Miracle-dz/UniFAR-FTUs huggingface dataset:
Tuberculosis surveillance in Cape Town, South Africa: an evaluation.

SETTING Cape Town, South Africa. OBJECTIVE To evaluate the current system of tuberculosis surveillance in the Cape Metro region. DESIGN This evaluation was based on the 'Updated Guidelines for Evaluating Public Health Surveillance Systems' of the Centers for Disease Control and Prevention, modified to render the framework applicable to the context of tuberculosis (TB) surveillance. The evaluation incorporated qualitative exploration of perceptions and experiences of system users. RESULTS System users were very accepting of the system and were committed to seeing it achieve its purpose within public health. Some individuals expressed concerns about the rigidity of the Electronic TB Register software and its analysis capabilities. Dissemination of TB data and evidence-based action within the Cape Metro region are strong attributes of Cape Town's TB surveillance system. At the time of the evaluation, integration of TB and human immunodeficiency virus (HIV) data was weak, as was multidrug-resistant TB (MDR-TB) surveillance; the South African Tuberculosis Control Programme is developing initiatives to improve these areas. CONCLUSIONS Cape Metro's TB surveillance is strong, although it would be strengthened by increasing availability of data reflecting TB-HIV co-infection and MDR-TB. Systems operations could be improved by increasing software flexibility, and increased integration of electronic data across health regions would enhance the capacity and assessment of control efforts.
Tuberculosis in household contacts of multidrug-resistant tuberculosis patients.

SETTING The burden of tuberculosis (TB) disease among household contacts of multidrug-resistant TB (MDR-TB) patients is poorly understood and might represent a target for transmission-interrupting interventions. DESIGN This retrospective cohort study, conducted in Lima, Peru, from June to September 2008, estimated the incidence of TB disease among household contacts of MDR-TB patients in 358 households. RESULTS Of 2112 household contacts in 80 households (22% of households), 108 (5%) developed TB disease during the study, giving an incidence rate of 2360 per 100 000 contact follow-up years for each of the first 3 years after exposure. Drug susceptibility tests (DST) were available for 50 diseased contacts, of whom 36 (80%) had MDR-TB. Forty-two pairs of index-contact DSTs were available, among which the contact had an identical or less resistant phenotype than the index case in 27 pairs. Multivariate Cox regression demonstrated that male contacts (hazard ratio [HR] 2.8, P < 0.05), with previous TB disease (HR 20.7, P < 0.001) and with associated (non-human immunodeficiency virus) comorbidities (HR 11.2, P < 0.001) were more likely to develop TB. CONCLUSION The high percentage of diseased household contacts highlights an opportunity for household-level interventions to prevent transmission, whether or not these cases were all attributable to the index case.
Disability Prevalence Among Adults: Estimates for 54 Countries and Progress Towards a Global Estimate

Objectives: We estimated disability prevalence among adults at global, regional and country levels using internationally comparable disability data and measure. Methods: We conducted a retrospective analysis of data from the World Health Survey (WHS) (2002-2004) for nationally representative samples of civilian, non-institutionalized populations in 54 countries. A disability was measured as having at least one severe or extreme difficulty with bodily functions (seeing, concentrating) and activities (moving around, self-care) based on an individual’s self-reports. Results: In the 54 countries under study, severe or extreme functional or activity difficulties are highly prevalent. For all countries, disability prevalence is estimated at 14% for all adults. Low and middle income countries have higher disability prevalence compared to high income countries. Among subgroups, disability prevalence stands at 12% among working age adults and 39% among the elderly. Women have higher prevalence than men. Conclusions: Disability is found to be highly prevalent among adults, with an estimated global prevalence at 14%. Disability deserves enhanced policy attention and resources in public health and international development.
Training general practitioners in cognitive behavioural therapy for panic disorder: Randomized-controlled trial

Background: Cognitive Behavioural Therapy (CBT) is an effective treatment for panic disorder and other common mental health problems, however its availability in British General Practice is limited. Work is needed to identify ways to improve access to patients in primary care. Aim: A pilot study to measure the effectiveness of a training programme in CBT for GPs for the treatment of panic disorder. Method: Randomized-controlled trial. GPs were randomized to early or late entry into a training programme in CBT, consisting of formal teaching and clinical supervision. Outcome measures were: knowledge of panic disorder using a multiple-choice questionnaire; evidence of ability to assess and plan management of patients with panic disorder using responses to role-played consultations; assessment of change in practice by analysis of patient records. Results: GPs significantly increased their ability to assess and plan management of panic disorder. There was no significant increase in knowledge. There was evidence for an increased use of CBT techniques with recruited patients. Conclusions: Training and clinical supervision in CBT led to a change in GP behaviour in the management of panic disorder. Further development could lead to greater availability of effective psychological management of other mental health problems. Declaration of Interest: This study was funded by a grant from the NHS Executeive R&D fund.
Predictors of recurrence of multidrug-resistant and extensively drug-resistant tuberculosis.

