This study investigated the association between vitamin D deficiency and extrapulmonary tuberculosis (EPT) in Tunisia. The study included 45 cases of EPT patients and 45 matched controls. The results found that vitamin D deficiency was significantly more common among EPT cases (80%) compared to controls (37.7%), with an odds ratio of 6.5. Vitamin D levels were also significantly lower in EPT cases compared to controls. Multivariate analysis identified vitamin D deficiency as an independent risk factor for EPT, with an odds ratio of 6.13. The study provides evidence that vitamin D deficiency is strongly associated with increased risk of extrapulmonary tuberculosis.
A systematic review on COVID-1: urological manifestations...Valentina Corona
1) Acute kidney injury leading to mortality is common amongst COVID-19 patients, occurring in 7.58% of patients with a mortality rate of 93.27% amongst those developing acute kidney injury. This is likely due to direct viral toxicity as the virus interacts with receptors in the kidneys.
2) While urinary symptoms are not a presenting symptom of COVID-19, 5.74% of COVID-19 patients had positive viral RNA detected in urine samples.
3) Viral RNA was also detected in stool samples of 65.82% of COVID-19 patients, detected from 2 to 47 days from symptom onset. This suggests precautions are needed when performing transurethral or transrectal
1) The study assessed predictors of death in severe COVID-19 patients admitted to a care center in Ethiopia by comparing characteristics of patients who died (cases) to those discharged alive (controls).
2) Significant predictors of death were found to be having diabetes, fever at admission, and shortness of breath, while having a fever was associated with being discharged alive.
3) Patients who were older (≥70 years), had pre-existing comorbidities, diabetes, or hypertension were more likely to die from severe COVID-19.
This study aimed to determine the epidemiology of candidemia and evaluate risk factors for mortality in patients with candidemia admitted to an Indian medical ICU. The incidence of candidemia was found to be 17.8 per 1,000 ICU admissions. Non-albican species accounted for 78.6% of candidemia. Previous antifungal use and a Candida score greater than 3 were found to independently predict increased ICU mortality. The Candida score integrates several risk factors and may provide a useful bedside tool for predicting mortality in patients with candidemia.
To Assess the Severity and Mortality among Covid 19 Patients after Having Vac...YogeshIJTSRD
The severity and mortality of COVID 19 cases has been associated with the Three category such as vaccination status, severity of disease and outcome. Objective presently study was aimed to assess the severity and mortality among covid 19 patients. Methods Using simple lottery random method 100 samples were selected. From these 100 patients, 50 patients were randomly assigned to case group and 50 patients in control group after informed consents of relative obtained. Patients in the case group who being died after got COVID 19 whereas 50 patients in the control group participated who were survive after got infected from COVID 19 patients. Result It has three categories such as a Vaccination status For the vaccination status we have seen 59 patients were not vaccinated and 41 patients was vaccinated out of 100. b Incidence There were 41 patients were vaccinated whereas 59 patients were not vaccinated. c Severity In the case of mortality we selected 50 patients who were died from the Corona and I got to know that out of 50 patients there were 12 24 patients were vaccinated whereas 38 76 patients were non vaccinated. Although for the 50 control survival group total 29 58 patients were vaccinated and 21 42 patients was not vaccinated all graph start. Conclusion we have find out that those people who got vaccinated were less infected and mortality rate very low. Prof. (Dr) Binod Kumar Singh | Dr. Saroj Kumar | Ms. Anuradha Sharma "To Assess the Severity and Mortality among Covid-19 Patients after Having Vaccinated: A Retrospective Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45065.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/45065/to-assess-the-severity-and-mortality-among-covid19-patients-after-having-vaccinated-a-retrospective-study/prof-dr-binod-kumar-singh
Application of ordinal logistic=China.pdfHenokBuno
This study aimed to identify determinants of illness severity for COVID-19 patients in China. Medical records from 598 COVID-19 patients admitted to four hospitals in China between January and March 2020 were analyzed. Patients were divided into moderate (n=400), severe (n=85), and critical (n=113) illness groups based on their condition. Ordinal logistic regression was used to identify predictors of more severe illness. The analysis found that older age, hypertension, abnormal liver enzymes and cardiac markers, longer time from illness onset to diagnosis and admission were associated with increased risk of more severe illness.
Clinical Features and Patterns of CD4+ T Lymphocyte Counts Among HIV/AIDS Pat...IjcmsdrJournal
Background:The use of CD4+ T Lymphocyte count as a vital component to ascertain the stage of HIV/AIDS disease as well as monitor the progress of the disease continues to take centre stage in the management of HIV/AIDS in Africa and beyond. Most health centres in Sub-saharan Africa rely on cut off reference values from different races and distant parts of the world.
Aim:This study was designed to establish the range of CD4+ T Lymphocyte counts among the HIV-negative individuals and also HIV-positive patients at initial booking in the anti-retroviral clinic of our hospital where clinical diagnosis was established.
Methods:Patients were recruited into the study as they report to the hospital on daily basis; structured questionnaires were administered where socio-demograhic and relevant clinical information were obtained. Blood samples (3-5mls) were collected using aseptic techniqueand processed where HIV screening was conducted, and CD4+ T Lymphocyte cell count was carried out using Cyflow (Partec, Germany). Results were fed into Microsoft excel 2007 version and analysed using SPSS 14.
Results:A total of 386 HIV-positive and 145 HIV-negative individuals were recruited into the study. The average CD4+ T Lymphocytes count among the HIV negative individuals was 850 cells /μL and ranged from 200 to 1950 cells/μL with CD4+ T Lymphocyte counts of less than 300 cells/μL being 5 (3.4%). The CD4+ T Lymphocyte counts of less than 500 cells/μL among the HIV-negative individuals was 19(13.1%). However, the CD4+ T Lymphocyte counts among HIV-infected individuals ranged from 50 to 1450 cells/μL, 0.8% (n=3) while 45.9% (n=177) presented with CD4+ T Lymhocyte counts of 50 or less and less than 250 cells/μL respectively. The fact that 75.9% (n=293) of the patients had a CD4+ T Lymphocyte counts of less than 500 cells/μL shows the general late presentation of patients with HIV infection at our health settings, and as much as 50% of these were aware of their HIV status the very first time.
Evaluation Of Adverse Effects Of Antituberculosis In El-Idrissi Hospital, Ken...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
A systematic review on COVID-1: urological manifestations...Valentina Corona
1) Acute kidney injury leading to mortality is common amongst COVID-19 patients, occurring in 7.58% of patients with a mortality rate of 93.27% amongst those developing acute kidney injury. This is likely due to direct viral toxicity as the virus interacts with receptors in the kidneys.
2) While urinary symptoms are not a presenting symptom of COVID-19, 5.74% of COVID-19 patients had positive viral RNA detected in urine samples.
3) Viral RNA was also detected in stool samples of 65.82% of COVID-19 patients, detected from 2 to 47 days from symptom onset. This suggests precautions are needed when performing transurethral or transrectal
1) The study assessed predictors of death in severe COVID-19 patients admitted to a care center in Ethiopia by comparing characteristics of patients who died (cases) to those discharged alive (controls).
2) Significant predictors of death were found to be having diabetes, fever at admission, and shortness of breath, while having a fever was associated with being discharged alive.
3) Patients who were older (≥70 years), had pre-existing comorbidities, diabetes, or hypertension were more likely to die from severe COVID-19.
This study aimed to determine the epidemiology of candidemia and evaluate risk factors for mortality in patients with candidemia admitted to an Indian medical ICU. The incidence of candidemia was found to be 17.8 per 1,000 ICU admissions. Non-albican species accounted for 78.6% of candidemia. Previous antifungal use and a Candida score greater than 3 were found to independently predict increased ICU mortality. The Candida score integrates several risk factors and may provide a useful bedside tool for predicting mortality in patients with candidemia.
