Diabetes and tuberculosis:An emerging dual threat to healthcare

Tuberculosis(TB)remains a huge global healthcare challenge even in the 21^(st) century though the prevalence has dropped in developed countries in recent decades.Diabetes mellitus(DM)is an important risk factor for the development and perpetuation of TB owing to the immune dysfunction in patients with DM.The coexistence of both diseases in the same individual also aggravates disease severity,complications,and chance of treatment failure because of gross immune alterations posed by DM as well as TB.Various complex cellular and humoral immunological factors are involved in the dangerous interaction between TB and DM,some of which remain unknown even today.It is highly important to identify the risk factors for TB in patients with DM,and vice versa,to ensure early diagnosis and management to prevent complications from this ominous coexistence.In their research study published in the recent issue of the World Journal of Diabetes,Shi et al elaborate on the factors associated with the development of TB in a large cohort of DM patients from China.More such research output from different regions of the world is expected to improve our knowledge to fight the health devastation posed by TB in patients with diabetes.

Epidemiological characteristics of 369 tuberculosis patients with multidrug resistance inHainan Island: A cross-sectional study

Objective:To investigate the epidemic characteristics of multidrug resistant tuberculosis in Hainan,China,to provide basic information and theories for the prevention and control of multidrug resistant tuberculosis.Methods:A retrospective descriptive epidemiological study was conducted.Data of multidrug resistant tuberculosis in Hainan Island from January 1,2014 to December 31,2019 were collected for statistical analysis.The counting data were described by frequency(percentage),and the measurement data were described by mean±standard deviation.Chi square test was used to compare the differences between different groups.If P<0.05,the difference was statistically significant.Results:From 2014 to 2019,the multidrug resistant rate of tuberculosis in Hainan Island was 24.9%(369/1484),8.0%(63/791)in newly-treated tuberculosis,and 44.2%(306/693)in retreatedmultidrug resistant rate of tuberculosis in Hainan Island was 24.9%(369/1484),8.0%(63/791)in newly-treatedtuberculosis,and 44.2%(306/693)in retreated tuberculosis.The multidrug resistant rate of newly-treated tuberculosis decreased by 0.05%per year,while that of retreated tuberculosis increased by 0.03%per year.multidrug resistant tuberculosis was mainly distributed in the city of Haikou(83 cases),Danzhou(44 cases),Wenchang(42 cases),Wanning(37 cases)and Dongfang(32 cases),accounting for 64.5%of all multidrug resistant tuberculosis.Among 369 multidrug resistant tuberculosis,81.0%were male.The proportion of newly-treated cases was 17.1%(63/369),while the proportion of retreated cases was 82.9%(306/369),which was significantly higher than that of newly-treated cases.The multidrug resistant rate of tuberculosis in different years was different.Conclusion:The drug resistance rate of tuberculosis in Hainan Island is higher than the national average level,which needs attention.The epidemiological characteristics of multidrug resistant tuberculosis with different treatment history were different.

In Vitro Anti-tuberculosis Activity of Total Crude Extract of Echinops Amplexicaulis against Multi-drug Resistant Mycobacterium Tuberculosis

