TBC 038: Clinical and Technological Advancements in TB Management

1. Cellular and Molecular Mechanisms in TB-DM Comorbidity

• Cellular Immunology: TB-DM interaction impairs immune cell function, especially macrophages and T cells, diminishing cytokine signaling and immune responses.
• Genomics: Genetic variants (e.g., IL-6 and IL-18 polymorphisms) increase TB-DM susceptibility, paving the way for personalized medicine.
• Transcriptomics: TB-DM exhibits unique gene expression patterns associated with chronic inflammation, especially in neutrophil and innate immune pathways.
• Proteomics: Altered protein expression in TB-DM patients reveals potential biomarkers, including elevated complement and coagulation cascade proteins linked to lipid metabolism dysregulation.
• Lipidomics and Metabolomics: Distinct lipid and metabolic profiles, such as disrupted bile acid and carbohydrate metabolism, serve as biomarkers and highlight the physiological impacts of DM on TB. See also: Scholarships Tips

2. Epidemiology and Public Health Strategies

• Prevalence and Risk Factors: DM prevalence among TB patients is influenced by age, lifestyle, socio-economic status, and hypertension, requiring molecular epidemiology to tailor public health strategies.
• Regional Variations: Disparities in TB-DM comorbidity across regions underscore the need for targeted interventions.
• Integrated Health Approaches: Proposed strategies include reciprocal TB and DM screening, addressing multimorbidities, and enhancing transmission dynamics research.
• WHO SEAR Data: In 2021, TB incidence was 234 per 100,000 population, with 38% undiagnosed/unreported cases and 763,000 deaths among HIV-negative individuals.

3. Socioeconomic and Environmental Impacts

• Economic Burden: Families in Southeast Asia face catastrophic costs (30%-80%) due to TB, highlighting the need for sustainable funding.
• Housing and Sanitation: Inadequate housing slightly affects TB treatment outcomes, while sanitation shows no direct correlation.
• Regional Initiatives: Strategies include domestic funding, digital technology, and multisectoral approaches targeting TB elimination by 2025-2030.
• Global Collaboration: Enhanced donor funding, public-private partnerships, and results-based financing are critical to addressing TB's socioeconomic impact.

4. Clinical and Technological Advancements

• Diagnostics and Treatment: Advances in rapid molecular diagnostics and digital X-rays have improved TB treatment coverage (78% by 2019).
• Single-Cell Analysis: Emerging technologies offer insights into immune dysfunction in TB-DM, identifying therapeutic targets and biomarkers.
• Predictive Tools: Integration of genetic, molecular, and clinical data supports the development of risk scores and precision medicine approaches.
• Vaccines: Research focuses on targeted TB vaccines for immunocompromised populations.

5. Challenges in TB Elimination and Patient Management

• Barriers to Care: Stigma, resource shortages, and inefficiencies in TB programs hinder early diagnosis and treatment adherence.
• Recurrent TB and Risk Factors: Irregular medication use, poor HbA1C control, and multiple TB episodes increase retreatment risk, especially in diabetic patients.
• Comorbidity Impact: Non-TB factors like age, renal disease, and cancer contribute to TB mortality, emphasizing holistic patient management.
• Policy Alignment: Coordinating local strategies with national and global goals enhances scalability and sustainability in TB control programs.

References:

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9. Adam, N., Pallikadavath, S., Cerasuolo, M. and Amos, M., 2021. Investigating the risk factors for contraction and diagnosis of human tuberculosis in Indonesia using data from the fifth wave of RAND’s Indonesian Family Life Survey (IFLS-5). Journal of Biosocial Science, 53(4), pp.577-589.