To Assess the Severity and Mortality among Covid 19 Patients after Having Vac...YogeshIJTSRD
The severity and mortality of COVID 19 cases has been associated with the Three category such as vaccination status, severity of disease and outcome. Objective presently study was aimed to assess the severity and mortality among covid 19 patients. Methods Using simple lottery random method 100 samples were selected. From these 100 patients, 50 patients were randomly assigned to case group and 50 patients in control group after informed consents of relative obtained. Patients in the case group who being died after got COVID 19 whereas 50 patients in the control group participated who were survive after got infected from COVID 19 patients. Result It has three categories such as a Vaccination status For the vaccination status we have seen 59 patients were not vaccinated and 41 patients was vaccinated out of 100. b Incidence There were 41 patients were vaccinated whereas 59 patients were not vaccinated. c Severity In the case of mortality we selected 50 patients who were died from the Corona and I got to know that out of 50 patients there were 12 24 patients were vaccinated whereas 38 76 patients were non vaccinated. Although for the 50 control survival group total 29 58 patients were vaccinated and 21 42 patients was not vaccinated all graph start. Conclusion we have find out that those people who got vaccinated were less infected and mortality rate very low. Prof. (Dr) Binod Kumar Singh | Dr. Saroj Kumar | Ms. Anuradha Sharma "To Assess the Severity and Mortality among Covid-19 Patients after Having Vaccinated: A Retrospective Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-5 , August 2021, URL: https://www.ijtsrd.com/papers/ijtsrd45065.pdf Paper URL: https://www.ijtsrd.com/other-scientific-research-area/other/45065/to-assess-the-severity-and-mortality-among-covid19-patients-after-having-vaccinated-a-retrospective-study/prof-dr-binod-kumar-singh
Application of ordinal logistic=China.pdfHenokBuno
This study aimed to identify determinants of illness severity for COVID-19 patients in China. Medical records from 598 COVID-19 patients admitted to four hospitals in China between January and March 2020 were analyzed. Patients were divided into moderate (n=400), severe (n=85), and critical (n=113) illness groups based on their condition. Ordinal logistic regression was used to identify predictors of more severe illness. The analysis found that older age, hypertension, abnormal liver enzymes and cardiac markers, longer time from illness onset to diagnosis and admission were associated with increased risk of more severe illness.
Clinical Features and Patterns of CD4+ T Lymphocyte Counts Among HIV/AIDS Pat...IjcmsdrJournal
Background:The use of CD4+ T Lymphocyte count as a vital component to ascertain the stage of HIV/AIDS disease as well as monitor the progress of the disease continues to take centre stage in the management of HIV/AIDS in Africa and beyond. Most health centres in Sub-saharan Africa rely on cut off reference values from different races and distant parts of the world.
Aim:This study was designed to establish the range of CD4+ T Lymphocyte counts among the HIV-negative individuals and also HIV-positive patients at initial booking in the anti-retroviral clinic of our hospital where clinical diagnosis was established.
Methods:Patients were recruited into the study as they report to the hospital on daily basis; structured questionnaires were administered where socio-demograhic and relevant clinical information were obtained. Blood samples (3-5mls) were collected using aseptic techniqueand processed where HIV screening was conducted, and CD4+ T Lymphocyte cell count was carried out using Cyflow (Partec, Germany). Results were fed into Microsoft excel 2007 version and analysed using SPSS 14.
Results:A total of 386 HIV-positive and 145 HIV-negative individuals were recruited into the study. The average CD4+ T Lymphocytes count among the HIV negative individuals was 850 cells /μL and ranged from 200 to 1950 cells/μL with CD4+ T Lymphocyte counts of less than 300 cells/μL being 5 (3.4%). The CD4+ T Lymphocyte counts of less than 500 cells/μL among the HIV-negative individuals was 19(13.1%). However, the CD4+ T Lymphocyte counts among HIV-infected individuals ranged from 50 to 1450 cells/μL, 0.8% (n=3) while 45.9% (n=177) presented with CD4+ T Lymhocyte counts of 50 or less and less than 250 cells/μL respectively. The fact that 75.9% (n=293) of the patients had a CD4+ T Lymphocyte counts of less than 500 cells/μL shows the general late presentation of patients with HIV infection at our health settings, and as much as 50% of these were aware of their HIV status the very first time.
Evaluation Of Adverse Effects Of Antituberculosis In El-Idrissi Hospital, Ken...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Clinical analysis of 228 patients with pulmonary fungal diseases iWilheminaRossi174
Clinical analysis of 228 patients with pulmonary fungal diseases in China
Abstract
Background: Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary fungal diseases is difficult. This study aims to investigate the clinical features of pulmonary fungal diseases.
Methods: We retrospectively analyzed the demographics, types of fungus,radiological characteristics,underlying diseases, the usage of steroid and immunosuppresants, laboratory tests of 228patients with pulmonary fungal disease diagnosed by pathological examination or laboratory culture from October 2011 to July 2018in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.
Results: A total of 228 patients, had a median age of 49years, which included 130 (57%) males and 98(43%) females. The most common fungal species identified were aspergillus (39.5 %), cryptococcus (18.4%), and mucormycosis (3.5 %).The main imaging findings were nodules or mass in 144 patients (63.2%), cavitation in 57 patients (25%),consolidation shadows or ground glass infiltrates in 15 patients (6.6%), and reverse halo sign in 12 patients (5.3%). The main infection sites were right upper lobe (26.8%), right lower lobe (21.5%) and the bronchus infection were 18 (7.9%) persons. For the underlying diseases, the prevalence of diseases was pulmonary tuberculosis (17.5%), bronchiectasis (16.2%), diabetes mellitus (9.2%) and the previous thoracic malignancy (6.6%) was common. The number of patients using steroid was 50% and the number of patients using immunosuppressant was 7%.
Conclusions: The imaging findings and the underlying diseases of patients should be taken into account when making diagnosis of pulmonary funga1disease for the purpo se to speculate the probable fungal pathogen and choose the most appropriate diagnostic tool.
Keywords:Pulmonary fungal disease; pathogen; imaging manifestation; Underlying disease; Clinical analysis; Chinese
(pneumomycosis; pulmonary mycosis?)invasive mould infection (IMI)Invasive fungal infections (IFIs),invasive aspergillosis
invasive mold disease, invasive aspergillosis, diabetes mellitus.
1. INTRODUCTION
In environment, the fungi produce small spores that are routinely inhaled and rapidly cleared from the normal host. However after long standing inhalation makes people more vulnerable to get effected .Moreover pulmonary fungal diseases are an opportunistic infection that predominantly attacks immunocompromised just as immunocompetent patients, however extensive utilization of gluccocorticoids and chemotherapeutics utilizes in patients make the pulmonary fungal disease no longer an uncommon occurrence. The complex underlying conditions such as pulmonary tuberculosis, bronchectasis, COPD and diabetes mellitus in the patients of pulmonary fungal disease and the non-specific nature of pathogen can confound identification and lead to under diagnosis. Due to its vague nature the dia ...
Estimates of the severity of coronavirus disease 2019 - a model-based analysisGuy Boulianne
This study used individual-level case data and aggregate case/death counts from China, Hong Kong, Macau, and other countries to estimate key severity metrics for COVID-19, accounting for biases. The researchers estimated that the mean duration from symptom onset to death is 17.8 days, and to hospital discharge is 24.7 days. They estimated the case fatality ratio in China to be 1.38% overall but higher in older age groups, and the infection fatality ratio in China to be 0.66% with increasing risk with age. They also estimated the proportion of infections likely to require hospitalization increases with age up to 18.4% for those aged 80+.
