자연주의적 탐구조사(Naturalistic Inquiry)

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

https://hull-repository.worktribe.com/preview/1797952/1-s2.0-S0140673618322797-main.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

https://openresearch-repository.anu.edu.au/bitstream/1885/164632/2/01_Bin%2bSayeed_Global%252C_regional%252C_and_national_2018.pdf

Global, regional, and national incidence, prevalence, andyears lived with disability for 354 diseases and injuries for195 countries and territories, 1990–2017: a systematicanalysis for the Global Burden of Disease Study 2017

WRITING GROUP MEMBERS Emelia J. Benjamin, MD, SCM, FAHA Michael J. Blaha, MD, MPH Stephanie E. Chiuve, ScD Mary Cushman, MD, MSc, FAHA Sandeep R. Das, MD, MPH, FAHA Rajat Deo, MD, MTR Sarah D. de Ferranti, MD, MPH James Floyd, MD, MS Myriam Fornage, PhD, FAHA Cathleen Gillespie, MS Carmen R. Isasi, MD, PhD, FAHA Monik C. Jiménez, ScD, SM Lori Chaffin Jordan, MD, PhD Suzanne E. Judd, PhD Daniel Lackland, DrPH, FAHA Judith H. Lichtman, PhD, MPH, FAHA Lynda Lisabeth, PhD, MPH, FAHA Simin Liu, MD, ScD, FAHA Chris T. Longenecker, MD Rachel H. Mackey, PhD, MPH, FAHA Kunihiro Matsushita, MD, PhD, FAHA Dariush Mozaffarian, MD, DrPH, FAHA Michael E. Mussolino, PhD, FAHA Khurram Nasir, MD, MPH, FAHA Robert W. Neumar, MD, PhD, FAHA Latha Palaniappan, MD, MS, FAHA Dilip K. Pandey, MBBS, MS, PhD, FAHA Ravi R. Thiagarajan, MD, MPH Mathew J. Reeves, PhD Matthew Ritchey, PT, DPT, OCS, MPH Carlos J. Rodriguez, MD, MPH, FAHA Gregory A. Roth, MD, MPH Wayne D. Rosamond, PhD, FAHA Comilla Sasson, MD, PhD, FAHA Amytis Towfighi, MD Connie W. Tsao, MD, MPH Melanie B. Turner, MPH Salim S. Virani, MD, PhD, FAHA Jenifer H. Voeks, PhD Joshua Z. Willey, MD, MS John T. Wilkins, MD Jason HY. Wu, MSc, PhD, FAHA Heather M. Alger, PhD Sally S. Wong, PhD, RD, CDN, FAHA Paul Muntner, PhD, MHSc On behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart Disease and Stroke Statistics—2017 Update

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

Objective: To describe the clinical profile of children with bacteriologically confirmed tuberculosis. 
Study Design: A multicentric study was conducted in three hospitals in Chennai city between July 1995 and December 1997. Children aged 6 months to 12 years with signs and symptoms suggestive of tuberculosis were investigated further. Clinical examination, chest radiograph, tuberculin skin test with 1 TU PPD and, sputum or gastric lavage for mycobacterial smear and culture were done for all and, lymph node biopsy when necessary. 

Results: A total of 2652 children were registered and tuberculosis was bacteriologically confirmed in 201. Predominant symptoms were history of an insidious illness (49%), fever and cough (47%), loss of weight (41%) and a visible glandular swelling (49%). Respiratory signs were few and 62% were undernourished. Over half the patients with confirmed TB had normal chest X-ray. Abnormal X-ray findings included parenchymal opacities in 47% and hilar or mediastinal lymphadenopathy in 26%. The prevalence of isoniazid resistance was 12.6% and MDR TB 4%. 

Conclusions: Children with tuberculosis present with fever and cough of insidious onset. Lymphadenopathy is a common feature even in children with pulmonary TB. A significant proportion of children have normal chest X-rays despite positive gastric aspirate cultures. Drug resistance rates in children mirror the pattern seen in adults in this geographic area.

/pdf/a-profile-of-bacteriologically-confirmed-pulmonary-27mvadc3t9.pdf

A profile of bacteriologically confirmed pulmonary tuberculosis in children.

