Ameliorer les soins post-tuberculose au Canada Romanowski, Kamila; Amin, Priya; Johnston, James C
Canadian Medical Association journal (CMAJ),
02/2023, Volume:
195, Issue:
5
Journal Article
Introduction The emerging epidemiological evidence of increased cardiovascular disease (CVD) risk among persons diagnosed with tuberculosis (TB) has not been systematically reviewed to date. Our aim ...was to review the existing epidemiological evidence for elevated risk of CVD morbidity and mortality among persons diagnosed with TB compared to controls. Materials and methods EMBASE, MEDLINE, and Cochrane databases were searched (inception to January 2020) for terms related to “tuberculosis” and “cardiovascular diseases”. Inclusion criteria: trial, cohort, or case-control study design; patient population included persons diagnosed with TB infection or disease; relative risk (RR) estimate and confidence interval reported for CVD morbidity or mortality compared to suitable controls. Exclusion criteria: no TB or CVD outcome definition; duplicate study; non-English abstract; non-human participants. Two reviewers screened studies, applied ROBINS-I tool to assess risk of bias, and extracted data independently. Random effects meta-analysis estimated a pooled RR of CVD morbidity and mortality for persons diagnosed with TB compared to controls. Results 6,042 articles were identified, 244 full texts were reviewed, and 16 were included, meta-analyzing subsets of 8 studies’ RR estimates. We estimated a pooled RR of 1.51 (95% CI: 1.16–1.97) for major adverse cardiac events among those diagnosed with TB compared to non-TB controls (p = 0.0024). A ‘serious’ pooled risk of bias was found across studies with between-study heterogeneity (I2 = 75.3%). Conclusions TB appears to be a marker for increased CVD risk; however, the literature is limited and is accompanied by serious risk of confounding bias and evidence of publication bias. Further retrospective and prospective studies are needed. Pending this evidence, best practice may be to consider persons diagnosed with TB at higher risk of CVD as a precautionary measure.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Objective To determine the diagnostic accuracy of serological tests for coronavirus disease-2019 (covid-19). Design Systematic review and meta-analysis. Data sources Medline, bioRxiv, and ...medRxiv from 1 January to 30 April 2020, using subject headings or subheadings combined with text words for the concepts of covid-19 and serological tests for covid-19. Eligibility criteria and data analysis Eligible studies measured sensitivity or specificity, or both of a covid-19 serological test compared with a reference standard of viral culture or reverse transcriptase polymerase chain reaction. Studies were excluded with fewer than five participants or samples. Risk of bias was assessed using quality assessment of diagnostic accuracy studies 2 (QUADAS-2). Pooled sensitivity and specificity were estimated using random effects bivariate meta-analyses. Main outcome measures The primary outcome was overall sensitivity and specificity, stratified by method of serological testing (enzyme linked immunosorbent assays (ELISAs), lateral flow immunoassays (LFIAs), or chemiluminescent immunoassays (CLIAs)) and immunoglobulin class (IgG, IgM, or both). Secondary outcomes were stratum specific sensitivity and specificity within subgroups defined by study or participant characteristics, including time since symptom onset. Results 5016 references were identified and 40 studies included. 49 risk of bias assessments were carried out (one for each population and method evaluated). High risk of patient selection bias was found in 98% (48/49) of assessments and high or unclear risk of bias from performance or interpretation of the serological test in 73% (36/49). Only 10% (4/40) of studies included outpatients. Only two studies evaluated tests at the point of care. For each method of testing, pooled sensitivity and specificity were not associated with the immunoglobulin class measured. The pooled sensitivity of ELISAs measuring IgG or IgM was 84.3% (95% confidence interval 75.6% to 90.9%), of LFIAs was 66.0% (49.3% to 79.3%), and of CLIAs was 97.8% (46.2% to 100%). In all analyses, pooled sensitivity was lower for LFIAs, the potential point-of-care method. Pooled specificities ranged from 96.6% to 99.7%. Of the samples used for estimating specificity, 83% (10 465/12 547) were from populations tested before the epidemic or not suspected of having covid-19. Among LFIAs, pooled sensitivity of commercial kits (65.0%, 49.0% to 78.2%) was lower than that of non-commercial tests (88.2%, 83.6% to 91.3%). Heterogeneity was seen in all analyses. Sensitivity was higher at least three weeks after symptom onset (ranging from 69.9% to 98.9%) compared with within the first week (from 13.4% to 50.3%). Conclusion Higher quality clinical studies assessing the diagnostic accuracy of serological tests for covid-19 are urgently needed. Currently, available evidence does not support the continued use of existing point-of-care serological tests. Study registration PROSPERO CRD42020179452.
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BFBNIB, CMK, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
Treatment outcomes for multidrug-resistant Mycobacterium Tuberculosis (MDRTB) are generally poor compared to drug sensitive disease. We sought to estimate treatment outcomes and identify risk factors ...associated with poor outcomes in patients with MDRTB.