Study of clinical and etiological profile of community acquired pneumonia in ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study examined the relationship between symptom onset to admission time (SOAT) and the severity of COVID-19 through a meta-analysis and retrospective analysis. The meta-analysis found that patients with adverse outcomes had a longer SOAT than those without adverse outcomes. The retrospective analysis initially found no significant difference in SOAT between severe and mild COVID-19 patients. However, after adjusting for confounding factors using propensity score matching, patients in the severe group were found to have a longer SOAT. This suggests that shortening SOAT may help reduce progression to severe illness in COVID-19 patients.
Efficacité de l'hydroxychloroquine et de l'azithromycineSociété Tripalio
Etude de l'IHU Méditerranée sur l'efficacité du couple hyroxychloroquine et azithromycine contre le coronavirus. Les résultats montrent une forte diminution de la mortalité de la maladie.
This study evaluated the prevalence of acute kidney injury (AKI) in 120 patients with confirmed dengue fever over one year at a hospital in India. The prevalence of AKI among these patients was found to be 27.5%. Several factors were analyzed to identify predictors of AKI in dengue patients, including demographics, severity of illness, laboratory values, and presence of complications. The majority of patients recovered and were discharged, while mortality was observed in 16.7% of cases. This research helps address the lack of data on renal involvement and AKI in dengue virus infection.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
—India constitutes about one fourth of the Global TB burden. Cutaneous TB is less common clinical form of tuberculosis accounting for 1-2 % of the total extra-pulmonary cases. Objective of this study was to describe the clinical and epidemiological pattern of Cutaneous TB presenting in the Skin Outpatient Department (OPD). Patients presenting with clinically suspected skin lesions of Cutaneous TB from January 2015 to August 2016 were included in the study. Dermatological and systemic examination was carried out and histopathogical examination of skin punch biopsy was done. It was observed that out of a total of sixty patients, 45 (75%) patients were found to have features of Cutaneous TB on histopathology. Lupus vulgaris (42.2%) was the most common form of Cutaneous TB. Most patients were in age group of 11-30 years. Male to female ratio was 1.6:1. Most common sites of involvement were lower limbs and neck. Mantoux test was positive(≥15 mm induration) in 66.7% cases. Typical tuberculoid histology was found in 91.1% cases. No cases of tuberculids were seen and non-specific chronic inflammation was seen in six cases. It was concluded that Cutaneous TB may present with different morphological patterns resembling other inflammatory, infective and neoplastic conditions. Proper and thorough investigations are necessary for detection of Cutaneous TB as the annual incidence of total TB cases in India is high.
Major reduction of NKT cells in patients with severe COVID-19 pneumoniaMHosseini6
This document summarizes a study examining immune cell subsets in patients with COVID-19 pneumonia. Peripheral blood samples were obtained from 45 COVID-19 patients and 19 healthy donors. Using flow cytometry, the study characterized T cells, NK cells, and NKT cells. COVID-19 patients had higher percentages of mature NK cells and lower percentages of NKT and less mature NK cells compared to healthy donors. Severe COVID-19 patients had significantly lower NKT cell percentages. Lower NKT cell percentages were independently associated with more severe disease. The findings suggest NKT cells may play a role in the pathogenesis of COVID-19.
The International Journal of Engineering & Science is aimed at providing a platform for researchers, engineers, scientists, or educators to publish their original research results, to exchange new ideas, to disseminate information in innovative designs, engineering experiences and technological skills. It is also the Journal's objective to promote engineering and technology education. All papers submitted to the Journal will be blind peer-reviewed. Only original articles will be published.
The papers for publication in The International Journal of Engineering& Science are selected through rigorous peer reviews to ensure originality, timeliness, relevance, and readability.
The value of real-world evidence for clinicians and clinical researchers in t...Arete-Zoe, LLC
In the midst of a rapidly spreading global pandemic, real-world evidence can offer invaluable insight into the most promising treatments, risk factors, and not only predict but suggest how to improve outcomes. Despite overwhelming news coverage, significant knowledge gaps regarding COVID-19 persist. The current uncertainties regarding incidence and the case fatality rate can only be addressed by widespread testing. But the paucity of testing, and diversity of approaches implemented in different countries, particularly among the general asymptomatic public, perpetuates a lack of understanding about spread and infectivity. The essential indicators that would describe the pandemic more accurately can be obtained using real-world data (RWD). To that purpose, we designed a data collection tool to collect data from hospitals that treat COVID-19 patients. The captured data will enhance our understanding of the COVID-19 pandemic, identify risk factors relevant for triage, relate to other similar seasonal infections and gain insight into the safety and efficacy of experimental and off-label therapies. Knowledge derived from a focused data collection effort will enable clinicians to adjust rapidly clinical protocols and discontinue interventions that turn out to be ineffective or harmful. By deploying our elegantly designed survey to capture routine clinical indicators, we avoid placing an additional burden on practitioners. Systematically generating real-world evidence can decrease the time to insight compared to randomized clinical trials, improving the odds for patients in rapidly changing conditions.
Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kamp...PUBLISHERJOURNAL
Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kampala International University Teaching Hospital, Bushenyi District
Okello, Andrew
School of Allied Health Sciences Kampala International University-Western Campus
________________________________________
ABSTRACT
This study on the prevalence of TB among HIV sero-positive was carried at the HIV CLINIC of Kampala International University Teaching Hospital (KIUTH), Ishaka Bushenyi district. A retrospective cross-sectional study design was used to conduct this research. The study targeted all patients attending KIUTH HIV/TB clinic. A standard structured and semi-structured questionnaires were designed and pre-tested for validity and reliability at Kampala International University Teaching Hospital HIV/Tuberculosis clinic before being used for data collection. Data collection started by recruitment of qualified research assistants, appropriate training and orientation of the interviewers before the survey for example when reading the questions. Quantitative methods of data analysis was used in which data was presented in form of bar charts, graphs and tables. The prevalence of TB among HIV sero-positive patients attending HIV clinic at KIUTH stands at 8.06 per 100 participants. The study found that generally, people are aware about the modes of transmission of TB but there is still need for more awareness. Many patients are still not certain whether TB is curable in HIV patients. As seen from the above study, most of the people are not yet aware whether HIV goes hand in hand with tuberculosis. The prevalence of TB in HIV sero-positive attending HIV clinic at KIUTH is high. Generally, TB is affecting patients of all ages and most patients are still not aware if TB in HIV is curable. Most patients have a perception that all TB patients have HIV. Health workers in HIV clinic of KIU-TH should teach patients the modes of transmission and prevention of TB. KIUTH also need to provide easy access to TB screening services to patients. There is need for financial support by the government to the unemployed patients and low-income earners in order to curb TB infections.
Keywords: Tuberculosis, HIV, Sero-positive, Bushenyi District
________________________________________
This study evaluated the diagnostic validity of cerebrospinal fluid (CSF) parameters for distinguishing tuberculous meningitis (TBM) from other causes of meningitis. The study assessed CSF analyses of adenosine deaminase activity, protein and glucose levels, and lymphocyte count in 157 patients in Peru, which has a high tuberculosis incidence. Adenosine deaminase activity above 6 U/l had the best performance, with 95% specificity and a positive likelihood ratio of 10.7, but only 55% sensitivity. No combination of CSF parameters achieved good performance for ruling out TBM. The study found that an elevated CSF adenosine deaminase level strongly supports a diagnosis of TBM
Cryptic Disseminated Tuberculosis: a Secondary Analysis of Previous Hospital-...fahmi khan
The main purpose of this study was to describe the demographic and clinical features of cryptic disseminated TB; it was also aimed to shed light on diagnostic test, procedure results, organ involvement, and outcomes of cryptic disseminated TB in patients with confirmed disseminated TB.
