scholarly journals Cochlear Dysfunction after Kanamycin Injection in Multidrug Resistant Tuberculosis Patients

2021 ◽  
Vol 56 (3) ◽  
pp. 216
Author(s):  
Aditya Brahmono ◽  
Nyilo Purnami ◽  
Bakti Surarso
Keyword(s):  
Hair Cells ◽  
Multidrug Resistant ◽  
Distortion Product Otoacoustic Emission ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
Specific Frequency ◽  
Frequency Area ◽  
Cochlear Dysfunction

Background: Longterm exposure to aminoglycoside such as kanamycin to cochlear cells is known to be associated with damage to outer hair cells in the organ Cortiand type 1 sensory hair cells in the vestibular organs which ultimately causes permanent damage to hair cells. Hair cell damage occurs from the basal cochlea (high frequency area) to the apex cochlea (low frequency area) and followed by damage from the auditory nerve. Evaluation of cochlear dysfunction on multidrug resistant tuberculosis (MDR TB) patients have been rarelyreported in the literature based on distortion product otoacoustic emission (DPOAE).Objectives: To prove cochlear dysfunction after kanamycin injection in MDR TB patient based on DPOAE examination of the overall frequencies and specific frequency.Methods: An observational longitudinal analytic with pre and post design without control group conducted in the infection division of MDR TB Outpatients Pulmonology Department and Otorhinolaryngology Community division of ORL-HNS Department Dr. Soetomo general hospital Surabaya, within 3 months in 2018, 15 ear with the best baseline examination were taken by consecutive sampling and statistical analysis for cochlear dysfunction based on overall  frequency and specific frequency DPOAE examination using Mc Nemar test.Results: Based on DPOAE examination of overall frequencies there was no cochlear dysfunction (p > 0.05) but a significant difference was found at frequency of 10,000 Hertz (Hz) (p = 0.002 ).Conclusion:On ototoxicity monitoring there was no cochlear dysfunction after 4 weeks  Kanamycin injection but cochlear dysfunction occurs at a specific frequency of 10,000 Hz.

scholarly journals Cochlear Dysfunction after Kanamycin Injection in Multidrug Resistant Tuberculosis Patients

2020 ◽  
Vol 56 (3) ◽  
pp. 216
Author(s):  
Aditya Brahmono ◽  
Nyilo Purnami ◽  
Bakti Surarso
Keyword(s):  
Hair Cells ◽  
Multidrug Resistant ◽  
Distortion Product Otoacoustic Emission ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
Specific Frequency ◽  
Frequency Area ◽  
Cochlear Dysfunction

Long-term exposure to aminoglycoside such as kanamycin to cochlear cells is known to be associated with damage to outer hair cells in the organ Corti and type 1 sensory hair cells in the vestibular organs which ultimately causes permanent damage to hair cells. Hair cell damage occurs from the basal cochlea (high frequency area) to the apex cochlea (low frequency area) and followed by damage from the auditory nerve. Evaluation of cochlear dysfunction on multidrug resistant tuberculosis (MDR TB) patients have been rarely reported in the literature based on distortion product otoacoustic emission (DPOAE). Objectives: To prove cochlear dysfunction after kanamycin injection in MDR TB patient based on DPOAE examination of the overall frequencies and specific frequency. This was an observational longitudinal analytic with pre and post design without control group conducted in the infection division of MDR TB Outpatients Pulmonology Department and Otorhinolaryngology Community division of ORL-HNS Department, Dr. Soetomo General Hospital, Surabaya, within 3 months in 2018, 15 ear with the best baseline examination were taken by consecutive sampling and statistical analysis for cochlear dysfunction based on overall frequency and specific frequency DPOAE examination using Mc Nemar test. Based on DPOAE examination of overall frequencies there was no cochlear dysfunction (p>0.05) but a significant difference was found at frequency of 10,000 Hertz (Hz) (p=0.002). On ototoxicity monitoring there was no cochlear dysfunction after 4 weeks Kanamycin injection but cochlear dysfunction occurs at a specific frequency of 10,000 Hz.

scholarly journals Analysis of Smear Microscopy and Culture Conversion Results in Multidrug-Resistant Tuberculosis Patients with and without Type 2 Diabetes Mellitus

2020 ◽  
Vol 26 (3) ◽  
Author(s):  
Henny Fauziah ◽  
Aprianti S. ◽  
Handayani I. ◽  
Kadir NA
Keyword(s):  
Diabetes Mellitus ◽  
Multidrug Resistant ◽  
World Health ◽  
Smear Microscopy ◽  
Tuberculosis Patients ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
Culture Conversion

