This study aimed to investigate the overall prognostic performance of the DECAF (dyspnoea, eosinopenia, consolidation, acidaemia, atrial fibrillation) score for in-hospital death in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) through a retrospective cohort study and an updated meta-analysis.Sensitivity, specificity, and predictive performance of DECAF were analysed, using receiver operating characteristic (ROC) curves and area under the curve (AUC) as criteria for accuracy. A literature search was performed in databases. The summary ROC (SROC) curve was used to assess the overall performance of the DECAF score.Twenty-three non-survivors and 292 survivors of AECOPD were included. At a cut-off value of 1.5, DECAF scores showed good sensitivity (78.3%), low specificity (55.1%), and AUC (0.719, 95% CI 0.614-0.824). Additionally, 22 studies (including our study) with 824 non-survivors and 8,957 survivors were included in this meta-analysis. The summary estimates were listed as follows: sensitivity 0.77 (95% CI 0.69-0.83); specificity 0.76 (95% CI 0.67-0.85); positive likelihood ratio 3.2 (95% CI 2.4-4.3); negative likelihood ratio 0.31 (95% CI 0.23-0.40); and diagnostic odds ratio 10.00 (95% CI 7-16). The AUC was 0.83 (95% CI 0.79-0.86).The DECAF score is a simple tool to predict mortality in hospitalised patients with AECOPD, and the results of this study should be further validated..

Nigeria ranks first in Africa and sixth among countries with a high Tuberculosis burden globally. The increasing incidence of drug resistance following poor treatment adherence among drug-susceptible TB (DS-TB) patients necessitates reviewing TB services in Nigeria. This study explored accessibility and patient-reported experiences in newly established TB treatment facilities.In this comparative cross-sectional analytic study, we administered the Patient Reported Experience Measure (PREM) questionnaire to 430 patients with DS-TB in 27 public and 18 private newly engaged facilities in Osun, Nigeria. Data were analysed using R Software.Private facilities were more accessible ( = 210, 97.2% vs = 194, 90.7%; = 0.004) and offered more satisfactory services ( = 209, 96.8% vs = 194, 90.7%; = 0.009). More patients in public facilities could not afford transportation costs (52.6% vs 35.8%; = 0.007), and payment for services was higher in private facilities ( < 0.001). After adjusting for covariates, the odds of experiencing satisfactory services were 3.12 times higher in private facilities (OR 3.12, 95%CI 1.19-8.15). Time-to-facility, marital status, and facility type predict patients' experience.Private facilities were more accessible and offered more satisfactory services. National TB programmes should decentralise TB services to private facilities and address gaps in public facilities..

We tested the hypothesis that because of the different metabolic states of (Mtb) in lesions, drugs in combination therapy often act effectively as monotherapy, leading to therapy failure and resistance emergence.Bactericidal and sterilizing activity studies were performed in the hollow fiber system of TB (HFS-TB) using the human equivalent dose of isoniazid (INH) 300 mg/day, rifampin (RIF) 600 mg/day, and pyrazinamide (PZA) 1.5 g/day either as monotherapy, two-, and three-drug combination for 28 days. The Mtb population (log CFU/ml) for each drug, either monotherapy or combination, was compared using an analysis of variance.In the bactericidal activity studies, the microbial kill was driven by INH, followed by RIF, and PZA monotherapy failed. During the sterilizing activity, INH and RIF displayed similar microbial kill. The INH + RIF and RIF + PZA combinations were significantly different from each other but not from the INH + RIF + PZA combination. RIF and INH-resistant subpopulations did not increase despite premixing the inoculum with isogenic-resistant strains.Effective monotherapy arising from the selectivity of antibiotics against special Mtb sub-populations may not be the primary mechanism of resistance emergence. Different metabolic populations of Mtb were killed by more than one drug and were not under monotherapy when combination therapy was administered..

