a major cause of morbidity and mortality. Nearly one-third of the world’s population is infected with MTB; TB has an annual incidence of 9 million new cases and each year causes 2 million deaths worldwide.
Objectives - To investigate the clinical effectiveness and cost-effectiveness of screening tests [interferon-gamma release assays (IGRAs) and tuberculin skin tests (TSTs)] in latent tuberculosis infection (LTBI) diagnosis to support National Institute for Health and Care Excellence (NICE) guideline development for three population groups: children, immunocompromised people and those who have recently arrived in the UK from high-incidence countries. All of these groups are at higher risk of progression from LTBI to active TB.
Results - In total, 6687 records were screened, of which 53 unique studies were included (a further 37 studies were identified from a previous NICE guideline). The majority of the included studies compared the strength of association for the QFT-GIT/G IGRA with the TST (5 mm or 10 mm) in relation to the incidence of active TB or previous TB exposure. Ten studies reported evidence on decision-analytic models to determine the cost-effectiveness of IGRAs compared with the TST for LTBI diagnosis. In children, TST (≥ 5 mm) negative followed by QFT-GIT was the most cost-effective strategy, with an incremental cost-effectiveness ratio (ICER) of £18,900 per quality-adjusted life-year (QALY) gained. In immunocompromised people, QFT-GIT negative followed by the TST (≥ 5 mm) was the most cost-effective strategy, with an ICER of approximately £18,700 per QALY gained. In those recently arrived from high TB incidence countries, the TST (≥ 5 mm) alone was less costly and more effective than TST (≥ 5 mm) positive followed by QFT-GIT or T-SPOT.TB or QFT-GIT alone.
Conclusions - Given the current evidence, TST (≥ 5 mm) negative followed by QFT-GIT for children, QFT-GIT negative followed by TST (≥ 5 mm) for the immunocompromised population and TST (≥ 5 mm) for recent arrivals were the most cost-effective strategies for diagnosing LTBI that progresses to active TB. These results should be interpreted with caution given the limitations identified. The evidence available is limited and more high-quality research in this area is needed including studies on the inconsistent performance of tests in high-compared with low-incidence TB settings; the prospective assessment of progression to active TB for those at high risk; the relative benefits of two-compared with one-step testing with different tests; and improved classification of people at high and low risk for LTBI
The Impact of Antiretroviral Therapy on Mortality in HIV Positive People during Tuberculosis Treatment: A Systematic Review and Meta-Analysis
No full textObjective: To quantify the impact of antiretroviral therapy (ART) on mortality in HIV-positive people during tuberculosis (TB) treatment. Design: We conducted a systematic literature review and meta-analysis. Studies published from 1996 through February 15, 2013, were identified by searching electronic resources (Pubmed and Embase) and conference books, manual searches of references, and expert consultation. Pooled estimates for the outcome of interest were acquired using random effects meta-analysis. Subjects The study population included individuals receiving ART before or during TB treatment. Main Outcome Measures: Main outcome measures were: (i) TB-case fatality ratio (CFR), defined as the proportion of individuals dying during TB treatment and, if mortality in HIV-positive people not on ART was also reported, (ii) the relative risk of death during TB treatment by ART status. Results: Twenty-one studies were included in the systematic review. Random effects pooled meta-analysis estimated the CFR between 8% and 14% (pooled estimate 11%). Among HIV-positive TB cases, those receiving ART had a reduction in mortality during TB treatment of between 44% and 71% (RR = 0.42, 95%CI: 0.29–0.56). Conclusion: Starting ART before or during TB therapy reduces the risk of death during TB treatment by around three-fifths in clinical settings. National programmes should continue to expand coverage of ART for HIV positive in order to control the dual epidemic.Version of Recor
54.5 Tb/s WDM Transmission over Field Deployed Fiber Enabled by Neural Network-Based Digital Pre-Distortion
No full textWe demonstrate a record 54.5 Tb/s WDM transmission at 11.35 bit/s/Hz over 48 km of field-deployed SMF connecting business and academic parks enabled by a novel joint I-Q Neural Network-based transmitter digital pre-distortion technique.Accepted Author ManuscriptTeam Sander Wahl
On energy storage of Lu2O3:Tb,M (M=Hf, Ti, Nb) sintered ceramics: Glow curves, dose-response dependence, radiation hardness and self-dose effect
No full textThermoluminescent properties and energy storage characteristics of Lu2O3:Tb,M (M = Hf, Ti, Nb) sintered ceramics induced by ionizing radiation are presented and discussed. Dose-response dependence, radiation hardness and fading are studied. A linearity of the former exceeding seven orders of magnitude is confirmed for Lu2O3:Tb,Hf and Lu2O3:Tb,Nb ceramics. Lu2O3:Tb,Hf shows the best TL performance and also its fading is the lowest reaching 15% over 7 h and shows tendency to saturate. During the same period of time the Lu2O3:Tb,Ti, despite having TL at higher temperatures, losses about 25% of the stored energy and the TL signal of Lu2O3:Tb,Nb fades by almost 40% over 7 h. First order TL kinetics is confirmed for all three compositions. A self-dose effect in Lu2O3:Tb,Hf due to a natural content of the radioactive isotope (2.6%) is proved to be important for long-time reading of low doses.Accepted Author ManuscriptRST/Luminescence Material
Generalized local Tb Theorems for Square Functions
No full textA local Tb theorem is an L-2 boundedness criterion by which the question of the global behavior of an operator is reduced to its local behavior, acting on a family of test functions b(Q) indexed by the dyadic cubes. We present two versions of such results, in particular, treating square function operators whose kernels do not satisfy the standard Littlewood-Paley pointwise estimates. As an application of one version of the local Tb theorem, we show how the solvability of the Kato problem (which was implicitly based on local Tb theory) may be deduced from this general criterion.Peer reviewe
Importance of TB contact investigations
No full textAbstractTuberculosis contact investigations are a top priority in TB infection control. The aim is to prevent the spread of infectious disease, identify potential TB sources, and treat individuals who are infected or actively ill. The contact investigation process is quite simple: identify close contacts; examine their symptoms and determine their clinical status; perform a chest X-ray; administer a tuberculin skin test and/or interferon gamma release assay; and evaluate the results. This communication documents a TB contact investigation that was conducted in one family during the months after the initial TB finding. Investigations of close family contacts found active TB in 3 individuals and latent TB in 1 unvaccinated child. This confirms that contact investigations are an easy intervention that results in rapid identification of TB sources. Treatment of these patients reduces the risk of exposure and spread of infection to additional community members [1]
Single-channel 1.61 Tb/s optical coherent transmission enabled by neural network-based digital pre-distortion
No full textWe propose a novel digital pre-distortion (DPD) based on neural networks for high-baudrate optical coherent transmitters. We demonstrate experimentally that it outperforms an optimized linear DPD giving a 1.2 dB SNR gain in a 128GBaud PCS-256QAM single-channel transmission over 80km of standard single-mode fiber resulting in a record 1.61 Tb/s net data rate.Accepted Author ManuscriptTeam Sander Wahl
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