Clinico-demographic profile of pre-extensively drug-resistant pulmonary tuberculosis patients in India

Drug-resistant tuberculosis (DR TB) is a major public health problem and an important area of research. Identification of various risk factors is essential for its prevention and management. Adults weighing more than 30 kg, aged 18 years or more diagnosed with pre extensively drug resistant TB (pre-XDR TB) were initiated on bedaquiline and linezolid based regimens along with pretomanid/delamanid as part of two multicentric clinical trials in India. Pre-XDR TB was defined as patients infected with M. tb strains resistant to rifampicin (may or may not be resistant to isoniazid) with additional resistance to fluoroquinolones and/or second line injectable as per the existing World Health Organization (WHO) definitions during the trial period. We describe here the baseline demographic and clinical profile of patients with pre-XDR TB and enrolled in those two trials. Of 554 Pre-XDR TB patients, 297 (54 %) were males. Median age (IQR) was 27 years [22.0–36.3] and body mass index was 17.4 [15.7–20.1] kg/m2. Of all, 326 (59 %) had BMI <18.5 kg/m2. History of previous episodes of TB was reported by 415 (75 %) patients. Among them, 142 (34 %) had taken treatment more than once, 279 (67 %) had treatment failure during the previous episodes. Persons with a known history of diabetes were 67 (12 %). Cough, cough with expectoration, fever and weight loss were the presenting complaints in 539 (97 %) and 487 (88 %), 337 (61 %) and 314 (57 %) respectively. Sputum smear microscopy showed more than ++ acid-fast bacilli in 264 (48 %). Chest x-ray showed bilateral lung involvement in 329 (60 %) with more than two zones involvement in 304 (55 %) and presence of cavities in 264 (48 %) patients. Persons in the younger age group, those with malnutrition and previous history of TB treatment were observed to be more in these cohort of patients with PreXDR TB. High rates of treatment failure during the earlier episodes of TB with increased disease severity and drug resistance during the current episode is a matter of grave concern. Improved treatment success during the management of drug sensitive TB, addressing the nutritional challenges are some of key areas of focus in the prevention of DRTB burden

Health related quality of life of tuberculosis patients in South India: A longitudinal assessment study.

In India, there is no information on health related quality of life (HRQoL) of patients with drug sensitive tuberculosis (TB) using a longitudinal design that includes post- treatment period. This study is the first of its kind in India to assess HRQoL of TB patients from a longitudinal prospective and to identify the factors associated with changes in HRQo

Optimal Dual RNA-Seq Mapping for Accurate Pathogen Detection in Complex Eukaryotic Hosts

Dual RNA-Seq technology has significantly advanced the study of biological interactions between two organisms by allowing parallel transcriptomic analysis. Existing analysis methods employ various combinations of open-source bioinformatics tools to process dual RNA-Seq data. Upon reviewing these methods, we intend to explore crucial criteria for selecting standard tools and methods, especially focusing on critical steps such as trimming and mapping reads to the reference genome. In order to validate the different combinatorial approaches, we performed benchmarking using top�ranking tools and a publicly available dual RNA-Seq Sequence Read Archive (SRA) dataset. An important observation while evaluating the mapping approach is that when the adapter trimmed reads are first mapped to the pathogen genome, more reads align to the pathogen genome than the unmapped reads derived from the traditional host-first mapping approach. This mapping method prevents the misalignment of pathogen reads to the host genome due to their shorter length. In this way, the pathogenic read information found at lesser proportions in a complex eukaryotic dataset is precisely obtained. This protocol presents a comprehensive comparison of these possible approaches, resulting in a robust unified standard methodology

Drug-resistant tuberculosis treatment outcomes among Saharia: a marginalized community of Madhya Pradesh, India

Few attempts have been made to explore the drug-resistant tuberculosis (DR-TB) outcomes and associated factors among underprivileged communities. This study aimed to determine DR-TB treatment out- comes and associated factors in the Saharia tribal group (TGs), a community with a high TB burden in Madhya Pradesh, India

