Sumona Datta

Background Throughout recorded history, tuberculosis is believed to have killed more people than any other infectious disease. Despite the World Health Organization’s determination that preventing and controlling tuberculosis will require understanding and reducing tuberculosis stigma, we noted strikingly diverse definitions and lack of consensus in describing tuberculosis stigma. Furthermore, we found no systematic reviews in the existing tuberculosis stigma literature characterizing, comparing, or assessing tuberculosis stigma definitions or their consistency. To address this knowledge gap, we intend to conduct a systematic review of existing tuberculosis stigma definitions used in the academic research literature, and through quantitative synthesis of the words and phrases contained within those definitions, identify themes that characterize tuberculosis stigma. Methods Studies containing definitions of tuberculosis stigma will be identified by searching two electronic databases -- PubMed and PsycINFO – using the Medical Subject Heading (MeSH) terms “stigma[MeSH Major Topic] AND tuberculosis[MeSH Major Topic]”. Study inclusion criteria will consist of: a) original research published in English, (due to logistical constraints); b) qualitative studies using semi-structured interviews and focus group discussions; c) quantitative studies including descriptive studies and trials, questionnaires, and cross-sectional surveys; and d) mixed method studies. Included studies will be searched for definitions of tuberculosis stigma using the search term “defin”. Descriptive words and phrases will be extracted from definitions and categorized into themes, based on noun, verb, adjective, and adverb derivatives; and synonym definitions. Predominant themes will then be identified and further categorized as emotion, thought, or behaviour themes. Relative frequencies of definitions, and definition words and phrases, will be compared quantitatively. Conclusions This systematic review and thematic analysis is intended to characterize academic definitions of tuberculosis stigma and identify predominant tuberculosis stigma themes contained within those definitions. Registration PROSPERO (CRD42023440978; 23 July 2023).

Background Throughout recorded history, tuberculosis is believed to have killed more people than any other infectious disease. Despite the World Health Organization’s determination that preventing and controlling tuberculosis will require understanding and reducing tuberculosis stigma, we noted strikingly diverse definitions and lack of consensus in describing tuberculosis stigma. Furthermore, we found no systematic reviews in the existing tuberculosis stigma literature characterizing, comparing, or assessing tuberculosis stigma definitions or their consistency. To address this knowledge gap, we intend to conduct a systematic review of existing tuberculosis stigma definitions used in the academic research literature, and through quantitative synthesis of the words and phrases contained within those definitions, identify themes that characterize tuberculosis stigma. Methods Studies containing definitions of tuberculosis stigma will be identified by searching two electronic databases -- PubMed and PsycINFO – using the Medical Subject Heading (MeSH) terms “stigma[MeSH Major Topic] AND tuberculosis[MeSH Major Topic]”. Study inclusion criteria will consist of: a) original research published in English, (due to logistical constraints); b) qualitative studies using semi-structured interviews and focus group discussions; c) quantitative studies including descriptive studies and trials, questionnaires, and cross-sectional surveys; and d) mixed method studies. Included studies will be searched for definitions of tuberculosis stigma using the search term “defin”. Descriptive words and phrases will be extracted from definitions and categorized into themes, based on noun, verb, adjective, and adverb derivatives; and synonym definitions. Predominant themes will then be identified and further categorized as emotion, thought, or behaviour themes. Relative frequencies of definitions, and definition words and phrases, will be compared quantitively. Conclusions This systematic review and thematic analysis is intended to characterize academic definitions of tuberculosis stigma and identify predominant tuberculosis stigma themes contained within those definitions. Registration PROSPERO (CRD42023440978; 23 July 2023).

Background: Some sputum smear microscopy protocols recommend placing filter paper over sputum smears during staining for Mycobacterium tuberculosis (TB). We found no published evidence assessing whether this is beneficial. We aimed to evaluate the effect of filter paper on sputum smear microscopy results. Methods: Sputum samples were collected from 30 patients with confirmed pulmonary TB and 4 healthy control participants. From each sputum sample, six smears (204 smears in total) were prepared for staining with Ziehl-Neelsen (ZN), auramine or viability staining with fluorescein diacetate (FDA). Half of the slides subjected to each staining protocol were randomly selected to have Whatman grade 3 filter paper placed over the dried smears prior to stain application and removed prior to stain washing. The counts of acid-fast bacilli (AFB) and precipitates per 100 high-power microscopy fields of view, and the proportion of smear that appeared to have been washed away were recorded. Statistical analysis used a linear regression model adjusted by staining technique with a random effects term to correct for between-sample variability. Results: The inclusion of filter paper in the staining protocol significantly decreased microscopy positivity independent of staining with ZN, auramine or FDA (p=0.01). Consistent with this finding, there were lower smear grades in slides stained using filter paper versus without (p=0.04), and filter paper use reduced AFB counts by 0.28 logarithms (95% confidence intervals, CI=0.018, 0.54, p=0.04) independent of staining technique. In all analyses, auramine was consistently more sensitive with higher AFB counts versus ZN (p=0.001), whereas FDA had lower sensitivity and lower AFB counts (p<0.0001). Filter paper use was not associated with the presence of any precipitate (p=0.5) or the probability of any smear washing away (p=0.6) during the staining process. Conclusions: Filter paper reduced the sensitivity of AFB microscopy and had no detectable beneficial effects so is not recommended.

