37 research outputs found
HIV-associated neurosyphilis: Report of a fatal case due to fear of work-place stigma
Syphilis and HIV infection are two STI diseases that have bidirectional
influence on the clinical course of each other. There is a high risk of
neurological extension if syphilis is not diagnosed early or if the
patient has a co-infection with HIV. Both diseases have stigma
associated with them and could affect the compliance to treatment, as
was the case with this young employee of the medical department of a
Nigerian tertiary hospital. He was diagnosed with HIV/ neurosyphilis
co-infection and responded to penicillin therapy, but the fear of
stigma at his workplace has made him to abandon hospital treatment for
unorthodox therapy, which unfortunately cost him his life.Syphilis et infection par le VIH sont deux maladies qui ont des STI
bidirectionnel infl uence sur l\u2019\ue9volution clinique de
l\u2019autre. Il ya un risque \ue9lev\ue9 de troubles
neurologiques extension si la syphilis n\u2019est pas
diagnostiqu\ue9 \ue0 un stade pr\ue9coce ou si le patient a une
co-infection avec le VIH. Les deux maladies sont les stigmatiser et
pourrait infl uer sur la conformit\ue9 du traitement, comme ce fut le
cas avec ce jeune personnel m\ue9dical d\u2019un h\uf4pital
tertiaire nig\ue9riane. Il a re\ue7u un diagnostic de neurosyphilis
et a r\ue9pondu \ue0 la th\ue9rapie de p\ue9nicilline, mais la
peur de la stigmatisation \ue0 son lieu de travail a fait de lui
\ue0 renoncer \ue0 l\u2019h\uf4pital pour un traitement de
th\ue9rapie peu orthodoxe qui, malheureusement, lui a co\ufbt\ue9
la vie
Risk factors for default from tuberculosis treatment in HIV-infected individuals in the state of Pernambuco, Brazil: a prospective cohort study
BACKGROUND: Concomitant treatment of Human Immunodeficiency Virus (HIV) infection and tuberculosis (TB) presents a series of challenges for treatment compliance for both providers and patients. We carried out this study to identify risk factors for default from TB treatment in people living with HIV. METHODS: We conducted a cohort study to monitor HIV/TB co-infected subjects in Pernambuco, Brazil, on a monthly basis, until completion or default of treatment for TB. Logistic regression was used to calculate crude and adjusted odds ratios, 95% confidence intervals and P-values. RESULTS: From a cohort of 2310 HIV subjects, 390 individuals (16.9%) who had started treatment after a diagnosis of TB were selected, and data on 273 individuals who completed or defaulted on treatment for TB were analyzed. The default rate was 21.7% and the following risk factors were identified: male gender, smoking and CD4 T-cell count less than 200 cells/mm3. Age over 29 years, complete or incomplete secondary or university education and the use of highly active antiretroviral therapy (HAART) were identified as protective factors for the outcome. CONCLUSION: The results point to the need for more specific actions, aiming to reduce the default from TB treatment in males, younger adults with low education, smokers and people with CD4 T-cell counts < 200 cells/mm3. Default was less likely to occur in patients under HAART, reinforcing the strategy of early initiation of HAART in individuals with TB
The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review
<p>Abstract</p> <p>Background</p> <p>In 2004, tuberculosis (TB) was responsible for 2.5% of global mortality (among men 3.1%; among women 1.8%) and 2.2% of global burden of disease (men 2.7%; women 1.7%). The present work portrays accumulated evidence on the association between alcohol consumption and TB with the aim to clarify the nature of the relationship.</p> <p>Methods</p> <p>A systematic review of existing scientific data on the association between alcohol consumption and TB, and on studies relevant for clarification of causality was undertaken.</p> <p>Results</p> <p>There is a strong association between heavy alcohol use/alcohol use disorders (AUD) and TB. A meta-analysis on the risk of TB for these factors yielded a pooled relative risk of 2.94 (95% CI: 1.89-4.59). Numerous studies show pathogenic impact of alcohol on the immune system causing susceptibility to TB among heavy drinkers. In addition, there are potential social pathways linking AUD and TB. Heavy alcohol use strongly influences both the incidence and the outcome of the disease and was found to be linked to altered pharmacokinetics of medicines used in treatment of TB, social marginalization and drift, higher rate of re-infection, higher rate of treatment defaults and development of drug-resistant forms of TB. Based on the available data, about 10% of the TB cases globally were estimated to be attributable to alcohol.</p> <p>Conclusion</p> <p>The epidemiological and other evidence presented indicates that heavy alcohol use/AUD constitute a risk factor for incidence and re-infection of TB. Consequences for prevention and clinical interventions are discussed.</p
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Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021
Background
Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020.
Methods
We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990–2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data.
Findings
We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5–14 years, 6·29% (5·05 to 7·70) in those aged 15–49 years, 5·72% (4·02 to 7·39) in those aged 50–69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5–14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15–49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50–69 years, and a 3·29% (–5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (–713 to 2180) fewer deaths.
Interpretation
Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups
HIV-associated neurosyphilis: Report of a fatal case due to fear of work-place stigma
Syphilis and HIV infection are two STI diseases that have bidirectional
influence on the clinical course of each other. There is a high risk of
neurological extension if syphilis is not diagnosed early or if the
patient has a co-infection with HIV. Both diseases have stigma
associated with them and could affect the compliance to treatment, as
was the case with this young employee of the medical department of a
Nigerian tertiary hospital. He was diagnosed with HIV/ neurosyphilis
co-infection and responded to penicillin therapy, but the fear of
stigma at his workplace has made him to abandon hospital treatment for
unorthodox therapy, which unfortunately cost him his life.Syphilis et infection par le VIH sont deux maladies qui ont des STI
bidirectionnel infl uence sur l’évolution clinique de
l’autre. Il ya un risque élevé de troubles
neurologiques extension si la syphilis n’est pas
diagnostiqué à un stade précoce ou si le patient a une
co-infection avec le VIH. Les deux maladies sont les stigmatiser et
pourrait infl uer sur la conformité du traitement, comme ce fut le
cas avec ce jeune personnel médical d’un hôpital
tertiaire nigériane. Il a reçu un diagnostic de neurosyphilis
et a répondu à la thérapie de pénicilline, mais la
peur de la stigmatisation Ă son lieu de travail a fait de lui
à renoncer à l’hôpital pour un traitement de
thérapie peu orthodoxe qui, malheureusement, lui a coûté
la vie
Effect Of Artesunate On The Nissl Bodies Of The Cerebellum Of Wistar Rats
The study was to assess the effect of the administration of different doses of artesunate on the Nissl bodies of the cerebellum of Wistar rats. Twenty adult albino Wistar rats weighing between 160-180g were equally assigned into four groups (A, B, C and D). Group A served as the control that received distilled water, while groups B, C and D were the experimental groups. Groups B and C received 2.86mg/kg and 5.71mg/kg of artesunate respectively for three days, while group D received 2.86mg/kg of artesunate for six days. Twelve hours after the last administration the animals were sacrificed. There was reduced staining intensity of Nisslbodies in groups B, C and D compared to the control. The reduction in staining was more in groups C and D especially in the granular and Purkinje cortical layers. These results revealed that artesunate cause reducedNissl bodies of the cerebellum of Wistar rats, and these reductions were dose and time dependent