Efficacy and safety data on pretomanid for drug-resistant TB

To summarise the efficacy and safety of pretomanid (Pa) based regimens in patients with drug-resistant TB (DR-TB). We included clinical trials, operational research and observational studies reporting the efficacy and safety of Pa-based regimens in DR-TB. The duration of the treatment was at least 24 weeks. Efficacy was reported as a favourable/unfavourable outcome and culture conversion. Safety was reported in terms of death and frequency of adverse events of special interest. Of the 127 articles identified, 13 were included. The proportion of favourable outcomes reported was 76−100%, and the median time to culture conversion was 4−6 weeks. Culture conversion rates ranged from 80–100% by the end of 3 months of treatment, regardless of the type of drug resistance. Treatment completion rates in the operational research studies varied between 18–93%. Safety events were not proportionate among the studies included, possibly due to the differing linezolid dosing (more frequent in the 1,200 mg dose regimen). Our review supports the use of Pa-based regimens in patients with DR-TB. The results indicate that Pa-based regimens are efficacious with tolerable safety profile in DR-TB patients

Long term outcomes in drug resistant tuberculosis with Bedaquiline, Pretomanid and varying doses of Linezolid

Assess the effectiveness of bedaquiline, pretomanid and linezolid (BPaL) regimens with varying doses and duration of linezolid at the end of 48 weeks post treatment among drug resistant tuberculosis (DR TB) patients

Truenat MTB assays for pulmonary tuberculosis and rifampicin resistance in adults and adolescents (Review)

Accurate and rapid diagnosis is crucial for ending the tuberculosis epidemic. Truenat assays are World Health Organization (WHO)-recommended rapid molecular diagnostic tests that detect Mycobacterium tuberculosis complex and rifampicin resistance

Clinical Text Classification for Tuberculosis Diagnosis Using Natural Language Processing and Deep Learning Model with Statistical Feature Selection Technique

In the medical field, various deep learning (DL) algorithms have been effec�tively used to extract valuable information from unstructured clinical text data, potentially leading to more effective outcomes. This study utilized clinical text data to classify clinical case reports into tuberculosis (TB) and non-tuberculosis (non-TB) groups using natural lan�guage processing (NLP), a pre-processing technique, and DL models. Methods: This study used 1743 open-source respiratory disease clinical text data, labeled via fuzzy matching with ICD-10 codes to create a labeled dataset. Two tokenization methods preprocessed the clinical text data, and three models were evaluated: the existing Text-CNN, the proposed Text-CNN with t-test, and Bio_ClinicalBERT. Performance was assessed using multiple metrics and validated on 228 baseline screening clinical case text data collected from ICMR–NIRT to demonstrate effective TB classification. Results: The proposed model achieved the best results in both the test and validation datasets. On the test dataset, it attained a precision of 88.19%, a recall of 90.71%, an F1-score of 89.44%, and an AUC of 0.91. Simi�larly, on the validation dataset, it achieved 100% precision, 98.85% recall, 99.42% F1-score, and an AUC of 0.982, demonstrating its effectiveness in TB classification. Conclusions: This study highlights the effectiveness of DL models in classifying TB cases from clinical notes. The proposed model outperformed the other two models. The TF-IDF and t-test showed statistically significant feature selection and enhanced model interpretability and efficiency, demonstrating the potential of NLP and DL in automating TB diagnosis in clinical decision settings

High-dose isoniazid for TB with low-to-moderate isoniazid resistance after 1 week of treatment

To evaluate the effect of high-dose isoniazid in patients with isoniazid-resistant TB by its bactericidal activity after 1 or more weeks of treatment.Using the rapid direct method of phenotypic drug susceptibility testing, we screened persons with positive sputum microscopy results and genotypic drug resistance for isoniazid resistance.Those with no growth at a critical concentration of 2.0 mg/L were invited to participate in a trial of high-dose isoniazid monotherapy lasting 6 days. After 3 days of no treatment, patients received isoniazid 15 mg/kg and were followed with serial quantitative sputum cultures from Days 0 to

Immunological Analysis of Different Treatment Strategies for Multisystem Inflammatory Syndrome in Children (MIS-C)

MIS-C is an uncommon but devastating ill�ness that occurs mainly in children after exposure to SARS�COV-2 [1]. Early diagnosis, rapid treatment with supportive care, anti-inflammatory medications, and/or immunosup�pressants & immunomodulators with a multidisciplinary approach is essential for effective management of this con�dition. However, the optimal therapeutic strategy remains obscure