Background： TB （Tuberculosis） is the second leading killer infectious disease after HIV （human immunodeficiency virus）. Its incidence is worsened by development of multi-drag resistant and extensive drug resistant TB stxains. Available treatment regimens are expensive, toxic and lengtjy resulting to problems of non-adherence and inadequate response. Medicinal plants on the other hand may offer hope for developing alternative medicine for treatment of TB. This study evaluated the anti-tuberculosis activity of Echinops amplexicaulis. Materials and methods： Total crude extracts ofE. amplexicaulis were tested for activity against a wild strain resistant to Rifampicin and Isoniazid （MDR）, a fully susceptible laboratory strain （H37Rv） and Mycobacwrium boris （BCG strain） using disk diffusion method. MIC （minimum inhibitory concentration） was determined using Middlebrook 7H9 broil1. The strains were sub-cultured on Middlebrook 7H10 medium and MBC （minimum bactericidal concentration） determined. Susceptibility was evaluated by measuring zones of inhibition; MIC was obtained as the lowest concentration with no significant growth as shown by clog formation ofMTB （Mycobacwria tuberculosis） cells on the walls of the macro broth tube and MBC was obtained as the lowest concentration that inhibited growth of MTB colonies on Middlebrook 7H10 medium. Results： The extract showed a significant effect at a concentration of 50 mg/mL against all the three test strains F （2, 18） = 437.7, p = 0.00. It exhibited a MIC of 0.0488 mg/mL against MDR-TB and M. boris. Its MBC was the same at 0.0977 mg/mL against both MDR TB and M. boris. The MIC was much lower （0.0122 mg/mL） for the H37Rv strain. Terpenoids, alkaloids and tannins were present in large amount in the extract while saponins were present in small amounts. Flavonoids were not detected in the extract. Conclusion： E. amplexicaulis has the potential to be developed into new anti-TB drug and outcome of tile study supports the folkloric claims of anti-tuberculosis activity of tile plant.

Prevalence and Risk Factors of Primary Drug-Resistant Tuberculosis in China

Objective To investigate the prevalence of primary drug-resistant tuberculosis（TB） and associated risk factors in China. We also explored factors contributing to the transmission of multidrug-resistant tuberculosis（MDR-TB）. Methods A total of 2794 representative, Mycobacterium tuberculosis isolates from treatment-naive patients were subjected to drug susceptibility testing, and risk factors for drug-resistant TB were analyzed. We also analyzed MDR-TB strain sublineages, drug-resistance-conferring mutations, and risk factors associated with clustered primary MDR strains. Results Among 2794 Mycobacterium tuberculosis isolates from treatment-naive patients, the prevalence of any resistance to first-line drugs was 33.2% and the prevalence of MDR-TB was 5.7%. We did not find any risk factors significantly associated with resistance to first-line drugs. The 93 primary MDR-TB isolates were classified into six sublineages, of which, 75（80.6%） isolates were the RD105-deleted Beijing lineage. The largest sublineage included 65（69.9%） isolates with concurrent deletions of RD105, RD207, and RD181. Twenty-nine（31.2%） primary MDR strains grouped in clusters; MDR isolates in clusters were more likely to have S531 L rpoB mutation. Conclusion This study indicates that primary drug-resistant TB and MDR-TB strains are prevalent in China, and multiple measures should be taken to address drug-resistant TB.

The History of Tuberculosis: Past, Present, and Future

Tuberculosis (TB), transmitted by the bacteria Mycobacterium tuberculosis has been a global epidemic for years. The evidence for infection with TB is centuries old. It can have an indolent course, and may remain inactive for years in individuals with the possibility of reactivation at any time, causing widespread systemic symptoms. The treatment and management of TB has become more effective over the years. It is estimated that more than one-third of the world population, especially in poor and developing countries are harboring this bacterium with varying manifestations of the disease from no symptoms to life-threatening infections. This manuscript describes the history of the disease and the discoveries. It also includes the recent advances and challenges facing the world and how governments and organizations are working together to control this disease.

Tuberculosis treatment-new approach to an old problem

Chronic mycobacterium infections are major causes of disease burden of 20%in a tropical country like India. The inflammatory cascade following these bacterial infections often leads to tissue damage and perpetuates necrosis, fibrosis and the disease process.Pulmonary tuberculosis,multi-drug resistant tuberculosis not only affects individuals but society at large.Current remedial measures using various technology platforms singularly did not produce effective and appreciable reduction in global disease burden.On the contrary,the conventional chemotherapeutic chemical moieties have demonstrated variable pharmacogenomic expression,increased drug resistance,non compliance of strict prolonged drug regimens with debilitating side effects and contraindications. Furthermore,secreted inflammatory cytokines results in chronic infection,immune deviation,and immunopathology in the lungs.Hence,identification of immune escape mechanisms leading to chronic mycobacterial infections is crucial for development of new treatments.The review would dwell into the basic pathogenic mechanism and the newer approaches that may need to be considered for developing novel therapeutic strategies.

