scholarly journals Increased Moxifloxacin Dosing among MDR-TB Patients with Low-Level Resistance to Moxifloxacin did not Improve Treatment Outcomes in a Tertiary Care Center in Mumbai, India

2021 ◽  
Author(s):  
Jeffrey A Tornheim ◽  
Zarir F Udwadia ◽  
Prerna R Arora ◽  
Ishita Gajjar ◽  
Samridhi Sharma ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Treatment Regimen ◽  
Care Center ◽  
Tertiary Care ◽  
High Dose ◽  
Tertiary Care Center ◽  
Low Level ◽  
Mdr Tb ◽  
Observational Cohort ◽  
600Mg Daily

Abstract Background Mycobacterium tuberculosis (Mtb) strains resistant to isoniazid and rifampin (MDR-TB) are increasingly reported worldwide, requiring renewed focus on the nuances of drug resistance. Patients with low-level moxifloxacin resistance may benefit from higher doses, but limited clinical data on this strategy are available . Methods We conducted a 5-year observational cohort study of MDR-TB patients at a tertiary care center in India. Participants with Mtb isolates resistant to isoniazid, rifampin, and moxifloxacin (at the 0.5µg/mL threshold) were analyzed according to receipt of high-dose moxifloxacin (600mg daily) as part of a susceptibility-guided treatment regimen. Univariable and multivariable cox proportional hazard models assessed the relationship between high-dose moxifloxacin and unfavorable treatment outcomes. Results Of 354 participants with MDR-TB resistant to moxifloxacin, 291 (82.2%) received high-dose moxifloxacin. The majority experienced good treatment outcomes (200, 56.5%), which was similar between groups (56.7% vs. 54.0%, p=0.74). Unfavorable outcomes were associated with greater extent of radiographic disease, lower initial body mass index, and concurrent treatment with fewer drugs with confirmed phenotypic susceptibility. Treatment with high-dose moxifloxacin was not associated with improved outcomes in either unadjusted [hazard ratio (HR) 1.2, 95% confidence interval (CI): 0.6–2.4] or adjusted models (HR 0.8, 95% CI: 0.5–1.4) or but was associated with joint pain (HR 3.2, 95% CI: 1.2–8.8). Conclusion In a large observational cohort, adding high-dose (600mg) moxifloxacin to a DST-based treatment regimen for MDR-TB was associated with increased treatment-associated side effects without improving overall outcomes and should be avoided for empiric treatment of moxifloxacin resistant MDR-TB.

High prevalence of nonconvulsive and subtle status epilepticus in an ICU of a tertiary care center: A three-year observational cohort study

2011 ◽  
Vol 96 (1-2) ◽  
pp. 140-150 ◽  
Author(s):  
Diana Rudin ◽  
Leticia Grize ◽  
Christian Schindler ◽  
Stephan Marsch ◽  
Stephan Rüegg ◽  
...  
Keyword(s):  
Cohort Study ◽  
Status Epilepticus ◽  
Care Center ◽  
Tertiary Care ◽  
Observational Cohort Study ◽  
Tertiary Care Center ◽  
High Prevalence ◽  
Observational Cohort

Primary B-cell CNS lymphoma clinicopathologic and treatment outcomes in 89 patients from a single tertiary care center

2014 ◽  
Vol 99 (4) ◽  
pp. 450-456 ◽  
Author(s):  
Samir Dalia ◽  
Peter Forsyth ◽  
Julio Chavez ◽  
Samantha Price ◽  
Bijal Shah ◽  
...  
Keyword(s):  
B Cell ◽  
Treatment Outcomes ◽  
Care Center ◽  
Tertiary Care ◽  
Cns Lymphoma ◽  
Tertiary Care Center

scholarly journals Study of Clinical Findings and Treatment Outcomes of Rhino-OrbitalCerebral Mucormycosis at a Tertiary Care Center in Central India

2021 ◽  
Vol 8 (40) ◽  
pp. 3464-3469
Author(s):  
Kavita Anand Dhabarde ◽  
Pallavi Madhusudan Doble ◽  
Nehali Sureshchandra Pant ◽  
Nisha Vilas Rahul
Keyword(s):  
Treatment Outcomes ◽  
Care Center ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Arterial Occlusion ◽  
Central India ◽  
Clinical Findings ◽  
Tertiary Care Center ◽  
Ocular Movements