  The World Health Organization (WHO) recommended microscopic AFB smear examination and culture as follow-ups to the response of MDR TB therapy. Analyzed the results of microscopic AFB smear and culture conversion as well as treatment outcome in Multidrug-Resistant Tuberculosis (MDR-TB) patients with and without Diabetes Mellitus (DM). This is a retrospective study involved 70 MDR-TB patients with (27 patients) with DM and without DM (43 patients) who had microscopic AFB smear and culture results at the start of the follow-up therapy. This research was conducted at Labuang Baji Regional Public Hospital, Makassar, from June to July 2019, used medical records of MDR-TB patients the period of June 2016 to December 2017. The results showed that 52 out of 70 MDR-TB patients had microscopic AFB smear and culture conversion in MDR-TB with DM (21 patients) and without DM (31 patients). The duration of microscopic AFB smear conversion in MDR TB patients with DM (3.33±0.54 months) was longer than patients without DM (2.07±0.05 months), p=0.001. While in culture conversion, there was no significant difference between MDR-TB with DM (1.28±0.64 months) and without DM (1.25±0.59), p=0.648. The recovery outcome between MDR-TB with (48.1%) and without DM (48.8%) was not significantly different. However, the output of treatment failure was greater in DM (11.2%) than without DM (2.3%), although statistically, there was no significant difference (p=0.568). Multidrug-resistant tuberculosis patients with DM experienced slower microscopic AFB smear conversion than MDR-TB patients without DM. However, in culture, there was no significant difference in the conversion period between the two groups. MDR-TB patients, both of with and without DM, had the same chance of recovery.

Treatment Outcome of a Shorter Regimen Containing Clofazimine for Multidrug-resistant Tuberculosis: A Randomized Control Trial in China

2019 ◽  
Vol 71 (4) ◽  
pp. 1047-1054 ◽  
Author(s):  
Yadong Du ◽  
Chao Qiu ◽  
Xiaohong Chen ◽  
Jing Wang ◽  
Wei Jing ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Sputum Culture ◽  
Control Group ◽  
Sputum Culture Conversion ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
Experimental Group ◽  
Culture Conversion

Abstract Background The emergence of multidrug-resistant tuberculosis (MDR-TB) poses a serious obstacle to global TB control programs. Methods We carried out a prospective, randomized, multicenter study in China that was focused on the potential of a shorter regimen containing clofazimine (CFZ) for the treatment of MDR-TB. There were 135 MDR-TB cases that met eligibility requirements and were randomly stratified into either the control group or experimental group. Patients in the control group received an 18-month treatment regimen, whereas patients in the experimental group received a 12-month treatment regimen containing CFZ. Results At the completion of the treatment period, the difference in sputum-culture conversion rates between the experimental group and the control group was not significant. Notably, by the end of 3 months of treatment, 68.7% patients receiving the experimental regimen had sputum-culture conversion, as compared with 55.9% of those receiving the control regimen; this was a significant difference, suggesting an early sputum conversion (P = .04). There were 67 adverse events reported in 56 patients in this study, including 32 in the control group and 35 in the experimental group. No significant difference in the overall incidences of adverse events was observed between the 2 groups. Conclusions The MDR-TB patients treated with the shorter regimen containing CFZ had a comparable successful outcome rate when compared to those with the standard regimen. The patients assigned to the experimental group achieved more rapid sputum-culture conversion, reflecting superior antimicrobial activity against MDR-TB. Clinical Trials Registration Chinese Clinical Trial Registry ChiCTR 1800020391.

scholarly journals Sequential analysis as a tool for detection of amikacin ototoxicity in the treatment of multidrug-resistant tuberculosis

2018 ◽  
Vol 44 (2) ◽  
pp. 85-92 ◽  
Author(s):  
Karla Anacleto de Vasconcelos ◽  
Silvana Maria Monte Coelho Frota ◽  
Antonio Ruffino-Netto ◽  
Afrânio Lineu Kritski
Keyword(s):  
Sequential Analysis ◽  
Treatment Initiation ◽  
Hearing Threshold ◽  
Multidrug Resistant ◽  
Distortion Product Otoacoustic Emission ◽  
Distortion Product ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
High Frequency Audiometry ◽  
Mdr Tb

