Pub Date : 2024-11-24DOI: 10.1016/j.jctube.2024.100499
Lodiong Jackson Dumo Lodiong , Jonathan Izudi , Boniface Amanee Elias Lumori
Introduction
In Uganda, people with multi-drug resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) have been treated with a bedaquiline-based regimen since 2020. Still, their treatment outcomes have not been rigorously studied. We describe the treatment outcomes of people with MDR/RR-TB treated with a bedaquiline-based regimen and analyze the factors associated with their treatment success at three referral hospitals in Uganda.
Method and materials
We retrospectively reviewed medical records for people with MDR/RR-TB treated with a bedaquiline-based regimen between January 2020 and December 2021 at 3 referral hospitals. Treatment success was defined as cure or treatment completion on a binary scale at the end of the MDR/RR-TB treatment. Factors independently associated with treatment success were analyzed using the modified Poisson regression analysis with robust standard errors, reported as risk ratio (RR) and 95% confidence interval (CI). Analyses were performed at a 5% level of statistical significance.
Results
Of 71 participants aged ≥ 15 years, 13 (18.3 %) completed treatment, 46 (64.8) were cured, 8 (11.3) died, and 4 were lost to follow-up. Overall, 59 (83.1) were successfully treated. Current alcohol consumption (adjusted RR [aRR] 0. 78, 95 % CI 0.60–0. 99) and high aspartate aminotransferase levels (aRR 0.77, 95 % CI 0.60–0.98) were associated with a lower treatment success.
Conclusion
The treatment success among people with MDR/RR-TB on a bedaquiline-based regimen was relatively high. High AST levels and alcohol consumption are associated with a lower treatment success. There is a need to strengthen psychosocial support regarding the harmful effects of alcohol consumption and its interaction with drugs, including routine monitoring of liver function to enhance the TB treatment success.
Our study is the first to describe treatment success among people with MDR/RR-TB in three large hospitals in Uganda, this provides a good picture of treatment success among people with MDR/RR-TB on bedaquiline-based regimens in the country. The weaknesses are the smaller sample size, we analyzed data spanning a relatively shorter period, and alcohol use was measured by self-reporting, this might have underestimated its association with treatment success.
{"title":"Treatment success and mortality among people with multi-drug resistant and rifampicin resistant-tuberculosis on bedaquiline-based regimen at three referral hospitals in Uganda: A retrospective analysis","authors":"Lodiong Jackson Dumo Lodiong , Jonathan Izudi , Boniface Amanee Elias Lumori","doi":"10.1016/j.jctube.2024.100499","DOIUrl":"10.1016/j.jctube.2024.100499","url":null,"abstract":"<div><h3>Introduction</h3><div>In Uganda, people with multi-drug resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) have been treated with a bedaquiline-based regimen since 2020. Still, their treatment outcomes have not been rigorously studied. We describe the treatment outcomes of people with MDR/RR-TB treated with a bedaquiline-based regimen and analyze the factors associated with their treatment success at three referral hospitals in Uganda.</div></div><div><h3>Method and materials</h3><div>We retrospectively reviewed medical records for people with MDR/RR-TB treated with a bedaquiline-based regimen between January 2020 and December 2021 at 3 referral hospitals. Treatment success was defined as cure or treatment completion on a binary scale at the end of the MDR/RR-TB treatment. Factors independently associated with treatment success were analyzed using the modified Poisson regression analysis with robust standard errors, reported as risk ratio (RR) and 95% confidence interval (CI). Analyses were performed at a 5% level of statistical significance.</div></div><div><h3>Results</h3><div>Of 71 participants aged ≥ 15 years, 13 (18.3 %) completed treatment, 46 (64.8) were cured, 8 (11.3) died, and 4 were lost to follow-up. Overall, 59 (83.1) were successfully treated. Current alcohol consumption (adjusted RR [aRR] 0. 78, 95 % CI 0.60–0. 99) and high aspartate aminotransferase levels (aRR 0.77, 95 % CI 0.60–0.98) were associated with a lower treatment success.</div></div><div><h3>Conclusion</h3><div>The treatment success among people with MDR/RR-TB on a bedaquiline-based regimen was relatively high. High AST levels and alcohol consumption are associated with a lower treatment success. There is a need to strengthen psychosocial support regarding the harmful effects of alcohol consumption and its interaction with drugs, including routine monitoring of liver function to enhance the TB treatment success.</div><div>Our study is the first to describe treatment success among people with MDR/RR-TB in three large hospitals in Uganda, this provides a good picture of treatment success among people with MDR/RR-TB on bedaquiline-based regimens in the country. The weaknesses are the smaller sample size, we analyzed data spanning a relatively shorter period, and alcohol use was measured by self-reporting, this might have underestimated its association with treatment success.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100499"},"PeriodicalIF":1.9,"publicationDate":"2024-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate regional variations in pyrazinamide (PZA) prescribing across Japan’s 47 prefectures and associated influential factors.
Methods
This study utilized the Standardized Claim Ratio (SCR) for PZA from Japan’s National Database of Health Insurance Claims in 2018. Pearson’s correlation coefficients assessed relationships between SCR and tuberculosis (TB) incidence, patient characteristics (age, liver disease), and healthcare resources (specialists, TB beds). Multiple regression analysis identified independent predictors of SCR.