OBJECTIVE To assess the treatment outcome of the first Green Light Committee (GLC) approved countrywide management of multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) in Estonia and to evaluate risk factors contributing to TB recurrence over 8 years of follow-up. DESIGN Prospective assessment of MDR- and XDR-TB patients starting second-line anti-tuberculosis drug treatment between 1 August 2001 and 31 July 2003, with follow-up until 31 December 2010. RESULTS In 211 MDR- and XDR-TB patients, treatment success was 61.1%; 22.3% defaulted, 8.5% failed and 8.1% died. TB recurrence among successfully treated patients was 8.5%, with no significant difference between XDR-TB and MDR-TB. TB recurrence was associated with resistance to all injectables (HR 2.27, 95%CI 1.16-5.06, P = 0.046), resistance to a greater number of drugs (HR 1.35, 95%CI 1.11-1.64, P = 0.003), and sputum smear positivity (HR 2.16, 95%CI 1.16-4.00, P = 0.016). A history of previous TB treatment was associated with TB recurrence among successfully treated patients (HR 4.28, 95%CI 1.13-16.15, P = 0.032). CONCLUSIONS The internationally recommended Category IV treatment regimens are sufficiently effective to cure 75% of adherent MDR- and XDR-TB patients. A history of previous treatment, resistance to all injectable agents and resistance to a greater number of drugs increase the recurrence of MDR- and XDR-TB.
A Case Report: Systemic Lupus Erythematosus with Presenting of Macrophage Activation Syndrome -

Macrophage activation syndrome (MAS) is a severe and rare fatal complication of systemic inflam - matory diseases in childhood. MAS has been described in patients with several rheumatic diseases, including systemic onset juvenile idiopathic arthritis (SoJIA), systemic lupus erythematosus (SLE), and Kawasaki disease. Here, we describe a girl who presented clinical and laboratory features of MAS, and an initial manifestation of SLE.
Isoniazid preventive treatment: predictors of adverse events and treatment completion.

SETTING Villa Marelli Institute (VMI), Niguarda Ca'Granda Hospital, Milan, Italy. BACKGROUND A recent report on the fatal side effects of isoniazid preventive therapy (IPT) from the United States has re-ignited discussion on the safety of this intervention. OBJECTIVE To evaluate IPT feasibility, treatment completion and adverse events (AE) and their determinants under field conditions. METHODS Data from consecutive subjects undergoing IPT at the VMI were recorded in an electronic database from 1992 to 2009. Logistic regression analysis was performed to detect completion and AE determinants. RESULTS A total of 11,963 patients were included in the study. AE (odds ratio [OR] 2.70, 95%CI 2.22-3.28) and human immunodeficiency virus positive status (OR 5.20, 95%CI 2.10-12.93) were the main determinants of treatment interruption among Italians, while social weakness (no housing/job; OR 2.88, 95%CI 2.43-3.42), AEs (OR 1.33, 95%CI 1.15-1.53, 2.22-3.28) and screening in undocumented subjects (OR 1.20, 95%CI 1.01-1.44) prevailed among foreigners. Age was the main determinant of transaminase increase (OR 1.03, 95%CI 1.03-1.04), as were AEs of the gastrointestinal (OR 1.02, 95%CI 1.02-1.03), central nervous (OR 1.02, 95%CI 1.02-1.05) and peripheral nervous systems (OR 1.04, 95%CI 1.02-1.05). CONCLUSION This analysis demonstrates the feasibility and safety of IPT, with determinants of interruption and AEs being predictable and addressable.
Completing treatment for latent tuberculosis: patient background matters.

