Effective Visual Media to Increase Knowledge and Comprehension of Multidrug Resistant Tuberculosis Among Patients and Their Caregivers

Indonesia ranks thirdamong countries with the largest number of TB cases after India and China. Globally, more than 3-4% of all TB cases are Multidrug-Resistant Tuberculosis (MDR TB). MDR TB is a more complicated TB that needs extra treatments, which extend treatment time and increase adverse effects. Thus, MDR TB patients and their families often feel demotivated about completing treatment, leading to loss to follow up, which contributes to the never-ending transmission and greatly affects the success rate of the national TB control program. Thus, better knowledge and perception on MDR treatment for patients and families plays a crucial role in dealing with this issue. A cross-sectional study was performed from April to June 2019 to evaluate the effectiveness of visual educational media for TB patients and their caregivers. Participants consisted of 144 patients diagnosed with MDR TB and their caregivers or family members (n=22). A pre-test was administered before an education session by a nurse and visual media were used as the educational material. At the end of the session, a post-test was performed. The post-test score was then compared to the pre-test score to evaluate the session’s effectiveness using the paired t-test. Result showed significant increase in the post-test score (t= 3.249, df=3, p=0.04), with the caregivers attained a higher score, showing better improvement in knowledge after the session compared to the patient group. Hence, the MDR TB educational intervention using visual media is considered effective to increase participants ‘understanding of MDR TB. It is expected that with increased knowledge on MDR TB, the treatment success rate will increase and becomes the catalyst for the nationwide TB control strategy

Effective Visual Media to Increase Knowledge and Comprehension of Multidrug Resistant Tuberculosis Among Patients and Their Caregivers

Indonesia ranks thirdamong countries with the largest number of TB cases after India and China. Globally, more than 3-4% of all TB cases are Multidrug-Resistant Tuberculosis (MDR TB). MDR TB is a more complicated TB that needs extra treatments, which extend treatment time and increase adverse effects. Thus, MDR TB patients and their families often feel demotivated about completing treatment, leading to loss to follow up, which contributes to the never-ending transmission and greatly affects the success rate of the national TB control program. Thus, better knowledge and perception on MDR treatment for patients and families plays a crucial role in dealing with this issue. A cross-sectional study was performed from April to June 2019 to evaluate the effectiveness of visual educational media for TB patients and their caregivers. Participants consisted of 144 patients diagnosed with MDR TB and their caregivers or family members (n=22). A pre-test was administered before an education session by a nurse and visual media were used as the educational material. At the end of the session, a post-test was performed. The post-test score was then compared to the pre-test score to evaluate the session’s effectiveness using the paired t-test. Result showed significant increase in the post-test score (t= 3.249, df=3, p=0.04), with the caregivers attained a higher score, showing better improvement in knowledge after the session compared to the patient group. Hence, the MDR TB educational intervention using visual media is considered effective to increase participants ‘understanding of MDR TB. It is expected that with increased knowledge on MDR TB, the treatment success rate will increase and becomes the catalyst for the nationwide TB control strategy

Secretion of Galectin-9 as a DAMP during Dengue Virus Infection in THP-1 Cells

Damage-associated molecular patterns (DAMPs) are endogenous cellular molecules released to the extracellular environment in response to stress conditions such as virus infection. Galectins are β-galactoside-binding proteins that are widely expressed in cells and tissues of the immune system, are localized in the cell cytoplasm, and have roles in inflammatory responses and immune responses against infection. Elevated levels of galectin-9 (Gal-9) in natural human infections have been documented in numerous reports. To investigate the effect of dengue virus (DENV) infection on expression of endogenous Gal-9, monocytic THP-1 cells were infected with varying doses of DENV-3 (multiplicity of infection (MOI) 0.01, 0.03 and 0.1) and incubated at varying time points (Day 1, Day 2, Day 3). Results showed augmentation of Gal-9 levels in the supernatant, reduction of Gal-9 levels in the cells and decreased expression of LGALS9 mRNA, while DENV-3 mRNA copies for all three doses remained stable through time. Dengue virus induced the secretion of Gal-9 as a danger response; in turn, Gal-9 and other inflammatory factors, and stimulated effector responses may have limited further viral replication. The results in this pilot experiment add to the evidence of Gal-9 as a potential DAMP

The effect of M. tuberculosis lineage on clinical phenotype.

Six lineages of Mycobacterium tuberculosis sensu stricto (which excludes M. africanum) are described. Single-country or small observational data suggest differences in clinical phenotype between lineages. We present strain lineage and clinical phenotype data from 12,246 patients from 3 low-incidence and 5 high-incidence countries. We used multivariable logistic regression to explore the effect of lineage on site of disease and on cavities on chest radiography, given pulmonary TB; multivariable multinomial logistic regression to investigate types of extra-pulmonary TB, given lineage; and accelerated failure time and Cox proportional-hazards models to explore the effect of lineage on time to smear and culture-conversion. Mediation analyses quantified the direct effects of lineage on outcomes. Pulmonary disease was more likely among patients with lineage(L) 2, L3 or L4, than L1 (adjusted odds ratio (aOR) 1.79, (95% confidence interval 1.49-2.15), p<0.001; aOR = 1.40(1.09-1.79), p = 0.007; aOR = 2.04(1.65-2.53), p<0.001, respectively). Among patients with pulmonary TB, those with L1 had greater risk of cavities on chest radiography versus those with L2 (aOR = 0.69(0.57-0.83), p<0.001) and L4 strains (aOR = 0.73(0.59-0.90), p = 0.002). L1 strains were more likely to cause osteomyelitis among patients with extra-pulmonary TB, versus L2-4 (p = 0.033, p = 0.008 and p = 0.049 respectively). Patients with L1 strains showed shorter time-to-sputum smear conversion than for L2. Causal mediation analysis showed the effect of lineage in each case was largely direct. The pattern of clinical phenotypes seen with L1 strains differed from modern lineages (L2-4). This has implications for clinical management and could influence clinical trial selection strategies