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Latest & greatest articles for tuberculosis
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Time to change the single-centre approach to management of patients with tuberculosis: a novel network platform with automatic data import and data sharing Time to change the single-centre approach to TB http://ow.ly/lCeM30hBcbB.
Signatures of Selection at Drug Resistance Loci in Mycobacterium tuberculosisTuberculosis (TB) is the leading cause of death by an infectious disease, and global TB control efforts are increasingly threatened by drug resistance in Mycobacterium tuberculosis. Unlike most bacteria, where lateral gene transfer is an important mechanism of resistance acquisition, resistant M. tuberculosis arises solely by de novo chromosomal mutation. Using whole-genome sequencing data from two natural populations (...) of M. tuberculosis, we characterized the population genetics of known drug resistance loci using measures of diversity, population differentiation, and convergent evolution. We found resistant subpopulations to be less diverse than susceptible subpopulations, consistent with ongoing transmission of resistant M. tuberculosis. A subset of resistance genes ("sloppy targets") were characterized by high diversity and multiple rare variants; we posit that a large genetic target for resistance
Household-Contact Investigation for Detection of Tuberculosis in Vietnam. Active case finding is a top priority for the global control of tuberculosis, but robust evidence for its effectiveness in high-prevalence settings is lacking. We sought to evaluate the effectiveness of household-contact investigation, as compared with standard, passive measures alone, in Vietnam.We performed a cluster-randomized, controlled trial at clinics in 70 districts (local government areas with an average (...) population of approximately 500,000 in urban areas and 100,000 in rural areas) in eight provinces of Vietnam. Health workers at each district clinic or hospital were assigned to perform either household-contact intervention plus standard passive case finding (intervention group) or passive case finding alone (control group). In the intervention districts, household contacts of patients with positive results for tuberculosis on sputum smear microscopy (smear-positive tuberculosis) were invited
Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy Our objective was to evaluate the efficacy of a standardised work-up in the diagnosis of pleural tuberculosis (TB) that included fibreoptic bronchoscopy and medical thoracoscopy. A consecutive series of 52 pleural TB patients observed during the period 2001-2015 was evaluated retrospectively. 20 females, mean (range) age 39.7 (18-74) years, and 32 males, mean (range) age 45.75 (21-83) years, were included (28 (...) non-EU citizens (53.8%)). The diagnosis of TB infections was established by identification (using stains, culture or molecular tests) of Mycobacterium tuberculosis in the pleura, sputum and/or bronchial specimens, or by evidence of caseous granulomas on pleural biopsies. Patients with and without lung lesions were considered separately. The diagnostic yield of the microbiological tests on pleural fluid was 17.3% (nine out of 52 patients). Among the 18 patients with lung lesions, bronchial samples
Efficacy and safety of intravenous chemotherapy during intensive treatment phase in patients with newly diagnosed pulmonary tuberculosis. The purpose of our study was to examine the efficacy and safety of intravenous chemotherapy during intensive treatment phase for patients with newly diagnosed pulmonary tuberculosis (pulmonary TB).The study involved 92 patients with newly diagnosed pulmonary TB aged between 20 years and 68 years. All patient with newly diagnosed pulmonary TB (...) and chemosensitive tuberculosis were enrolled in this study. The patients were allocated to two groups. The first (control) group of 46 patients received standard chemotherapy orally. The second (main) group consisted of 46 patients who were prescribed isoniazid, rifampin, ethambutol by i / v transfusion, and pyrazinamide orally as a part of the standard treatment.Symptoms of intoxication in pulmonary TB patients from the second group were eliminated faster (1.42±0.35) of a month than the same symptoms
Extrapulmonary tuberculosis Extrapulmonary tuberculosis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Extrapulmonary tuberculosis Last reviewed: February 2019 Last updated: May 2018 Summary Epidemiological risk factors include birth in high TB-prevalent countries, exposure at place of residence/work in an institutional setting, and homelessness. Diagnosis may be delayed as a result of non-specific clinical (...) manifestations that progress slowly and the low sensitivity of acid-fast bacilli (AFB) smear on extrapulmonary specimens. Microbiological proof is the key to diagnosis and treatment, and tissue biopsy is frequently required. Other supportive findings are granulomas and positive AFB stain on pathology, and chest x-ray findings. Initial therapy is a 4-drug regimen of isoniazid, rifampicin, pyrazinamide, and ethambutol; treatment lasts for at least 6 months. Definition Tuberculosis (TB) is caused
