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Credit: CC0 Public Domain For centuries, we have known that tuberculosis is a social disease. It thrives on poverty and social factors such as malnutrition, poor housing, overcrowding, unsafe work environments and stigma. Globally in 2021 an estimated 2.2 million cases of TB were attributable to undernourishment, 0.86 million to HIV infection, 0.74 million to alcohol use disorders, 0.69 million to smoking and 0.37 million to diabetes. But knowledge about social determinants alone does not always translate into tangible action and progress. A new trial in India, called RATIONS, aimed to determine the effect of nutritional supplementation on new cases of tuberculosis in households of adults with pulmonary TB. The research found that providing food baskets to people with TB and their households could go a long way to prevent and mitigate the disease. No easy silver bullets The TB community has typically looked for biomedical solutions, or “silver bullets”, for a social pathology, and we are struggling to make progress. Since the COVID pandemic, TB mortality and incidence have increased globally, putting TB back on top as the single most deadly infectious killer of humankind. In 2021, 1.6 million people died of TB. In Africa, TB incidence is high (212 per 100,000 population) with a high case fatality rate because of the HIV epidemic. Undernutrition is the most important cause of TB. This has been shown in studies in many countries, including South Africa, where researchers found poor levels of nutrition in patients admitted to a specialized TB hospital. Malnutrition refers to all forms of deficiencies in nutrition, including over-nutrition and obesity. Undernutrition refers more specifically to a deficiency of nutrients. While we know that many patients with TB have poor nutrition, the latest evidence is that undernutrition also plays a key role in TB within households. The results of the Reducing Activation of Tuberculosis by Improvement of Nutritional Status (RATIONS) trial show that improved nutrition in family members of patients with lung TB reduced all forms of TB by nearly 40%, and infectious TB by nearly 50%. This trial recruited 10,345 household members of 2,800 patients with lung TB. All TB patients received a monthly 10kg food basket (rice, pulses, milk powder, oil) and multivitamins for six months. In one group family members received 5kg rice and 1.5kg pulses per person per month, while the other group of family members did not get food baskets. Food worked like a vaccine in this trial, cutting the risk of household members developing TB. Nutrition could also protect against other conditions such as anemia, diarrhea and respiratory infections, but these were not not the main focus of the trial. An accompanying paper, based on the results of the RATIONS trial, showed that severe undernutrition was present in nearly half of all patients. An early weight gain in the first two months was associated with 60% lower risk of TB mortality. The other benefits were higher treatment success and better weight gain. During the six-month follow-up period, a remarkable treatment success rate of 94% was achieved. Getting food to patients How expensive was the intervention? The cost of a food basket was US$13 per TB patient per month and US$4 per household member per month and could be delivered, even in rural areas, using field staff. Even before the RATIONS trial, the Indian government had recognized the need for nutrition support for people with TB, and in 2018 launched “Nikshay Poshan Yojana”, a direct benefit transfer scheme. Under this scheme, each TB patient receives a financial incentive of US$6 per month for the duration of the anti-TB treatment (typically, six months for people with drug-sensitive TB). Emerging data suggests that while the scheme improves the treatment completion rates among patients with TB in India, they often receive their payments late. There is a need to improve the efficiency and provide timely payments. The new RATIONS trial suggests that directly providing food baskets may be another effective strategy. Many countries, including India, have other social security programs, including public distribution systems to provide food grains at subsidized prices. Using existing channels to provide extra food rations to people with TB, and expanding the menu to include proteins such as pulses and millets, is a strategy worth exploring. This could also have positive effects on other diseases such as diabetes. Implications for South Africa South Africa is one of the countries labeled by the World Health Organization as a “high TB burden country”. What does this latest research mean for South Africa? Statistics South Africa reported that in 2021 2.6 million people had inadequate access to food and a further 1.1 million stated they had “severe” inadequate access to food. More than 683,000 children five years and younger experienced hunger. This toxic mix requires prevention of TB by nutritional support, drugs to prevent TB infections and early diagnosis with molecular tests and treatment. With high levels of food insecurity and undernutrition in South Africa, fueled by the highest levels of inequality, it is critical that South Africa includes social benefits for people with TB and those in their households to reduce the prevalence of TB in the country and to meet the Sustainable Development Goals for 2030. Regardless of how social benefits are distributed, action must be based on evidence. We need better tests, cures and vaccines for TB, but they alone cannot end the epidemic. TB patients must be provided with the social benefits that they need and deserve, as a basic human right. Provided by The Conversation This article is republished from The Conversation under a Creative Commons license. Read the original article. Citation: TB research shows a good diet can cut infections by nearly 50% (2023, August 28) retrieved 28 August 2023 from https://medicalxpress.com/news/2023-08-tb-good-diet-infections.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

