Hierarchical true prevalence, risk factors and clinical symptoms of tuberculosis among suspects in Bangladesh

Abstract

Background The study was aimed to estimate the true prevalence of human tuberculosis (TB); identify risk factors and clinical symptoms of TB; and detect rifampicin (RIF) sensitivity in three study areas of Bangladesh. Methods The cross-sectional study was conducted in three Bangladesh districts during 2018. Potential risk factors, clinical symptoms, and comorbidities were collected from 684 TB suspects. Sputum specimens were examined by LED microscopy. TB hierarchical true prevalence, risk factors and clinical symptoms were estimated and identified using a Bayesian analysis framework. Rifampicin sensitivity of M. tuberculosis (MTB) was detected by GeneXpert MTB/RIF assay. Results The median TB true prevalence was 14.2% (3.8; 34.5). Although overall clustering of prevalence was not found, several DOTS centers were identified with high prevalence (22.3% to 43.7%). Risk factors for TB identified (odds ratio) were age (> 25 to 45 years 2.67 (1.09; 6.99), > 45 to 60 years 3.43 (1.38; 9.19) and individuals in families/neighborhoods where a TB patient(s) has (ve) already been present (12.31 (6.79; 22.60)). Fatigue, night sweat, fever and hemoptysis were identified as important clinical symptoms. Seven of the GeneXpert MTB/RIF positive sputum specimens (65) were resistant to rifampicin. Conclusions About one in every seven TB suspects was affected with TB. A number of the TB patients carry multi drug resistant MTB. Hierarchical true prevalence estimation allowed identifying DOTS centers with high TB burden. Insights from this study will enable more efficient use of DOTScenters-based TB surveillance to end the TB epidemic in Bangladesh by 2035.

Clinical Approach to Myelopathy Diagnosis

“…Inflammatory myelopathies constitute the most frequently occurring myelopathies and have diverse immune-mediated disease mechanisms associated with them. With a better understanding of the immune process and the discovery of new disease biomarkers, the diagnostic spectrum of this group of myelopathies continues to expand ( table 1-4 52-59 and table 1-5 60-67 ). The mechanisms of immune-mediated disease include demyelinating disease associated with multiple sclerosis, autoimmune myelopathies associated with specific antibodies against neural antigens (eg, NMO, MOG-associated disorders, paraneoplastic disorders), autoimmune myelopathies related to systemic autoimmune or rheumatologic diseases (eg, Sjögren syndrome, systemic lupus erythematous), infection-associated myelopathies, and other inflammatory myelopathies caused by the use of medications that target immune pathways that trigger autoimmune responses against the spinal cord such as immune checkpoint inhibitors used in cancer treatment 68 or tumor necrosis factor inhibitors in the treatment of rheumatologic disorders 69 …”

Retraction: Epidemiological insights into paratuberculosis in camels in Saudi Arabia: Bayesian estimation of true prevalence and identification of risk factors

“…Following the publication of this article [ 1 ], concerns were raised about undisclosed competing interests between the corresponding author and the Editorial Board member who handled the manuscript through peer review [ 2 – 4 ].…”