BACKGROUND Mucormycosis is a potentially lethal angioinvasive fungal infection. Increasing incidence of rhino-orbital-cerebral mucormycosis in setting of corona virus disease-19 (COVID-19) during second wave in India and elsewhere has become a matter of immediate concern. This study was done to assess the clinical findings and treatment outcomes of rhino-orbital-cerebral-mucormycosis presenting to a tertiary care center in central India. METHODS This is a longitudinal study. We observed 38 COVID-19 associated mucormycosis cases. Their demographic data, clinical manifestations, underlying systemic conditions, microbiological and radiological reports, medical treatments and surgical interventions were recorded and analysed. RESULTS Common ocular presenting features were ophthalmoplegia (68 %), proptosis (44 %), periorbital swelling (13 %), diminution of vision (37 %), central retinal arterial occlusion (2.5 %), optic atrophy (2.5 %). Visual acuity at 1 month after surgery was compared with that at presentation and was found unchanged in 27 patients, improved in 3 patients and deteriorated in 6 patients. Functional outcome was evaluated in terms of ocular movements, and it was found that ocular movements were same as presentation in 30 patients, improved in 3 patients and deteriorated in 3 patients at follow up one month after surgery. Radiological outcome was evaluated, and it was found that residual disease was present in 4 patients and absent in 32 patients. Mortality was found in 2 patients at 1 month follow-up period. CONCLUSIONS Early diagnosis, blood sugar levels control, urgent systemic antifungal therapy and sinus debridement surgery are lifesaving in cases of COVID-19 associated mucormycosis. KEYWORDS Mucormycosis, COVID-19, Diabetes Mellitus, Ophthalmoplegia, Orbital Apex Syndrome, Orbital Cellulitis, Proptosis

scholarly journals Ph Positive ALL: Real World Experience from a Tertiary Care Center in North India

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5901-5901
Author(s):  
Sanjeevan Sharma ◽  
Uday Yanamandra ◽  
Mir Moslem ◽  
Rajan Kapoor ◽  
Suman Pramanik ◽  
...  
Keyword(s):  
Overall Survival ◽  
Real World ◽  
Lymphoblastic Leukemia ◽  
Care Center ◽  
Tertiary Care ◽  
North India ◽  
High Dose ◽  
Tertiary Care Center ◽  
Complex Karyotype ◽  
Cns Disease

Abstract Introduction: The outcomes of Philadelphia positive acute lymphoblastic leukemia(Ph-ALL) have improved significantly after the introduction of tyrosine kinase inhibitors (TKI). The presence of Philadelphia positivity once considered as poor prognosis mandating transplantation, now even can be managed with TKI added to steroids. The data is scarce on Ph-ALL from real-world settings with resource constraints. Objective: To study the characteristics and outcomes of Ph+ve ALL from real world settings. Methodology: It is a retrospective observational study wherein the data of all patients of Ph-ALL managed at a tertiary care center in North India over the last 14 years (2004-2018) were analyzed. All case records of the Ph-ALL were perused, digitalized and their survival statistics derived. Results:Amongst a total of 611 ALL case records, 55 (9%) were Ph-ALL. Ph-ALL cases with complete data (n-51) were analysed for overall survival. The mean age of the patients was 31± 2.41 years (range 3-76) (Fig. 1A). Males constituted 74.5% (n-38) and females, 25.4% (n-13) of our cohort. On risk stratification, 11 (21.5%), 5 (9.8%), and 35 (68.6%) patients were classified as standard, intermediate and high risk. Twenty five percent patients had associated complex karyotype in addition to the Ph positivity. Of these 24 patients (47.05%) received adult ALL (GMALL protocol), 15 patients (29.4%) received paediatric BFM protocol, and12 patients (23.5%) received Hyper-CVAD. Week 4 Bone marrow evaluation was in CR in 87.2% of patients. L-Asparaginase was given in only 60% of the patients. An interruption in the therapy of more than 2 weeks for various reasons was present in 23.4% of the patients, mainly secondary to infections. Prophylactic cranial irradiation was given in 34.7% of the patients and high dose methotrexate was given in 30.4% of the patients. Relapse was seen in 22% of the patients. CNS disease was present in 17.6% of the patients. Only 19.6% of the patients were subjected to transplant. All patients received TKI, of which 44% received high dose imatinib and 56% patients received dasatinib. A total of 19.6% patients succumbed to the illness at various stages of the therapy. The cumulative overall survival at 1y (1y-OS) was 95.68% with 3y and 5y OS being 72.09% and 63.07% (Fig. 1B). The survival was not statistically different between patients with and without complex karyotype (p-0.52),based on type of TKI administered (Dasatinib Vs high dose Imatinib) (p-0.76), males and females (p-0.41), risk category (p-0.41) or by the presence of CNS disease (p-0.21) (Fig. 1C-G). The survivals based on the type of protocol was statistically different with the best survival with GMALL protocol and the least survival with Hyper-CVAD therapy (log rank p<0.001)(Fig. 1H). Conclusion: We have demonstrated in this study the improved outcomes of Ph-ALL who usually present late in resource constraint settings. There was no additional benefit of dasatinib over high dose imatinib in this cohort. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

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