28 research outputs found
Challenges and Progress with Diagnosing Pulmonary Tuberculosis in Low- and Middle-Income Countries
No full textCase finding and the diagnosis of tuberculosis (TB) are key activities to reach the World Health Organization’s End TB targets by 2030. This paper focuses on the diagnosis of pulmonary TB (PTB) in low- and middle-income countries. Sputum smear microscopy, despite its many limitations, remains the primary diagnostic tool in peripheral health facilities; however, this is being replaced by molecular diagnostic techniques, particularly Xpert MTB/RIF, which allows a bacteriologically confirmed diagnosis of TB along with information about whether or not the organism is resistant to rifampicin within two hours. Other useful diagnostic tools at peripheral facilities include chest radiography, urine lipoarabinomannan (TB-LAM) in HIV-infected patients with advanced immunodeficiency, and the loop-mediated isothermal amplification (TB-LAMP) test which may be superior to smear microscopy. National Reference Laboratories work at a higher level, largely performing culture and phenotypic drug susceptibility testing which is complemented by genotypic methods such as line probe assays for detecting resistance to isoniazid, rifampicin, and second-line drugs. Tuberculin skin testing, interferon gamma release assays, and commercial serological tests are not recommended for the diagnosis of active TB. Linking diagnosis to treatment and care is often poor, and this aspect of TB management needs far more attention than it currently receives
National guidelines on screening for diabetes among patients with tuberculosis in India: Need for clarity and change in screening cut off?
No full textDo diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya
No full textAbstractAimsAmong diabetes mellitus (DM) patients with poor glycemic control enrolled into a self-monitoring of blood glucose (SMBG) program in Kenya, to assess the level of SMBG adherence, its associated factors and its relation to glycemic control (defined as HbA1c <7% and/or 2% absolute reduction relative to baseline).MethodsIn this retrospective cohort study, we used routinely collected data of patients enrolled during 2012–2013. We assessed adherence to SMBG by dividing the number of glucose tests performed by the number recommended. A level of ≥80% was considered ‘good adherence’. Glycemic control was considered as absolute change from baseline of 2%.ResultsOf 164 patients (59% female; 76% rural), the proportions with good SMBG adherence were 34%, 17%, 15% and 10% during 0–6, 7–12, 13–18 and 19–24 months into the HGM program respectively. In multivariate analysis, male gender, urban place of residence and payment for glucostrips were associated with poor adherence during 0–12 months. The mean reduction in HbA1c compared to baseline was 1.2%, 1.1%, 0.8% and 0.7% at 6, 12, 18 and 24 months, respectively. We did not find any association between SMBG adherence and glycemic control.ConclusionsAdherence to SMBG was sub-optimal, especially among those who had to pay for glucostrips. Patient education and provision of free glucostrips are recommended to improve adherence and glycemic control
Not Available
No full textNot AvailableThirty groundnut genotypes (18 of Virginia bunch, 5 Spanish bunch and 7 Virginia runner group)
were screened for their relative response to Caryedon serratus using no choice test under laboratory
condition (32 to 35
0
C). The results showed that the number of eggs laid by C. serratus ranged
from 19.3 to 115.0 and adult emergence varied from 11.0 to 63.7 beetles. Per cent damage to the
kernels was highest in ‘GG-20 (80.7%) and lowest in T-28 (7.6 %)’. First three principle components
(PC) accounted for approximately 84% observed variation in the data. Breakdown of cumulative
variance revealed the contribution of PC 1 and PC 2 and PC 3 were 46, 21 and 17%, respectively
towards cumulative variance. The vertex genotypes were GG- 20, AK-303, AK-265, T-28, ALR-1
and ALR-3 of these genotypes, onl y one genotype, T-28 exhibited l ess egg counts, adul ts
emergence and % damage while the rest recorded higher values for these traits. Association studies
also revealed that genotypes with large seed size may be more susceptible to bruchid infestation.Not Availabl
What Are the Barriers for Uptake of Antiretroviral Therapy in HIV-Infected Tuberculosis Patients? A Mixed-Methods Study from Ayeyawady Region, Myanmar
No full textAntiretroviral therapy (ART) coverage among HIV-infected tuberculosis (HIV-TB) patients has been suboptimal in Myanmar and the reasons are unknown. We aimed to assess the ART uptake among HIV-TB patients in public health facilities of Ayeyawady Region from July 2017–June 2018 and explore the barriers for non-initiation of ART. We conducted an explanatory mixed-methods study with a quantitative component (cohort analysis of secondary programme data) followed by a descriptive qualitative component (thematic analysis of in-depth interviews of 22 providers and five patients). Among 12,447 TB patients, 11,057 (89%) were HIV-tested and 627 (5.7%) were HIV-positive. Of 627 HIV-TB patients, 446 (71%) received ART during TB treatment (86 started on ART prior to TB treatment and rest started after TB treatment). Among the 181 patients not started on ART, 60 (33%) died and 41 (23%) were lost-to-follow-up. Patient-related barriers included geographic and economic constraints, poor awareness, denial of HIV status, and fear of adverse drug effects. The health system barriers included limited human resource, provision of ART on ‘fixed’ days only, weaknesses in counselling, referral and feedback mechanism, and clinicians’ reluctance to start ART early due to concerns about immune reconstitution inflammatory syndrome. We urge the national TB and HIV programs to take immediate actions to improve the ART uptake