Results
Median SCR for PZA was 90.0 (range 40.2–187.1), with a 3-fold difference between top and bottom prefectures. In univariate analysis, SCR correlated positively with TB incidence (r = 0.42), respiratory/infectious disease/TB specialists, and negatively with elderly TB patients (r = -0.33) and liver disease per TB case. Multiple regression revealed higher SCR associated with higher TB incidence (β = 0.44, p < 0.001), lower elderly patients (β = -0.33, p = 0.005), and more respiratory specialists (β = 0.41, p < 0.001).
Conclusions
Regional PZA prescription patterns are multifaceted, significantly influenced by TB prevalence, elderly patient ratios, and the availability of respiratory specialists. To enhance PZA prescribing conformity and TB management, fostering respiratory expertise across Japan is imperative.
{"title":"Dissecting regional variability in Pyrazinamide prescribing practices for tuberculosis treatment in Japan","authors":"Nobuaki Kobayashi, Hiromi Matsumoto, Takeshi Kaneko","doi":"10.1016/j.jctube.2024.100497","DOIUrl":"10.1016/j.jctube.2024.100497","url":null,"abstract":"<div><h3>Objectives</h3><div>To investigate regional variations in pyrazinamide (PZA) prescribing across Japan’s 47 prefectures and associated influential factors.</div></div><div><h3>Methods</h3><div>This study utilized the Standardized Claim Ratio (SCR) for PZA from Japan’s National Database of Health Insurance Claims in 2018. Pearson’s correlation coefficients assessed relationships between SCR and tuberculosis (TB) incidence, patient characteristics (age, liver disease), and healthcare resources (specialists, TB beds). Multiple regression analysis identified independent predictors of SCR.</div></div><div><h3>Results</h3><div>Median SCR for PZA was 90.0 (range 40.2–187.1), with a 3-fold difference between top and bottom prefectures. In univariate analysis, SCR correlated positively with TB incidence (r = 0.42), respiratory/infectious disease/TB specialists, and negatively with elderly TB patients (r = -0.33) and liver disease per TB case. Multiple regression revealed higher SCR associated with higher TB incidence (β = 0.44, p < 0.001), lower elderly patients (β = -0.33, p = 0.005), and more respiratory specialists (β = 0.41, p < 0.001).</div></div><div><h3>Conclusions</h3><div>Regional PZA prescription patterns are multifaceted, significantly influenced by TB prevalence, elderly patient ratios, and the availability of respiratory specialists. To enhance PZA prescribing conformity and TB management, fostering respiratory expertise across Japan is imperative.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100497"},"PeriodicalIF":1.9,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-13DOI: 10.1016/j.jctube.2024.100496
Yao Didier Koffi , Paul Aboa Koffi , Evans Ehouman , Saint-Pierre Kouadio , Mamadou Kaloga
Background
Buruli ulcer (BU) is an infectious skin disease caused by Mycobacterium ulcerans. It primarily affects disadvantaged rural populations and mainly impacts children who are chronically malnourished being especially vulnerable. In Côte d’Ivoire, the estimated prevalence of BU in children is 30 %. Malnutrition may further deteriorate the nutritional status of these individuals. This study aimed to compare the healing time of BU patients treated with the standard protocol (SP) of 8 weeks of rifampicin and clarithromycin combined with wound care versus those treated with the standard protocol plus nutritional support using Skin Renewal Medicine-1 (SPSRM-1) (UNHWA Medical Centre, Seoul, Republic of Korea). Additionally, the study measured the effects of SRM-1 on the patients’ nutritional status.
Method
This was a prospective, randomized, single-blind paired interventional study conducted in BU-endemic health districts of Côte d’Ivoire. This 12-month study had two arms: the standard protocol versus the test treatment (SPSRM-1). SRM-1 is a cereal-based nutraceutical composed of 60 % cereal, 25 % vegetable, and 15 % plant concentrate. Patients included in the study had uncomplicated category I and II ulcerations without comorbidities. Nutritional status including haemoglobin, albumin levels, and body mass index (BMI) was evaluated from enrolment to the end of the study, alongside ulcer healing rates.
Results
Sixty BU wound patients were enrolled: 30 in the control group and 30 in the test group, with a mean age of 22 years. Of the patients, 28.3 % were malnourished, and 42 % had hypoalbuminemia. At the primary endpoint, 6 patients (20.0 %) in the SPSRM1 and 5 patients (16.7 %) in the SP group achieved complete epithelialization, with a reduction rate of 0.7 % per day in the SPSRM1 group compared to 0.3 % per day in the SP group. Patients who received SRM-1 had a higher BMI than those who did not, with a mean difference of 1.72 kg/m2 favouring the test group. Haemoglobin and albumin levels also showed improvement at the secondary endpoint compared to the control group.
Conclusion
This study demonstrated the potential benefit of adding nutritional support to improve BU treatment outcomes, by shortening the healing time of ulcerations. However, further studies with larger sample sizes are necessary to confirm these findings.