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study aims to correlate CT severity scores based on chest CT scans with clinical outcomes in COVID-19 patients admitted to the ICU. The study will collect data on 500 ICU patients including demographics, medical history, lab results, oxygen requirements, treatments, and outcomes at discharge and 6 months. CT severity scores will be assigned by a radiologist based on a previously established 25-point scoring system. The primary objective is to correlate CT scores with mortality, and secondary objectives are to examine relationships between CT scores and other clinical parameters and outcomes. Previous studies have found associations between worse CT findings, older age, comorbidities, and poorer prognosis in COVID-19 patients.
Guidance isth _management_of_coagulopathy_in_covid-19 Dr. Freddy Flores Malpa...Freddy Flores Malpartida
1) This document provides interim guidance from the International Society on Thrombosis and Haemostasis (ISTH) on recognizing and managing coagulopathy in COVID-19.
2) It recommends measuring D-dimers, prothrombin time, and platelet count in all COVID-19 patients to help stratify risk, with increased D-dimers indicating a higher risk of severe illness.
3) For hospitalized COVID-19 patients, the guidance suggests regular monitoring of D-dimers, prothrombin time, platelet count, and fibrinogen to identify worsening coagulopathy, which correlates with poorer outcomes. More aggressive care may be warranted for patients with worsening markers.
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
1) The study examined causes of death among 964 HIV-infected adults in France in the year 2000, in the era of potent antiretroviral therapy (HAART).
2) The main underlying causes of death were AIDS-related (47%), viral hepatitis (11%), cancer not related to AIDS or hepatitis (11%), cardiovascular disease (7%), and bacterial infections (6%).
3) Among AIDS-related deaths, HIV infection had been diagnosed recently in 20%. Smoking was recorded in 72% of cancer deaths and alcohol consumption in 54% of hepatitis deaths.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Clinical analysis of 228 patients with pulmonary fungal diseases iWilheminaRossi174
Clinical analysis of 228 patients with pulmonary fungal diseases in China
Abstract
Background: Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary fungal diseases is difficult. This study aims to investigate the clinical features of pulmonary fungal diseases.
Methods: We retrospectively analyzed the demographics, types of fungus,radiological characteristics,underlying diseases, the usage of steroid and immunosuppresants, laboratory tests of 228patients with pulmonary fungal disease diagnosed by pathological examination or laboratory culture from October 2011 to July 2018in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.
Results: A total of 228 patients, had a median age of 49years, which included 130 (57%) males and 98(43%) females. The most common fungal species identified were aspergillus (39.5 %), cryptococcus (18.4%), and mucormycosis (3.5 %).The main imaging findings were nodules or mass in 144 patients (63.2%), cavitation in 57 patients (25%),consolidation shadows or ground glass infiltrates in 15 patients (6.6%), and reverse halo sign in 12 patients (5.3%). The main infection sites were right upper lobe (26.8%), right lower lobe (21.5%) and the bronchus infection were 18 (7.9%) persons. For the underlying diseases, the prevalence of diseases was pulmonary tuberculosis (17.5%), bronchiectasis (16.2%), diabetes mellitus (9.2%) and the previous thoracic malignancy (6.6%) was common. The number of patients using steroid was 50% and the number of patients using immunosuppressant was 7%.
Conclusions: The imaging findings and the underlying diseases of patients should be taken into account when making diagnosis of pulmonary funga1disease for the purpo se to speculate the probable fungal pathogen and choose the most appropriate diagnostic tool.
Keywords:Pulmonary fungal disease; pathogen; imaging manifestation; Underlying disease; Clinical analysis; Chinese
(pneumomycosis; pulmonary mycosis?)invasive mould infection (IMI)Invasive fungal infections (IFIs),invasive aspergillosis
invasive mold disease, invasive aspergillosis, diabetes mellitus.
1. INTRODUCTION
In environment, the fungi produce small spores that are routinely inhaled and rapidly cleared from the normal host. However after long standing inhalation makes people more vulnerable to get effected .Moreover pulmonary fungal diseases are an opportunistic infection that predominantly attacks immunocompromised just as immunocompetent patients, however extensive utilization of gluccocorticoids and chemotherapeutics utilizes in patients make the pulmonary fungal disease no longer an uncommon occurrence. The complex underlying conditions such as pulmonary tuberculosis, bronchectasis, COPD and diabetes mellitus in the patients of pulmonary fungal disease and the non-specific nature of pathogen can confound identification and lead to under diagnosis. Due to its vague nature the dia ...
Estimates of the severity of coronavirus disease 2019 - a model-based analysisGuy Boulianne
This study used individual-level case data and aggregate case/death counts from China, Hong Kong, Macau, and other countries to estimate key severity metrics for COVID-19, accounting for biases. The researchers estimated that the mean duration from symptom onset to death is 17.8 days, and to hospital discharge is 24.7 days. They estimated the case fatality ratio in China to be 1.38% overall but higher in older age groups, and the infection fatality ratio in China to be 0.66% with increasing risk with age. They also estimated the proportion of infections likely to require hospitalization increases with age up to 18.4% for those aged 80+.
Study of clinical and etiological profile of community acquired pneumonia in ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study examined the relationship between symptom onset to admission time (SOAT) and the severity of COVID-19 through a meta-analysis and retrospective analysis. The meta-analysis found that patients with adverse outcomes had a longer SOAT than those without adverse outcomes. The retrospective analysis initially found no significant difference in SOAT between severe and mild COVID-19 patients. However, after adjusting for confounding factors using propensity score matching, patients in the severe group were found to have a longer SOAT. This suggests that shortening SOAT may help reduce progression to severe illness in COVID-19 patients.
Efficacité de l'hydroxychloroquine et de l'azithromycineSociété Tripalio
Etude de l'IHU Méditerranée sur l'efficacité du couple hyroxychloroquine et azithromycine contre le coronavirus. Les résultats montrent une forte diminution de la mortalité de la maladie.
This study evaluated the prevalence of acute kidney injury (AKI) in 120 patients with confirmed dengue fever over one year at a hospital in India. The prevalence of AKI among these patients was found to be 27.5%. Several factors were analyzed to identify predictors of AKI in dengue patients, including demographics, severity of illness, laboratory values, and presence of complications. The majority of patients recovered and were discharged, while mortality was observed in 16.7% of cases. This research helps address the lack of data on renal involvement and AKI in dengue virus infection.
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
—India constitutes about one fourth of the Global TB burden. Cutaneous TB is less common clinical form of tuberculosis accounting for 1-2 % of the total extra-pulmonary cases. Objective of this study was to describe the clinical and epidemiological pattern of Cutaneous TB presenting in the Skin Outpatient Department (OPD). Patients presenting with clinically suspected skin lesions of Cutaneous TB from January 2015 to August 2016 were included in the study. Dermatological and systemic examination was carried out and histopathogical examination of skin punch biopsy was done. It was observed that out of a total of sixty patients, 45 (75%) patients were found to have features of Cutaneous TB on histopathology. Lupus vulgaris (42.2%) was the most common form of Cutaneous TB. Most patients were in age group of 11-30 years. Male to female ratio was 1.6:1. Most common sites of involvement were lower limbs and neck. Mantoux test was positive(≥15 mm induration) in 66.7% cases. Typical tuberculoid histology was found in 91.1% cases. No cases of tuberculids were seen and non-specific chronic inflammation was seen in six cases. It was concluded that Cutaneous TB may present with different morphological patterns resembling other inflammatory, infective and neoplastic conditions. Proper and thorough investigations are necessary for detection of Cutaneous TB as the annual incidence of total TB cases in India is high.
Major reduction of NKT cells in patients with severe COVID-19 pneumoniaMHosseini6
This document summarizes a study examining immune cell subsets in patients with COVID-19 pneumonia. Peripheral blood samples were obtained from 45 COVID-19 patients and 19 healthy donors. Using flow cytometry, the study characterized T cells, NK cells, and NKT cells. COVID-19 patients had higher percentages of mature NK cells and lower percentages of NKT and less mature NK cells compared to healthy donors. Severe COVID-19 patients had significantly lower NKT cell percentages. Lower NKT cell percentages were independently associated with more severe disease. The findings suggest NKT cells may play a role in the pathogenesis of COVID-19.