Background: Peru followed strict quarantine measures to control COVID-19 but reported excess mortality rates during the pandemic that were the highest globally. High obesity prevalence in Peru may have contributed to COVID-19 mortality, although economic hardship during the pandemic could have reduced obesity. To investigate these potential associations, we updated surveys of economic status, nutritional status, and risk factors for severe COVID-19 in residents of Callao, in the Lima metropolitan area of Peru. Methods: We attempted in December 2021 to invite members of households selected randomly from a map that had provided data in previous surveys 2016-2018 and 2019-2020 to participate in another survey. Households were contacted by telephone and, if uncontactable, were visited. Demographic, economic, and health-related data were collected using the Kobo toolbox platform. Results. We interviewed 83% (305/369) of censused household members for 65% (90/138) of previously participating households. Dissaving activities were reported by all households during the pandemic, more than 2016-2018 (51%, 95% confidence interval, CI=41-62%) and 2019-2020 (44%, 95%CI=33-53%, both p<0.0001). Moreover, 90% (81/90, 95%CI=82-95%) of households reported inability to afford sufficient food and hunger rates increased 1.4 times compared with 2016-2018 (95%CI=1.02, 2.0, p=0.04). Despite financial and food insecurity during the pandemic, the mean adult body mass index was maintained unchanged from the 2019-2020 survey at 27 kg/m2 (standard deviation, SD=4.5 kg/m2), having increased (p=0.0001) from 26 kg/m2 (SD=4.1 kg/m2) in 2016-2018. Overweight/obesity was the most common risk factor for severe COVID-19, and adults were 3.1 times (95%CI=2.3-4.2, p<0.0001) more likely to be overweight/obese than they were to have a co-morbid illness. There was considerable dietary diversity and only 23% of participants had taken micronutrient supplements and 11% probiotics in the past year. Conclusion: Obesity was the most prevalent risk factor for severe COVID-19 despite economic pressure, food insecurity, and hunger during the pandemic.

Background: COVID-19 variants threaten health globally. Despite improving vaccines and treatments, there is an urgent need for alternative strategies to prevent or reduce the severity of COVID-19. Potential strategies include probiotics, which are safe, inexpensive, globally available and have been studied previously in relation to respiratory infections. Methods: We performed a systematic review and meta-analyses of experimental, trial or observational research evidence evaluating probiotics compared with control groups for preventing or treating COVID-19. We searched PubMed, ProQuest, Google Scholar and Web of Science bibliographic databases for studies published until December 6, 2021. We then performed meta-analyses for outcomes reported consistently across studies. Outcomes reported inconsistently or not amenable to meta-analysis were compared descriptively. Results: We identified six eligible studies, which were all published in 2020 and 2021: one randomized controlled trial and five retrospective cohort studies. The only randomized controlled trial reported that groups that ingested probiotics compared with control groups that did not ingest probiotics did not differ significantly with respect to death, severe disease requiring admission to an intensive care unit or disease progression (all p>0.5). The five retrospective cohort studies reported various apparently beneficial and harmful COVID-19 outcome associations with probiotic ingestion. Meta-analyses revealed no significant associations between probiotic use and death, severe disease, or disease progression caused by COVID-19. Descriptive data revealed that probiotic ingestion was associated with a trend towards worsened duration of hospital stay, improvements in measures of respiratory condition and worsened disease duration. The evidence for these contradictory associations was weak because all studies were prone to bias and none were considered to be of high quality. Conclusions: Current evidence does not suggest that probiotics affect COVID-19 severity or mortality. However, additional higher quality studies need to be conducted to definitively determine if probiotics would be a useful adjunctive treatment for COVID-19.

Background : People with tuberculosis disease and their household members may suffer direct out-of-pocket expenses and indirect costs of lost income. These tuberculosis-related costs can worsen poverty, make tuberculosis treatment completion unaffordable, impair quality of life and increase the risk of death. Costs due to tuberculosis are usually defined as catastrophic if they exceed 20% of the pre-disease annual household income. The World Health Organisation strategy to “End TB” and the United Nations Sustainable Development Goals include the target that no households should face catastrophic costs due to tuberculosis. However, there is limited evidence and policy concerning how this global priority of eliminating catastrophic costs due to tuberculosis should be achieved. This systematic review and meta-analysis aims to address this knowledge gap. Methods : Publications assessing interventions that aimed to eliminate catastrophic costs will be identified by searching three electronic databases (PubMed, Scopus and Web of Science) together with reference lists from pertinent publications. We will screen eligible studies, extract data, and assess the risk of bias with the quality assessment tool from the National Heart, Lung, and Blood Institute. Discrepancies will be resolved by discussion between the reviewers. If we find sufficient comparable studies quantifying strategies to eliminate catastrophic costs then a meta-analysis will be performed. This systematic review and meta-analysis is registered with the PROSPERO database (CRD42022292410). Conclusion : This systematic review and meta-analysis aims to rigorously assess the evidence for strategies to eliminate catastrophic costs due to tuberculosis.

Background: The World Health Organization strategy to “End TB” by 2030 includes the milestone of no affected households facing catastrophic costs due to tuberculosis (TB). Costs due to TB are usually defined as catastrophic if they exceed 20% of the pre-disease annual household income. Several countries have conducted national TB cost surveys but strategies to quantify and eliminate catastrophic costs are incompletely defined. Methods: Publications related to strategies to quantify and eliminate catastrophic costs will be identified by searching three electronic databases (PubMed - Medline, Scopus and Web of Science) together with reference lists from pertinent publications. We will screen eligible studies, extract data, and assess the risk of bias with the quality assessment tool from the National Heart, Lung, and Blood Institute. Discrepancies will be resolved by discussion between the reviewers. If we find sufficient comparable studies quantifying strategies to eliminate catastrophic costs then a meta-analysis will be performed. This systematic review and meta-analysis is registered with the PROSPERO database (CRD42022292410). Conclusion: This systematic review and meta-analysis aims to rigorously assess the evidence for strategies to quantify or eliminate catastrophic costs due to TB.