Culture Conversion in Patients Treated with Bedaquiline and/or Delamanid: A Prospective Multi-country Study.

3 mesi ago
Culture Conversion in Patients Treated with Bedaquiline and/or Delamanid: A Prospective Multi-country Study. Franke, MF; Khan, P; Hewison, C; Khan, U; Huerga, H; Seung, KJ; Rich, ML; Zarli, K; Samieva, N; Oyewusi, L; Nair, P; Mudassar, M; Melikyan, N; Lenggogeni, P; Lecca, L; Kumsa, A; Khan, M; Islam, S; Hussein, K; Docteur, W; Chumburidze, N; Berikova, E; Atshemyan, H; Atwood, S; Alam, M; Ahmed, S; Bastard, M; Mitnick, CD; endTB observational study team Background Bedaquiline and delamanid offer the possibility of more effective and less toxic multidrug-resistant tuberculosis (MDR-TB) treatment. With this treatment, however, some patients, remain at high risk for an unfavorable treatment outcome. The endTB observational study is the largest multicountry cohort of patients with rifampin-resistant/MDR-TB treated in routine care, according to WHO guidance, with delamanid- and/or bedaquiline-containing regimens. We report frequency of sputum culture conversion within six-months of treatment initiation and risk factors for non-conversion. Methods We included patients with a positive baseline culture who initiated a first endTB regimen prior to April 2018. Two consecutive negative cultures collected > 15 days apart constituted culture conversion. We used generalized mixed models to derive marginal predictions for the probability of culture conversion in key subgroups. Findings 1,109 patients initiated a multidrug treatment containing bedaquiline (63%), delamanid (27%) or both (10%). Of these, 939 (85%) experienced culture conversion within six months. In adjusted analyses, patients with HIV had a lower probability of conversion (0·73 [95% CI: 0·62, 0·84]) than patients without HIV (0·84 [95% CI: 0·79, 0·90]; p=0·03). Patients with both cavitary disease and highly positive sputum smear had a lower probability of conversion (0·68 [95% CI: 0·57, 0·79]) relative to patients without either (0·89; 95% CI: 0·84, 0·95; p=0·0004). Hepatitis C infection, diabetes mellitus/glucose intolerance, and baseline resistance were not associated with conversion. Interpretation Frequent sputum conversion in patients with rifampin-resistant/MDR-TB who were treated with bedaquiline and/or delamanid underscores the need for urgent expanded access to these drugs. There is a need to optimize treatment for patients with HIV and extensive disease. We regret that this article is behind a paywall.

Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study.

3 mesi 1 settimana ago
Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study. Mukuve, A; Noorani, M; Sendagire, I; Mgonja, M Background: Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally. The primary objective was to determine the magnitude of screening for GDM among women receiving ANC at the Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital, Dar es Salaam. Secondary objectives were: to determine the methods used by health practitioners to screen for GDM, to determine the magnitude of undiagnosed gestational diabetes mellitus among women attending ANC and factors associated with screening for GDM among these women. Methods: A cross-sectional analytical study was done. Data collection was done using pre-tested questionnaires and reviewing antenatal care records. The proportion of women attending ANC who were screened for GDM was determined. The 75 g Oral Glucose Tolerance Test (OGTT) was offered to women who had not been screened after education and consent. Results: Only 107 out of 358 (29.9%) had been offered some form of GDM screening. Tests used for GDM screening were random blood sugar (56.8%), fasting blood sugar (32.8%), HbA1C (6%) and 75 g OGTT (3.4%). The uptake of the OGTT was 27%. Of these women the prevalence of GDM was 27.9%. Factors associated with screening for GDM were history of big baby, history of pregnancy induced hypertension and participant awareness of GDM (all p: < 0.05). Conclusions: Screening for GDM among women attending ANC was lower than the World Health Organization target. Efforts should be directed towards promoting GDM screening, increasing awareness about GDM and developing more effective screening methods.

Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study.

