IntroductionTo understand better the risk of tuberculosis transmission with increasing delay in tuberculosis treatment, we undertook a retrospective cohort study in Shenzhen, China.MethodsAll pulmonary tuberculosis cases in the Shenzhen tuberculosis surveillance database from 1993–2010 were included. Sputum smear positivity and presence of pulmonary cavity were used as proxies for risk of tuberculosis transmission.ResultsAmong 48,441pulmonary tuberculosis cases, 70% presented with symptoms of pulmonary TB, 62% were sputum smear positive, and 21% had a pulmonary cavity on chest x-ray. 95.3% of patients self-presented for evaluation of illness after a median 58 days of delay after symptoms began. The proportion presenting sputum smear positive (p<0.001) and with a pulmonary cavity (p<0.001) increased significantly with increasing duration of delay.ConclusionsDelayed diagnosis and treatment of tuberculosis is associated with a significantly increased risk of pulmonary sputum smear positivity and pulmonary cavity. To decrease risk of transmission, treatment delay needs to be reduced further.

For the early diagnosis of TBM based on antibodies in the CSF, the detection of anti-M37Ra, anti-antigen 5, or anti-M37Rv provides the greatest sensitivity and specificity.

Background: Sodium–glucose cotransporter-2 (SGLT2) inhibitors have proven to be effective in improving glycemic control in patients with type 2 diabetes mellitus (T2DM). However, the risk of diabetic ketoacidosis (DKA) in patients remains unclear. The purpose of this study is to conduct this systematic review and network meta-analysis for the risk of DKA of SGLT2 inhibitors in patients with T2DM.Methods: We searched for randomized controlled trials (RCTs) concerning SGLT2 inhibitors in patients with T2DM in PubMed, EMBASE (Ovid SP), Cochrane Central Register of Controlled Trials (Ovid SP), and ClinicalTrials.gov from inception to January 2022. The primary outcomes were the risk of DKA. We assessed the sparse network with a fixed-effect model and consistency model in a frequentist framework with a graph-theoretical method by the netmeta package in R. We assessed the evidence quality of evidence of outcomes according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).Results: In total, 36 studies involving 52,264 patients were included. The network showed that there was no significant difference observed among SGLT2 inhibitors, other active antidiabetic drugs, and placebo in the risk of DKA. There was no significant difference in the DKA risk between different doses of SGLT2 inhibitors. The certainty of the evidence ranged from very low to moderate. The probabilities of rankings and P-score showed that compared to placebo, SGLT2 inhibitors might increase the risk of DKA (P-score = 0.5298). Canagliflozin might have a higher DKA risk than other SGLT2 inhibitors (P-score = 0.7388).Conclusion: Neither SGLT2 inhibitors nor other active antidiabetic drugs were associated with an increased risk of DKA compared to placebo, and the risk of DKA with SGLT2 inhibitors was not found to be dose-dependent. In addition, the use of canagliflozin was less advisable than other SGLT2 inhibitors according to the rankings and P-score.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier PROSPERO, CRD42021297081.

OBJECTIVES: To investigate the associations of objectively measured daily step counts and intensity with overweightness/obesity in older women. METHODS: Totally, 1 085 community-dwelling older women were included. Overweightness/obesity indicators were measured by body composition analyzer. Daily step counts, peak 1-minute cadence (peak 1 cadence), and peak 30-minute cadence (peak 30 cadence) were measured via tri-axial accelerometer. Multiple linear regression analyses were used to assess the association of total daily step counts, peak cadence and their joint effects with different overweightness/obesity indicators. Receiver operating characteristic curve (ROC) analysis was used to determine the optimal daily steps, peak 1 cadence, peak 30 cadence cut-off values to distinguish overweightness/obesity. RESULTS:After adjusting for confounders, a significant association was found between daily step counts, cadence or intensity and the overweightness/obesity. Each 1 000 step increase in daily step counts was associated with a 0.2% reduction in body fat ratio (BFR). Each 1 steps/min increase in peak 1 cadence and peak 30 cadence was associated with a decrease in BFR 0.09% and 0.07%, respectively. The joint effect showed that the high step and intensity (HSHI) group had the best effect on reducing obesity. ROC curve analysis showed that the optimal cut-off points of daily step count, peak 1 cadence and peak 30 cadence for predicting overweightness/obesity were 9 135 steps, 126.9 steps/min and 89.0 steps/min, respectively. CONCLUSION: Increasing daily step count and intensity in walking activities is an effective way to lose weight although daily step count is not associated with BMI. It is recommended that older women walk more than 9 135 steps a day. Different steps and intensity combination can be considered according to the actual condition of older women, and increase daily step count or step intensity appropriately.