{"title":"Efficacy of nutritional support in combination with standard Buruli ulcer treatment: A case study in Côte d’Ivoire","authors":"Yao Didier Koffi , Paul Aboa Koffi , Evans Ehouman , Saint-Pierre Kouadio , Mamadou Kaloga","doi":"10.1016/j.jctube.2024.100496","DOIUrl":"10.1016/j.jctube.2024.100496","url":null,"abstract":"<div><h3>Background</h3><div>Buruli ulcer (BU) is an infectious skin disease caused by <em>Mycobacterium ulcerans</em>. It primarily affects disadvantaged rural populations and mainly impacts children who are chronically malnourished being especially vulnerable. In Côte d’Ivoire, the estimated prevalence of BU in children is 30 %. Malnutrition may further deteriorate the nutritional status of these individuals. This study aimed to compare the healing time of BU patients treated with the standard protocol (SP) of 8 weeks of rifampicin and clarithromycin combined with wound care versus those treated with the standard protocol plus nutritional support using Skin Renewal Medicine-1 (SPSRM-1) (UNHWA Medical Centre, Seoul, Republic of Korea). Additionally, the study measured the effects of SRM-1 on the patients’ nutritional status.</div></div><div><h3>Method</h3><div>This was a prospective, randomized, single-blind paired interventional study conducted in BU-endemic health districts of Côte d’Ivoire. This 12-month study had two arms: the standard protocol versus the test treatment (SPSRM-1). SRM-1 is a cereal-based nutraceutical composed of 60 % cereal, 25 % vegetable, and 15 % plant concentrate. Patients included in the study had uncomplicated category I and II ulcerations without comorbidities. Nutritional status including haemoglobin, albumin levels, and body mass index (BMI) was evaluated from enrolment to the end of the study, alongside ulcer healing rates.</div></div><div><h3>Results</h3><div>Sixty BU wound patients were enrolled: 30 in the control group and 30 in the test group, with a mean age of 22 years. Of the patients, 28.3 % were malnourished, and 42 % had hypoalbuminemia. At the primary endpoint, 6 patients (20.0 %) in the SPSRM1 and 5 patients (16.7 %) in the SP group achieved complete epithelialization, with a reduction rate of 0.7 % per day in the SPSRM1 group compared to 0.3 % per day in the SP group. Patients who received SRM-1 had a higher BMI than those who did not, with a mean difference of 1.72 kg/m<sup>2</sup> favouring the test group. Haemoglobin and albumin levels also showed improvement at the secondary endpoint compared to the control group.</div></div><div><h3>Conclusion</h3><div>This study demonstrated the potential benefit of adding nutritional support to improve BU treatment outcomes, by shortening the healing time of ulcerations. However, further studies with larger sample sizes are necessary to confirm these findings.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100496"},"PeriodicalIF":1.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) However, the emergence of drug-resistant strains of this bacterium, especially multidrug-resistant (MDR) strains, is a serious concern. This study aimed to evaluate the global prevalence of MDR M. leprae and its implications.
Methods
Using PRISMA guidelines, we systematically reviewed ISI Web of Science, MEDLINE, and EMBASE up to August 2023 to assess the prevalence of MDR M. leprae. We included human clinical trials on MDR M. leprae, as well as excluded reviews, animal studies, and unavailable full texts. Data was analyzed using Comprehensive Meta-Analysis software, and publication bias was addressed using Egger’s, Begg’s tests, and the trim-fill method.
Results
Overall, 861 articles were initially identified, of which 28 met the methodological criteria for inclusion in the quantitative synthesis. Statistically, the combined prevalence of drug resistant M. leprae was approximated at 11.7 % (95 % CI: 7.7–17.3; I2: 90.79; p value = 0.01). Specific drug resistance rates included 7.4 % to dapsone and 5.1 % to rifampin, among others. The global rate for MDR M. leprae was measured at 2.2 % (95 % CI: 1.2–3.9; I2: 82.68; p value = 0.01). Factors such as bacterial density and the lepromatous phase were associated with elevated DR M. leprae risk (OR: 2.69; 95 % CI: 1.35–2.48). A systematic assessment of publication bias indicated a minimal impact on the general results.
Conclusions
The increasing prevalence of MDR M. leprae globally requires urgent and strategic interventions to prevent further spread, which in turn is effective in treating leprosy patients.
背景麻风病是由麻风分枝杆菌（M. leprae）引起的一种慢性传染病，但这种细菌耐药菌株的出现，尤其是耐多药（MDR）菌株的出现，令人严重关切。本研究旨在评估 MDR M. Leprae 在全球的流行情况及其影响。方法根据 PRISMA 指南，我们系统回顾了截至 2023 年 8 月的 ISI Web of Science、MEDLINE 和 EMBASE，以评估 MDR M. Leprae 的流行情况。我们纳入了有关 MDR 麻风菌的人类临床试验，但排除了综述、动物研究和无法获得的全文。我们使用综合荟萃分析软件对数据进行了分析，并使用Egger检验、Begg检验和修剪填充法解决了发表偏倚问题。结果共初步确定了861篇文章，其中28篇符合纳入定量综述的方法学标准。据统计，耐药性麻风杆菌的综合感染率约为 11.7 %（95 % CI：7.7-17.3；I2：90.79；P 值 = 0.01）。具体的耐药率包括：7.4%对达克松耐药，5.1%对利福平耐药。MDR麻风杆菌的总体耐药率为2.2%（95% CI：1.2-3.9；I2：82.68；P值=0.01）。细菌密度和麻风期等因素与 DR M. Leprae 风险升高有关（OR：2.69；95 % CI：1.35-2.48）。对发表偏倚的系统评估表明，发表偏倚对总体结果的影响很小。结论全球范围内MDR麻风杆菌的流行率不断上升，需要紧急采取战略性干预措施以防止其进一步扩散，这反过来又能有效治疗麻风病人。
{"title":"Computational investigation of the global prevalence of multidrug resistant Mycobacterium leprae: A systematic review and meta-analysis","authors":"Hamidreza Zivarifar , Forough Ahrari , Mohsen Karbalaei","doi":"10.1016/j.jctube.2024.100495","DOIUrl":"10.1016/j.jctube.2024.100495","url":null,"abstract":"<div><h3>Background</h3><div>Leprosy is a chronic infectious disease caused by <em>Mycobacterium leprae</em> (<em>M. leprae</em>) However, the emergence of drug-resistant strains of this bacterium, especially multidrug-resistant (MDR) strains, is a serious concern. This study aimed to evaluate the global prevalence of MDR <em>M. leprae</em> and its implications.</div></div><div><h3>Methods</h3><div>Using PRISMA guidelines, we systematically reviewed ISI Web of Science, MEDLINE, and EMBASE up to August 2023 to assess the prevalence of MDR <em>M. leprae</em>. We included human clinical trials on MDR <em>M. leprae</em>, as well as excluded reviews, animal studies, and unavailable full texts. Data was analyzed using Comprehensive Meta-Analysis software, and publication bias was addressed using Egger’s, Begg’s tests, and the trim-fill method.