The International Journal of Engineering & Science is aimed at providing a platform for researchers, engineers, scientists, or educators to publish their original research results, to exchange new ideas, to disseminate information in innovative designs, engineering experiences and technological skills. It is also the Journal's objective to promote engineering and technology education. All papers submitted to the Journal will be blind peer-reviewed. Only original articles will be published.
The papers for publication in The International Journal of Engineering& Science are selected through rigorous peer reviews to ensure originality, timeliness, relevance, and readability.
The value of real-world evidence for clinicians and clinical researchers in t...Arete-Zoe, LLC
In the midst of a rapidly spreading global pandemic, real-world evidence can offer invaluable insight into the most promising treatments, risk factors, and not only predict but suggest how to improve outcomes. Despite overwhelming news coverage, significant knowledge gaps regarding COVID-19 persist. The current uncertainties regarding incidence and the case fatality rate can only be addressed by widespread testing. But the paucity of testing, and diversity of approaches implemented in different countries, particularly among the general asymptomatic public, perpetuates a lack of understanding about spread and infectivity. The essential indicators that would describe the pandemic more accurately can be obtained using real-world data (RWD). To that purpose, we designed a data collection tool to collect data from hospitals that treat COVID-19 patients. The captured data will enhance our understanding of the COVID-19 pandemic, identify risk factors relevant for triage, relate to other similar seasonal infections and gain insight into the safety and efficacy of experimental and off-label therapies. Knowledge derived from a focused data collection effort will enable clinicians to adjust rapidly clinical protocols and discontinue interventions that turn out to be ineffective or harmful. By deploying our elegantly designed survey to capture routine clinical indicators, we avoid placing an additional burden on practitioners. Systematically generating real-world evidence can decrease the time to insight compared to randomized clinical trials, improving the odds for patients in rapidly changing conditions.
Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kamp...PUBLISHERJOURNAL
Incidence of Tuberculosis in HIV Sero-positive Patients at HIV Clinic at Kampala International University Teaching Hospital, Bushenyi District
Okello, Andrew
School of Allied Health Sciences Kampala International University-Western Campus
________________________________________
ABSTRACT
This study on the prevalence of TB among HIV sero-positive was carried at the HIV CLINIC of Kampala International University Teaching Hospital (KIUTH), Ishaka Bushenyi district. A retrospective cross-sectional study design was used to conduct this research. The study targeted all patients attending KIUTH HIV/TB clinic. A standard structured and semi-structured questionnaires were designed and pre-tested for validity and reliability at Kampala International University Teaching Hospital HIV/Tuberculosis clinic before being used for data collection. Data collection started by recruitment of qualified research assistants, appropriate training and orientation of the interviewers before the survey for example when reading the questions. Quantitative methods of data analysis was used in which data was presented in form of bar charts, graphs and tables. The prevalence of TB among HIV sero-positive patients attending HIV clinic at KIUTH stands at 8.06 per 100 participants. The study found that generally, people are aware about the modes of transmission of TB but there is still need for more awareness. Many patients are still not certain whether TB is curable in HIV patients. As seen from the above study, most of the people are not yet aware whether HIV goes hand in hand with tuberculosis. The prevalence of TB in HIV sero-positive attending HIV clinic at KIUTH is high. Generally, TB is affecting patients of all ages and most patients are still not aware if TB in HIV is curable. Most patients have a perception that all TB patients have HIV. Health workers in HIV clinic of KIU-TH should teach patients the modes of transmission and prevention of TB. KIUTH also need to provide easy access to TB screening services to patients. There is need for financial support by the government to the unemployed patients and low-income earners in order to curb TB infections.
Keywords: Tuberculosis, HIV, Sero-positive, Bushenyi District
________________________________________
This study evaluated the diagnostic validity of cerebrospinal fluid (CSF) parameters for distinguishing tuberculous meningitis (TBM) from other causes of meningitis. The study assessed CSF analyses of adenosine deaminase activity, protein and glucose levels, and lymphocyte count in 157 patients in Peru, which has a high tuberculosis incidence. Adenosine deaminase activity above 6 U/l had the best performance, with 95% specificity and a positive likelihood ratio of 10.7, but only 55% sensitivity. No combination of CSF parameters achieved good performance for ruling out TBM. The study found that an elevated CSF adenosine deaminase level strongly supports a diagnosis of TBM
Cryptic Disseminated Tuberculosis: a Secondary Analysis of Previous Hospital-...fahmi khan
The main purpose of this study was to describe the demographic and clinical features of cryptic disseminated TB; it was also aimed to shed light on diagnostic test, procedure results, organ involvement, and outcomes of cryptic disseminated TB in patients with confirmed disseminated TB.
Serum Procalcitonin as a marker of infection in chronic kidney disease patien...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This study aims to correlate CT severity scores based on chest CT scans with clinical outcomes in COVID-19 patients admitted to the ICU. The study will collect data on 500 ICU patients including demographics, medical history, lab results, oxygen requirements, treatments, and outcomes at discharge and 6 months. CT severity scores will be assigned by a radiologist based on a previously established 25-point scoring system. The primary objective is to correlate CT scores with mortality, and secondary objectives are to examine relationships between CT scores and other clinical parameters and outcomes. Previous studies have found associations between worse CT findings, older age, comorbidities, and poorer prognosis in COVID-19 patients.
Guidance isth _management_of_coagulopathy_in_covid-19 Dr. Freddy Flores Malpa...Freddy Flores Malpartida
1) This document provides interim guidance from the International Society on Thrombosis and Haemostasis (ISTH) on recognizing and managing coagulopathy in COVID-19.
2) It recommends measuring D-dimers, prothrombin time, and platelet count in all COVID-19 patients to help stratify risk, with increased D-dimers indicating a higher risk of severe illness.
3) For hospitalized COVID-19 patients, the guidance suggests regular monitoring of D-dimers, prothrombin time, platelet count, and fibrinogen to identify worsening coagulopathy, which correlates with poorer outcomes. More aggressive care may be warranted for patients with worsening markers.
This document summarizes a study on the prevalence of type 2 diabetes among hepatitis C virus seropositive subjects in Dutse, Nigeria. The study found that 16.1% of male and 19.4% of female HCV-infected subjects had fasting blood sugar levels above 7 mmol/L, indicating a higher risk of diabetes compared to the control group. Liver enzymes were significantly higher in the HCV group. While some metabolic syndrome parameters differed between groups, the differences were not statistically significant. The study concludes that there is a high prevalence of type 2 diabetes among HCV-infected individuals in Dutse, and factors like age, BMI, triglycerides, and HDL may contribute to the development of diabetes.
1) The study examined causes of death among 964 HIV-infected adults in France in the year 2000, in the era of potent antiretroviral therapy (HAART).
2) The main underlying causes of death were AIDS-related (47%), viral hepatitis (11%), cancer not related to AIDS or hepatitis (11%), cardiovascular disease (7%), and bacterial infections (6%).
3) Among AIDS-related deaths, HIV infection had been diagnosed recently in 20%. Smoking was recorded in 72% of cancer deaths and alcohol consumption in 54% of hepatitis deaths.
Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Communicating effectively and consistently with students can help them feel at ease during their learning experience and provide the instructor with a communication trail to track the course's progress. This workshop will take you through constructing an engaging course container to facilitate effective communication.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
2. Tuberculosis 126 (2021) 102034
2
2. Methods
2.1. Study design
We conducted a case-control study including all cases of EPT hos
pitalized in the infectious diseases department over a two-year period
from April 2017 until April 2019.
