Mortality during tuberculosis treatment in South Africa using an 8-year analysis of the national tuberculosis treatment register

In 2011, the South African HIV treatment eligibility criteria were expanded to allow all tuberculosis (TB) patients lifelong ART. The impact of this change on TB mortality in South Africa is not known. We evaluated mortality in all adults (≥ 15 years old) treated for drug-susceptible TB in South Africa between 2009 and 2016. Using a Cox regression model, we quantified risk factors for mortality during TB treatment and present standardised mortality ratios (SMR) stratified by year, age, sex, and HIV status. During the study period, 8.6% (219,618/2,551,058) of adults on TB treatment died. Older age, male sex, previous TB treatment and HIV infection (with or without the use of ART) were associated with increased hazard of mortality. There was a 19% reduction in hazard of mortality amongst all TB patients between 2009 and 2016 (adjusted hazard ratio: 0.81 95%CI 0.80–0.83). The highest SMR was in 15–24-year-old women, more than double that of men (42.3 in 2016). Between 2009 and 2016, the SMR for HIV-positive TB patients increased, from 9.0 to 19.6 in women, and 7.0 to 10.6 in men. In South Africa, case fatality during TB treatment is decreasing and further interventions to address specific risk factors for TB mortality are required. Young women (15–24-year-olds) with TB experience a disproportionate burden of mortality and interventions targeting this age-group are needed.

The impact of the evolving HIV response on the epidemiology of tuberculosis in South African children and adolescents

Background Few studies have evaluated tuberculosis control in children and adolescents. We used routine tuberculosis surveillance data to quantify age- and HIV-stratified trends over time and investigate the relationship between tuberculosis, HIV, age and sex. Methods All children and adolescents (0-19 years) routinely treated for drug-susceptible tuberculosis in South Africa and recorded in a de-duplicated national electronic tuberculosis treatment register (2004-2016) were included. Age- and HIV-stratified tuberculosis case notification rates (CNRs) were calculated in four age bands: 0-4, 5-9, 10-14 and 15-19 years. The association between HIV infection, age and sex in children and adolescents with TB was evaluated using multivariable logistic regression. Results Of 719,400 children and adolescents included, 339,112 (47%) were 0-4-year-olds. The overall tuberculosis CNR for 0-19-year-olds declined by 54% between 2009 and 2016 (incidence rate ratio [IRR]=0.46, 95% confidence interval [CI] 0.45-0.47). Trends varied by age and HIV, with the smallest reductions (2013-2016) in HIV-positive 0-4-year-olds (IRR=0.90, 95%CI 0.85-0.95) and both HIV-positive (IRR=0.84, 95%CI 0.80-0.88) and HIV-negative (IRR=0.89, 95%CI 0.86-0.92) 15-19-year-olds. Compared to 0-4-year-old males, odds of HIV co-infection among 15-19-year-olds were nearly twice as high in females (adjusted odd’s ratio [aOR]=2.49, 95%CI 2.38-2.60) than in males (aOR=1.35, 95%CI 1.29-1.42). Conclusions South Africa’s national response to the HIV epidemic has made a substantial contribution to the observed declining trends in tuberculosis CNRs in children and adolescents. The slow decline of tuberculosis CNRs in adolescents and young HIV-positive children is concerning. Understanding how tuberculosis affects children and adolescents beyond conventional age bands and by sex, can inform targeted tuberculosis control strategies.

Commonly Encountered Ailments in Working Bullocks in Western Maharashtra, India

Aim: The aim of present study was to determine the common diseases encountered by Animal Rahat teams in working bullocks in Western Maharashtra, India and also emphasize on diseases of higher prevalence encountered in more numbers during hard working season viz. sugarcane crushing season. This is based on analysis of Animal Rahat ‘Streatment data of five years which is from April, 2015 to March, 2020.Animal Rahat, an animal welfare organization provides free treatment services to working bullocks in180 villages and 26sugar factories of Western Maharashtrai.e. in Solapur, Sangli, Satara and Kolhapur districts. Every year’s thousands of animals are being treated for various ailments and these treatment data’s are recorded in specified treatment register and on monthly basis these treatment data’s are converted to soft and analysed.

TB-diabetes comorbidity and associated factors in Maekel Zone, Eritrea: A cross sectional study.