</div></div><div><h3>Results</h3><div>Overall, 861 articles were initially identified, of which 28 met the methodological criteria for inclusion in the quantitative synthesis. Statistically, the combined prevalence of drug resistant <em>M. leprae</em> was approximated at 11.7 % (95 % CI: 7.7–17.3; <em>I<sup>2</sup></em>: 90.79; <em>p</em> value = 0.01). Specific drug resistance rates included 7.4 % to dapsone and 5.1 % to rifampin, among others. The global rate for MDR <em>M. leprae</em> was measured at 2.2 % (95 % CI: 1.2–3.9; <em>I<sup>2</sup></em>: 82.68; <em>p</em> value = 0.01). Factors such as bacterial density and the lepromatous phase were associated with elevated DR <em>M. leprae</em> risk (OR: 2.69; 95 % CI: 1.35–2.48). A systematic assessment of publication bias indicated a minimal impact on the general results.</div></div><div><h3>Conclusions</h3><div>The increasing prevalence of MDR <em>M. leprae</em> globally requires urgent and strategic interventions to prevent further spread, which in turn is effective in treating leprosy patients.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100495"},"PeriodicalIF":1.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Millions of individuals worldwide are afflicted by the fatal infectious disease tuberculosis, which accounts for thousands of avoidable deaths. The literature has provided a good description of the clinical manifestation and radiologic features of pulmonary tuberculosis. However, the parenchymal complication of pulmonary tuberculosis presenting as cystic lung disease, has not been widely documented in the literature and is one of the incredibly uncommon causes of diffuse cystic lung disease. It is very uncommon to have a patient with possible pulmonary lymphangioleomyomatosis to be superinfected with bacteriologically confirmed tuberculosis.
This report describes a young female patient who was admitted to the hospital, had repeated chest tube insertions and drainage of recurrent spontaneous pneumothoraxes secondary to likely diffuse cystic lung disease related to pulmonary tuberculosis. First, it was thought that the most likely diagnosis was pulmonary lymphangioleomyomatosis. The patient ultimately diagnosed with diffuse cystic lung disease associated with pulmonary tuberculosis as the most likely cause of her clinical presentation considering the high index of suspicion and her sputum gene xpert results. For drug-susceptible tuberculosis, the patient was finally started on anti-tuberculosis medication. She had both clinical and radiological improvement after completion of her anti tuberculosis treatment.
Thus, it is reasonable to conclude that tuberculosis may contribute to diffuse cystic lung disease (DCLD) in tuberculosis endemic settings such as Ethiopia, and that appropriate diagnostic efforts should be undertaken to make the diagnosis. A high index of clinical suspicion is crucial to prevent delays in the diagnosis of diffuse cystic lung disease associated with pulmonary tuberculosis.
{"title":"Pulmonary tuberculosis related diffuse cystic lung disease with recurrent pneumothorax mimicking pulmonary lymphangioleomyomatosis in Ethiopia: A review and case report","authors":"Haba Churako , Melese Tesema , Lijalem Tema , Tsion Ababiya , Desalegn Wodajo , Teshome Hadaro , Amanuel Tateso , Eyosiyas Anjajo , Temesgen Sidamo , Abenezer Bekele","doi":"10.1016/j.jctube.2024.100494","DOIUrl":"10.1016/j.jctube.2024.100494","url":null,"abstract":"<div><div>Millions of individuals worldwide are afflicted by the fatal infectious disease tuberculosis, which accounts for thousands of avoidable deaths. The literature has provided a good description of the clinical manifestation and radiologic features of pulmonary tuberculosis. However, the parenchymal complication of pulmonary tuberculosis presenting as cystic lung disease, has not been widely documented in the literature and is one of the incredibly uncommon causes of diffuse cystic lung disease. It is very uncommon to have a patient with possible pulmonary lymphangioleomyomatosis to be superinfected with bacteriologically confirmed tuberculosis.</div><div>This report describes a young female patient who was admitted to the hospital, had repeated chest tube insertions and drainage of recurrent spontaneous pneumothoraxes secondary to likely diffuse cystic lung disease related to pulmonary tuberculosis. First, it was thought that the most likely diagnosis was pulmonary lymphangioleomyomatosis. The patient ultimately diagnosed with diffuse cystic lung disease associated with pulmonary tuberculosis as the most likely cause of her clinical presentation considering the high index of suspicion and her sputum gene xpert results. For drug-susceptible tuberculosis, the patient was finally started on anti-tuberculosis medication. She had both clinical and radiological improvement after completion of her anti tuberculosis treatment.</div><div>Thus, it is reasonable to conclude that tuberculosis may contribute to diffuse cystic lung disease (DCLD) in tuberculosis endemic settings such as Ethiopia, and that appropriate diagnostic efforts should be undertaken to make the diagnosis. A high index of clinical suspicion is crucial to prevent delays in the diagnosis of diffuse cystic lung disease associated with pulmonary tuberculosis.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100494"},"PeriodicalIF":1.9,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142699677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1016/j.jctube.2024.100493
Anda Viksna , Darja Sadovska , Vija Riekstina , Anda Nodieva , Ilva Pole , Renate Ranka , Iveta Ozere
Background
The recurrence of tuberculosis (TB) continues to place a significant burden on patients and TB programs worldwide. Repeated TB episodes can develop either due to endogenous reactivation of previously treated TB or exogenous reinfection with a distinct strain of Mycobacterium tuberculosis (Mtb). Determining the precise cause of the recurrent TB episodes and identifying reasons for endogenous reactivation of previously successfully treated patients is crucial for introducing effective TB control measures.
