BACKGROUND:Existing rates of death and recurrent tuberculosis (TB) among people treated for rifampicin- or multidrug-resistant tuberculosis (RR/MDR-TB) are likely underestimates. We determined long-term disease outcomes among a cohort of people treated for RR/MDR-TB. METHODS:We conducted a prospective cohort study among patients treated by the National TB Program (NTP) in 10 provinces of Vietnam. Individuals with confirmed RR/MDR-TB starting World Health Organization-recommended regimens were followed up for ≥32 months. After this period, we surveyed the cohort to measure vital status and subsequent TB episodes. Family members completed verbal autopsies for deceased participants. We calculated rates of mortality and TB re-occurrence, and standardized mortality ratio (SMR) using participants' household contacts as a reference population. RESULTS:Between March 2016 and July 2020, 1755 patients were enrolled, of whom we assessed 1364 (77.7%) at final follow-up. Median follow-up time was 4.3 years. Successful treatment outcomes were reported for 1357/1755 (77.3%) individuals. From enrollment until end of follow-up, 289 participants died (16.5%; mortality rate, 42.6/1000 person-years); overall SMR was 5.6 and post-treatment SMR was 3.0. Tuberculosis was the probable or confirmed cause of death in 96 deceased participants. Many (71/165; 43.0%) deaths occurring on-treatment were not reported to the NTP. The rate of subsequent TB episodes among all participants, regardless of treatment outcome, was 10.3/1000 person-years. CONCLUSIONS:RR/MDR-TB survivors have high risks of mortality and re-occurring TB. Programmatic reports underestimate the true mortality rate both during and after treatment. Interventions are urgently needed to strengthen programmatic follow-up, improve treatment outcomes, and monitor for TB recurrence.

We retrospectively surveyed patient experiences and acceptability of a 6-month levofloxacin multidrug-resistant tuberculosis preventive treatment regimen. While the regimen was broadly acceptable, most respondents would not take it again. https://bit.ly/3I3O4fl.

Background: In 2021, an estimated 450 000 incident people developed Rifampicin-resistant (RR) or multidrug-resistant (MDR)-TB (defined as resistance to both rifampicin and isoniazid) worldwide. Given that the commonly used rapid molecular diagnostic test, GeneXpert, only detect resistance, programmatic reporting groups MDR/RR-TB together. Household contacts (HHCs) of a patient with active MDR/RR-TB are at high risk for a TB infection (TBI) and disease, as they have a prolonged exposure to the index cases. This study aimed to establish the prevalence of TBI and factors associated with TB infection among HHCs. Methods: A cross-sectional survey was conducted among close contacts of patients with MDR/RR-TB, who participated in screening for TB infection, as a part of the VQUIN multidrug-resistant tuberculosis (MDR-TB) trial. TBI status was defined based upon a tuberculin skin test result (TST) of at least 10mm. Logistic regression was used to evaluate the relationship between the characteristics of HHCs or the index case, and HHCs with positive TST. The primary outcome was the prevalence of TBI amongst the HHCs, and the risk factors associated with TBI in this population. Results: 3823 HHCs of 1758 MDR/RR-TB index cases participated in screening. The prevalence of TB infection at baseline was 71.2%, comprising 2438 (63.8%) individuals with baseline positivity, and an additional 283 (7.4%) demonstrating TST conversion after 8-12 weeks. Factors associated with a positive TST in the multivariable model included, HHCs with older age groups had a higher prevalence of infection. Other factors associated with an increased prevalence of infection included: normal BMI (aOR = 1.33, 95% CI: 1.06-1.66), smoking history (aOR = 1.76, 95% CI: 1.39-2.23), a prior history of TB (aOR = 4.56, 95% CI: 2.49-8.35), the presence of a BCG scar (aOR = 1.23, 95% CI: 1.02-1.50 ), and more than eight hours spent each day on average over the previous three months with the index patient (aOR = 1.52, 95% CI: 1.28-1.81). Conclusion: This study identified that HHCs amongst the MDR/RR-TB patients had a high TBI prevalence and identified a number of risk factors of contracting TBI. Evidence for the effectiveness of preventive therapy to treat TB infection in MDR/RR-TB contacts is urgently needed.

BACKGROUND Prevention of drug-resistant tuberculosis is a global health priority. However, trials evaluating the effectiveness of treating Mycobacterium tuberculosis infection among contacts of persons with drug-resistant tuberculosis are lacking. METHODS We conducted a double-blind, randomized, controlled trial comparing 6 months of daily levofloxacin (weight-based doses) with placebo to treat M. tuberculosis infection. The trial population comprised household contacts of persons with bacteriologically confirmed rifampicin-resistant or multidrug-resistant (MDR) tuberculosis in Vietnam. Contacts of any age with a positive tuberculin skin test or immunologic impairment were eligible. The primary end point was bacteriologically confirmed tuberculosis within 30 months. Secondary end points included grade 3 or 4 adverse events, death from any cause, and acquired drug resistance. RESULTS Of 3948 persons screened for eligibility, 61 (1.5%) had coprevalent tuberculosis (defined as active tuberculosis disease diagnosed before randomization) and 2041 underwent randomization. Of these 2041 participants, 1995 (97.7%) completed 30 months of follow-up, had a primary end-point event, or died. Confirmed tuberculosis occurred in 6 participants (0.6%) in the levofloxacin group and 11 (1.1%) in the placebo group (incidence rate ratio, 0.55; 95% confidence interval [CI], 0.19 to 1.62); this difference was not significant. There was little difference in grade 3 or 4 adverse events between the two groups (risk difference, 1.0 percentage point; 95% CI, -0.3 to 2.4). Adverse events of any grade were reported in 306 participants (31.9%) taking levofloxacin and 125 (13.0%) taking placebo (risk difference, 18.9 percentage points; 95% CI, 14.2 to 23.6). No acquired fluoroquinolone resistance was observed. CONCLUSIONS Although the incidence of tuberculosis was lower in the levofloxacin group than in the placebo group at 30 months, the difference was not significant.