BACKGROUND Treatment of latent infection with Mycobacterium tuberculosis effectively reduces future activation and transmission of tuberculosis. However, patient adherence to preventive treatment influences its effectiveness. Treatment completion is commonly considered as a proxy for adherence. OBJECTIVE To identify factors associated with failure to complete preventive treatment. DESIGN Data from 415 consecutive patients who started preventive treatment at the Karolinska University Hospital, Stockholm, Sweden, between 2002 and 2007 were collected and treatment completion was evaluated. Patients were classified as 'completers' or 'non-completers'. Association between treatment completion status and patient characteristics was assessed using logistic regression. RESULTS Younger patients, patients originating from Somalia and asylum seekers were more likely to be non-completers. The proportion of completers increased from 71% in 2002 to 87% in 2007. However, this trend appears to be caused mostly by an increase in the proportion of European patients. CONCLUSION The finding of a low rate of treatment completion among Somalis should be regarded as a call for intervention on the individual patient level, also taking into account socio-cultural aspects such as perceptions of health care by the Somali community. Treatment completion continues to be of concern as it is not improving among risk populations.
Detailed Heat Transfer Distribution on the Endwall of a Trapezoidal Duct with an In-Line Pin Array

This study presents the measurements of detailed endwall heat transfer and pressure drop in a pin-®nned trapezoidal duct. The trapezoidal duct is inserted with an in-line pin array of ®ve rows and ®ve columns, with the same spacings between the pins in streamwise and spanwise directions of Sx/d5Sy/d5 2.5. The eects of the lateralow ejection (0<  e<  1.0) and ow Reynolds number (6000< Re  40000) are examined. Transient liquid crystal technique is employed to measure the detailed heat transfer on the endwall of a pin®nned trapezoidal duct. Results indicate that the pin-®nned trapezoidal duct of a lateralow rate about e5 0.3 has a local minimum endwall-averaged Nusselt number. In addition, the trapezoidal duct of lateral outlet ow only (e5 1.0) has a highest endwall heat transfer as well as pressure drop. Finally, the correlation of the endwall-averaged heat transfer for the pin-®nned trapezoidal duct is developed by taking account of the lateralow rate and the ow Reynolds number.
Analysis of the economic burden of diagnosis and treatment of tuberculosis patients in rural China.

SETTING A county in Jiangsu Province, China. OBJECTIVES To estimate the costs of the diagnosis and treatment of tuberculosis (TB) from the patient's perspective and to identify determinants of the patient's financial burden. DESIGN In a cross-sectional survey, we interviewed 316 patients diagnosed from January 2010 to May 2011 who had already completed their anti-tuberculosis treatment. The financial burden on TB patients included out-of-pocket costs and productivity losses. RESULTS The average per capita total out-of-pocket cost was 3024.0 Chinese yuan (CNY), with a median cost of 1086 CNY (interquartile range [IQR] 480-2456). Mean out-of-pocket medical and non-medical costs were respectively 2565.7 CNY and 458.3 CNY. Productivity lost by patients and family members was 2615.2 CNY (median 500, IQR 250-2025). Factors associated with out-of-pocket costs and productivity losses included hospitalisation, adverse drug reactions, cost of drugs to 'protect' the liver, cost of second-line anti-tuberculosis drugs and diagnostic delay. CONCLUSION Although the government of China has implemented a 'free TB service policy', the economic burden on patients is still heavy. More patient-centred interventions are essential to reduce the financial burden on patients.
Active case finding for tuberculosis among people who inject drugs on methadone treatment in Dar es Salaam, Tanzania.

SETTING Active case finding is a World Health Organization (WHO) endorsed strategy for improving tuberculosis (TB) case detection. Despite WHO recommendations for active case finding among people who inject drugs (PWID), few studies have been published. The historical focus of case finding has been in populations that are human immunodeficiency virus-positive, incarcerated or at higher occupational risk. OBJECTIVE We sought to examine the yield of active case finding among PWID newly started on methadone in Tanzania. DESIGN Of 222 methadone clients, 156 (70%) met with study administrators; 150 consented to participate, 139 (93%) of whom were male. The median age was 34 years. A symptom-based questionnaire was developed by the investigators and administered to every consenting patient by a native Swahili speaker. RESULTS Of the 150 patients surveyed, 16 (11%) had one or more TB symptoms and were referred for laboratory testing. Six new TB cases were identified in this active case finding program, with a prevalence of 4%. CONCLUSION This study presents the first data on TB prevalence in a population of PWID in Tanzania. This prevalence is 23 times that of the general Tanzanian TB prevalence of 0.2%. These results have significant implications for TB control.
Increase in anti-tuberculosis drug resistance in Botswana: results from the fourth National Drug Resistance Survey.

