ObjectiveTo evaluate the effect of health economics of census versus high-risk population screening for tuberculosis in Mianyan city, in order to provide references for the selection of suitable tuberculosis screening method in western region of China. MethodsWe included active tuberculosis patients by residents health screening of 21 villages and towns in Mianyan city from June 2013 to March 2013. Relevant data was analyzed by referencing the National Assessment of Tuberculosis Control Program in 2001-2010. Results184047 residents were screened by tuberculosis census and 128 active tuberculosis patients were diagnosed while 61045 residents were screened by high-risk population screening and 76 active tuberculosis patients were diagnosed. The cost-utility ratio and benefit-cost ratio of tuberculosis census were 6174.17 and 3.84, respectively. The cost-utility ratio and benefit-cost ratio of high risk population screening were 3106.16 and 7.62, respectively. ConclusionHigh-risk population screening has higher cost-utility ratio and benefit-cost ratio than tuberculosis census with higher missed diagnosis. Benefits and harms of tuberculosis detection rate and cost should be fully balanced before tuberculosis screening method were chosen in western underdeveloped region of China.
Tuberculosis risk prediction and drug intervention for latent tuberculosis infection (LTBI) patients plays an important role in achieving the goal of eliminating tuberculosis. At present, the diagnostic methods of LTBI still have some defects and cannot predict the risk of LTBI progression to active tuberculosis. In this paper, studies of LTBI advancing into tuberculosis in genomics, transcriptomics, proteomics and metabonomics have been comprehensively summarized, and the further development of markers for risk prediction is prospected.
Objective To explore the value of procalcitonin (PCT) in differential diagnosis of invasive candidiasis. Methods PubMed, Embase, Medline, Cochrane Library, China National Knowledge Infrastructure and Wanfang Data were searched for articles published from the dates of establishment of databases to January 2021. A prospective and retrospective cohort studies and a case-control studies of PCT in differential diagnosis of invasive candidiasis were collected. RevMan 5.3 software QUADAS-2 risk assessment tool was used to evaluate the quality of the literature. Meta-Disc 1.4 software was used to determine whether the original data had threshold effect and heterogeneity. Stata 14.0 software was used to analyze meta, judge publication bias and draw Deeks diagram. Results A total of 9 articles and 943 patients were included. There were 259 cases in candida group and 684 cases in control group. The study showed that the total sensitivity was 0.86 [95% confidence interval (CI) (0.80, 0.91)], specificity was 0.78 [95%CI (0.70, 0.84)], positive likelihood ratio was 3.92 [95%CI (2.77, 5.55)], negative likelihood ratio was 0.18 [95%CI (0.12, 0.27)], the area under receiver operator characteristic curve was 0.90 [95%CI (0.87, 0.92)], diagnostic odds ratio was 19.75 [95%CI (10.71, 36.43)]. The results of heterogeneity test showed that there was heterogeneity caused by non-threshold effect between studies. The results of subgroup analysis showed that the heterogeneity I2 value of PCT<2 ng/mL subgroup decreased significantly, and the result was more stable, with sensitivity. The results show that sensitivity was 0.86 [95%CI (0.79, 0.91)], specificity was 0.72 [95%CI (0.63, 0.80)], the area under receiver operator characteristic curve was 0.87 [95%CI (0.83, 0.89)]. Conclusions Serum PCT in the differential diagnosis of invasive candidiasis has certain accuracy and negative predictive value. However, PCT is only an auxiliary test. The differential diagnosis of invasive candidiasis should be combined with clinical features and other diagnostic indexes.
