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Impact of diabetes and smoking on mortality in tuberculosis.

PLoS One. 2013;8(2):e58044

Authors: Reed GW, Choi H, Lee SY, Lee M, Kim Y, Park H, Lee J, Zhan X, Kang H, Hwang S, Carroll M, Cai Y, Cho SN, Barry CE, Via LE, Kornfeld H

Abstract
BACKGROUND: Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent.
METHODS: A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption.
RESULTS: The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients.
CONCLUSIONS: In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.

PMID: 23469139 [PubMed - in process]

Strategies for Developing Tuberculosis Vaccines: Emerging Approaches.

Curr Drug Targets. 2013 Mar 6;

Authors: Mollica A, Stefanucci A, Costante R

Abstract
The current vaccine against TB, bacille Calmette-Guèrin (BCG) fails to protect against the most prevalent disease form, the pulmonary TB in adults. Thus, it is not a satisfactory vaccine. Given that T cells are central to protection against TB, future vaccine design should focus on T-lymphocyte populations. Most vaccines do not prevent infection but instead disease, that if they allow establishment of the pathogen in the host but prevent its harmful effects. The development of synthetic peptide-based immunogens is emerging as a possible approach in human vaccination in the future, as a replacement for conventional vaccines that use killed or attenuated whole microorganisms. The advantages of such synthetic vaccines (high potency, low adverse reactions, low cross-reactivity and high stability) are offset somewhat by the poorer inherent immunogenicity of these constructs. There is a greater need therefore to develop adjuvant/carrier systems to increase the immunogenicity of these newer vaccine candidates.

PMID: 23469877 [PubMed - as supplied by publisher]

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Bronchoscopic Evaluation in Childhood Pulmonary Tuberculosis: Risk Factors of Airway İnvolvement and Contribution to the Bacteriologic Diagnosis.

Pediatr Infect Dis J. 2013 Mar 6;

Authors: Cakir E, Kut A, Ozkaya E, Gedik AH, Midyat L, Nursoy M

Abstract
We aimed to describe the risk factors of airway involvement and to investigate the contribution of bronchoscopy in the bacteriologic diagnosis of tuberculosis. Airway involvement was more often present in patients with resistance to tuberculosis therapy than in the patients having bronchoscopy performed at initial presentation. Addition of broncho-alveolar lavage to the diagnostic work up increased the mycobacteriologic yield statistically.

PMID: 23470678 [PubMed - as supplied by publisher]

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Exploring the impact of screening with low-dose CT on lung cancer mortality in mild to moderate COPD patients: A pilot study.

Respir Med. 2013 Feb 25;

Authors: de-Torres JP, Casanova C, Marín JM, Zagaceta J, Alcaide AB, Seijo LM, Campo A, Carrizo S, Montes U, Cordoba-Lanus E, Baz-Dávila R, Aguirre-Jaime A, Celli BR, Zulueta JJ

Abstract
BACKGROUND: COPD is an independent risk factor for lung cancer, especially in patients with mild to moderate disease. OBJECTIVE: To determine if performing lung cancer screening in GOLD 1 and 2 COPD patients, results in reduced lung cancer mortality. METHODS: This study compared patients with mild to moderate COPD from 2 cohorts matched for age, gender, BMI, FEV1%, pack-yrs history and smoking status. The screening group (SG) had an annual low dose computed tomography (LDCT). The control group (CG) was prospectively followed with usual care. Lung cancer incidence and mortality densities were compared between groups. RESULTS: From an initial sample of 410 (SG) and 735 (CG) patients we were able to match 333 patients from each group. At the same follow-up time lung cancer incidence density was 1.79/100 person-years in the SG and 4.14/100 person-years in the CG (p = 0.004). The most frequent histological type was adenocarcinoma in both SG and CG (65% and 46%, respectively), followed by squamous cell carcinoma (25% and 37%, respectively). Eighty percent of lung cancers in the SG (16/20) were diagnosed in stage I, and all of CG cancers (35/35) were in stage III or IV. Mortality incidence density from lung cancer (0.08 vs. 2.48/100 person-years, p < 0.001) was lower in the SG. CONCLUSIONS: This pilot study in patients with mild to moderate COPD suggests that screening with LDCT detects lung cancer in early stages, and could decrease lung cancer mortality in that high risk group. Appropriately designed studies should confirm these important findings.

PMID: 23465176 [PubMed - as supplied by publisher]