2.2. Data collection and definition of cases and controls
We collected data from the patients’ medical records for cases.
Controls were interviewed according to a pre-established questionnaire.
Data including socio-demographic characteristics (age, gender), smok
ing, alcohol use and previous medical history of patients were reviewed.
For cases, we notified the site of EPT, the diagnostic criteria and the
treatment prescribed. HIV serologic testing was performed for cases.
We included all cases of EPT diagnosed during the study period. The
diagnosis was confirmed with bacteriological proof, based on a positive
microscopy using Ziehl–Neelsen staining for acid-fast bacilli or growth
of Mycobacterium tuberculosis (M. tuberculosis) in culture. Histological
findings including epithelioid cell granulomas with caseous necrosis
confirmed the diagnosis. In default, it was based on strong clinical,
radiological evidence associated with positive tuberculin skin test and
followed by an adequate response to antitubercular treatment.
Controls were healthy non-hospitalized volunteers randomly
selected from the general population. They were matched to case sub
jects by gender and age (we tolerated a variation of ±5 years).
At enrolment, we excluded from the study patients with previous
condition that may affect vitamin D metabolism such as chronic renal
failure, previous bone disease and recent surgery.
2.3. Measurement of vitamin D levels
We measured serum concentrations of 25-dihydoxyvitamin D (25
(OH)D3) for cases, before starting antitubercular therapy, and for con
trols. Plasma concentration of 25(OH)D3 was measured by Roche Cobas
E601 electrochemiluminescence immunoassay analyzer. Vitamin D
deficiency was defined as 25(OH)D3 <20 ng/ml.
2.4. Other biological parameters’ measurement
We performed the assay of standard biochemical parameters such as
creatinine, urea and blood glucose, C-reactive protein (CRP) and pro
tides. Liver function tests included the determination of alanine
aminotransferase, aspartate aminotransferase, total bilirubin, gamma
glutamyl transferase, alkaline phosphatases, total cholesterol and tri
glycerides. The parameters of the phosphocalcic balance were measured
such as calcemia, phosphoremia and parathyroid hormone. In addition,
all participants received a blood count to determine hemoglobin level.
2.5. Statistical analysis
We performed statistical analysis using SPSS 20. Categorial variables
were carried out by numbers and percentages. Continuous variables
were driven by means and standard deviations when they were normally
distributed. Otherwise, we used medians and inter quartile range. For
quantitative variables, we checked the normality of the distribution by
the Kolmogorov-Smirnov test and the Shapiro-Wilk test. We used Chi
square and Fisher exact test to compare two frequencies when appli
cable. For the comparison of two means, we used Student’s T test for
independent samples when they were normally distributed. Otherwise,
we used Mann-Whitney test. The difference between two groups was
considered significant when p < 0.05.
To evaluate the risk factors associated with EPT, we calculated the
unadjusted and adjusted Odds ratio (OR) by using multivariate logistic
regression analysis. The final logistic regression model included
variables that changed the OR by at least 20%.
The analysis of the receiver operating characteristic (ROC) curve was
carried out to determine the area under the curve, the sensitivity and the
specificity at an optimal threshold value of the vitamin D level in order
to predict EPT.
3. Results
During the study period, we included 45 cases of EPT and 45 controls
matched by gender and age.
3.1. Extrapulmonary tuberculosis cases’ characteristics
Lymph nodes TB represented the main site of EPT (29 cases; 64.4%),
followed by urogenital TB (5 cases; 11.1%) and osteoarticular TB (4
cases; 8.9%). Multifocal TB was noted in 8 cases (17.7%). The diagnosis
was confirmed with histopathological proof in 36 cases (80%) and
bacteriological proof in 4 cases (8.9%).
Eight cases were confirmed based on clinical evidence (17.7%):
Clinical and radiological features suggested the diagnosis of TB and
tuberculin skin test was positive. However, no caseous necrosis was
found in specimen taken for histological examination, microscopy using
Ziehl–Neelsen staining for acid-fast bacilli and culture for Mycobacterium
tuberculosis were negative. These cases were at first considered as
probable TB until adequate response was obtained with antitubercular
therapy, confirming therefore, the diagnosis of TB.
Patients received antitubercular therapy, which was based on fixed-
dose combinations in 42 cases (93.3%). All cases were HIV negative.
3.2. Comparison between cases and controls
In the matched groups, no differences were found between cases and
controls regarding the patients’ demographic characteristics, except for
the educational level: a higher educational level was noted among the
control group (95.5% vs 73.3%; p < 0.001) (Table 1).
Comparison of laboratory investigations showed that CRP levels
were significantly higher (8.6 ± 10.2 vs 1.6 ± 1.3 mg/L; p < 0.001) and
hemoglobin levels were significantly lower (12.1 ± 1.7 vs 13.4 ± 1.65 g/
dL; p = 0.002) among cases (Table 2).
We did not find any significant difference between the two groups
Table 1
Comparison of demographic characteristics between extrapulmonary tubercu
losis cases and controls.
Variables Cases Controls p-value
Total, n (%) 45 (100) 45 (100) –
Gender, n (%) 1
Male 14 (31.1) 14 (31.1)
Female 31 (68.9) 31 (68.9)
Age (years), mean (SD) 40 ± 13 39 ± 13.5 0.87
Male 46 ± 17.7 46 ± 14 0.3
Female 40.9 ± 16.6 39.6 ± 15 0.1
Underlying comorbid disease, n (%)
Diabetes mellitus 3 (6.7) 3 (6.7) 1
High blood pressure 4 (8.9) 4 (8.9) 1
Smoking history 7 (15.6) 7 (15.6) 1
Alcohol use 3 (6.7) 1 (2.2) 0.6
Socioeconomic status, n (%)
Marital status 0.2
Married 29 (64.4) 34 (75.6)
Single 16 (35.6) 11 (24.4)
Educational level <0.001
Primary education 12 (26.7) 2 (4.4)
Secondary or university education 33 (73.3) 43 (95.5)
Employment status 0.4
Employed 21 (46.7) 25 (55.6)
Unemployed 24 (53.3) 20 (44.4)
n: number; %: percentage; SD: standard deviation.
F. Hammami et al.
3. Tuberculosis 126 (2021) 102034
3
when we compared the factors that influence vitamin D metabolism
except for the phosphorus level, which was significantly lower among
controls (1.04 ± 0.1 vs 1.14 ± 0.1 mmol/L; p = 0.01) (Table 2).
3.3. The association between vitamin D and extrapulmonary tuberculosis
Vitamin D deficiency was significantly more frequent among cases
(80% vs 37.7%; p < 0.001), with an odds ratio (OR) of 6.5 (IC95% =
2.5–16). The mean levels of vitamin D were significantly lower among
cases (11.9 ± 8.8 vs 22.3 ± 11 ng/mL; p < 0.001). As to gender, VDD
was significantly more frequent among males in the case group in
comparison with males in the control group (57.1% vs 14.3%; p = 0.04).
Females with EPT were significantly more affected with VDD in com
parison with females in the control group (90.3% vs 48.4%; p < 0.001).
The mean levels of vitamin D was significantly lower in the case group
among both males (19.4 ± 8.6 vs 27.6 ± 9.8 ng/mL; p = 0.04) and fe
males (8.5 ± 6.6 vs 19.9 ± 12.1 ng/mL; p < 0.001), in comparison with
males and females in the control group, respectively (Table 3). Females
had significantly lower levels of vitamin D in comparison with males
among the case group (8.5 ± 6.6 vs 19.4 ± 8.6 ng/mL; p < 0.001) and
the control group (19.9 ± 12.1 vs 27.6 ± 9.8 ng/mL; p = 0.029).