86例耐多药肺结核患者胸部影像分析

目的探讨耐多药肺结核的胸部影像学特点。方法收集我院诊治的86例耐多药肺结核为观察组与96例不耐药肺结核患者为对照组,所有患者均行胸部CT和X线胸片检查。对病灶范围、空洞个数、空洞大小、洞壁厚度和纵隔淋巴结情况进行分析。结果两组在空洞大小方面差异无统计学意义,P>0.05;无空洞方面,观察组较对照组发生率低,P<0.005;观察组在累及3个以上肺野、毁损肺、空洞数量、厚壁空洞、纵隔淋巴结肿大方面发生率较高,P<0.005。结论耐多药肺结核以累及3个以上肺野、多发空洞、厚壁空洞、毁损肺、纵隔淋巴结肿大为主要影像学特点。

耐多药空洞型肺结核三种治疗方法疗效的比较

目的:探讨经两种途径介导注药和常规方法治疗耐多药肺结核(MDR-TB)的疗效与安全性。方法:将212例MDR-TB患者依治疗方法分为肺穿刺组(69例)、纤支镜组(69例)和常规组(74例)。三组均行全身常规抗痨。此外,肺穿刺组在CT下模拟定位经皮肺穿刺将左氧氟沙星、丁胺卡那霉素、异烟肼准确地注入空洞内;纤支镜组在电视透视下经纤维支气管镜导管介入空洞并注入同样的抗痨药物。比较三种治疗方法的疗效。结果:9个月后肺穿刺组痰菌阴转率、病灶显效率(显著吸收+吸收)、空洞闭合率分别为85.5%、85.5%、50.7%;纤支镜组依次为88.4%、87.0%、53.6%;常规组为66.2%、50.0%、16.2%。肺穿刺组和纤支镜组比较差异均无显著性(P>0.05);肺穿刺组、纤支镜组分别与常规组比较差异均有显著性(P<0.01)。并发症发生率肺穿刺组为44.9%,与纤支镜组的27.5%比较,差异有显著性(P<0.05)。结论:经两种途径介导注药治疗MDR-TB的疗效相同,且均优于常规全身化疗,经皮肺穿刺注药并发症发生率高。

耐多药肺结核的影像特点

目的 搜集经药物敏感试验证实的耐多药肺结核 ,探讨耐药肺结核的影像学特点。方法 选取耐多药肺结核 51例为观察组 ,同期不耐药的肺结核病人 46例为对照组。全部病人均有正、侧位胸片 ,部分病人有同期体层或CT片。结果 (1)观察组与对照组相比 ,病变分布差异无显著性意义 (P值均 >0 .0 5)。 (2 )比较病变形态 ,观察组肺内多发结节 (10例 )、播散病灶 (2 3例 )、空腔(9例 )及合并肺毁损 (10例 )多于对照组 ,二者差异有显著性意义 (P <0 0 5)。 (3 )病变的动态变化 ,病变进展观察组多于对照组 ,好转病例观察组少于对照组 ,二者差异有显著性意义 (P <0 0 5)。结论 分析耐多药肺结核的影像表现提示 ,耐多药肺结核具有病变严重 ,活动性明显 。

125例耐多药肺结核胸部影像学分析

目的收集经药物敏感试验证实的耐多药肺结核,探讨耐多药肺结核的胸部影像学特点,提高对耐多药肺结核的认识。方法选取符合标准的耐多药肺结核125例为观察组,同期不耐药的肺结核患者120例为对照组。全部患者均有正、侧位胸片及胸部CT扫描片。结果①观察组与对照组相比,观察组病变分布广泛,明显多于对比组,两者差异有统计学意义(P<0.05)。②比较病变形态,观察组肺内播散病灶、合并空洞及合并肺毁损多于对照组,二者差异有统计学意义(P<0.05)。③病变的动态变化,病变进展观察组多于对照组,好转病例观察组少于对照组,二者差异有统计学意义(P<0.05)。结论耐多药肺结核的胸部影像具有病变严重,较多肺内播散病灶、合并空洞及合并肺毁损的特点。