Objective To investigate and analyze the incidence and clinical characteristics of malnutrition in patients with tuberculosis and type 2 diabetes. Methods four hundred patients with tuberculosis and type 2 diabetes were diagnosed in the tuberculosis Department of West China Hospital of Sichuan University from June 1, 2018 to April 30, 2023. The incidence and clinical characteristics of malnutrition were analyzed using the nutritional risk Screening 2002 score and the Global Malnutrition Leadership Initiative criteria. Results 170 patients (42.5%) were malnourished. In malnourished patients, 78 cases (45.9%) had fever, 132 cases (77.6%) had cough, 44 cases (25.9%) had hemoptysis, and 36 cases (21.2%) had night sweating. Compared with the non-malnourished patients, the difference was statistically significant (P<0.05). Lymphocyte count was (1.0±0.5)×109/L, albumin was (31.4±20.5)g/L; CD3 count 792.7±205.0, CD4 count 535.4±15.0, CD8 count 429.5±123.0, CD3%: 65.5%±11.1%, CD4%: 39.1%±9.6%, CD8%: 19.1%±9.6%, CD4/CD8: 1.3±0.2, which were significantly lower than those in the group without malnutrition. Pulmonary cavity occurred in 44 cases (25.9%), lesions in 2 - 4 lung fields in 76 cases (44.7%) and lesions in ≥5 lung fields in 52 cases (30.6%), all of which were significantly higher than those in the non-malnutrition group. The above differences were statistically significant.Conclusion We should pay more attention to the screening of malnutrition in patients with tuberculosis and type 2 diabetes. Patients with malnutrition have more obvious clinical symptoms, lower immunity, and more serious imaging lesions.
ObjectiveTo compare the performance of 36-item short form health survey (SF-36) and World Health Organization quality of life-bref (WHOQOL-Bref) in assessing quality of life (QOL) in patients with pulmonary tuberculosis (TB). MethodsThe WHOQOL-Bref questionnaire and the SF-36 questionnaire were administered to patients with tuberculosis undergoing treatment from July to September 2013. The statistical methods of reliability analysis, factor analysis and the Pearson correlation coefficient analysis were used. ResultsIt showed that the WHOQOL-Bref and the SF-36 both had good reliability (Cronbach α=0.863 and 0.920, respectively). Constructive validity of the two instruments were checked by factor analysis and the Pearson correlation coefficient analysis, which indicated that both the two instruments had good validity. Among scales measuring similar concepts, many subscales of the SF-36 and the four domains of the WHOQOL-Bref unexpectedly had a fair correlation with one another. For example, the physical QOL, psychological QOL, and social relation QOL domains of the WHOQOL-Bref and physical functioning, mental health, and social functioning of the SF-36 were 0.482, 0.745, and 0.572, respectively. ConclusionThe WHOQOL-Bref and the SF-36 have an approximately equivalent practicability in assessing the quality of life in patients with TB.
ObjectiveTo investigate the epidemiology of tuberculosis in Mianyang city, and investigate its risk factors to provide scientific evidence for tuberculosis prevention and management. MethodsA stratified cluster random sampling method was applied and 184094 residents were recruited in the study. The prevalence of tuberculosis was analyzed by questionnaires, physical examinations, X-ray, and laboratory tests. The risk factors of tuberculosis were analyzed by binary logistic regression method. ResultsOne hundred and seventy-five subjects were diagnosed with active tuberculosis, and the incidence of tuberculosis was 95.06 per thousand. There were 32 smear-positive pulmonary tuberculosis patients, and the incidence was 17.38/100 per thousand. Males, farmers and workers, diabetes, family history of tuberculosis, smoking, drinking were risk factors for tuberculosis. ConclusionsThe prevalence of tuberculosis in Mianyang city is similar with the whole country. Male, farmers and workers, diabetes, family history of tuberculosis, smoking, and drinking maybe the risk factors of tuberculosis.
ObjectiveTo understand basic characteristics and clinical features of tuberculosis in Mianyang, Sichuan, and to investigate the risk factors of two case-finding methods for tuberculosis:"passive finding" and "active screening". MethodsOne-hundred and seventy-five active tuberculosis patients screened by physical examination in 21 villages of Fucheng and Jiangyou from June 2013 to March 2014 were included. Information about basic characteristics and clinical features of tuberculosis was collected using questionnaire, chest X-ray and laboratory examinations. We also applied binary logistic regression to explore the risk factors of finding for tuberculosis. ResultsIn all 175 tuberculosis patients, 41.71% were over 60 years old and 73.71% were farmers. Productive cough over two weeks was the most common symptom, accountting for 58.29%. 19.63% were sputum smear-positive while 70.87% were PPD-positive. Binary logistic regression analysis demonstrated that tuberculosis history significantly influenced the findings for tuberculosis (OR=15.809,95%CI: 6.708~37.258). ConclusionsActive tuberculosis patients screened by physical examination in Mianyang, Sichuan were mainly elderly male over 60 years old and farmers, with single pulmonary symptom as the primary clinical feature. The patients with tuberculosis history may be found by "passive finding".