Conference Material > Poster
Simon M, Seignoux J, Fadumiyo A, Muderhwa Y
MSF Paediatric Days 2022. 2022 November 30; DOI:10.57740/186d-3m61
Conference Material > Video (talk)
Masri S
MSF Scientific Days International 2020: Innovation. 2020 May 14
Conference Material > Abstract
Gouillou M
Epicentre Scientific Day 2024. 2024 May 23
BACKGROUND
endTB is a Phase 3, randomized, controlled, non-inferiority trial, comparing five 9-month experimental regimens consisting of 4-5 drugs (including bedaquiline, delamanid, clofazimine, linezolid, fluoroquinolones, and pyrazinamide) to the standard of care for rifampicin-resistant, fluoroquinolone-susceptible tuberculosis. Three experimental regimens (endTB1, endTB2, endTB3) were non-inferior to the control in the primary analysis. This analysis explores the efficacy results of the endTB clinical trial in key subgroups (HIV positive, low BMI, diabetes, severe disease) to help clinicians to make the choice between these three regimens for patients with a more difficult to treat form of disease.
METHODS
For each subgroup, proportion of favourable outcome at Week 73 was calculated in each arm. Risk differences and 95% confidence intervals were estimated in the modified intention-to-treat population (mITT), which included all randomized participants who took at least one dose of study treatment and had a positive pre-randomization tuberculosis culture. Results in each arm were plotted on forest plots.
RESULTS
In HIV-infected patients, efficacy results are consistent with the overall results in endTB1 and endTB2 while in endTB3 the effect of trt favours the control arm. No differences from the overall population were observed in any of the 3 arms in patients with a more severe disease, while treatment effect in patients with low BMI, favours the control arm in all 3 arms. Treatment effect in patients with diabetes, favours the experimental arm in all 3 arms.
CONCLUSION
All 3 arms could reasonably be used in patients with severe disease or diabetes. endTB1 and endTB2 appeared to be particularly efficacious in HIV positive patients. Longer or regimens with more drugs may achieve better results in patients with low BMI. Additional research is needed to confirm these findings.
endTB is a Phase 3, randomized, controlled, non-inferiority trial, comparing five 9-month experimental regimens consisting of 4-5 drugs (including bedaquiline, delamanid, clofazimine, linezolid, fluoroquinolones, and pyrazinamide) to the standard of care for rifampicin-resistant, fluoroquinolone-susceptible tuberculosis. Three experimental regimens (endTB1, endTB2, endTB3) were non-inferior to the control in the primary analysis. This analysis explores the efficacy results of the endTB clinical trial in key subgroups (HIV positive, low BMI, diabetes, severe disease) to help clinicians to make the choice between these three regimens for patients with a more difficult to treat form of disease.
METHODS
For each subgroup, proportion of favourable outcome at Week 73 was calculated in each arm. Risk differences and 95% confidence intervals were estimated in the modified intention-to-treat population (mITT), which included all randomized participants who took at least one dose of study treatment and had a positive pre-randomization tuberculosis culture. Results in each arm were plotted on forest plots.
RESULTS
In HIV-infected patients, efficacy results are consistent with the overall results in endTB1 and endTB2 while in endTB3 the effect of trt favours the control arm. No differences from the overall population were observed in any of the 3 arms in patients with a more severe disease, while treatment effect in patients with low BMI, favours the control arm in all 3 arms. Treatment effect in patients with diabetes, favours the experimental arm in all 3 arms.
CONCLUSION
All 3 arms could reasonably be used in patients with severe disease or diabetes. endTB1 and endTB2 appeared to be particularly efficacious in HIV positive patients. Longer or regimens with more drugs may achieve better results in patients with low BMI. Additional research is needed to confirm these findings.
Journal Article > LetterFull Text
Lancet Diabetes Endocrinol. 2022 February 7; Volume S2213-8587 (Issue 22); 00036-5.; DOI:10.1016/S2213-8587(22)00036-5
Kehlenbrink S, Mahboob O, Al-Zubi S, Boulle P, Aebischer-Perone S, et al.