INTRODUCTION:Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem globally. Long, complex treatment regimens coupled with frequent adverse events have resulted in poor treatment adherence and patient outcomes. Smartphone-based mobile health (mHealth) technologies offer national TB programmes an appealing platform to improve patient care and management; however, clinical trial evidence to support their use is lacking. This trial will test the hypothesis that an mHealth intervention can improve treatment success among patients with MDR-TB and is cost-effective compared with standard practice. METHODS AND ANALYSIS:A community-based, open-label, parallel-group randomised controlled trial will be conducted among patients treated for MDR-TB in seven provinces of Vietnam. Patients commencing therapy for microbiologically confirmed rifampicin-resistant or multidrug-resistant tuberculosis within the past 30 days will be recruited to the study. Participants will be individually randomised to an intervention arm, comprising use of an mHealth application for treatment support, or a 'standard care' arm. In both arms, patients will be managed by the national TB programme according to current national treatment guidelines. The primary outcome measure of effectiveness will be the proportion of patients with treatment success (defined as treatment completion and/or bacteriological cure) after 24 months. A marginal Poisson regression model estimated via a generalised estimating equation will be used to test the effect of the intervention on treatment success. A prospective microcosting of the intervention and within-trial cost-effectiveness analysis will also be undertaken from a societal perspective. Cost-effectiveness will be presented as an incremental cost per patient successfully treated and an incremental cost per quality-adjusted life-year gained. ETHICS:Ethical approval for the study was granted by The University of Sydney Human Research Ethics Committee (2019/676). DISSEMINATION:Study findings will be disseminated to participants and published in peer-reviewed journals and conference proceedings. TRIAL REGISTRATION NUMBER:ACTRN12620000681954.

Fire is one of the most commonly occurring disasters and is the main cause of catastrophic personal injury and devastating property damage. An early detection system is necessary to prevent fires from spreading out of control. In this paper, we propose a multistage fire detection method using convolutional neural networks (CNNs) and long short-term memory (LSTM) networks. In the first stage, fire candidates are detected by using their salient features, such as their color, flickering frequency, and brightness. In the second stage, a pretrained CNN model is used to extract the 2D features of flames that are the input for the LSTM network. In the last stage, a softmax classifier is utilized to determine whether the flames represent a true fire or a nonfire moving object. The experimental results show that our proposed method can achieve competitive performance compared with other state-of-the-art methods and is suitable for real-world applications.

BACKGROUND:Tuberculosis (TB) continues to account for significant morbidity and mortality annually. Household contacts (HHCs) of persons with TB are a key population for targeting prevention and control interventions. We aimed to identify risk factors associated with developing TB among HHCs.METHODS:We conducted a nested case-control study among HHCs in 8 provinces in Vietnam enrolled in a randomized controlled trial of active case finding for TB. Cases were any HHCs diagnosed and registered with TB within the Vietnam National TB Program during 2 years of follow-up. Controls were selected by simple random sampling from the remaining HHCs. Risk factor data were collected at enrollment and during follow-up. A logistic regression model was developed to determine predictors of TB among HHCs.RESULTS:We selected 1254 HHCs for the analysis: 214 cases and 1040 controls. Underlying characteristics varied between both groups; cases were older, more likely to be male, with a higher proportion of reported previous TB and diabetes. Risk factors associated with a TB diagnosis included being male (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.03-2.0), residing in an urban setting (aOR, 1.8; 1.3-2.5), prior TB (aOR, 4.6; 2.5-8.7), history of diabetes (aOR, 3.1; 1.7-5.8), current smoking (aOR, 3.1; 2.2-4.4), and prolonged history of coughing in the index case at enrollment (OR , 1.6; 1.1-2.3).CONCLUSIONS:Household contacts remain an important key population for TB prevention and control. TB programs should ensure effective contact investigations are implemented for household contacts, particularly those with additional risk factors for developing TB.

interoperability.Standardized data management provides data and interface standard for medical information construction, realizes effective integration and data sharing of multi-source heterogeneous data, realizes integrated application, improves work efficiency and assists clinical diagnosis and treatment decision-making, and gradually promotes the strategic goal of intelligent hospital construction.