Pulmonary tuberculosis Pulmonary tuberculosis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Pulmonary tuberculosis Last reviewed: February 2019 Last updated: March 2018 Summary A notifiable disease. Specific risk factors include having lived in Asia, Latin America, Eastern Europe, or Africa for years; exposure to an infectious TB case; residence in an institutional setting and homelessness. Symptoms may include (...) TB is crucial in interrupting TB transmission. Definition Pulmonary tuberculosis is an infectious disease caused by Mycobacterium tuberculosis . In many cases, M tuberculosis becomes dormant before it progresses to active TB. It most commonly involves the lungs and is communicable in this form, but may affect almost any organ system including the lymph nodes, CNS, liver, bones, genitourinary tract, and gastrointestinal tract. History and exam presence of risk factors cough fever anorexia weight
Symptom screening for active tuberculosis in pregnant women living with HIV. This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the accuracy of the four-symptom screen (cough, fever, night sweats, or weight loss) for identifying active TB in pregnant PLHIV who are screened in an outpatient or community setting. To investigate potential sources of heterogeneity of the accuracy of the four-symptom screen between studies including: ART
Strategies for the Management of Latent or Previously Treated Tuberculosis: Clinical Effectiveness, Cost-Effectiveness, and Guidelines Strategies for the Management of Latent or Previously Treated Tuberculosis: Clinical Effectiveness, Cost-Effectiveness, and Guidelines | CADTH.ca Find the information you need Strategies for the Management of Latent or Previously Treated Tuberculosis: Clinical Effectiveness, Cost-Effectiveness, and Guidelines Strategies for the Management of Latent or Previously (...) Treated Tuberculosis: Clinical Effectiveness, Cost-Effectiveness, and Guidelines Last updated: December 20, 2018 Project Number: RB1290-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What is the comparative clinical effectiveness of strategies for the identification and management of latent or previously treated tuberculosis in individuals entering a new country? What is the comparative cost-effectiveness of strategies
Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis. Multidrug drug resistant Tuberculosis (MDR-TB) and extensively drug resistant Tuberculosis (XDR-TB) have emerged as significant public health threats worldwide. This systematic review and meta-analysis aimed to investigate the effects of community-based treatment to traditional hospitalization in improving treatment success rates among MDR-TB and XDR (...) -TB patients in the 27 MDR-TB High burden countries (HBC).We searched PubMed, Cochrane, Lancet, Web of Science, International Journal of Tuberculosis and Lung Disease, and Centre for Reviews and Dissemination (CRD) for studies on community-based treatment and traditional hospitalization and MDR-TB and XDR-TB from the 27 MDR-TB HBC. Data on treatment success and failure rates were extracted from retrospective and prospective cohort studies, and a case control study. Sensitivity analysis, subgroup
Chapter 135 – Tuberculosis Chapter 135 - Tuberculosis - CanadiEM Chapter 135 – Tuberculosis In , by Chris Lipp December 14, 2017 Episode 135 of CRACKCast covers Rosen’s 9th edition, Chapter 127, tuberculosis. TB, or not TB, that is the question. This episode will elucidate the early recognition, risk factors, therapy and precautions regarding this worldwide killer. Shownotes – Key concepts Early recognition of patients with risk for TB should begin at ED triage. Patients thought to have active (...) , and gastrointestinal systems. Therapy should be determined based on consultation. The most commonly used agents are INH, RIF, PZA, and EMB. Resistant strains, including MDR-TB and XDR, have been increasing in frequency. Rosen’s In Perspective This is a huge worldwide killer! Mycobacterium tuberculosis (MTB) is an airborne pathogen and easily spreads through talking, coughing and any close indoor contact. Think of: Primary TB infection – often subclinical Reactivation of TB – post-primary infection Think about
Interventions to increase tuberculosis case detection at primary healthcare or community-level services. Pulmonary tuberculosis is usually diagnosed when symptomatic individuals seek care at healthcare facilities, and healthcare workers have a minimal role in promoting the health-seeking behaviour. However, some policy specialists believe the healthcare system could be more active in tuberculosis diagnosis to increase tuberculosis case detection.To evaluate the effectiveness of different (...) strategies to increase tuberculosis case detection through improving access (geographical, financial, educational) to tuberculosis diagnosis at primary healthcare or community-level services.We searched the following databases for relevant studies up to 19 December 2016: the Cochrane Infectious Disease Group Specialized Register; the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library, Issue 12, 2016; MEDLINE; Embase; Science Citation Index Expanded, Social