SETTING Although approximately 0.5 million cases of multidrug-resistant tuberculosis (MDR-TB) occur globally each year, surveillance data are limited. Botswana is one of the few high TB burden countries to have carried out multiple anti-tuberculosis drug resistance surveys (in 1995-1996, 1999 and 2002). OBJECTIVE In 2007-2008, we conducted the fourth national survey of anti-tuberculosis drug resistance in Botswana to assess anti-tuberculosis drug resistance, including trends over time. In the previous survey, 0.8% (95%CI 0.4-1.5) of new patients and 10.4% (95%CI 5.6-17.3) of previously treated patients had MDR-TB. DESIGN During the survey period, eligible specimens from all new sputum-smear positive TB patients and from all TB patients with history of previous anti-tuberculosis treatment underwent mycobacterial culture and anti-tuberculosis drug susceptibility testing (DST). RESULTS Of 924 new TB patients and 137 with previous anti-tuberculosis treatment with DST results, respectively 23 (2.5%, 95%CI 1.6-3.7) and 9 (6.6%, 95%CI 3.3-11.7) had MDR-TB. The proportion of new TB patients with MDR-TB has tripled in Botswana since the previous survey. CONCLUSION Combatting drug-resistant TB will require the scale-up of MDR-TB diagnosis and treatment to prevent the transmission of MDR-TB and strengthening of general TB control to prevent the emergence of resistance.
Cathelicidin and human β-defensin 2 in bronchoalveolar lavage fluid of children with pulmonary tuberculosis.

BACKGROUND The antimicrobial peptide cathelicidin LL-37/hCAP-18 and human β-defensins (hBD) are key factors in innate immune responses of the respiratory tract. OBJECTIVE To determine LL-37 and hBD-2 concentrations in the bronchoalveolar lavage (BAL) fluid of paediatric patients (aged <16 years) with pulmonary tuberculosis (TB) and to compare these with concentrations in healthy children. METHODS We measured peptide concentrations using an immunosorbent assay (ELISA). RESULTS Forty TB patients and 40 healthy controls were enrolled in the study (mean age 9.2 ± 4.7 and 8.3 ± 4.2 years, respectively, P = 0.97). The two groups exhibited no statistically significant difference in terms of sex, body mass index, relative weight or 25-hydroxyvitamin D levels. The mean BAL LL-37 level of the TB group was significantly higher than that of the control group (0.95 ± standard deviation [SD] 1.33 vs. 0.35 ± SD 0.51 ng/ml, P = 0.01, t = 2.54). The hBD-2 level was also higher in the TB group; however, the difference was not statistically significant (0.30 ± SD 0.58 vs. 0.14 ± SD 0.30 ng/ml, P = 0.11). There was no correlation between LL-37, hBD-2 and 25-hydroxyvitamin D levels. CONCLUSIONS Our data suggest that LL-37 and hBD-2 may play an important role in TB pathogenesis in children. To our knowledge, this is the first study on BAL LL-37 and hBD-2 concentrations in children with pulmonary TB.
The effects of statin use on the development of tuberculosis among patients with diabetes mellitus.

OBJECTIVE To evaluate whether statin use affects the development of tuberculosis (TB) among patients with diabetes mellitus (DM). METHODS This is a retrospective cohort study of patients with newly diagnosed type 2 DM based on the South Korean nationwide claims database. The participants were type 2 DM patients aged 20-99 years who were newly treated with anti-diabetic drugs between 1 January 2007 and 31 December 2010. Patients who had statin prescriptions before a diagnosis of diabetes or were diagnosed with TB before diabetes were excluded. RESULTS Of 840,899 newly diagnosed type 2 DM patients, 281,842 (33.5%) patients were statin users and 559,057 (66.5%) were non-users. During the study period, 4075 [corrected] individuals were diagnosed with TB; the estimated incidence of TB in our cohort was 251/100,000 patient-years (95%CI 243-258). In comparison to non-TB patients, statin users were less frequent among TB patients (19.2% vs. 33.6%). After adjustment for potential baseline confounders, statin use was not associated with the development of TB in DM patients (aHR 0.98; 95%CI 0.89-1.07). CONCLUSIONS TB development among newly diagnosed type 2 DM was considerable, and statin use among these diabetics was not associated with a protective effect on TB incidence.
Determinants of recurrence after successful treatment of Mycobacterium avium complex lung disease.