AMSTERDAM: According to European Society of Cardiology (ESC) Guidelines on Infective Endocarditis, patients with specific cardiac conditions, such as valvular heart disease and congenital abnormalities, or those needing pacemakers, should practice good dental and skin hygiene to help prevent uncommon but potentially fatal infections of the heart’s inner lining and valves.The findings were published in European Heart Journal.“Infective endocarditis is an uncommon but very serious disease that can present with many different symptoms, and thus may be challenging to diagnose,” said Guidelines task force chairperson Professor Michael Borger of Leipzig Heart Centre, Germany. “Patient education is therefore paramount to early diagnosis and treatment. Those with valvular heart disease or previous heart valve surgery should be particularly diligent with regards to prevention and recognizing symptoms.”An infection of the heart’s inner lining, most usually the heart valves, is referred to as infectious endocarditis. It happens when germs or fungus enter the bloodstream, such as after surgery, dental work, or skin diseases. Fever, night sweats, unexpected weight loss, cough, disorientation, and fainting are among the symptoms. The infection may result in the valve being destroyed, abscesses, and cell and microbe clusters that can fragment into smaller pieces and spread to other regions of the body (a process known as embolization). Also possible are heart failure, septic shock, and stroke.Worldwide each year there are nearly 14 new cases of infective endocarditis for every 100,000 individuals and more than 66,000 patients die. “The mortality rate is extremely high and therefore preventive strategies in patients at high risk are pivotal,” said Guidelines task force chairperson Dr. Victoria Delgado of the Germans Trias i Pujol University Hospital, Badalona, Spain.Those at highest risk include survivors of previous episodes of infective endocarditis and patients with prosthetic heart valves, congenital heart disease (not including isolated congenital heart valve abnormalities) or a left ventricular assist device. In these patients, prophylactic antibiotics are recommended before oral or dental procedures. Patients at intermediate risk are those with pacemakers, severe valvular heart disease, congenital heart valve abnormalities (including bicuspid aortic valve) and hypertrophic cardiomyopathy, a disease where the heart muscle is thickened. In these patients, the need for antibiotic prophylaxis prior to dental procedures should be evaluated on an individual basis. Antibiotic prophylaxis is not needed in those at low risk.The main targets for antibiotic prophylaxis are oral streptococci. The document states that “the emerging and increasing antibiotic resistance among oral streptococci is of concern”. Dr. Delgado said: “Streptococci are naturally present in the mouth but can enter the bloodstream when oral hygiene is suboptimal and during dental procedures. Rises in antibiotic use for infectious diseases have led to resistance, meaning that antibiotics become ineffective. Caution in the use of antibiotics is therefore needed and self-medication should be avoided.”The Guidelines recommend other preventive measures for patients at intermediate and high risk including twice daily tooth cleaning, professional dental cleaning (twice yearly for high risk and yearly for intermediate risk patients), consulting a general practitioner for fever with no obvious reason, strict skin hygiene, treatment of chronic skin conditions, and disinfection of wounds. Piercings and tattoos are discouraged.Recommendations are provided for diagnosis, treatment, and management of complications. Diagnosis is based on clinical suspicion, blood cultures, and imaging. Echocardiography is the first-line imaging technique, and new diagnostic criteria include findings on other imaging techniques. There are new recommendations on the use of computed tomography, nuclear imaging and magnetic resonance imaging plus novel diagnostic algorithms when the infection involves native heart valves, prosthetic heart valves, and implanted cardiac devices such as pacemakers and defibrillators.Treatment aims to cure the infection and preserve heart valve function. The Guidelines recommend appropriate antibiotics, determined from blood cultures, as the mainstay of therapy, with duration depending on the severity of infection. Surgery to remove infected material and drain abscesses is indicated for patients with heart failure or uncontrolled infection, and to prevent embolisation. Surgery should generally occur earlier than previously recommended because of improved survival.One of the worst complications of endocarditis is stroke. Decisions about the timing of surgery in patients who have suffered a stroke must balance the risk of neurological deterioration during the procedure against that of delaying surgical therapy. Novel recommendations are to proceed with urgent heart valve surgery in patients with ischaemic stroke due to embolism but delay surgery in patients with haemorrhagic stroke. In addition, thrombectomy (removal of the embolus through a catheter) may be considered in very select patients with stroke.A new section in the Guidelines is devoted to patient-centred care and shared decision-making. Professor Borger said: “Infective endocarditis is a life-threatening condition with lengthy treatment and can be emotionally distressing for patients and families. Patients must be at the centre of care to achieve the best physical and mental outcomes.”