ABSTRACT Objective: To investigate early detection of amikacin-induced ototoxicity in a population treated for multidrug-resistant tuberculosis (MDR-TB), by means of three different tests: pure-tone audiometry (PTA); high-frequency audiometry (HFA); and distortion-product otoacoustic emission (DPOAE) testing. Methods: This was a longitudinal prospective cohort study involving patients aged 18-69 years with a diagnosis of MDR-TB who had to receive amikacin for six months as part of their antituberculosis drug regimen for the first time. Hearing was assessed before treatment initiation and at two and six months after treatment initiation. Sequential statistics were used to analyze the results. Results: We included 61 patients, but the final population consisted of 10 patients (7 men and 3 women) because of sequential analysis. Comparison of the test results obtained at two and six months after treatment initiation with those obtained at baseline revealed that HFA at two months and PTA at six months detected hearing threshold shifts consistent with ototoxicity. However, DPOAE testing did not detect such shifts. Conclusions: The statistical method used in this study makes it possible to conclude that, over the six-month period, amikacin-associated hearing threshold shifts were detected by HFA and PTA, and that DPOAE testing was not efficient in detecting such shifts.

scholarly journals The Role of IL-6 Gene Polymorphism in Multidrug-Resistant Tuberculosis Patients in Iraq

2020 ◽  
Vol 10 (01) ◽  
pp. 81-84
Author(s):  
Diyar K. Flaifel ◽  
Ibtisam H. Al-Azawi
Keyword(s):  
Gene Polymorphism ◽  
Multidrug Resistant ◽  
Multi Drug Resistance ◽  
Control Group ◽  
First Year ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
And Control

Background: Tuberculosis (TB) remains to be a leading cause of morbidity and mortality in developing countries, and the incidence of the disease is increasing in developed. One-third of the world’s population is infected by Mycobacterium tuberculosis (Mtb). Still, only about 5% of infected individuals develop the disease within the first year of infection, and another 5% develop the disease later in life. Aim of the study: Is to investigate the relationship between the levels of Interleukin 6 (IL-6) and detection of multidrug-resistant tuberculosis (MDR-TB) in Al-Diwaniyah population. Patients and methods: The current study included 120 patients with tuberculosis who were classified into two groups. The first group included 60 TB patients who were sensitive to anti TB drugs and 60 patients with multi-drug resistance (MDR) based on gene Xpert. The study also included 60 healthy individuals serving as a control group. Demographic characteristics of study and control groups were retrieved. IL-6 (-572G/C) genotype polymorphism was carried out using polymerase chain reaction (PCR) and according to the instruction of the providing company. Serum level of IL-6 was also measured by ELISA according to the instruction of the providing company. Results: It has been observed that genotype CC was more frequent in sensitive TB patients than both MDR TB patients and control subjects, 73.3 % versus 60 % and 61.7 %, respectively. Serum IL-6 level was significantly higher in MDR TB patients than in control group (p = 0.007), and there was no significant difference in its level between sensitive and MDR TB patients (p = 0.284). Conclusion: IL-6 gene polymorphism is not associated with multidrug resistance in TB patients; however, Serum IL-6 level was significantly higher in MDR TB patients than in the control group.

Effect of Global Fund financial support for patients with multidrug-resistant tuberculosis

2020 ◽  
Vol 24 (7) ◽  
pp. 686-693 ◽  
Author(s):  
T. Watthananukul ◽  
T. Liabsuetrakul ◽  
P. Pungrassami ◽  
V. Chongsuvivatwong
Keyword(s):  
Financial Support ◽  
Global Fund ◽  
Positive Impact ◽  
Multidrug Resistant ◽  
Drug Adherence ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Significant Difference ◽  
Mdr Tb ◽  
The Impact

SETTING: The Global Fund provides financial support for patients with multidrug-resistant tuberculosis (MDR-TB), patients' families and hospitals providing services for these patients in Thailand, but the impact of this support has not been evaluated.OBJECTIVE: To assess the impact of Global Fund financial support on drug adherence, out-of-pocket (OOP) payments, sputum culture conversion and the perception of the usefulness of this support.DESIGN: A retrospective cohort study was conducted in eight provincial hospitals with and without financial support in four regions of Thailand. MDR-TB patients aged ≥15 years registered in 2015–2016 who received treatment at these hospitals for at least 6 months were included.RESULTS: There was no significant difference in drug adherence rates. The OOP payments during treatment were significantly lower in patients who received financial support (P < 0.001). Although the supported group had higher positive culture rates at the beginning of treatment, sputum converted at a faster rate than for the unsupported group (P = 0.034). More than 80% of both groups perceived financial support as being useful, leading to faster diagnosis and improving follow-up compliance.CONCLUSION: Financial support for MDR-TB patients has a positive impact on treatment and should be continued.

scholarly journals The epidemiologic impact and cost-effectiveness of new tuberculosis vaccines on multidrug-resistant tuberculosis in India and China