Lancet Diabetes Endocrinol. 2022 February 7; Volume S2213-8587 (Issue 22); 00036-5.; DOI:10.1016/S2213-8587(22)00036-5
Journal Article > ResearchFull Text
BMC Complement Altern Med. 2016 August 17; Volume 16 (Issue 1); DOI:10.1186/s12906-016-1264-0
Bairy S, Kumar AMV, Raju MSN, Achanta S, Naik B, et al.
BMC Complement Altern Med. 2016 August 17; Volume 16 (Issue 1); DOI:10.1186/s12906-016-1264-0
With an estimated 65 million Diabetes Mellitus (DM) patients, India ranks second in the world in terms of DM burden. The emphasis of current medical practice has been on pharmacotherapy but, despite the best combination therapies, acheiving glycaemic control (reduction of blood sugar to desirable levels) is a challenge. 'Integrated Naturopathy and Yoga'(INY) is an alternative system of medicine that lays emphasis on the role of diet and physical exercise. We assessed the short term effect of INY as an adjunct to pharmacotherapy on glycaemic control among type 2 DM patients.
Journal Article > EditorialFull Text
Public Health Action. 2013 November 4; Volume 3 (Issue Suppl 1); S1-S2.; DOI:10.5588/pha.13.0039
Satyanarayana S, Kumar AMV, Wilson N, Kapur A, Harries AD, et al.
Public Health Action. 2013 November 4; Volume 3 (Issue Suppl 1); S1-S2.; DOI:10.5588/pha.13.0039
Conference Material > Poster
Barber MJ, Gotham D, Bygrave H, Cepuch C
MSF Scientific Day International 2024. 2024 May 16; DOI:10.57740/icqWaSzfB1
Journal Article > CommentaryAbstract Only
Endocrinology and Metabolism Clinics
ENDOCRINOL METAB CLIN NORTH AM
Endocrinol Metab Clin North Am. 2023 June 18; Volume 52 (Issue 4); 603-615.; DOI:10.1016/j.ecl.2023.05.010
Kehlenbrink S, Jobanputra K, Reddy A, Boulle P, Gomber A, et al.
Endocrinology and Metabolism Clinics
ENDOCRINOL METAB CLIN NORTH AM
Endocrinol Metab Clin North Am. 2023 June 18; Volume 52 (Issue 4); 603-615.; DOI:10.1016/j.ecl.2023.05.010
Despite the increasing prevalence of diabetes in populations experiencing humanitarian crisis, along with evidence that people living with diabetes are at higher risk for poor outcomes in a crisis, diabetes care is not routinely included in humanitarian health interventions. We here describe 4 factors that have contributed to the inequities and lack of diabetes inclusion in humanitarian programmes: (1) evolving paradigms in humanitarian health care, (2) complexities of diabetes service provision in humanitarian settings, (3) social and cultural challenges, and (4) lack of financing. We also outline opportunities and possible interventions to address these challenges and improve diabetes care among crisis-affected populations.
Other > Pre-Print
Sci Rep. 2024 March 8; DOI:10.21203/rs.3.rs-3967595/v1
Bulti AB, Dumicho AY, Shigayeva A, van Cutsem G, Steele SJ, et al.
Sci Rep. 2024 March 8; DOI:10.21203/rs.3.rs-3967595/v1
BACKGROUND
Tuberculosis (TB) among hospitalized patients is underdiagnosed. This study assessed systematic TB-screening, followed by an enhanced TB-diagnostic package for hospitalized patients implemented by trained lay health workers in KwaZulu-Natal, South Africa.
METHODS
In this before-and-after study we included patients ≥ 18 years. The intervention consisted of systematic clinical screening for TB, HIV and diabetes mellitus by lay health workers and provision of an enhanced TB-diagnostic package including sputum Xpert MTB/Rif Ultra, urine lateral-flow lipoarabinomannan assay (LF-LAM), chest x-ray, and sputum culture. We compared TB case findings with people hospitalized one year preceding the intervention.
