BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR).METHODS: A panel of global experts in the field of TB care and PR was identified; 62 participated in a Delphi process. A 5-point Likert scale was used to score the initial ideas for standards and after several rounds of revision the document was approved (with 100% agreement).RESULTS: Five clinical standards were defined: Standard 1, to assess patients at the end of TB treatment for PTLD (with adaptation for children and specific settings/situations); Standard 2, to identify patients with PTLD for PR; Standard 3, tailoring the PR programme to patient needs and the local setting; Standard 4, to evaluate the effectiveness of PR; and Standard 5, to conduct education and counselling. Standard 6 addresses public health aspects of PTLD and outcomes due to PR.CONCLUSION: This is the first consensus-based set of Clinical Standards for PTLD. Our aim is to improve patient care and quality of life by guiding clinicians, programme managers and public health officers in planning and implementing adequate measures to assess and manage PTLD.

The optical properties of slab-like photonic crystals are often discussed on the basis of effective index (EI) approximations, where a 2-D effective refractive index profile replaces the actual 3-D structure. Our aim is to assess this approximation by analogous steps that reduce finite 2-D waveguide Bragg-gratings (to be seen as sections through 3-D PC slabs and membranes) to 1-D problems, which are tractable by common transfer matrix methods. Application of the EI method is disputable in particular in cases where locally no guided modes are supported, as in the holes of a PC membrane. A variational procedure permits to derive suitable effective permittivities even in these cases. Depending on the structural properties, these values can well turn out to be lower than one, or even be negative. Both the "standard" and the variational procedures are compared with reference data, generated by a rigorous 2-D Helmholtz solver, for a series of example structures. Keywords

A variational approach for the semivectorial modal analysis of dielectric waveguides with arbitrary piecewise constant rectangular 2D cross-sections is developed. It is based on a representation of a mode profile as a superposition of modes of constituting slab waveguides times some unknown continuous coefficient functions, defined on the entire coordinate axis. The propagation constant and the lateral functions are found from a variational principle. It appears that this method with one or two modes in the expansion preserves the computational efficiency of the "standard" effective index method while providing more accurate estimates for propagation constants, and well-defined continuous approximations for mode profiles. By including a larger number of suitable trial fields, the present approach can also serve as a technique for rigorous semivectorial mode analysis.

TB affects around 10.6 million people each year and there are now around 155 million TB survivors. TB and its treatments can lead to permanently impaired health and wellbeing. In 2019, representatives of TB affected communities attending the ‘1st International Post-Tuberculosis Symposium´ called for the development of clinical guidance on these issues. This clinical statement on post-TB health and wellbeing responds to this call and builds on the work of the symposium, which brought together TB survivors, healthcare professionals and researchers. Our document offers expert opinion and, where possible, evidence-based guidance to aid clinicians in the diagnosis and management of post-TB conditions and research in this field. It covers all aspects of post-TB, including economic, social and psychological wellbeing, post TB lung disease (PTLD), cardiovascular and pericardial disease, neurological disability, effects in adolescents and children, and future research needs.

BackgroundA substantial proportion of tuberculosis patients remain with pulmonary symptoms and reduced physical capacity despite successful treatment. We performed a systematic review to analyse the burden of post-tuberculosis lung impairment measured by lung function testing.MethodsWe searched the PubMed database for articles published between database inception and November 2020 and performed meta-analyses to estimate the prevalence, type and severity of lung impairment among drug-susceptible and multidrug-resistant tuberculosis survivors. Methodological quality of included studies was assessed using the Newcastle–Ottawa scale.Results54 articles were included in this review. For subjects with former drug-susceptible tuberculosis, the combined estimated mean was 76.6% (95% CI 71.6–81.6) of predicted for forced expiratory volume in 1 s (FEV1) and 81.8% (95% CI 77.4–86.2) for forced vital capacity (FVC). In former patients with multidrug-resistant tuberculosis, it was 65.9% (95% CI 57.1–74.7) for FEV1and 76.0% (95% CI 66.3–85.8) for FVC, respectively. The analysis of impairment types in former patients with drug-susceptible and multidrug-resistant tuberculosis showed that 22.0%versus19.0% had obstructive, 23.0%versus22.0% restrictive and 15.0%versus43.0% had mixed impairment type, respectively. In the majority of studies, at least 10–15% of tuberculosis survivors had severe lung impairment.ConclusionsThis systematic review showed long-term abnormal spirometry results in a significant proportion of tuberculosis survivors.