3.4. Factors associated with extrapulmonary tuberculosis
In the univariate analysis, we found that patients with EPT had pri
mary educational level in 85.7% of the cases (OR = 7.81; p = 0.007) and
had VDD in 67.9% of the cases (OR = 6.58; p < 0.001). (Table 4).
In the multivariate analysis, after adjustment for the educational
level, we found that VDD was an independent predictor of EPT (OR =
6.13; p < 0.001) (Table 5).
The cutoff value of vitamin D predictor of EPT was 18.5 ng/mL which
was associated with a sensitivity of 80% and a specificity of 62% (Fig. 1).
4. Discussion
Our study highlighted the link between VDD and EPT. We found that
vitamin D levels were significantly lower among cases in comparison
with controls and VDD was an independent predictor of EPT. In fact,
previous studies found similar results when studying the association
between vitamin D and both EPT and pulmonary TB [8,9]. A recent
meta-analysis reported that VDD was associated with an increased risk
of TB [10]. The level of VDD was correlated with the severity of the
disease. A recent study reported that patients with tubercular meningitis
had significantly lower value of Vitamin D level in comparison with
other forms of TB [9]. Besides, low vitamin D levels were associated with
a five-fold increased risk for progression to TB [11]. That risk was mostly
pronounced among HIV-positive patients with severe deficiency [12].
Vitamin D and TB remain strongly linked. Previous meta-analysis
reported that VDD increased the risk of TB, which is concordant with
our results. However, it reported that TB increased the risk of VDD, as
well, which might be explained by malnutrition and vitamin D receptor
polymorphism [13]. A previous study found a high expression of vitamin
D receptor in macrophage from persons with previous EPT when
compared with macrophages from persons with previous pulmonary TB,
TB contacts with latent M. tuberculosis infection and uninfected contacts,
while vitamin D levels were similarly low in all groups [14]. Vitamin D
can be obtained either from diet and dietary supplements or from
exposure to sunlight [15,16]. In fact, 80% of the vitamin D results from
cutaneous production due to sunlight exposure, that’s why its deficiency
was more prevalent among patients who avoid sun exposure [17]. This
might explain the results found in our study about females who had
significantly lower levels of vitamin D, which is mostly related to their
religious belief and their protective clothing.
The role for vitamin D in the modulation of immune function were
suggested, previously. In fact, vitamin D increases the antimicrobial
activity of the macrophage and monocyte [18], by the activation of
cathelicidin-mediated killing of ingested mycobacteria [19] and the
release of interferon-γ which induce autophagy and phagosomal
maturation leading to degradation of mycobacteria [20]. The exposi
tion of human monocytes to M. tuberculosis enhances both the cell
ability to produce vitamin D in the site of infection and to respond to
this metabolite [18].
Table 2
Comparison of laboratory investigations between extrapulmonary tuberculosis
cases and controls.
Variables EPT cases
(45 cases)
Controls
(45 cases)
p-value
ASAT (UI/L) 24.4 ± 6.9 17.1 ± 4.4 0.004
ALAT (UI/L) 24.4 ± 13 16.5 ± 7.5 0.01
Total bilirubin (μmol/L) 9.9 ± 4.9 10.1 ± 6.7 0.2
GGT (UI/L) 35.4 ± 40.2 17.6 ± 9.6 <0.001
CRP (mg/L) 8.6 ± 10.2 1.6 ± 1.3 <0.001
Hemoglobin level (g/dL) 12.1 ± 1.7 13.4 ± 1.6 0.002
Protides (g/L) 73.7 ± 5.2 73.2 ± 4 0.06
Blood glucose (mmol/L) 4.3 ± 1.2 5 ± 0.6 0.6
Total cholesterol
(mmol/L)
4.1 ± 1.6 4.9 ± 0.9 0.4
Triglycerides (mmol/L) 1.1 ± 0.5 1.5 ± 1.1 0.1
Creatinine (μmol/L) 61.7 ± 22.5 65.1 ± 13 0.1
Urea (mmol/L) 4.5 ± 1.1 4.4 ± 1.2 0.1
Alkaline phosphatase
(UI/L)
77 ± 42.6 61.6 ± 16.9 0.06
Calcemia (mmol/L) 2.3 ± 0.2 2.2 ± 0.2 0.1
PTH (pg/mL) 37.8 ± 12.2 42.3 ± 9.3 0.5
Phosphorus (mmol/L) 1.14 ± 0.1 1.04 ± 0.1 0.01
EPT: extrapulmonary tuberculosis, ASAT: aspartate aminotransferase, ALAT:
alanine aminotransferase, GGT: gammaglutamyl transferase, CRP: C-reactive
protein, PTH: parathyroid hormone.
Table 3
The distribution of vitamin D deficiency according to gender among extrap
ulmonary tuberculosis cases and controls.
Cases Controls p-value
Vitamin D deficiency, n (%) 36 (80) 17 (37.7) <0.001
Males 8/14 (57.1) 2/14 (14.3) 0.04
Females 28/31 (90.3) 15/31 (48.4) 0.001
Mean levels of vitamin D (ng/mL) 11.9 ± 8.8 22. ±11 < 0.001
Males 19.4 ± 8.6 27.6 ± 9.8 0.04
Females 8.5 ± 6.6 19.9 ± 12.1 0.001
n: number; %: percentage.
Table 4
Factors associated with extrapulmonary tuberculosis in the univariate logistic
regression.
Variables N (%) OR p-value
Gender Males (N = 28) 14 (50) – 1
Females (N = 62) 31 (50)
Age groups [17–36 years[ (N = 38) 19 (50) – 1
≥36 years (N = 52) 26 (50)
Employment status Employed (N = 46) 21 (45.7) – 0.4
Unemployed (N = 44) 24 (54.5)
Primary educational
level
Yes (N¼14) 12 (85.7) 7.81 0.007
No (N¼76) 33 (43.4)
Marital status Married (N = 63) 29 (46) – 0.2
Single (N = 27) 16 (59.3)
Diabetes mellitus Yes (N = 6) 3 (50) – 1
No (N = 84) 42 (50)
High blood pressure Yes (N = 8) 4 (50) – 1
No (N = 82) 41 (50)
Smoking Yes (N = 14) 7 (50) – 1
No (N = 76) 38 (50)
Alcohol use Yes (N = 4) 3 (75) – 0.6
No (N = 86) 42 (48.8)
Vitamin D deficiency Yes (N¼53) 36 (67.9) 6.58 <0.001
No (N¼37) 9 (24.3)
N: number, %: percentage, OR: odds ratio.
F. Hammami et al.
4. Tuberculosis 126 (2021) 102034
4
Although it has no direct antimicrobial activity, vitamin D was used
to treat pulmonary TB, since it modulates host response [21]. Previous
study reported that oral supplementation with a daily vitamin D at a
dose of 5000 IU is optimal for cathelicidin induction and efficient
intracellular killing of M. tuberculosis [22]. In fact, vitamin D supple
mentation, associated with antitubercular therapy, accelerated sputum
smear conversion [23,24]. Besides, vitamin D has anti-inflammatory
effects and can, therefore, reduce the severity of infection by
decreasing the overall inflammatory state [25].
We believe that VDD was associated with EPT, and Vitamin D sup
plementation as a preventive therapy and treatment adjunct with anti
tubercular therapy should be considered. However, our data are limited
and are not really robust enough to propose that. More studies are
required to confirm and propose vitamin D supplementation.
5. Conclusion
Our study provides strong evidence that VDD was an independent
predictor of EPT. More studies are needed in order to evaluate the po
tential preventive role of vitamin D and the benefit of possible
supplementation.
6. Formatting of funding sources
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Author contributions
Conceptualization: FH, MK, HBA, MBJ. Methodology: FH, MK, YM,
MBJ. Formal analysis: FH, MK, YM, AC, MBJ. Writing - Review &
Editing: FH, MK, MBJ. Visualization: FH, MK, MT, KR, FS, MBJ. Su
pervision: MK, MT, HBA, KR, MBJ. Final approval of the version to be
submitted: all authors.