Methods
Here, we aimed to provide a retrospective individual analysis of the clinical data of pulmonary TB patients with assumed endogenous infection reactivation based on WGS results to identify the reasons for reactivation. Patient medical files were reviewed to describe the provoking factors for endogenous reactivation.
Results
In total, 25 patients with assumed endogenous TB reactivation were included in the study group, and 30 patients with one TB episode during the study period were included in the control group. There were no statistically significant differences identified between studied patient groups in patients age (t(53) = −1.53, p = 0.13), body mass index (t(53) = 0.82, p = 0.42), area of residency (χ2(1;55) = 0.015, p = 0.9), employment status (χ2(1;55) = 0.076, p = 0.78) and presence of comorbidities (χ2(1;55) = 3.67, p = 0.78). Study group patients had statistically significantly more frequently positive sputum smear microscopy results (χ2(1;55) = 8.72, p = 0.0031), longer time to sputum smear (t(31) = −2.2, p = 0.036) and sputum culture conversion (W (55) = 198.5, p = 0.0029). Smoking was statistically significantly (χ2(1;55) = 5.77, p = 0.016) more frequently represented among study group patients. The median treatment duration for drug susceptible TB was 6 months in both in the control group (IQR 6–6) and among study group patients (IQR 6–7.75). The median treatment duration for multidrug-resistant TB was 20 months (IQR 17–23) in the control group and 19 months (IQR 16–19) in the study group patients.
Conclusion
Positive SSM for acid-fast bacteria, delayed time to sputum smear and sputum culture conversion, smoking, and incomplete therapy in the study group patients with multidrug-resistant TB should be considered as potential reasons for reactivation in recurrent TB patient group in our study.
{"title":"Endogenous reactivation cases identified by whole genome sequencing of Mycobacterium tuberculosis: Exploration of possible causes in Latvian tuberculosis patients","authors":"Anda Viksna , Darja Sadovska , Vija Riekstina , Anda Nodieva , Ilva Pole , Renate Ranka , Iveta Ozere","doi":"10.1016/j.jctube.2024.100493","DOIUrl":"10.1016/j.jctube.2024.100493","url":null,"abstract":"<div><h3>Background</h3><div>The recurrence of tuberculosis (TB) continues to place a significant burden on patients and TB programs worldwide. Repeated TB episodes can develop either due to endogenous reactivation of previously treated TB or exogenous reinfection with a distinct strain of <em>Mycobacterium tuberculosis</em> (Mtb). Determining the precise cause of the recurrent TB episodes and identifying reasons for endogenous reactivation of previously successfully treated patients is crucial for introducing effective TB control measures.</div></div><div><h3>Methods</h3><div>Here, we aimed to provide a retrospective individual analysis of the clinical data of pulmonary TB patients with assumed endogenous infection reactivation based on WGS results to identify the reasons for reactivation. Patient medical files were reviewed to describe the provoking factors for endogenous reactivation.</div></div><div><h3>Results</h3><div>In total, 25 patients with assumed endogenous TB reactivation were included in the study group, and 30 patients with one TB episode during the study period were included in the control group. There were no statistically significant differences identified between studied patient groups in patients age (t<sub>(53)</sub> = −1.53, p = 0.13), body mass index (t<sub>(53)</sub> = 0.82, p = 0.42), area of residency (χ<sup>2</sup><sub>(1;55)</sub> = 0.015, p = 0.9), employment status (χ<sup>2</sup><sub>(1;55) =</sub> 0.076, p = 0.78) and presence of comorbidities (χ<sup>2</sup><sub>(1;55)</sub> = 3.67, p = 0.78). Study group patients had statistically significantly more frequently positive sputum smear microscopy results (χ<sup>2</sup><sub>(1;55)</sub> = 8.72, p = 0.0031), longer time to sputum smear (t<sub>(31)</sub> = −2.2, p = 0.036) and sputum culture conversion (W <sub>(55)</sub> = 198.5, p = 0.0029). Smoking was statistically significantly (χ<sup>2</sup><sub>(1;55)</sub> = 5.77, p = 0.016) more frequently represented among study group patients. The median treatment duration for drug susceptible TB was 6 months in both in the control group (IQR 6–6) and among study group patients (IQR 6–7.75). The median treatment duration for multidrug-resistant TB was 20 months (IQR 17–23) in the control group and 19 months (IQR 16–19) in the study group patients.</div></div><div><h3>Conclusion</h3><div>Positive SSM for acid-fast bacteria, delayed time to sputum smear and sputum culture conversion, smoking, and incomplete therapy in the study group patients with multidrug-resistant TB should be considered as potential reasons for reactivation in recurrent TB patient group in our study.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100493"},"PeriodicalIF":1.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bovine tuberculosis, caused by Mycobacterium bovis, is a chronic zoonotic disease that persists in Ethiopia despite global control efforts, impacting public health and the economy. However, little is known about the epidemiology of bovine tuberculosis in Southwest Ethiopia. This study aims to assess the prevalence of bovine tuberculosis and identify associated risk factors in dairy cattle. A cross-sectional study was conducted from October 2022 to October 2023 in four districts in the Sheka, Bench-Sheko, and Keffa zones. A multistage sampling approach was employed, resulting in the selection of 1,152 cattle from various herds. Tuberculin skin testing was performed to detect bovine tuberculosis, and data on potential risk factors were collected through questionnaires. Logistic regression models were used to analyze the association between bovine tuberculosis and various risk factors. The overall prevalence of bovine tuberculosis was 4.95% at the cow level and 22.19% at the herd level in the study areas. Significant herd-level risk factors for bovine tuberculosis included lowland areas, larger herd sizes, and the introducing new animals. At the cow level, risk factors included age, breed, body condition, herd size, introduction of new animals, and management system. The study reveals a high prevalence of bovine tuberculosis in dairy cattle in Southwest Ethiopia, identifying key risk factors. Effective control requires targeted interventions, such as improved management practices, enhanced farmer awareness, and a better understanding of and guidance on bovine tuberculosis strategies in Ethiopia. Future research should isolate and characterize M. bovis in the study areas.