Background : In Eritrea, no study document the true burden of TB-diabetes comorbidity. However, diabetes has been constantly increasing with a prevalence of 3.4 %. Similarly, even though TB notification is showing a declining trend the prevalence is 123/100,000 population. With an increasing diabetes trend, the country is at higher risk of rising TB-diabetes comorbidity which can further complicate TB care, control and prevention activities. Thus, this study was conducted to assess the prevalence of diabetes among pulmonary positive TB patients and its influencing factors in Maekel zone, Eritrea. Methods: This study was a cross sectional study conducted in all (11) TB diagnostic and treatment sites of Maekel zone. All consecutive pulmonary positive TB cases who were registered during the period of 2015-2018 in the national TB treatment register and were eligible included in the analysis. Pretested data extraction tool was used to collect the required information. Data analysis was done by SPSS version 23. Simple frequencies, percentages and means were used to describe the data. Chi-square test and logistic regression analysis was also performed. Results: A total of 490 pulmonary positive TB cases were eligible for the study and the overall prevalence of diabetes among pulmonary positive TB cases was 4.3%. Univariate logistic regression showed that participants with an older age (45-90) were more likely to have TB-diabetes comorbidity (COR: 4.397[CI: 1.675-11.545], p<0.01) than those aged 10-44 years old. In addition, subjects whose weight was 65kg and above were more likely (COR: 7.647[CI: 1.965-29.758], p<0.01) to have TB- diabetes comorbidity than those with lower body weight. Conclusion: TB-diabetes comorbidity observed in this study is low but given the growing diabetes trend in the country, an integrated TB-DM services should be given regularly on full scale at all health facilities.

The neutrophil-to-lymphocyte ratio is associated with multiple sclerosis

Background Subtypes of white blood cell counts are known biomarkers of systemic inflammation and a high neutrophil-to-lymphocyte ratio (NLR) has been associated with several autoimmune diseases. Few studies have investigated the NLR in multiple sclerosis (MS). Objective To examine the association between NLR, MS and disability measured by the MS severity score (MSSS). Methods Patients were included from the Danish Multiple Sclerosis Biobank. Information on patient NLR was obtained just before their first treatment and clinical information was provided by the Danish Multiple Sclerosis Treatment Register. Information on NLR from controls was collected from the Danish Blood Donor Study. Patients and controls were 1:2 propensity score matched by baseline confounders. Results Propensity score matching left 740 of 743 MS patients and 1420 of 4691 controls for further analyses. Odds-ratio (OR) was 3.64 (95% confidence interval 2.87–4.60, p < 0.001) for MS disease per unit increase of logarithmically transformed NLR (ln-NLR), corresponding to an OR of 2.68 for each doubling of NLR. Mean NLR was 2.12 for patients and 1.72 for controls ( p < 0.001). Ln-NLR correlated weakly with patient MSSS ( R2 = 0.019, p = 0.008). Conclusion Patients with early MS had increased levels of NLR compared to healthy controls and NLR was weakly correlated with MSSS.

Smoking affects the interferon beta treatment response in multiple sclerosis

ObjectiveTo investigate whether smoking in patients with relapsing-remitting multiple sclerosis (RRMS) treated with interferon beta (IFN-β) is associated with the relapse rate and whether there is an interaction between smoking and human leukocyte antigen (HLA)–DRB1*15:01, HLA-A*02:01, and the N-acetyltransferase-1 (NAT1) variant rs7388368A.MethodsDNA from 834 IFN-β–treated patients with RRMS from the Danish Multiple Sclerosis Biobank was extracted for genotyping. Information about relapses from 2 years before the start of treatment to either the end of treatment or the last follow-up visit was obtained from the Danish Multiple Sclerosis Treatment Register. Smoking information came from a comprehensive questionnaire.ResultsWe found that the relapse rate in patients with RRMS during IFN-β treatment was higher in smokers compared to nonsmokers, with an incidence rate ratio (IRR) of 1.20 (95% confidence interval [CI] 1.021–1.416, p = 0.027) and with an IRR increase of 27% per pack of cigarettes per day (IRR 1.27, 95% CI 1.056–1.537, p = 0.012). We found no association or interaction with HLA and the NAT1 variant.ConclusionIn this observational cohort study, we found that smoking is associated with increased relapse activity in patients with RRMS treated with IFN-β, but we found no association or interaction with HLA or the NAT1 variant.

Profile of multi drug resistant (MDR) and rifampicin resistant TB patients treated under category IV of RNTCP

Background: The emergence of resistance to drugs used to treat tuberculosis (TB) and particularly multidrug resistance TB (MDR-TB) has become a significant health problem and obstacle to effective TB control in India. Present study was conducted to study clinical and sociodemograohic profile of MDR and rifampicin resistant TB patients registered for treatment under RNTCP in Yavatmal district of Maharashtra state.Methods: All drug resistant (MDR and rifampicin resistant) TB patients residents of Yavatmal district, treated at DOTS plus site with Standardized Treatment Regimen (STR) from 1st quarter 2009 to 3rd quarter 2013 were included. Data was obtained from electronic treatment register maintained at DOTS Plus site.Results: There were total 60 confirmed MDR and rifampicin resistant TB patients from Yavatmal district. Male patients (65.00%) were comparatively more than females (35.00%). Almost half (46.67%) of the patients belonged to the productive age group i.e. 30-45 years followed by another one third (35.00%) in the age group of 15-30 years. 93.33% patients were previously treated under RNTCP (under CAT II), out of them 48.51% were failure, 37.50% relapse and 14.29% defaulter.Conclusions: Among MDR and rifampicin resistant TB patients, maximum patients were males, belonged to the social and productive age group, HIV negative and previously treated due to treatment failure.