RESULTS
In the pre-intervention phase, 5217 people were hospitalized. Among 4913 (94.2%) people not on TB treatment, 367 (7.5%) were diagnosed with TB. In the intervention phase, 4015 eligible people were hospitalized. Among 3734 (93.0%) people not on TB treatment, 560 (15.0%) were diagnosed with TB. The proportion of patients diagnosed with TB was higher in the intervention phase (15.0% vs. 7.5%, p < 0.001). Overall in-hospital mortality was lower in the intervention phase [166/3734(4.5%) vs. 336/4913(6.8%), p < 0.001].
CONCLUSION
Lay health worker-led implementation of systematic TB-screening, coupled with provision of an enhanced TB-diagnostic package significantly improved TB case detection and mortality among hospitalized adults.
Tuberculosis (TB) among hospitalized patients is underdiagnosed. This study assessed systematic TB-screening, followed by an enhanced TB-diagnostic package for hospitalized patients implemented by trained lay health workers in KwaZulu-Natal, South Africa.
METHODS
In this before-and-after study we included patients ≥ 18 years. The intervention consisted of systematic clinical screening for TB, HIV and diabetes mellitus by lay health workers and provision of an enhanced TB-diagnostic package including sputum Xpert MTB/Rif Ultra, urine lateral-flow lipoarabinomannan assay (LF-LAM), chest x-ray, and sputum culture. We compared TB case findings with people hospitalized one year preceding the intervention.
RESULTS
In the pre-intervention phase, 5217 people were hospitalized. Among 4913 (94.2%) people not on TB treatment, 367 (7.5%) were diagnosed with TB. In the intervention phase, 4015 eligible people were hospitalized. Among 3734 (93.0%) people not on TB treatment, 560 (15.0%) were diagnosed with TB. The proportion of patients diagnosed with TB was higher in the intervention phase (15.0% vs. 7.5%, p < 0.001). Overall in-hospital mortality was lower in the intervention phase [166/3734(4.5%) vs. 336/4913(6.8%), p < 0.001].
CONCLUSION
Lay health worker-led implementation of systematic TB-screening, coupled with provision of an enhanced TB-diagnostic package significantly improved TB case detection and mortality among hospitalized adults.
Journal Article > ResearchFull Text
PLOS One. 2021 February 3; Volume 16 (Issue 2); e0245372.; DOI:10.1371/journal.pone.0245372
Kaufmann B, Boulle P, Berthou F, Fournier M, Beran D, et al.
PLOS One. 2021 February 3; Volume 16 (Issue 2); e0245372.; DOI:10.1371/journal.pone.0245372
Strict storage recommendations for insulin are difficult to follow in hot tropical regions and even more challenging in conflict and humanitarian emergency settings, adding an extra burden to the management of people with diabetes. According to pharmacopeia unopened insulin vials must be stored in a refrigerator (2-8°C), while storage at ambient temperature (25-30°C) is usually permitted for the 4-week usage period during treatment. In the present work we address a critical question towards improving diabetes care in resource poor settings, namely whether insulin is stable and retains biological activity in tropical temperatures during a 4-week treatment period. To answer this question, temperature fluctuations were measured in Dagahaley refugee camp (Northern Kenya) using log tag recorders. Oscillating temperatures between 25 and 37°C were observed. Insulin heat stability was assessed under these specific temperatures which were precisely reproduced in the laboratory. Different commercialized formulations of insulin were quantified weekly by high performance liquid chromatography and the results showed perfect conformity to pharmacopeia guidelines, thus confirming stability over the assessment period (four weeks). Monitoring the 3D-structure of the tested insulin by circular dichroism confirmed that insulin monomer conformation did not undergo significant modifications. The measure of insulin efficiency on insulin receptor (IR) and Akt phosphorylation in hepatic cells indicated that insulin bioactivity of the samples stored at oscillating temperature during the usage period is identical to that of the samples maintained at 2-8°C. Taken together, these results indicate that insulin can be stored at such oscillating ambient temperatures for the usual four-week period of use. This enables the barrier of cold storage during use to be removed, thereby opening up the perspective for easier management of diabetes in humanitarian contexts and resource poor settings.