ShORRT (Short, all-Oral Regimens for Rifampicin-resistant Tuberculosis) Research Package

TDR in close collaboration with the Global TB Programme at WHO and technical partners the WHO Global TB Programme is leading the development of ShORRT (Short, all-Oral Regimens For Rifampicin-resistant Tuberculosis), an operational research package to assess the effectiveness, safety, feasibility, acceptability, cost and impact (including on health-related quality of life) of the use of all-oral shorter drug regimens for adults and children with MDR/RR-TB

Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020

Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic

Shifts in Mycobacterial Populations and Emerging Drug-Resistance in West and Central Africa.

In this study, we retrospectively analysed a total of 605 clinical isolates from six West or Central African countries (Benin, Cameroon, Central African Republic, Guinea-Conakry, Niger and Senegal). Besides spoligotyping to assign isolates to ancient and modern mycobacterial lineages, we conducted phenotypic drug-susceptibility-testing for each isolate for the four first-line drugs. We showed that phylogenetically modern Mycobacterium tuberculosis strains are more likely associated with drug resistance than ancient strains and predict that the currently ongoing replacement of the endemic ancient by a modern mycobacterial population in West/Central Africa might result in increased drug resistance in the sub-region

Tuberculose pulmonaire en milieu carcéral au Niger : aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs

Objectif : Décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs de la tuberculose pulmonaire en milieu carcéral au Niger. Il s’agissait d’une étude transversale réalisée sur 3ans incluant tous les cas confirmés de tuberculose pulmonaire à microscopie positive (TPM+), les co-infections VIH/ tuberculose et les cas de tuberculose pulmonaire à microscopie négative (TPM-). Résultats : Au total 3322 étaient détenus avec une prévalence de la tuberculose de 0,84%. Tous les patients étaient des hommes. La moyenne d’âge était de 36 ans avec des extrêmes allant de 21 à 62 ans. 17,85% exerçaient dans le secteur informel.35, 71% provenaient des milieux urbains. Sur le plan juridique 71,48% des patients étaient des condamnés et 36% des patients avaient une durée de détention de plus de 3ans au moment du diagnostic. La triade faite de toux (100% de cas) –fièvre (92,85% de cas) -expectoration (67,85% de cas) dominait le tableau clinique. L’amaigrissement (46,42% de cas) et la cachexie (42,46% de cas) constituaient l’essentiel des signes généraux. Le taux de co-infection VIH/SIDA- tuberculose s’élevait à 21,42%. Sur le plan thérapeutique 82,14% des patients étaient de la catégorie 1. 53,56% des patients avaient fait l’objet d’une hospitalisation tandis que 46,44% avaient observé le traitement selon un mode ambulatoire. La guérison était de 46,42% de cas, le décès était 28,53 %. Conclusion : Des mesures préventives et thérapeutiques efficaces sont indispensables en milieu pénitencier.   Objectives: Describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of pulmonary tuberculosis in prisons in Niger. This was a cross-sectional 3-year study that included all confirmed cases of smear-positive pulmonary tuberculosis, HIV / TB co-infections, and smearnegative pulmonary tuberculosis (TPM-). Results: A total of 3322 inmates and the prevalence of tuberculosis was 0.84%. All the patients were men. The average age was 36 years old with extremes ranging from 21 to 62 years old. 17.85% were in the informal sector. 35 71% came from urban areas. In legal terms, 71.48% of patients were convicted and 36% of patients had a detention period of more than 3 years at the time of diagnosis. The triad made of cough (100% of cases) -fever (92.85% of cases) -expectoration (67.85% of cases) dominated the clinical picture. Weight loss (46.42% of cases) and cachexia (42.46% of cases). The clinical signs, the bacteriological examination of the sputum as well as the x-ray (50% of the patients) formed the basis of the diagnosis with miliary predominance. The HIV / AIDS-TB co-infection rate was 21.42%. 82.14% of patients were in Category 1. 53.56% of patients had been hospitalized while 46.44% had been on ambulatory therapy. The therapeutic success was 46, 42% and the death rate was 28.53%. Conclusion: Effective preventive and therapeutic measures are essential in a penitentiary environment

Peritoneal cytology does not increase the prognostic information provided by TNM in gastric cancer.

Background: This study aimed at verifying whether peritoneal cytology could improve the prognostic information provided by TNM staging in gastric cancer patients. Method: The presence of free peritoneal tumor cells was investigated in 168 patients who underwent curative resection for gastric cancer from January 1992 to July 2002 in Verona, Italy. The influence of peritoneal cytology on survival was evaluated by a Cox regression model, controlling for potential confounders. Results: Twenty-three patients (14%) had positive peritoneal cytology. Patients with positive lavage were more likely to present serosal infiltration (100 vs. 46%) and nodal metastases (91 vs. 67%; P < 0.001). Positive lavage was associated with a very poor prognosis: 3-year survival was only 9% (95% CI 2-27%) when peritoneal cancer cells had been detected, whereas survival reached 50% (95% CI 42-59%) in patients with a negative cytology. In multivariate survival analysis, peritoneal cytology was an independent predictor of mortality when controlling for sex, age, site, histology, and nodal metastases, but not when adjusting also for depth of tumor invasion (RR of positive versus negative = 1.2, 95% CI 0.7-2.0). Similarly, the influence of peritoneal cytology on survival was no longer significant when univariate analysis was restricted to T3/T4 patients (RR = 1.5, 0.9-2.5). Conclusions: Positive peritoneal cytology was a marker of poor prognosis in gastric cancer patients. Nevertheless, peritoneal lavage did not increase the prognostic information already provided by the TNM staging system in this Italian series

Short-Course Regimen for Multidrug-Resistant Tuberculosis: A Decade of Evidence

About ten years ago, the first results of the so-called &ldquo;Bangladesh regimen&rdquo;, a short regimen lasting nine months instead of 20 months, revolutionized multidrug-resistant tuberculosis (MDR-TB) treatment. Similar short regimens were studied in different settings, relying for their efficacy on a later generation fluoroquinolone, either gatifloxacin, moxifloxacin, or levofloxacin. We review the published material on short MDR-TB regimens, describe their different compositions, their results in national tuberculosis programs in middle- and low-income countries, the risk of acquiring resistance to fluoroquinolone, and the occurrence of adverse events. With over 80% success, the regimen performs much better than longer regimens (usually around 50%). Monitoring of adverse events allows adapting its composition to prevent severe adverse events such as deafness. We discuss the current applicability and usefulness of the short injectable-containing regimen given the 2019 recommendation of the World Health Organization (WHO) for a new long all-oral regimen. We conclude that the most effective fluoroquinolone is gatifloxacin, currently not listed as an essential medicine by WHO. It is a priority to restore its status as an essential medicine