KARACHI: The metropolis has witnessed a surge in viral eye infections during the ongoing rainy season, with dozens of cases being reported on a daily basis. Public and private hospitals across the city have been grappling with the mounting cases of conjunctivitis, commonly known as red eye. Jinnah Hospital, a prominent medical facility in the city, has recorded 50 instances in its Outpatient Department (OPD) each day. Of these, 25 cases pertain specifically to the red eye infection, afflicting both children and adults alike. Leading Consultant Ophthalmologist, Dr Muhammad Moizuddin, has attributed this sudden surge to the transmission of the infection through direct contact with the ocular discharge of affected individuals. The infection, known to linger for a period of 8 to 10 days, manifests with a reddening of the eye, accompanied by moisture and discomfort. Dr Moizuddin advises the affected individuals to maintain strict hygiene practices, including separating their personal items such as towels and toiletries. In the midst of this growing concern, the afflicted are advised to employ prescribed eye drops and clean tissues for the cleansing of their eyes. Cold water, it is noted, brings relief to the affected eyes, offering a temporary reprieve from the discomfort. The consensus remains that adherence to cautionary measures and impeccable cleanliness are pivotal in stemming the transmission of this highly contagious eye infection. Detailing the symptoms of conjunctivitis, Dr Rabia Chaudhry, Assistant Ophthalmologist at Jinnah Hospital Karachi, emphasised the emergence of redness, itching, and inflammation of the eyes. She further noted the formation of lumps near the ears and, in some instances, the involvement of the cornea, potentially affecting the visual acuity of the individual. Read also: Treatment of genetic diseases stressed While a swift recovery is anticipated if the infection confines itself to the white part of the eye, instances where the cornea is compromised demand a longer healing timeline, spanning two to three weeks. Dr Chaudhry highlighted the significance of precautionary measures, given the infection’s propensity for person-to-person transmission. Unlike common misconception, she asserts that the infection isn’t contracted through mere eye contact; rather, it is facilitated by direct exposure to the infected individual’s ocular fluids. Notably, many cases have shown a co-occurrence of red eye with cold, flu, and cough symptoms. Dr Chaudhry further imparted crucial advice on how to mitigate the risk of transmission within households and workplaces. By maintaining personal hygiene and avoiding shared items, individuals can considerably reduce the chances of spreading the infection. Proper hand washing before administering eye drops, coupled with careful application, forms a vital line of defence. The sting of light often accompanies the infection, for which sunglasses and cold compresses can provide respite. Children have not been spared by this contagion; therefore special attention is urged to their well-being.

