A promising drug delivery method could replace injections with pills

Exposure To Indoor Smoking, Poor Household Conditions May Increase Risk Of Developing Pediatric Tuberculosis

Manipal: A systematic review and meta-analysis, published in the European Journal of Pediatrics has shed light on the risk factors for the development of tuberculosis (TB) among the pediatric population.

Pediatric tuberculosis poses a significant health burden, leading to high mortality and morbidity rates among children worldwide. The disease's complexity and resemblance to other respiratory conditions make accurate diagnosis and intervention challenging.

In addition to what is already known, the research has identified exposure to indoor smoking, poor household conditions, and indoor smoking as important risk factors for developing pediatric tuberculosis.

The findings highlight that children living in poor household conditions and getting exposed to passive indoor smoking demand more attention for preventing pediatric TB in addition to routine contact screening for the pediatric group.

A systematic review of studies from PubMed, Embase, and Google Scholar was conducted, focusing on risk factors related to pediatric TB. Meta-analysis was performed to assess the strength of the association between specific risk factors and the development of TB in children.

The meta-analysis revealed that out of the eleven analyzed risk factors, four were significantly associated with pediatric TB:

1. Contact with known TB cases: Children who had contact with individuals diagnosed with TB had a 6.42 times higher odds (95% confidence interval [CI]: 3.85, 10.71) of developing TB themselves.

2. Exposure to smoke: Children exposed to indoor smoking were at 2.61 times higher odds (95% CI: 1.24, 5.51) of contracting TB compared to their non-exposed counterparts.

3. Overcrowding in houses: Overcrowded living conditions contributed to a 2.29 times higher odds (95% CI: 1.04, 5.03) of pediatric TB.

4. Poor household conditions: Children living in suboptimal household conditions faced a 2.65 times higher odds (95% CI: 1.38, 5.09) of developing TB.

The study also identified heterogeneity among the included studies, underscoring the need for further research and standardized screening protocols.

The findings of this meta-analysis underscore the importance of screening for specific risk factors in the pediatric population to combat the prevalence of TB. Routine contact screening for children exposed to known TB cases is essential, and clinicians should be vigilant in identifying children living in overcrowded and poorly maintained households. Moreover, passive exposure to indoor smoking emerged as a previously unexplored risk factor, emphasizing the need for public health initiatives to address this issue.

This comprehensive meta-analysis sheds light on key risk factors associated with pediatric TB, providing clinicians and policymakers with valuable insights to strengthen disease prevention and control measures. By identifying and addressing these risk factors, healthcare providers can take proactive steps to reduce the burden of pediatric TB and improve the overall health outcomes of vulnerable children.

Reference:

Siddalingaiah, N., Chawla, K., Nagaraja, S. B., & Hazra, D. (2023). Risk factors for the development of tuberculosis among the pediatric population: a systematic review and meta-analysis. European Journal of Pediatrics, 182(7), 3007–3019. Https://doi.Org/10.1007/s00431-023-04988-0

Tackling Tuberculosis In Children Through Non-Invasive Sampling

Although tuberculosis (TB) is treatable and preventable, it can be difficult to diagnose in children, according to the World Health Organization. TB is usually diagnosed using respiratory samples, such as sputum, a nasal wash, or sampling of stomach contents, 42 Technology (42T) shared in a news release. Collecting such samples, however, can involve unpleasant, invasive procedures, making it difficult to get samples from children.

Stool is the ideal noninvasive sample, but extensive pre-processing has been needed for analysis in highly sensitive PCR tests. 42T, FIND (the global alliance for diagnostics), and Rutgers University set out to determine whether stool samples and an automated PCR test could be used as a viable alternative to smear microscopy and culture techniques when diagnosing children.

Three different sample-processing methods were trialed by multiple research institutions in the past three years. After the data was pooled, WHO recommended that stool should now be used as the primary sample for TB diagnosis in children up to 10 years old, according to the release.

42T, FIND, and Rutgers devised a solution that processes stool samples without the need for any specialist laboratory equipment or technical skills. It works in conjunction with the Cepheid Xpert MTB/RIF ultra assay, which was codeveloped by David Alland's team at Rutgers, FIND, and others. (Cepheid has been in the news for its EUA for a molecular test designed for use on the GeneXpert system that can detect viruses causing COVID-19, flu, and RSV infections.)

"Diagnosing pediatric TB is a major challenge requiring fresh thinking, because traditional samples for TB testing just aren't accessible from young children," stated Morten Ruhwald, head of TB at FIND, in the release from 42T. "Stool is so easy to collect from almost anyone—so being able to use that to test for TB is a major step forward. FIND was pleased to work with 42T and other partners to help generate crucial data for the WHO review, and we warmly welcome the update to the guidelines."

Added Sarah Knight, 42T's head of healthcare technology: "Large-scale trials have shown the kit to be both effective and easy to use in a variety of settings.  And we're pleased that it has helped to inform the WHO in making its ground-breaking policy update on diagnosing childhood TB."

Tuberculosis Was Horrible. They Did What They Could.

When white nurses started to quit, the city's panicked commissioner of health turned to the only skilled caregivers he thought he could lure: Black nurses whose career opportunities were all but nonexistent in the Jim Crow South. Hundreds answered the call. Their tenacity in the face of harsh working conditions and pervasive racism is humbling and inspiring — as is their contribution to the development of a breakthrough TB treatment.

Such drugs were desperately needed. In the first half of the 20th century, physicians administered "therapies" like gold salts, and sawed out people's ribs to collapse their afflicted lungs, in the hopes of slowing the infection's progression. The patients' suffering — their slow suffocation, mostly (although bones, brains, tongues, kidneys and genitals could also be invaded) — was agonizing. One young woman had spent nearly 10 years at Sea View by the time she died in 1952; she was only 20 years old. Hundreds of others languished, "turning tuberculosis into a dreadful job, a grotesque career."

Into this scene of despair marched the Black Angels. We meet the tall, graceful preacher's daughter Edna Sutton, who fled Savannah, Ga., only to encounter a segregated cafeteria, heckling orderlies and invasive "cleanliness" inspections during her training at Harlem Hospital (dubbed "the Morgue" for its shocking mortality rate). After arriving at Sea View in 1932, Sutton became a surgical nurse, working in an operating room where temperatures could reach 107 degrees. She would keep vigil with dying patients, later bringing herself solace by reciting favorite Bible verses on the Staten Island Ferry.

Sutton enlisted her easygoing 16-year-old niece, Virginia Allen, now one of the last living Black Angels, as an aide on the pediatric ward. Children with "faces and necks turning red and fingers clenched into small fists" wailed in pain. It was a harrowing experience "that no amount of singing and reading or playing with puppets or cars or paper dolls could eradicate."

Then there was Missouria Meadows-Walker of Clinton, S.C., who arrived at Sea View at age 24 to work on a men's ward where patients snarled at her as she shaved them, taking macabre bets among themselves on who would be the next to die. She would sing "Swing Low, Sweet Chariot" to the dead as she bathed their corpses.

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