Severe exacerbation is the predominant cause of COPD hospitalisation. We investigated sex-specific risk factors of severe exacerbation and explored the potential interactions of regions, smoking status, and age.The present study included 13,641 males and 13,051 females with spirometry-defined COPD at baseline from the China Kadoorie Biobank. Hazard ratios (HRs) and 95% confidence intervals (CIs) of risk factors with severe exacerbation were estimated using the Cox models.During a median of 11.5 years follow-up, 5,967 cases of COPD hospitalisation were recorded. GOLD (Global Initiative for Obstructive Lung Disease) stage, tobacco smoking, and underweight were positively associated with COPD hospitalisation in both sexes. Stronger associations were observed in females than in males; the corresponding HRs for males and females were respectively 1.87 (95% CI 1.73-2.03) and 2.47 (95% CI 2.24-2.72) for a history of respiratory diseases and 1.46 (95% CI 1.33-1.60) and 1.65 (95% CI 1.46-1.87) for coughing frequently and coughing up sputum after getting up in the morning for ≥3 months. Higher risks were found among urban residents, non-current smokers, and patients <60 years old.Our findings may help clinicians and the public to identify COPD patients at high risk of exacerbation requiring hospitalisation and take targeted measures in time..

In recent years, research on TB multimorbidity has increasingly focused on integrated care delivery, particularly concerning common mental disorders (CMDs). Engagement with relevant stakeholders, including service users and providers, has highlighted the critical intersection of TB and CMD, which affects a substantial percentage of individuals. Studies have found that depression affects approximately 45% of TB patients, and anxiety affects around 40%. Moreover, there is a significant evidence and service gap in delivering CMD care, which emphasises the need for a comprehensive approach to address the dual burden of these health challenges.

Hyponatraemia is associated with morbidity and mortality among various medical disorders. Evidence on the association between hyponatraemia at the time of exacerbation and the prognosis in patients with bronchiectasis is lacking.This was a single-centre retrospective study. We included all bronchiectasis patients who were hospitalised in a regional hospital in Hong Kong for exacerbation from 1 January 2019 to 30 June 2022, to assess the association between hyponatraemia during hospitalised exacerbation and the subsequent outcomes.169 patients were included in this study, of which 46 (27.2%) had hyponatraemia upon admission. Patients in the hyponatraemia group had shorter overall survival (OS) with a median OS of 31.3 months (95% CI 0.76-717.0) in the hyponatraemia group and 104.4 months (95% CI 0.82-1208.3) in the non-hyponatraemia group, adjusted hazard ratio (aHR) of 1.87 (95% CI 1.09-3.20; = 0.023). Patients in the hyponatraemia group also had shorter time-to-next hospitalised bronchiectasis exacerbation with a median time-to-next hospitalised bronchiectasis exacerbation of 72.1 months (95% CI 0.25-362.1) in the hyponatraemia group and 144.6 months (95% CI 1.53-1437.8) in the non-hyponatraemia group, aHR of 2.04 (95% CI 1.07-3.88; = 0.030).This is the first report on the incidence and prognostic value of hyponatraemia in hospitalised bronchiectasis exacerbation, which was observed in 27.2% of patients. It was associated with significantly increased mortality and shorter time-to-next hospitalised bronchiectasis exacerbation when compared with the non-hyponatraemia group..

Understanding the motivations behind clinical trial participation can help enhance recruitment strategies and determine the generalizability of trial results. This study focuses on the reasons for participating in or declining the Tuberculosis Trials Consortium Study 33 (iAdhere), a clinical trial on the treatment of latent tuberculosis infection (LTBI).A quantitative evaluation was conducted among screened patients to ascertain their reasons for participating or not in the iAdhere trial. The study gathered data from enrolled participants and those who chose not to enroll.Among 1,002 enrolled individuals, 290 participants provided 749 reasons for enrolling. The most common reasons included access to shorter treatment regimens (56%), avoiding progression to TB disease (45%), and improving health (21%). Of the 670 eligible persons who chose not to enroll, 551 individuals provided 800 reasons, with the most common being a preference for standard therapy (17%), disinterest in study medication or TB therapy (both 13%), and the inconvenience of daily observed treatment (12%).The desire for shorter treatment options and preventing active disease motivates participation in LTBI trials. The diverse reasons for declining enrolment suggest the importance of developing targeted recruitment strategies. These findings support exploring shorter treatment regimens and can guide future recruitment efforts..

