International Journal of Tuberculosis and Lung Disease最新文献

Severe exacerbation is the predominant cause of COPD hospitalisation. We investigated sex-specific risk factors of severe exacerbation and explored the potential interactions of regions, smoking status, and age.The present study included 13,641 males and 13,051 females with spirometry-defined COPD at baseline from the China Kadoorie Biobank. Hazard ratios (HRs) and 95% confidence intervals (CIs) of risk factors with severe exacerbation were estimated using the Cox models.During a median of 11.5 years follow-up, 5,967 cases of COPD hospitalisation were recorded. GOLD (Global Initiative for Obstructive Lung Disease) stage, tobacco smoking, and underweight were positively associated with COPD hospitalisation in both sexes. Stronger associations were observed in females than in males; the corresponding HRs for males and females were respectively 1.87 (95% CI 1.73-2.03) and 2.47 (95% CI 2.24-2.72) for a history of respiratory diseases and 1.46 (95% CI 1.33-1.60) and 1.65 (95% CI 1.46-1.87) for coughing frequently and coughing up sputum after getting up in the morning for ≥3 months. Higher risks were found among urban residents, non-current smokers, and patients <60 years old.Our findings may help clinicians and the public to identify COPD patients at high risk of exacerbation requiring hospitalisation and take targeted measures in time..

Understanding the motivations behind clinical trial participation can help enhance recruitment strategies and determine the generalizability of trial results. This study focuses on the reasons for participating in or declining the Tuberculosis Trials Consortium Study 33 (iAdhere), a clinical trial on the treatment of latent tuberculosis infection (LTBI).A quantitative evaluation was conducted among screened patients to ascertain their reasons for participating or not in the iAdhere trial. The study gathered data from enrolled participants and those who chose not to enroll.Among 1,002 enrolled individuals, 290 participants provided 749 reasons for enrolling. The most common reasons included access to shorter treatment regimens (56%), avoiding progression to TB disease (45%), and improving health (21%). Of the 670 eligible persons who chose not to enroll, 551 individuals provided 800 reasons, with the most common being a preference for standard therapy (17%), disinterest in study medication or TB therapy (both 13%), and the inconvenience of daily observed treatment (12%).The desire for shorter treatment options and preventing active disease motivates participation in LTBI trials. The diverse reasons for declining enrolment suggest the importance of developing targeted recruitment strategies. These findings support exploring shorter treatment regimens and can guide future recruitment efforts..

SHINE (Shorter Treatment for Minimal Tuberculosis in Children) was the first Phase 3 paediatric TB treatment-shortening trial. Robust chest X-ray (CXR) classification methods were integral to excluding severe disease for trial eligibility and to retrospectively adjudicating TB status at baseline. We describe and critically evaluate the CXR classification approaches and processes used in the SHINE trial.Children with non-severe TB were randomised to 4- vs 6-months anti-TB treatment. Radiologically non-severe TB was defined on CXR. CXRs were systematically interpreted by on-site clinicians prospectively for eligibility determination and retrospectively by experts to inform adjudication of baseline TB status and disease severity.A screening CXR was successfully obtained from all 1,204 enrolled children; 1,134 CXRs from children with intra-thoracic TB were reviewed by expert readers. Compared with the expert panel, enrolling clinicians classified more CXRs as abnormal and 'typical TB' and all as radiologically non-severe. The expert panel retrospectively classified 71/1,134 (6%) CXRs as severe. Of these, 4 (5.6%) had unfavourable outcomes compared with 34 (3.0%) in the trial overall.Using CXRs to classify radiological disease severity and inform eligibility decisions in real-time by local enrolling clinicians was feasible and safe in this large paediatric TB trial. Retrospective central expert CXR review was successful. Refinement of the CXR methods for the classification of both disease severity and TB status could support standardised implementation in routine care and research..

Until recently, multidrug-resistant TB (MDR-TB) was treated with lengthy and toxic regimens. New three-drug anti-TB regimens raise the question of whether they are sufficiently active for MDR-TB in Central Asia, an MDR-TB hotspot region.In a cohort of rifampicin-resistant (RR) and MDR-TB patients in the Kyrgyz Republic, we investigated the impact of the number of drugs that were tested susceptible by whole-genome sequencing (WGS) and conventional drug susceptibility testing (DST) and used for treatment on the treatment response, defined as 'matches'. Logistic regressions were performed to assess the effect of having ≥ 4 susceptible drugs in a regimen at baseline and at Month 2 on the treatment response.The study included 227 participants with RR/MDR-TB (30.8% female; median age 30.4 years). The age- and sex-adjusted analysis showed an association between a regimen with ≥ 4 WGS matches at baseline (adjusted odds ratio [aOR] 2.10, 95% CI 1.00-4.41). No association was found when using conventional DST to define matches.Our study confirms that the inclusion of four efficacious anti-TB drugs in an MDR-TB regimen increases the chances of a positive treatment response. Susceptibility of at least four drugs in WGS-DST predicts a positive treatment response..

More than 10 million individuals develop active TB each year. The diagnosis and treatment of TB create greenhouse gas emissions, contributing to climate change. This study estimates the carbon footprint (CF) of successfully treating one person with drug-susceptible pulmonary TB (DS-PTB) in India.We defined the cascade of care for DS-PTB using national guidelines, interviews, and direct observation. We estimated the inputs for TB diagnosis and treatment in United States dollars, kilowatts per hour, and kilometres travelled; we converted them into carbon dioxide emissions equivalents (CO₂e) using an appropriate calculator.The CF of diagnosing and treating one person with DS-PTB in India is 103.8 kg CO₂e: 31.9% attributable to diagnosis and 68.1% to treatment. Emissions came primarily from first-line drugs (21.2%), hospitalisations (17.4%), and laboratory processes.We conservatively estimate that treating all persons with TB in India would produce at least 290,640 metric tonnes of CO₂e per year, approximately the same emissions as 63,182 passenger cars in the United States. It is evident that one of India's leading public health challenges also contributes meaningfully to climate change..

Treatment outcomes and long-term survival of non-tuberculous mycobacterial pulmonary disease (NTM-PD) in a real-world setting are difficult to assess, especially for species other than Mycobacterium avium complex (MAC).This was a retrospective cohort study on all Croatian residents with respiratory NTM isolates from 2006 to 2015, with follow-up to 2020.Therapy was started in 98/137 (71.5%) of patients, significantly more often in patients with fibrocavitary disease and/or sputum smear positivity. Unsuccessful treatment outcomes were recorded in 39/98 (39.8%) patients (14 deaths and 25 treatment failures). One-year and 5-year all-cause mortality were respectively 18.2% and 37.6%. Guideline-based treatment (GBT) was started in 50/98 (51%) of treated patients and followed for the recommended duration in 35.7% (35/98). This resulted in a higher chance of cure (OR 3.79, 95% CI 1.29 to 11.1; P = 0.012) than inadequately treated/untreated patients. For Mycobacterium xenopi disease, high cure rates (>80%) were achieved both with GBT and non-GBT treatment regimens.Guideline-based therapy resulted in a four-time higher chance of being cured. The impact of GBT on treatment outcomes was clear for MAC disease, but no apparent effect was observed for patients with M. xenopi disease..

TB disproportionately affects poorer, vulnerable people and communities, and has severe social and economic impacts on those affected. However, many countries do not yet include social protection in their programmatic response to TB. Here, we provide a critical perspective on the guidance developed by the WHO and the International Labour Organization (ILO) to help countries implement social protection programmes. The guidance emphasises the need for a multisectoral response to TB, and includes practical information on how to design appropriate social protection programmes that respond to the needs of people affected by TB.