{"title":"Bovine tuberculosis reactor cattle in Southwest Ethiopia: Risk factors for bovine tuberculosis","authors":"Dereje Tulu Robi , Tsegaye Teklemariam , Belay Gezahegn Gebreyes , Ararsa Bogale , Tamirat Haile , Melkam Aleme , Dawit Dejene , Shiferaw Temteme , Beksisa Urge","doi":"10.1016/j.jctube.2024.100492","DOIUrl":"10.1016/j.jctube.2024.100492","url":null,"abstract":"<div><div>Bovine tuberculosis, caused by <em>Mycobacterium bovis</em>, is a chronic zoonotic disease that persists in Ethiopia despite global control efforts, impacting public health and the economy. However, little is known about the epidemiology of bovine tuberculosis in Southwest Ethiopia. This study aims to assess the prevalence of bovine tuberculosis and identify associated risk factors in dairy cattle. A cross-sectional study was conducted from October 2022 to October 2023 in four districts in the Sheka, Bench-Sheko, and Keffa zones. A multistage sampling approach was employed, resulting in the selection of 1,152 cattle from various herds. Tuberculin skin testing was performed to detect bovine tuberculosis, and data on potential risk factors were collected through questionnaires. Logistic regression models were used to analyze the association between bovine tuberculosis and various risk factors. The overall prevalence of bovine tuberculosis was 4.95% at the cow level and 22.19% at the herd level in the study areas. Significant herd-level risk factors for bovine tuberculosis included lowland areas, larger herd sizes, and the introducing new animals. At the cow level, risk factors included age, breed, body condition, herd size, introduction of new animals, and management system. The study reveals a high prevalence of bovine tuberculosis in dairy cattle in Southwest Ethiopia, identifying key risk factors. Effective control requires targeted interventions, such as improved management practices, enhanced farmer awareness, and a better understanding of and guidance on bovine tuberculosis strategies in Ethiopia. Future research should isolate and characterize <em>M. bovis</em> in the study areas.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100492"},"PeriodicalIF":1.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.jctube.2024.100489
Patrick D. Crowley , James J. Vaillant , Joshua D. Shirley , Nancy L. Wengenack , Mary Jo Kasten
Mycobacterium smegmatis is a rapidly growing nontuberculous mycobacterium that is rarely isolated from clinical specimens and is frequently considered to be a contaminant. We conducted a retrospective review of mycobacterial cultures positive for M. smegmatis from 1998 to 2023 at our institution to evaluate the clinical significance of recovering this mycobacterium. Antimicrobial susceptibility patterns were also determined. Twenty-two M. smegmatis isolates were identified from 17 patients, 12 of whom met criteria for clinical chart review. M. smegmatis was deemed a cause of infection in 5/5 isolates from skin or soft tissue, 3/3 from bone, 1/1 from blood, and 0/3 from respiratory specimens. All cases thought to be significant were treated with at least 2 active agents for periods varying from 2 weeks up to 8 months. 18 isolates had antimicrobial susceptibility testing performed and all were susceptible to doxycycline, imipenem, linezolid, moxifloxacin, trimethoprim/sulfamethoxazole, and tobramycin while all isolates were resistant to clarithromycin. When recovered in culture, the presence of M. smegmatis should be correlated with clinical presentation as it may represent a true infection.