3 mesi 1 settimana ago
Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study. Mukuve, A; Noorani, M; Sendagire, I; Mgonja, M Background: Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally. The primary objective was to determine the magnitude of screening for GDM among women receiving ANC at the Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital, Dar es Salaam. Secondary objectives were: to determine the methods used by health practitioners to screen for GDM, to determine the magnitude of undiagnosed gestational diabetes mellitus among women attending ANC and factors associated with screening for GDM among these women. Methods: A cross-sectional analytical study was done. Data collection was done using pre-tested questionnaires and reviewing antenatal care records. The proportion of women attending ANC who were screened for GDM was determined. The 75 g Oral Glucose Tolerance Test (OGTT) was offered to women who had not been screened after education and consent. Results: Only 107 out of 358 (29.9%) had been offered some form of GDM screening. Tests used for GDM screening were random blood sugar (56.8%), fasting blood sugar (32.8%), HbA1C (6%) and 75 g OGTT (3.4%). The uptake of the OGTT was 27%. Of these women the prevalence of GDM was 27.9%. Factors associated with screening for GDM were history of big baby, history of pregnancy induced hypertension and participant awareness of GDM (all p: < 0.05). Conclusions: Screening for GDM among women attending ANC was lower than the World Health Organization target. Efforts should be directed towards promoting GDM screening, increasing awareness about GDM and developing more effective screening methods.

Responding to SARS-CoV-2 in South Africa: what can we learn from drug-resistant tuberculosis?

3 mesi 1 settimana ago
Responding to SARS-CoV-2 in South Africa: what can we learn from drug-resistant tuberculosis? Ndjeka, N; Conradie, F; Meintjes, G; Reuter, A; Hughes, J; Padanilam, X; Ismail, N; Kock, Y; Master, I; Romero, R; Te Riele, J; Enwerem, M; Ferreira, H; Maartens, G Rapid adoption of new diagnostic tools, parallel process of research and implementation, decentralisation of services, the use of personal protective equipment, as well as strong partnership and collaboration, could strengthen the fight against COVID-19

Thymus size in children with moderate malnutrition: a cohort study from Burkina Faso

3 mesi 1 settimana ago
Thymus size in children with moderate malnutrition: a cohort study from Burkina Faso Rytter, MJ; Cichon, B; Fabiansen, C; Yameogo, CW; Windinmi, SZ; Michaelsen, KF; Filteau, S; Jeppesen, DL; Friis, H; Briend, A; Christensen, VB Background: Moderate acute malnutrition (MAM) affects millions of children, increasing their risk of dying from infections. Thymus atrophy may be a marker of malnutrition-associated immunodeficiency, but factors associated with thymus size in children with MAM are unknown, as is the effect of nutritional interventions on thymus size. Methods: Thymus size was measured by ultrasound in 279 children in Burkina Faso with MAM, diagnosed by low mid-upper arm circumference (MUAC) and/or low weight-for-length z-score (WLZ), who received 12 weeks treatment with different food supplements as part of a randomized trial. Correlates of thymus size and of changes in thymus size after treatment, and after another 12 weeks of follow-up were identified. Results: Thymus size correlated positively with age, anthropometry and blood haemoglobin, and was smaller in children with malaria. Children with malnutrition diagnosed using MUAC had a smaller thymus than children diagnosed based on WLZ. Thymus size increased during and after treatment, similarly across the different food supplement groups. Conclusions: In children with MAM, the thymus is smaller in children with anaemia or malaria, and grows with recovery. Assuming that thymus size reflects vulnerability, low MUAC seems to identify more vulnerable children than low WLZ in children with MAM. Impact: Thymus atrophy is known to be a marker of the immunodeficiency associated with malnutrition in children.In children with moderate malnutrition, we found the thymus to be smaller in children with anaemia or malaria.Assuming that thymus size reflects vulnerability, low MUAC seems to identify more vulnerable children than low weight for length.Thymus atrophy appears reversible with recovery from malnutrition, with similar growth seen in children randomized to treatment with different nutritional supplements. We regret that this article is behind a paywall.

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