COVID-19 was never just another cold. We knew it was going to stick around and keep changing to try to get the upper hand on our immune systems.Related video above: New EG.5 COVID-19 variant spikes in parts of the U.S.But we’ve changed, too. Our B cells and T cells, keepers of our immune memories, aren’t as blind to this virus as they were when we first encountered the novel coronavirus in 2020. The U.S. Centers for Disease Control and Prevention has screened blood samples and estimates that 97% of people in the U.S. have some immunity to COVID-19 through vaccination, infection or both.Then there’s science: We have updated vaccines and good antivirals to lean on when cases start to rise. Masks still work. Rapid tests are in stores. We now know how to filter the air and to ventilate our spaces.Those strategies, plus our hard-won immunity, had helped bring our national numbers of infections, hospitalizations and deaths down to levels that felt almost forgettable.Almost.Now that COVID-19 infections have started to rise again, it feels like people all over the country are testing positive, and it’s hard to know how to react. The government has been dialing back its response since the end of the public health emergency in May. Good COVID-19 data is hard to come by and harder to interpret.So if people are less likely to be hospitalized or die from a COVID-19 infection now, has the danger passed? Is there still reason to worry if you do catch the infection for a second, third or fourth time?Experts say it’s less risky to catch COVID-19 than it used to be, but there are still good reasons not to treat it casually.”At this point, the risk is lower because of our prior immunity, whether for severe outcomes or for long COVID,” said Dr. Megan Ranney, an emergency physician and dean of the Yale School of Public Health.”COVID is still more dangerous than the flu, but its level of danger is becoming less,” she said, noting that we’re still very early in our human experience with the coronavirus, even four years in, and there are still things we don’t know.”But for it to behave like other respiratory viruses in terms of seasonality and surges is entirely expected,” she added.It would be “really weird” for COVID to disappear or for it not to cause illnesses, hospitalizations and deaths. “It is still a virus,” Ranney said.But a somewhat predictable waxing and waning of infections doesn’t make COVID-19 something to turn our backs on.Our immune systems are better at spotting dangerAfter more than three grueling years, nearly all Americans have some immunity against COVID-19.That means our immune systems – as long as they’re healthy and working as they should – will remember most forms of the coronavirus when it next comes our way.That process takes some time to get going, however. That lag may give the virus enough of a window to get a foothold in our nasal passages or lungs, and we get sick. We may feel crummy for a few days, but then our B cells and T cells get their antibody production up and running. Eventually, they shut the virus down, and we get better.That’s what should happen. But for many, their immune system just doesn’t kick in as quickly or as vigorously as it should.Immune function drops off naturally with age. About 1 in 4 Americans is over the age of 60, according to census data. Then there are certain medications and health conditions that suppress immune function. About 3% of the U.S. population – 7 million people – is severely immunocompromised, according to the National Institutes of Health. This is a group taking medications to protect organ transplants or who are getting powerful drugs for cancer treatment, for example.Then there’s individual variability. Through genetic bad luck, some people may just be at higher risk of serious reactions to COVID-19 infections, and they probably wouldn’t know it.Taken together, that’s a sizeable pool of people who benefit greatly from having antibodies at the ready to take on the coronavirus as fast as possible. Vaccines get those antibodies in place and ready to work as soon as they’re needed.Sometimes, people are so immunocompromised that vaccines can’t help them much, either. They benefit from preventive shots containing COVID-fighting antibodies that are built to stick around the body for a few months. Until this year, there was such a preventive product available, Evusheld. But the virus has evolved so much that Evusheld lost its potency, and in January, the FDA revoked its authorization.Since then, people who have very low immune function haven’t had anything to protect them from infection or severe disease. But that could change. The government announced this week that it’s funding the development of a new preventive antibody through the drug company Regeneron. Trials of that drug are expected to start this fall, according to the U.S. Department of Health and Human Services.While nearly all of us have immune systems that can recognize key parts of the virus now, even that memory to the infection fades over time. The longer it has been since you’ve been infected or vaccinated, the more forgetful your immune system becomes.Those B cells and T cells, “they’re going to be a little slower to respond. They’re not they’re not as primed and ready to go,” Ranney said.Your strongest immunity will be in the two weeks to two months after you get your vaccines. That means it’s smart to try to get your shots shortly before COVID is expected to be on the upswing. Just like for flu, experts expect the worst of COVID to hit in the fall and winter.CDC Director Dr. Mandy Cohen said that even though cases are going up now, most people will be better off waiting a few weeks to get the newly updated COVID-19 vaccines rather than trying to get one of the older bivalent vaccines right now. But this is dependent on personal risk, so if you’re concerned, talk