{"title":"Rapidly growing knowledge of Mycobacterium smegmatis: A case series and review of antimicrobial susceptibility patterns","authors":"Patrick D. Crowley , James J. Vaillant , Joshua D. Shirley , Nancy L. Wengenack , Mary Jo Kasten","doi":"10.1016/j.jctube.2024.100489","DOIUrl":"10.1016/j.jctube.2024.100489","url":null,"abstract":"<div><div><em>Mycobacterium smegmatis</em> is a rapidly growing nontuberculous mycobacterium that is rarely isolated from clinical specimens and is frequently considered to be a contaminant. We conducted a retrospective review of mycobacterial cultures positive for <em>M. smegmatis</em> from 1998 to 2023 at our institution to evaluate the clinical significance of recovering this mycobacterium. Antimicrobial susceptibility patterns were also determined. Twenty-two <em>M. smegmatis</em> isolates were identified from 17 patients, 12 of whom met criteria for clinical chart review. <em>M. smegmatis</em> was deemed a cause of infection in 5/5 isolates from skin or soft tissue, 3/3 from bone, 1/1 from blood, and 0/3 from respiratory specimens. All cases thought to be significant were treated with at least 2 active agents for periods varying from 2 weeks up to 8 months. 18 isolates had antimicrobial susceptibility testing performed and all were susceptible to doxycycline, imipenem, linezolid, moxifloxacin, trimethoprim/sulfamethoxazole, and tobramycin while all isolates were resistant to clarithromycin. When recovered in culture, the presence of <em>M. smegmatis</em> should be correlated with clinical presentation as it may represent a true infection.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100489"},"PeriodicalIF":1.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Background and Objective</h3><div>The global incidence rate of tuberculosis and related death among the elderly are 3 times and 6 times more than that of non-elderly, respectively. Therefore, the successful treatment of tuberculosis in the elderly affects all national tuberculosis control programs. Given the fact that “medication adherence” is the main key to effective treatment, it is essential to identify the factors related to medication adherence in the elderly with tuberculosis and provide appropriate interventions. Family caregivers play a pivot role in the elderly care and treatment, and their characteristics can influence the medication adherence of the elderly with tuberculosis. The objective of present study was determining the medication adherence of the elderly with tuberculosis and the factors related to their family caregivers in Iran.</div></div><div><h3>Method</h3><div>The present study was carried out through descriptive-analytical method and convenience sampling. 305 elderly patients with tuberculosis as well as their family caregivers who met the inclusion criteria were selected from those who referred to infectious diseases clinic of Masih Deneshvari Hospital in Tehran. Demographic and background data, 12-item standard general health questionnaire, Zarit Scale of Caregiver Burden questionnaire and Morisky Green Levine Medication Adherence questionnaire were used for the elderly with tuberculosis. The significance level for statistical tests was considered 0.05. Data analysis of the study was done using SPSS-25 software. Independent <em>t</em>-test, One-way ANOVA, Tukey’s test, Spearman’s correlation test and ordinal logistic regression model were also used for the analytical statistics.</div></div><div><h3>Findings</h3><div>Out of the elderly with tuberculosis, 44.92 % had low medication adherence, 27.54 % had moderate medication adherence, and 27.54 % had full medication adherence. Medication adherence of married elderly was significantly better than single, widowed or lonely elderly (p < 0.001 and F = 53.192). The medication adherence was significantly better among the elderly whose caregivers had better general health (p > 0.001 and r = 0.776) and no burden or low burden according to Zarit scale (p > 0.001 and F = 357/96). In addition, there was a significant relationship between general characteristics of the caregivers (age, gender, marital status, number of children, education, knowledge about tuberculosis, sources of information, relativity to the patient, number of caregivers, employment status, and affordability) and the medication adherence of the elderly with tuberculosis. The results of simultaneous regression test of ordinal logistic regression showed that variables predict medication adherence behavior to a very acceptable level. The coefficient of determination values obtained from McFadden (0.4), Nagelkerke (0.747) and Cox-Snell (0.714) statistics demonstrated high explanatory power of the mod
{"title":"Relationship of family caregivers’ associated factors with medication adherence among elderly with tuberculosis in Iran","authors":"Somayeh Hassani , Farahnaz Mohammadi Shahboulagi , Mahshid Foroughan , Payam Tabarsi , Gholamreza Ghaedamini Harouni , Hamidreza Jamaati , Mohammad Varahram , Seyed Mohammad Seyedmehdi , Seyed Alireza Nadji","doi":"10.1016/j.jctube.2024.100488","DOIUrl":"10.1016/j.jctube.2024.100488","url":null,"abstract":"<div><h3>Background and Objective</h3><div>The global incidence rate of tuberculosis and related death among the elderly are 3 times and 6 times more than that of non-elderly, respectively. Therefore, the successful treatment of tuberculosis in the elderly affects all national tuberculosis control programs. Given the fact that “medication adherence” is the main key to effective treatment, it is essential to identify the factors related to medication adherence in the elderly with tuberculosis and provide appropriate interventions. Family caregivers play a pivot role in the elderly care and treatment, and their characteristics can influence the medication adherence of the elderly with tuberculosis. The objective of present study was determining the medication adherence of the elderly with tuberculosis and the factors related to their family caregivers in Iran.</div></div><div><h3>Method</h3><div>The present study was carried out through descriptive-analytical method and convenience sampling. 305 elderly patients with tuberculosis as well as their family caregivers who met the inclusion criteria were selected from those who referred to infectious diseases clinic of Masih Deneshvari Hospital in Tehran. Demographic and background data, 12-item standard general health questionnaire, Zarit Scale of Caregiver Burden questionnaire and Morisky Green Levine Medication Adherence questionnaire were used for the elderly with tuberculosis. The significance level for statistical tests was considered 0.05. Data analysis of the study was done using SPSS-25 software. Independent <em>t</em>-test, One-way ANOVA, Tukey’s test, Spearman’s correlation test and ordinal logistic regression model were also used for the analytical statistics.</div></div><div><h3>Findings</h3><div>Out of the elderly with tuberculosis, 44.92 % had low medication adherence, 27.54 % had moderate medication adherence, and 27.54 % had full medication adherence. Medication adherence of married elderly was significantly better than single, widowed or lonely elderly (p < 0.001 and F = 53.192). The medication adherence was significantly better among the elderly whose caregivers had better general health (p > 0.001 and r = 0.776) and no burden or low burden according to Zarit scale (p > 0.001 and F = 357/96). In addition, there was a significant relationship between general characteristics of the caregivers (age, gender, marital status, number of children, education, knowledge about tuberculosis, sources of information, relativity to the patient, number of caregivers, employment status, and affordability) and the medication adherence of the elderly with tuberculosis. The results of simultaneous regression test of ordinal logistic regression showed that variables predict medication adherence behavior to a very acceptable level. The coefficient of determination values obtained from McFadden (0.4), Nagelkerke (0.747) and Cox-Snell (0.714) statistics demonstrated high explanatory power of the mod","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100488"},"PeriodicalIF":1.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142658472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-21DOI: 10.1016/j.jctube.2024.100487
Joseph Baruch Baluku , Priscilla Sheilla Apolot , Brenda Namanda , Sharon Namiiro , Shamim Katusabe , Diana Karungi , Reagan Nkonge , Mary Madalen Angut , Jasper Nidoi , Robinah Nalwanga , Charles Mondo , Emmanuel Seremba , Charles Kabugo
Introduction
In-hospital mortality rates for tuberculosis (TB) patients are high within the first seven days of admission. This study sought to identify predictors of early inpatient mortality and assess the performance of a predictive score for early mortality in a Ugandan tertiary hospital.