BACKGROUND The long-term treatment outcomes of Mycobacterium avium complex (MAC) lung disease (LD) have not been adequately evaluated. OBJECTIVE We evaluated the determinants of microbiological recurrence after successful treatment for MAC LD. DESIGN The medical records of 295 MAC LD patients treated with combination chemotherapy from 2004 to 2013 were reviewed. The clinical data, microbiological study results and chest computerised tomography findings were collected for each patient. RESULTS Ninety-one patients who maintained negative sputum conversion during treatment and had a minimum 10-month follow-up period after treatment were included. The median duration of follow-up was 25 months. Seventy-one (78.0%) patients remained microbiologically disease-free, while 20 (22.0%) had microbiological recurrence after successful treatment. Age, sex and body mass index were not associated with microbiological recurrence. Longer intervals between initial diagnosis and administration of medication (P = 0.024), increased number of involved lobes (P = 0.033) and failure of sputum conversion within 6 months of initiating treatment (P = 0.017) were significantly associated with microbiological recurrence. CONCLUSION Microbiological recurrence after successful anti-MAC chemotherapy was associated with the time interval between initial diagnosis and administration of medication, number of lobes involved and time to sputum conversion during treatment.
The Intracellular Content of the Three Transcobalamins at Various Stages of Normal and Leukaemic Myeloid Cell Development

A study of the three serum transcobalamins (TC) in myeloproliferative disorders and acute leukaemia has suggested a granulocyte origin for the three binders; the later stages of this cell line might be releasing ‘TC I’and ‘TC III’while ‘TC II’which is increased in sera from patients with acute myelogenous leukaemia, probably originates at least in part from myeloblasts.
Changes in lung function according to disease extent before and after pulmonary tuberculosis.

OBJECTIVE To evaluate changes in lung function in individuals before and after treatment for pulmonary tuberculosis (PTB) in relation to extent of disease. DESIGN Using a retrospective cohort design, changes in and predictors of lung function were evaluated. RESULTS A total of 41 patients were included in the final analysis. The median decline in annualised forced expiratory volume in 1 sec (FEV1) was 180.0 ml/year (95%CI 118.9-356.1) in advanced PTB and 94.7 ml/year (95%CI 33.4-147.3) in localised PTB (ΔFEV1% predicted/year 9.4%, 95%CI 4.4-14.0 vs. 3.8%, 95%CI 1.8-6.2). The median decline in annualised forced vital capacity (FVC) was 309.6 ml/year (95%CI 137.0-359.0) in advanced PTB and 101.1 ml/year (95%CI 30.3-219.6) in localised PTB (ΔFVC % predicted/year 7.3%, 95%CI 5.3-12.3 vs. 2.9%, 95%CI 0.9-6.5). CONCLUSIONS As the sample size of our study was small, the conclusions could be biased. Nevertheless, our findings show that PTB causes a significant decline in lung function even in localised PTB, whereas advanced PTB was associated with excessive or even higher decline. This study suggests that early diagnosis and treatment of PTB is needed to preserve lung function.
Relationship between serum vitamin D concentrations and clinical outcome of community-acquired pneumonia.

SETTING Hospitalised patients with community-acquired pneumonia (CAP) in a tertiary referral hospital in South Korea. OBJECTIVE To determine the burden of vitamin D deficiency in patients hospitalised with CAP and to investigate whether vitamin D deficiency affected clinical outcomes. DESIGN Serum 25-hydroxyvitamin D (25[OH]D) levels were measured at admission; vitamin D deficiency was defined as 25(OH)D <20 ng/ml. Data were retrospectively analysed for incidence of vitamin D deficiency. The primary outcome was the relationship between serum vitamin D concentration and 28-day all-cause mortality in CAP. RESULTS The mean age was 68.1 years (standard deviation [SD] ± 14.6), and the mean pneumonia severity index was 98.0 (± SD 28.6). Of the 797 patients (males 66.0%), 641 (80.4%) had vitamin D deficiency. Overall mean serum 25(OH)D level was 14.0 ± 7.4 ng/ml. The 28-day all-cause mortality rate in vitamin D-deficient patients was significantly higher than in non-deficient patients (8.3% vs. 2.6%, P = 0.01), and serum vitamin D level was negatively associated with risk of 28-day mortality in CAP after adjustment for pneumonia severity index and serum lactate levels (OR 0.94, 95%CI 0.90-0.99, P < 0.01). CONCLUSION The prevalence of vitamin D deficiency was ~80% in patients hospitalised with CAP. Vitamin D deficiency was also a significant predictor of increased 28-day all-cause mortality.