Declaration of competing interest
The authors declare no competing interest.
Acknowledgements
None.
References
[1] Who. Global tuberculosis report 2019. 2019.
[2] Ben Ayed H, Koubaa M, Marrakchi C, Rekik K, Hammami F, Smaoui F, et al.
Extrapulmonary tuberculosis: update on the epidemiology, risk factors and
prevention strategies. Int J Trop Dis 2018;1. https://doi.org/10.23937/ijtd-2017/
1710006. 006.
[3] Duarte R, Lönnroth K, Carvalho C, Lima F, Carvalho ACC, Muñoz-Torrico M, et al.
Tuberculosis, social determinants and co-morbidities (including HIV).
Pulmonology 2018;24(2):115–9. https://doi.org/10.1016/j.rppnen.2017.11.003.
[4] Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic
review and meta-analysis. Int J Epidemiol 2008;37(1):113–9. https://doi.org/
10.1093/ije/dym247.
[5] Facchini L, Venturini E, Galli L, de Martino M, Chiappini E. Vitamin D and
tuberculosis: a review on a hot topic. J Chemother 2015;27(3):128–38. https://doi.
org/10.1179/1973947815Y.0000000043.
[6] Primary Health care directory, Ministry of Health. Tuberculosis management guide
in Tunisia. 2018.
[7] Ben Ayed H, Koubaa M, Gargouri L, Ben Jemaa M, Trigui M, Hammemi F, et al.
Epidemiology and disease burden of tuberculosis in south of Tunisia over a 22-year
period: current trends and future projections. PloS One 2019;14(7):e0212853.
https://doi.org/10.1371/journal.pone.0212853.
[8] Nouri-Vaskeh M, Sadeghifard S, Saleh P, Farhadi J, Amraii M, Ansarin K. Vitamin D
deficiency among patients with tuberculosis: a cross-sectional study in Iranian-
azari population. Tanaffos 2019;18(1):11–7.
[9] Balgi V, Sj M, SD K, Surendran A, Cg S. The study of correlation between vitamin D
and tuberculosis in newly detected tuberculosis - pulmonary and extra pulmonary
patients attending to K R hospital, Mysuru, Karnataka, India. Int J Adv Med 2019;7
(1):34. https://doi.org/10.18203/2349-3933.ijam20195622.
[10] Huang SJ, Wang XH, Liu ZD, Cao WL, Han Y, Ma AG, et al. Vitamin D deficiency
and the risk of tuberculosis: a meta-analysis. Drug Des Dev Ther 2017;11:91–102.
https://doi.org/10.2147/DDDT.S79870.
[11] Talat N, Perry S, Parsonnet J, Dawood G, Hussain R. Vitamin D deficiency and
tuberculosis progression. Emerg Infect Dis 2010;16(5):853–5. https://doi.org/
10.3201/eid1605.091693.
[12] Aibana O, Huang CC, Aboud S, Arnedo-Pena A, Becerra MC, Bellido-Blasco JB,
et al. Vitamin D status and risk of incident tuberculosis disease: a nested case-
control study, systematic review, and individualparticipant data meta-analysis.
PLoS Med 2019;16(9):e1002907. https://doi.org/10.1371/journal.pmed.1002907.
[13] Gou X, Pan L, Tang F, Gao H, Xiao D. The association between Vitamin D status and
tuberculosis in children: a meta-analysis. Medicine 2018;97(35):e12179. https://
doi.org/10.1097/MD.0000000000012179.
[14] Fiske CT, Blackman A, Maruri F, Rebeiro PF, Huaman M, Kator J, et al. Increased
vitamin D receptor expression from macrophages after stimulation with M.
tuberculosis among persons who have recovered from extrapulmonary
tuberculosis. BMC Infect Dis 2019;19(1):366. https://doi.org/10.1186/s12879-
019-3958-7.
[15] Holick MF. Vitamin D deficiency. N Engl J Med 2007;357(3):266–81. https://doi.
org/10.1056/NEJMra070553.
[16] Selvaraj P, Harishankar M, Afsal K. Vitamin D: immuno-modulation and
tuberculosis treatment1. Can J Physiol Pharmacol 2015;93(5):377–84. https://doi.
org/10.1139/cjpp-2014-0386.
Table 5
Independent predictor factors of extrapulmonary tuberculosis in the univariate and multivariate analysis.
Univariate analysis Multivariate analysis
p-value R2 OR IC95% p-value ORa CI95%
Vitamin D deficiency <0.001 17.4% 6.58 2.55–17 <0.001 6.13 2.29–16.4
Primary educational level 0.01 13% 7.81 1.63–37.3 0.024 6.78 1.29–35.67
Single 0.25 2% 1.7 0.68–4.25 – – –
R2: Nagelkerke R Square = 31%, OR: odds ratio, ORa: adjusted odds ratio, CI: confidence interval.
Fig. 1. Receiver operating characteristic curve determining vitamin D level
predictive of extrapulmonary tuberculosis.
F. Hammami et al.
5. Tuberculosis 126 (2021) 102034
5
[17] Saraff V, Shaw N. Sunshine and vitamin D. Arch Dis Child 2016;101(2):190–2.
https://doi.org/10.1136/archdischild-2014-307214.
[18] Sassi F, Tamone C, D’amelio P. Vitamin D: nutrient, hormone, and
immunomodulator. Nutrients 2018;10(11):1656. https://doi.org/10.3390/
nu10111656.
[19] Liu PT, Stenger S, Tang DH, Modlin RL. Cutting edge: vitamin D-mediated human
antimicrobial activity against Mycobacterium tuberculosis is dependent on the
induction of cathelicidin. J Immunol 2007;179(4):2060–3. https://doi.org/
10.4049/jimmunol.179.4.2060.
[20] Fabri M, Stenger S, Shin DM, Yuk JM, Liu PT, Realegeno S, et al. Vitamin D is
required for IFN-γ-mediated antimicrobial activity of human macrophages. Sci
Transl Med 2011;3(104):104ra102. https://doi.org/10.1126/
scitranslmed.3003045.
[21] Martineau AR, Honecker FU, Wilkinson RJ, Griffiths CJ. Vitamin D in the treatment
of pulmonary tuberculosis. J Steroid Biochem Mol Biol 2007;103(3–5):793–8.
https://doi.org/10.1016/j.jsbmb.2006.12.052.
[22] Mily A, Rekha RS, Kamal SMM, Akhtar E, Sarker P, Rahim Z, et al. Oral intake of
phenylbutyrate with or without vitamin D3 upregulates the cathelicidin LL-37 in
human macrophages: a dose finding study for treatment of tuberculosis. BMC Pulm
Med 2013;13:23. https://doi.org/10.1186/1471-2466-13-23.
[23] Coussens AK, Wilkinson RJ, Hanifa Y, Nikolayevskyy V, Elkington PT, Islam K,
et al. Vitamin D accelerates resolution of inflammatory responses during
tuberculosis treatment. Proc Natl Acad Sci U S A 2012;109(38):15449–54. https://
doi.org/10.1073/pnas.1200072109.
[24] Nursyam Elly Wijaya, Amin Zulkifli, Martin CR. The effect of vitamin D as
supplementary treatment in patients with moderately advanced pulmonary
tuberculous lesion. Acta Med Indones 2006;38(1):3–5. https://pubmed.ncbi.nlm.
nih.gov/16479024/.
[25] Abhimanyu, Coussens AK. The role of UV radiation and Vitamin D in the
seasonality and outcomes of infectious disease. Photochem Photobiol Sci 2017;16
(3):314–38. https://doi.org/10.1039/c6pp00355a.
F. Hammami et al.