‘Integrated Naturopathy and Yoga’ reduces blood pressure and the need for medications among a cohort of hypertensive patients in South India: 3-months follow-up study
No full textNot Available
No full textNot AvailableThirty groundnut genotypes (18 of Virginia bunch, 5 Spanish bunch and 7 Virginia runner group)
were screened for their relative response to Caryedon serratus using no choice test under laboratory
condition (32 to 350 C). The results showed that the number of eggs laid by C. serratus ranged
from 19.3 to 115.0 and adult emergence varied from 11.0 to 63.7 beetles. Per cent damage to the
kernels was highest in ‘GG-20 (80.7%) and lowest in T-28 (7.6 %)’. First three principle components
(PC) accounted for approximately 84% observed variation in the data. Breakdown of cumulative
variance revealed the contribution of PC 1 and PC 2 and PC 3 were 46, 21 and 17%, respectively
towards cumulative variance. The vertex genotypes were GG- 20, AK-303, AK-265, T-28, ALR-1
and ALR-3 of these genotypes, only one genotype, T-28 exhibited less egg counts, adults
emergence and % damage while the rest recorded higher values for these traits. Association studies
also revealed that genotypes with large seed size may be more susceptible to bruchid infestation.Not Availabl
Not Available
No full textNot AvailableThirty groundnut genotypes (18 of Virginia bunch, 5 Spanish bunch and 7 Virginia runner group)
were screened for their relative response to Caryedon serratus using no choice test under laboratory
condition (32 to 35
0
C). The results showed that the number of eggs laid by C. serratus ranged
from 19.3 to 115.0 and adult emergence varied from 11.0 to 63.7 beetles. Per cent damage to the
kernels was highest in ‘GG-20 (80.7%) and lowest in T-28 (7.6 %)’. First three principle components
(PC) accounted for approximately 84% observed variation in the data. Breakdown of cumulative
variance revealed the contribution of PC 1 and PC 2 and PC 3 were 46, 21 and 17%, respectively
towards cumulative variance. The vertex genotypes were GG- 20, AK-303, AK-265, T-28, ALR-1
and ALR-3 of these genotypes, onl y one genotype, T-28 exhibited l ess egg counts, adul ts
emergence and % damage while the rest recorded higher values for these traits. Association studies
also revealed that genotypes with large seed size may be more susceptible to bruchid infestation.Not Availabl
The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground
No full textEnding the tuberculosis (TB) epidemic by 2030 requires two key actions: rapid diagnosis and effective treatment of active TB and identification and treatment of latent TB infection to prevent progression to active disease. We introduce this perspective by documenting the growing importance of TB preventive therapy on the international agenda coupled with global data showing poor implementation of preventive activities in programmatic settings. We follow this with two principal objectives. The first is to examine implementation challenges around diagnosis and treatment of active TB. Within this, we include recent evidence about the continued morbidity and heightened mortality that persists after TB treatment is successfully completed, thus elevating the importance of TB preventive therapy. The second objective is to outline how current TB preventive therapy activities have been shaped and are managed and propose how these can be improved through research and innovation. This includes expanding and giving higher priority to certain high-risk groups including those with fibrotic lung lesions on chest X-ray, showcasing the need to develop and deploy new biomarkers to more accurately predict risk of disease and making shorter treatment regimens, especially with rifapentine-isoniazid, more user-friendly and widely available. Ending the TB epidemic requires not only cure of the disease but preventing it before it even begins
Extending contact screening within a 50-m radius of an index tuberculosis patient using Xpert MTB/RIF in urban Pakistan: Did it impact treatment outcomes?
No full textBackground
Pakistan implemented initiatives to detect tuberculosis (TB) patients through extended contact screening (ECS); it improved case detection but treatment outcomes need assessment.
Objectives
To compare treatment outcomes of pulmonary TB (PTB) patients detected by ECS with those detected by routine passive case finding (PCF).
Methods
A cohort study using secondary program data conducted in Lahore, Faisalabad and Rawalpindi districts and Islamabad in 2013–15. We used log binomial regression models to assess if ECS was associated with unfavorable treatment outcomes (death, loss-to-follow-up, failure, not evaluated) after adjusting for potential confounders.
Results
We included 79,431 people with PTB; 4604 (5.8%) were detected by ECS with 4052 (88%) bacteriologically confirmed. In all PTB patients the proportion with unfavorable outcomes was not significantly different in ECS group (9.6%) compared to PCF (9.9%), however, among bacteriologically confirmed patients unfavorable outcomes were significantly lower in ECS (9.9%) than PCF group (11.6%, P = 0.001). ECS was associated with a lower risk of unfavorable outcomes (adjusted relative risk (aRR) 0.90; 95% CI 0.82–0.99) among ‘all PTB’ patients and bacteriologically confirmed PTB patients (aRR 0.91; 95% CI 0.82–1.00).
Conclusion
In PTB patients detected by ECS the treatment outcomes were not inferior to those detected by PCF.publishedVersio