Self-administered Versus Directly Observed Once-Weekly Isoniazid and Rifapentine Treatment of Latent Tuberculosis Infection: A Randomized Trial. Expanding latent tuberculosis treatment is important to decrease active disease globally. Once-weekly isoniazid and rifapentine for 12 doses is effective but limited by requiring direct observation.To compare treatment completion and safety of once-weekly isoniazid and rifapentine by self-administration versus direct observation.An open-label, phase 4 (...) randomized clinical trial designed as a noninferiority study with a 15% margin. Seventy-five percent or more of study patients were enrolled from the United States for a prespecified subgroup analysis. (ClinicalTrials.gov: NCT01582711).Outpatient tuberculosis clinics in the United States, Spain, Hong Kong, and South Africa.1002 adults (aged ≥18 years) recommended for treatment of latent tuberculosis infection.Participants received once-weekly isoniazid and rifapentine by direct observation, self
Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: a large-scale implementation study Tuberculosis (TB) is a major cause of death in Ethiopia. One of the main barriers for TB control is the lack of access to health services.We evaluated a diagnostic and treatment service for TB based on the health extension workers (HEW) of the Ethiopian Health Extension Programme in Sidama Zone, with 3.5 million population. We added the services to the HEW routines
Lipid Profile in Tuberculosis Patients with and without Human Immunodeficiency Virus Infection Understanding whether the preceding low lipid profile leads to active tuberculosis (TB) or active TB leads to low lipid profile is crucial.Lipid profile concentrations were determined from 159 study participants composed of 93 active TB patients [44 HIV coinfected (HIV+TB+) and 49 HIV negative (HIV-TB+)], 41 tuberculin skin test (TST) positive cases [17 HIV coinfected (HIV+TST+) and 24 HIV negative
Observational study to estimate the changes in the effectiveness of bacillus Calmette Guerin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK Observational study to estimate the changes in the effectiveness of bacillus Calmette Guerin (BCG) vaccination with time since vaccination for preventing tuberculosis in the UK Observational study to estimate the changes in the effectiveness of bacillus Calmette Guerin (BCG) vaccination with time since vaccination (...) for preventing tuberculosis in the UK Mangtani P, Nguipdop-Djomo P, Keogh R H, Trinder L, Smith P G, Fine P E, Sterne J, Abubakar I, Vynnycky E, Watson J, Elliman D, Lipman M & Rodrigues L C Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Mangtani P, Nguipdop-Djomo P, Keogh R H, Trinder L, Smith P G, Fine P E, Sterne J, Abubakar I, Vynnycky E, Watson J
Bronchial Wash Gene Xpert MTB/RIF in Lower Lung Field Tuberculosis: Sensitive, Superior, and Rapid in Comparison with Conventional Diagnostic Techniques Lower lung field tuberculosis (LLF TB) is an atypical presentation of tuberculosis (TB). LLF TB is common, and a proportionate number of non-resolving pneumonia cases are diagnosed to have pulmonary TB.The prospective observational study was conducted during June 2013 to December 2015 in the Department of Pulmonary Medicine, MIMSR Medical (...) of the institutional review board. Consent was taken from the patients before inclusion in the study. Statistical analysis was done using chi-square test.In the present study, 300 (11.53%) cases of LLF TB of total 2600 pulmonary tuberculosis were included, females constitutes 66.66% (200/300) with mean age of 58.4 ± 11.8 years and males constitutes 33.34% (100/300) with mean age of 56.8 ± 10.6 years. Constitutional symptoms were observed as cough in 93% cases, fever in 83% cases, shortness of breath in 72% cases
Do chain pharmacies perform better than independent pharmacies? Evidence from a standardised patient study of the management of childhood diarrhoea and suspected tuberculosis in urban India Pharmacies and drug stores are frequently patients' first point of care in many low-income and middle-income countries, but their practice is often poor. Pharmacy retailing in India has traditionally been dominated by local, individually owned shops, but recent years have seen the growth of pharmacy chains (...) . In theory, lower-powered profit incentives and self-regulation to preserve brand identity may lead to higher quality in chain stores. In practice, this has been little studied.We randomly selected a stratified sample of chain and independent pharmacies in urban Bengaluru. Standardised patients (SPs) visited pharmacies and presented a scripted case of diarrhoea for a child and suspected tuberculosis (TB). SPs were debriefed immediately after the visit using a structured questionnaire. We measured