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chathika K Weerasuriya ◽  
Rebecca C Harris ◽  
C Finn McQuaid ◽  
Fiammetta Bozzani ◽  
Yunzhou Ruan ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Multidrug Resistant ◽  
Second Line ◽  
Second Line Therapy ◽  
China And India ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Line Therapy ◽  
Mdr Tb

Abstract Background Despite recent advances through the development pipeline, how novel tuberculosis (TB) vaccines might affect rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) is unknown. We investigated the epidemiologic impact, cost-effectiveness, and budget impact of hypothetical novel prophylactic prevention of disease TB vaccines on RR/MDR-TB in China and India. Methods We constructed a deterministic, compartmental, age-, drug-resistance- and treatment history-stratified dynamic transmission model of tuberculosis. We introduced novel vaccines from 2027, with post- (PSI) or both pre- and post-infection (P&PI) efficacy, conferring 10 years of protection, with 50% efficacy. We measured vaccine cost-effectiveness over 2027–2050 as USD/DALY averted-against 1-times GDP/capita, and two healthcare opportunity cost-based (HCOC), thresholds. We carried out scenario analyses. Results By 2050, the P&PI vaccine reduced RR/MDR-TB incidence rate by 71% (UI: 69–72) and 72% (UI: 70–74), and the PSI vaccine by 31% (UI: 30–32) and 44% (UI: 42–47) in China and India, respectively. In India, we found both USD 10 P&PI and PSI vaccines cost-effective at the 1-times GDP and upper HCOC thresholds and P&PI vaccines cost-effective at the lower HCOC threshold. In China, both vaccines were cost-effective at the 1-times GDP threshold. P&PI vaccine remained cost-effective at the lower HCOC threshold with 49% probability and PSI vaccines at the upper HCOC threshold with 21% probability. The P&PI vaccine was predicted to avert 0.9 million (UI: 0.8–1.1) and 1.1 million (UI: 0.9–1.4) second-line therapy regimens in China and India between 2027 and 2050, respectively. Conclusions Novel TB vaccination is likely to substantially reduce the future burden of RR/MDR-TB, while averting the need for second-line therapy. Vaccination may be cost-effective depending on vaccine characteristics and setting.

PP581 Catastrophic Costs Of Multidrug-Resistant Tuberculosis: Estimation Based On The Cost Of Treatment In China

2020 ◽  
Vol 36 (S1) ◽  
pp. 43-43
Author(s):  
Lijun Shen ◽  
Shangshang Gu ◽  
Fan Zhang ◽  
Zhao Liu ◽  
Yuehua Liu
Keyword(s):  
Market Price ◽  
Multidrug Resistant ◽  
Policy Support ◽  
World Health ◽  
Chinese Patients ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Drug Affordability ◽  
The Cost

IntroductionChina bears a considerably high burden of multidrug-resistant tuberculosis (MDR-TB). Second-line anti-TB drugs are urgently needed yet domestic MDR-TB drugs are expensive and lack policy support. Patients’ living conditions are closely related to the drug affordability. The national TB prevention programs should play a critical role. The purpose of this study is to measure the cost of treating MDR-TB patients under different treatment schemes and price sources. The results of this study are expected to inform the relevant drug protection policies and provide inputs for further cost-effectiveness analyses.MethodsBased on the treatment plan of China's Multidrug-Resistant Pulmonary Tuberculosis Clinical Path (2012 edition) and the World Health Organization (WHO) Drug-Resistant Tuberculosis Treatment Guide (2018 edition), the treatment costs of MDR-TB were measured under different scenarios. Catastrophic health expenditure was then calculated if the treatment cost exceeds 40 percent of the household's non-subsistence income. National, rural and disposable income per capita in 2018, were used to represent Chinese patients’ affordability.ResultsUnder varied treatment schemes and market price sources in China, the total costs for MDR-TB patients range from 19,401 to 126,703 CNY [2,853 to 18,633 USD] per person. Under current prices, all treatment schemes recommended by the WHO will incur catastrophic costs for Chinese MDR-TB patients. Significant differences were found between rural and urban areas as 52.8 percent of the treatment listed in the 2012 China Guideline would lead to catastrophic cost for rural patients but not urban ones.ConclusionsOur study concludes that the domestic drugs are more expensive than the international purchase price and the treatment of MDR-TB imposes substantial economic burden on patients, especially in the rural areas. The results of the study also indicate that it is urgent for the state to emphasize government responsibility and initiate centralized procurement for price negotiations to reduce the market price of MDR-TB drugs. The urban-rural gap should also be addressed in the design of future policies to ensure the drug affordability for all patients in need.

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