Background. There are very few community-based studies
on the prevalence of asthma in Indian children. We aimed to
estimate the prevalence of asthma in children under 12 years of
age and to study possible differences in the prevalence of
childhood asthma in urban and rural areas of Tamil Nadu.
Methods. A total of 584 children from Chennai and 271
children from 25 villages around Chennai formed the urban and
rural groups, respectively. From November 1999 to February
2000, data were collected using a simplified version of the
ISAAC questionnaire, which was administered by trained students.
Symptoms suggestive of asthma or hyperreactive airways
disease in children under 12 years of age were recorded from the
selected urban and rural populations by questioning the parents.
The results were analysed separately for children 0-5 and 6-12
years of age.
Results. Of the 855 children studied, the overall prevalence
of breathing difficulty (including asthma) was 18% and the
prevalence of ‘diagnosed’ asthma was 5%. Twenty-two per cent of urban and 9% of rural children 6-12 years of age reported
breathing difficulty ‘at any time in the past’ (p<0.01). A
significantly higher proportion of 6-12-year-old urban children
also reported nocturnal dry cough (28.4%v. 18.7%,p<0.05).
Urban children reported recent wheeze more often than rural
children (92% v. 77%, p=0.01).
Conclusions. Symptoms suggestive of asthma were present
in 18% of children under 12 years of age. Though the
prevalence of diagnosed childhood asthma was about 5% in both
urban and rural areas, the prevalence of ‘breathing difficulty’ and
nocturnal cough was significantly higher among urban children in
the age group of 6-12 years. Children living in urban areas also
reported ‘recent wheeze’ more often than rural children. Our
data suggest that the actual prevalence of asthma and other
‘wheezy’ illnesses may be higher than that previously documented.
Further studies are needed to confirm the difference in
prevalence between urban and rural children and also to identify
possible causes that could account for the higher urban prevalence
of asthma in Tamil Nadu.

Prevalence of asthma in urban and rural children in Tamil Nadu.

To the Editor: HIV-1 and Mycobacterium tuberculosis are the two leading infectious agents causing death worldwide. Increasing morbidity and mortality among HIV1–infected individuals in areas where M tuberculosis is endemic are attributable to tuberculosis (TB) to a large extent. Because of the pivotal role of the human leukocyte antigen (HLA) genes and gene products in controlling the immune response, the association between HLA genes and infectious diseases has been extensively studied. Various studies have identified an association between HLA genes (class I and class II) and HIV-1 infection and disease progression. Most of the studies carried out in whites and Africans have indicated that HLA-B27 and HLA-B57 are associated with a slow progression to AIDS and that HLA-B35 is associated with rapid disease progression. Further, studies carried out in Asian populations have linked the development of pulmonary TB with the HLA class II region, specifically HLA-DR2. In the context of HIV-1 and M tuberculosis coinfection, there is a dearth of reports on the HLA genes predisposing to development of TB in HIV-1–infected individuals. In the present study, we have explored the possible association between HLA (-A, -B, and -DR loci) and HIV-1 with and without TB in a group of south Indian patients. The study population comprised 151 HIV-1–seropositive subjects without TB (HIVTB ) (64 male, mean age 6 SD: 32.1 6 6.9 years; 87 female, mean age 6 SD: 28.6 6 6.7 years) and 108 HIV-1–seropositive subjects with active TB (HIVTB) (78 male, mean age 6 SD: 35.3 6 5.7 years; 30 female, mean age 6 SD: 31.0 6 7.1 years) recruited from the HIVand TB clinics of the Tuberculosis Research Center, Chennai, India, and 170 healthy controls from the same ethnic background (104 male, mean age 6 SD: 33.0 6 8.0 years; 66 female, mean age 6 SD: 32.9 6 8.8 years). The diagnosis of TB was based on sputum smear examination for acid-fast bacilli and confirmed by culture for M tuberculosis. HIV-1 was diagnosed using 2 rapid tests (HIV tridot, J. Mitra, India; CombAids, Span Diagnostics, India), and a positive result was confirmed by a third test (Western blot, J. Mitra, India). The present study was approved by the institutional ethical committee, and written informed consent was obtained from all the participants of the study. The patients and controls represented the same ethnic group of the south Indian population from the state of Tamilnadu. HLA-A and HLA-B typing was carried out using a 2-stage microlymphocytotoxicity test. HLA-DR genotyping was studied by polymerase chain reaction and sequence-specific oligo probe method. The frequencies of HLA antigens of patients and controls were compared using the x test. P values with Yates correction and odds ratios were calculated using the Statcalc program (Epi Info version 6.04, Centers for Disease Control and Prevention, Atlanta, GA, July 1996) with 95% confidence intervals. The P values were further corrected by the Bonferroni inequality method, wherein the P values obtained were multiplied with the number of antigens studied in each locus and expressed as P-corrected (Pc) values. Among the antigens studied, a decreased frequency of HLA-A11, HLAB17, HLA-B35, and HLA-DR7 and an increased frequency of HLA-A19 (32 + 33), HLA-B18, HLA-B40, and HLADR2 were observed in the HIVTB and HIVTB groups compared with healthy controls. The difference attained statistical significance only in the case of HLA-A11 (overall HIV-1–infected vs. controls: Pc = 0.00066), HLA-B40 (Pc = 0.019), and HLA-DR2 (Pc = 0.037). When the HIV-1TB and HIV1TB groups were compared, HLA-A11 alone showed marginal significance (P = 0.0179, Pc = 0.196; Table 1). In the present study, an increased prevalence of HLA-B40 and HLA-DR2 antigens was observed in HIV-1–infected and HIV-1 and M tuberculosis–coinfected individuals, suggesting their association with susceptibility to HIV-1 and HIV-1 and M tuberculosis coinfection. On the other hand, a decreased prevalence of HLAA11 was observed in both HIV patient groups. This suggests that the presence of A11 may be associated with protection against HIV-1 and, more strongly, against HIV-1 and M tuberculosis coinfection. Moreover, our study also revealed that HLA-A11 is not associated with any protection against TB infection (HIV TB patients: HLA-A11 frequency of 26.5%; data not shown). This suggests that strong protection observed is against HIV-1 and M tuberculosis coinfection. Because this is a cross-sectional study, further follow-up studies may delineate the role of HLA-A11 in protection against HIV-1 infection and HIV-1 and M tuberculosis coinfection. A higher frequency of HLA-A11 was observed among highly exposed persistently seronegative women of Thailand, which suggests the protective role of HLA-A11 against HIV-1 infection. Another recent report also corroborates the protective role of HLAA11, wherein it describes that the immune system of individuals expressing HLAA11 frequently elicits CD8 T-cell responses against a common HLAA11–restricted escape variant epitope in HIV-1 gag. A number of potential mechanisms have been put forward to explain the association of HLA-A11 with resistance to HIV-1 infection and HIV-1 and M tuberculosis coinfection. HLAA11 is one of the most common class I alleles in the world, ranging from 4% to 33% depending on the particular ethnic background, and it is highly prevalent in Southeast Asia. A*1101 is the most prevalent variant of A11 and is known preferably to bind peptide residues with small or aliphatic side chains at position 2 and with positively charged side chains at the C-terminus position. The structural features of the A*1101 binding groove permit peptides to adopt a backbone conformation with two bulges separated by a secondary anchor residue. This may allow for binding of unrestricted specificity of viral peptides of various