Background Patients completing treatment for tuberculosis (TB) in high-prevalence settings face a risk of developing recurrent disease. This has important consequences for public health, given its association with drug resistance and a poor prognosis. Previous research has implicated individual factors such as smoking, alcohol use, HIV, poor treatment adherence, and drug resistant disease as risk factors for recurrence. However, little is known about how these factors co-act to produce recurrent disease. Furthermore, perhaps factors related to the index disease means higher burden/low resource settings may be more prone to recurrent disease that could be preventable. Methods We conducted a case-control study nested within a cohort of consecutively enrolled adults who were being treated for smear positive pulmonary TB in 70 randomly selected district clinics in Vietnam. Cases were patients with recurrent TB, identified by follow-up from the parent cohort study. Controls were selected from the cohort by random sampling. Information on demographic, clinical and disease-related characteristics was obtained by interview. Treatment information was extracted from clinic registries. Logistic regression, with stepwise selection, was used to develop a fully adjusted model for the odds of recurrence of TB. Results We recruited 10,964 patients between October 2010 and July 2013. Median follow-up was 988 days. At the end of follow-up, 505 patients (4.7%) with recurrence were identified as cases and 630 other patients were randomly selected as controls. Predictors of recurrence included multidrug-resistant (MDR)-TB (adjusted odds ratio 79.6; 95% CI: 25.1-252.0), self-reported prior TB therapy (aOR=2.5; 95% CI: 1.7-3.5), and incomplete adherence (aOR=1.9; 95% CI 1.1-3.1). Conclusions Index disease treatment history is a leading determinant of relapse among patients with TB in Vietnam. Further research is required to identify interventions that will reduce the risk of recurrent disease and enhance its early detection within high-risk populations.

Background: Ensuring patients fully adhere to their treatment is a major challenge for TB control programmes in resource-limited settings. This study was conducted three outpatient tuberculosis clinics in Hanoi, Vietnam. We aimed to evaluate the feasibility of using asynchronous Video Directly Observed Therapy (VDOT) to support treatment adherence among patients with bacteriologically confirmed pulmonary tuberculosis. Methods: In this cohort study, consecutive adult patients with bacteriologically confirmed pulmonary TB were invited to enroll in a programme of VDOT. Patients were trained to use a smartphone to record themselves taking treatment for TB. Videos were uploaded to an online server and reviewed daily by study staff for at least two months. Adherence was evaluated based upon monthly pill count. Results: Between November 2016 and January 2017, 40 of 78 eligible participants (51.3%) agreed to commence VDOT. Among participating patients, 27 (71.1%) of patients took all required doses. A median of 88.4% (interquartile range 75.8%-93.7%) of doses were correctly recorded and uploaded. Participants rated the VDOT interface highly, despite facing some initial technical difficulties. Conclusion: VDOT was feasible and resulted in high rates of treatment adherence in a resource-limited setting. (C) 2017 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Drainage Group (DG). 63 patients (61.8%) formed the Medical Management Group (MMG). DG: Median (IQR) P:F ratio significantly increased from 185 (109) to 304 (123) and 260 (81) at 24 and 48 hours respectively (p<0.01). MMG: no change from baseline P:F ratio 269 (130) (Figure 1). No significant difference detected in adverse events between groups: DG 7/39 (17.9%), MMG 7/63 (11.1%), p=0.38, nor mortality (28.6% and 28.2%, p=0.89). Conclusion: Drainage of clinically significant pleural effusions safely improves oxygenation in critically ill patients. Further research to guide effusion management in ICU is required. Acknowledgement: EF and KH receive support from the WA Department of Health and YCGL from NHMRC.

Background: In Japan, recommended treatment durations are 6 or 9 months for patients with isoniazidand rifampin-susceptible tuberculosis (TB) and, following culture conversion, 18 months for patients with multidrug resistant TB (MDR-TB). However, Japan does not report nationwide data of treatment duration of MDR-TB. Aims: To examine treatment duration of MDR-TB patients registered in TB surveillance in Japan between 2011 and 2012. Methods: We analysed routinely collected data of newly notified MDR-TB patients from national TB surveillance system in Japan, in terms of treatment duration and co-morbidities. Treatment duration was calculated by subtracting the therapy start date from the therapy end date. Results: Between 2011 and 2012, a total of 147 MDR-TB patients were newly notified to TB surveillance. 85 (57.8%) had completed treatment at the end of 2015. Duration of treatment was calculated for 80 (94.1%) patients. Mean of treatment duration was 724 days. Median was 761 days and interquartile range was 563-859 days. Mean of treatment duration by age group 0-29, 30-39, 40-49, 50-59, 60-69, 70+ was 663 days, 803 days, 813 days, 831 days, 747 days and 601 days, respectively. Mean of treatment duration by male and female was 737 days and 701 days. Mean of treatment duration by diabetes and nondiabetes was 837 days and 709 days. There were no HIV-positive patients. Conclusions: On average, the treatment duration of MDR-TB patients in Japan exceeded 24 months, and of those with DM was 28 months. The treatment duration was the longest among those aged 50-59. Further clinical study may be necessary to investigate the possible risk factors for prolonged treatment.