Pleural infection leading to empyema is a severe condition marked by accumulated infected fluid in the pleural space. Pneumonia with parapneumonic effusion is its most common precursor. The global incidence of pleural infections has increased significantly, with existing literature mainly focusing on bacterial empyema, leaving a gap in comparative analyses.A retrospective review was conducted on 561 cases of bacterial, tuberculous, and fungal empyema over a 10-year period. The study compared and analysed overall survival rates, 30-day mortality rates after surgery, and clinical characteristics.The three empyema groups displayed distinct clinical characteristics. Fungal empyema had the worst overall survival compared to bacterial and tuberculous empyema, which had similar survival rates based on 30-day and 2-year mortality. Fungal empyema, advanced age, and high Charlson Comorbidity Index (CCI) score were independent predictors of poor prognosis.Fungal empyema has the highest mortality rate post-decortication surgery. Advanced age and high CCI score are independent predictors of poor prognosis..

Understanding factors associated with increased risk for tuberculosis (TB) recurrence is essential in lowering the TB burden. We aimed to quantify the burden, risk factors, and timing of TB presumptive recurrence.We analyzed test results from 2013 to 2017 in the South African National Health Laboratory Service's database. We defined a person's TB episode to start with their first positive TB test. In the absence of treatment outcome data, we assumed the episode concluded 6 months later for rifampicin-susceptible TB (RS-TB) and 18 months later for rifampicin-resistant TB (RR-TB), provided that at least one negative smear or culture test was recorded within this period. We defined a presumptive recurrent TB episode to start with a positive TB test after the completion of a prior episode. We calculated recurrence measures stratified by various demographics and RR-TB status.Of 574,316 people with RS-TB, 4.7% experienced at least one presumptive recurrent TB episode. Higher local TB notification rates, HIV coinfection, and males experienced higher recurrence rates. Most (89.4%) of the first RS-TB recurrences occurred within a year of the initial episode.Our findings of when and among whom recurrent TB is more likely to occur can be used to assist early interventions and inform impact on patient care..

SHINE (Shorter Treatment for Minimal Tuberculosis in Children) was the first Phase 3 paediatric TB treatment-shortening trial. Robust chest X-ray (CXR) classification methods were integral to excluding severe disease for trial eligibility and to retrospectively adjudicating TB status at baseline. We describe and critically evaluate the CXR classification approaches and processes used in the SHINE trial.Children with non-severe TB were randomised to 4- vs 6-months anti-TB treatment. Radiologically non-severe TB was defined on CXR. CXRs were systematically interpreted by on-site clinicians prospectively for eligibility determination and retrospectively by experts to inform adjudication of baseline TB status and disease severity.A screening CXR was successfully obtained from all 1,204 enrolled children; 1,134 CXRs from children with intra-thoracic TB were reviewed by expert readers. Compared with the expert panel, enrolling clinicians classified more CXRs as abnormal and 'typical TB' and all as radiologically non-severe. The expert panel retrospectively classified 71/1,134 (6%) CXRs as severe. Of these, 4 (5.6%) had unfavourable outcomes compared with 34 (3.0%) in the trial overall.Using CXRs to classify radiological disease severity and inform eligibility decisions in real-time by local enrolling clinicians was feasible and safe in this large paediatric TB trial. Retrospective central expert CXR review was successful. Refinement of the CXR methods for the classification of both disease severity and TB status could support standardised implementation in routine care and research..

Reducing systemic inequities in testing, access to care, social protection - and in the scientific process - is essential to end TB. Incorporating social science methods and expertise on inequity into the mainstream TB response would help ensure that political commitments to equity move beyond symbolic gestures. We convened a meeting between TB social scientists, people with lived experience, civil society and community members to discuss equity within the global TB response. Here, we propose five means by which a social science lens can strengthen equitable, person-centred responses and reconcile the public health significance of TB with the principles of social justice.

TB disproportionately affects poorer, vulnerable people and communities, and has severe social and economic impacts on those affected. However, many countries do not yet include social protection in their programmatic response to TB. Here, we provide a critical perspective on the guidance developed by the WHO and the International Labour Organization (ILO) to help countries implement social protection programmes. The guidance emphasises the need for a multisectoral response to TB, and includes practical information on how to design appropriate social protection programmes that respond to the needs of people affected by TB.