Association of human leukocyte antigen-A11 with resistance and B40 and DR2 with susceptibility to HIV-1 infection in south India.

Background & objectives: In India, phase-I human clinical trials for a preventive HIV vaccine are
being conducted at Pune and Chennai Centres. In order to find out the willingness of populations
at risk to participate in future preventive HIV vaccine trials (HIVVTs) and to assess the factors
that enhance or deter them from participation, a study was conducted at Chennai and Madurai in
Tamil Nadu.
Methods: This cross-sectional study was conducted among transport workers, people attending
sexually transmitted infection clinics, injection drug users, men having sex with men, women in
sex industry and a representative sample of monogamous married women, by employing
measurement scales. A structured questionnaire on knowledge and attitudes about the HIV vaccine
was used to measure the participants’ knowledge and attitudes about HIV vaccine and HIVVTs.
Results: Of the 112 participants, 67 (60%) were men. Mean age of the respondents was 32 yr;
68 per cent were high school educated. Majority of respondents were willing to participate in a
future HIVVT and the reasons were altruism, protection from HIV, and support for the researchers.
Major concerns were vaccine efficacy, side effects of the vaccine and the impact of a HIV vaccine
on the participants’ lives. Majority (85%) agreed that sex without condom would not be safe despite
the availability of an HIV vaccine.
Interpretation & conclusion: It is likely that high-risk volunteers will be willing to enroll in HIVVTs.
Barriers and concerns should be dealt with carefully by providing correct information. Also there
is a need for more education to ensure participants’ understanding of key concepts of HIV vaccine
trial.

A pilot study on willingness to participate in future preventive HIV vaccine trials.

Drug-resistant tuberculosis (DR-TB) is a serious problem that impedes the success of the TB control program. Of note, multidrug-resistant (MDR)-TB and extensively drug-resistant (XDR)-TB have certainly complicated the scenario. One of the possible strategies to overcome drug resistance in an economic and simple manner would involve modification of existing anti-TB drugs to obtain derivatives that can work on resistant TB bacilli. These may have improved half-life and increased bioavailability, be more efficacious, and serve as cost-effective alternatives, as compared to new drugs identified through conventional methods of drug discovery and development. Although extensive literature is available on the activity of various derivatives of first-line drugs (isoniazid, rifampicin and pyrazinamide) on drug-susceptible Mycobacterium tuberculosis (MTB), reports on the activity of derivatives on resistant MTB are very limited, to our knowledge. In light of this, the present review aims to provide a concise report on the derivatives of first-line drugs that have the potential to overcome the resistance to the parental drug and could thus serve as effective alternatives.

Soumya Swaminathan

Papers

A profile of bacteriologically confirmed pulmonary tuberculosis in children.

Prevalence of asthma in urban and rural children in Tamil Nadu.

Association of human leukocyte antigen-A11 with resistance and B40 and DR2 with susceptibility to HIV-1 infection in south India.

A pilot study on willingness to participate in future preventive HIV vaccine trials.

A note on derivatives of Isoniazid, Rifampicin and Pyrazinamide showing activity against resistant Mycobacterium tuberculosis