Materials and methods
A case-control study was conducted at Kiruddu National Referral Hospital in Kampala, Uganda. Cases included patients admitted with TB who died within seven days of admission, while controls survived beyond this period. Logistic regression was utilized to identify early mortality predictors. The performance of an adapted predictive score (PROS score) was evaluated, assigning scores based on the following criteria: Pulse rate >100 beats/min (1 point), Respiratory rate >20 breaths/min (2 points), Oxygen saturation <92 % (4 points), and Systolic blood pressure <90 mmHg (2 points).
Results
Of 602 hospitalized TB patients, 187 (31.0 %) died during admission. Among these, 78 (41.7 %) died within seven days. Wasting (adjusted odds ratio [aOR] = 5.76, 95 % confidence interval [CI] 2.12–15.63, p = 0.001) and respiratory rate >20 breaths/min (aOR = 2.89, 95 % CI 1.19–7.00, p = 0.019) predicted early mortality. PROS score of ≥1 demonstrated a sensitivity of 87.8 % and negative predictive value of 90.0 %. The ultimate TB treatment success rate of all hospitalized patients (n = 599) was 47.4 % with 275 (45.9 %) dying during TB treatment.
Conclusion
Early and long term mortality rates among hospitalized TB patients are high. Wasting and tachypnea predict early inpatient mortality. The PROS score could be useful in ruling out low-risk patients in low-resource settings.
{"title":"A predictive score for early in-patient tuberculosis mortality: A case-control study","authors":"Joseph Baruch Baluku , Priscilla Sheilla Apolot , Brenda Namanda , Sharon Namiiro , Shamim Katusabe , Diana Karungi , Reagan Nkonge , Mary Madalen Angut , Jasper Nidoi , Robinah Nalwanga , Charles Mondo , Emmanuel Seremba , Charles Kabugo","doi":"10.1016/j.jctube.2024.100487","DOIUrl":"10.1016/j.jctube.2024.100487","url":null,"abstract":"<div><h3>Introduction</h3><div>In-hospital mortality rates for tuberculosis (TB) patients are high within the first seven days of admission. This study sought to identify predictors of early inpatient mortality and assess the performance of a predictive score for early mortality in a Ugandan tertiary hospital.</div></div><div><h3>Materials and methods</h3><div>A case-control study was conducted at Kiruddu National Referral Hospital in Kampala, Uganda. Cases included patients admitted with TB who died within seven days of admission, while controls survived beyond this period. Logistic regression was utilized to identify early mortality predictors. The performance of an adapted predictive score (<strong>PROS</strong> score) was evaluated, assigning scores based on the following criteria: <strong>P</strong>ulse rate >100 beats/min (1 point), <strong>R</strong>espiratory rate >20 breaths/min (2 points), <strong>O</strong>xygen saturation <92 % (4 points), and <strong>S</strong>ystolic blood pressure <90 mmHg (2 points).</div></div><div><h3>Results</h3><div>Of 602 hospitalized TB patients, 187 (31.0 %) died during admission. Among these, 78 (41.7 %) died within seven days. Wasting (adjusted odds ratio [aOR] = 5.76, 95 % confidence interval [CI] 2.12–15.63, p = 0.001) and respiratory rate >20 breaths/min (aOR = 2.89, 95 % CI 1.19–7.00, p = 0.019) predicted early mortality. PROS score of ≥1 demonstrated a sensitivity of 87.8 % and negative predictive value of 90.0 %. The ultimate TB treatment success rate of all hospitalized patients (n = 599) was 47.4 % with 275 (45.9 %) dying during TB treatment.</div></div><div><h3>Conclusion</h3><div>Early and long term mortality rates among hospitalized TB patients are high. Wasting and tachypnea predict early inpatient mortality. The PROS score could be useful in ruling out low-risk patients in low-resource settings.</div></div>","PeriodicalId":37942,"journal":{"name":"Journal of Clinical Tuberculosis and Other Mycobacterial Diseases","volume":"37 ","pages":"Article 100487"},"PeriodicalIF":1.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号