We performed a systematic search (to December 2008) to identify trials describing outcomes of patients treated for MDRTB. We pooled appropriate data to estimate WHO-defined outcomes at the end of treatment and follow-up. Where appropriate, pooled covariates were analyzed to identify factors associated with worse outcomes. Among articles identified, 36 met our inclusion criteria, representing 31 treatment programmes from 21 countries. In a pooled analysis, 62% 95% CI 57-67 of patients had successful outcomes, while 13% 9-17 defaulted, 11% 9-13 died, and 2% 1-4 were transferred out. Factors associated with worse outcome included male gender 0.61 (OR for successful outcome) 0.46-0.82, alcohol abuse 0.49 0.39-0.63, low BMI 0.410.23-0.72, smear positivity at diagnosis 0.53 0.31-0.91, fluoroquinolone resistance 0.45 0.22-0.91 and the presence of an XDR resistance pattern 0.57 0.41-0.80. Factors associated with successful outcome were surgical intervention 1.91 1.44-2.53, no previous treatment 1.42 1.05-1.94, and fluoroquinolone use 2.20 1.19-4.09.
We have identified several factors associated with poor outcomes where interventions may be targeted. In addition, we have identified high rates of default, which likely contributes to the development and spread of MDRTB.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Improving post-tuberculosis care in Canada Romanowski, Kamila; Amin, Priya; Johnston, James C
Canadian Medical Association journal (CMAJ),
12/2022, Volume:
194, Issue:
47
Journal Article
Peer reviewed
Open access
An estimated 155 million people, or 1 in 50 people globally, have survived tuberculosis (TB) disease. In Canada, about 1700 people receive diagnoses of active TB disease each year and 2% of the 8 ...million migrants in Canada have a history of TB disease. People who survive TB have elevated rates of respiratory and cardiovascular disease, cancer, depression and all-cause mortality, despite completing effective TB therapy. A 2021 study found that immigrants to British Columbia who survived TB had a 69% higher risk of non-TB death from respiratory and cardiovascular disease, injury or poisoning, and cancer-related death than the general population. Elevated mortality and morbidity rates may be driven by sequelae of TB disease itself or may reflect unmeasured confounding by systemic, socioeconomic, medical or behavioral factors. Regardless of causation, collaborative and integrated actions to address the problem are needed. New international and Canadian standards for post-TB care have been outlined, but a combination of patient engagement, careful service coordination and better research will be needed to ensure that patients maintain optimal health after successful treatment for TB disease.
Cancer is a major cause of death among people who experience tuberculosis (TB), but little is known about its timing and incidence following TB treatment. Our primary objectives were to estimate the ...pooled risk of all and site-specific malignancies in people with TB compared to the general population or suitable controls. Our secondary objective was to describe the pooled risk of cancer at different time points following TB diagnosis.
This study was prospectively registered (PROSPERO: CRD42021277819). We systematically searched MEDLINE, Embase, and the Cochrane Database for studies published between 1980 and 2021. We included original observational research articles that estimated cancer risk among people with TB compared to controls. Studies were excluded if they had a study population of fewer than 50 individuals; used cross-sectional, case series, or case report designs; and had a follow-up period of less than 12 months. Random-effects meta-analysis was used to obtain the pooled risk of cancer in the TB population.
Of the 5,160 unique studies identified, data from 17 studies were included. When compared to controls, the pooled standardized incidence ratios (SIR) of all cancer (SIR 1.62, 95% CI 1.35-1.93, I2 = 97%) and lung cancer (SIR 3.20, 95% CI 2.21-4.63, I2 = 90%) was increased in the TB population. The pooled risk of all cancers and lung cancer was highest within the first year following TB diagnosis (SIR 4.70, 95% CI 1.80-12.27, I2 = 99%) but remained over five years of follow-up.
People with TB have an increased risk of both pulmonary and non-pulmonary cancers. Further research on cancer following TB diagnosis is needed to develop effective screening and early detection strategies. Clinicians should have a high index of suspicion for cancer in people with TB, particularly in the first year following TB diagnosis.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Patient reported outcome measures (PROMs) are standardised validated questionnaires completed by patients to provide information on their perceived functional well-being and health status 1. These ...questionnaires can address various aspects of health including symptoms, quality of life, functionality, and physical, mental and social well-being. PROMs play an important role in increasing patient engagement, improving health systems, and ensuring that clinical care and research is person-centred.
Over 75% of patients admitted to hospital with COVID-19 have abnormal patient-reported outcome measures 3 months after symptom onset, with a third of patients reporting at least moderate impairment in major dimensions of quality of life
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Améliorer les soins post-tuberculose au Canada Romanowski, Kamila; Amin, Priya; Johnston, James C.
Canadian Medical Association journal (CMAJ),
02/2023, Volume:
195, Issue:
5
Journal Article
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