scholarly journals Linezolid-containing Regimen Lowers Mortality of Rifampicin/multidrug-resistant Tuberculous Meningitis in Shenzhen, China

2020 ◽  
Author(s):  
Mu-tong Fang ◽  
You-feng Su ◽  
Guo-fang Deng ◽  
Pei-ze Zhang ◽  
Hou-ming Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tuberculous Meningitis ◽  
Migrant Workers ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Therapeutic Effects ◽  
Related Risk ◽  
Significant Difference ◽  
High Risk Factor ◽  
Previously Treated

Abstract Background: The morbidity of rifampicin/multidrug-resistant tuberculous meningitis (RR/MDR-TBM) is increasing in many countries and regions in the world. Its mortality is significantly higher than non rifampicin/multidrug-resistant ones (NRR/MDR-TBM ). This article aims to explore the RR/MDR-TBM related risk factors, and compare the different therapeutic effects to the RR/MDR-TBM patients between linezolid-containing anti-tuberculosis regimen and non linezolid regimen in Shenzhen city. Furthermore, we want to find a better therapy for pathogen negative TBM with RR/MDR-TBM related risk factors. Methods: 137 cases with confirmed TBM (pathogen positive), who were hospitalized in the Third People’s Hospital of Shenzhen from June 2014 to March 2020, were enrolled in this study, all patients were divided into RR/MDR-TBM group (12 cases) and NRR/MDR-TBM group (125 cases) according to the GeneXpert MTB/RIF and (or) phenotypic drug susceptibility test of CSF (cerebral spinal fluid). The risk factors related to RR/MDR-TBM were investigated through comparing the clinical and examination features between the two groups.The mortality of RR/MDR-TBM patients treated with different regimens was analyzed to compare their respective therapeutic effects to the RR/MDR-TBM . P<0.05 differences is considered statistically significant. Results: Most of the patients(111/137, 81%) were from southern or southwestern China, and a large proportion(72/137, 52.55%) is migrant workers. 12 cases were RR/MDR-TBM (12/137,8.8%) in all TBM patients while 125 cases were NRR/MDR-TBM(125/137,91.2%). The proportion of previously treated cases in RR/MDR-TBM group was significantly higher than that in NRR/MDR-TBM group (6/12vs12/125, 50%vs10.5%,P<0.01), while there was no significant difference in other clinical and examination features between the two groups. The mortality of RR/MDR-TBM treated with the linezolid-containing regimen was significantly lower than that treated with non linezolid regimen (P=0.045). Conclusions: The main related high-risk factor of RR/MDR-TBM is the history of anti-tuberculosis treatment. Linezolid -containing regimen appears to lower the mortality of RR/MDR-TBM significantly. Therefore, it is recommended that linezolid-containing regimen can be used as a better empirical anti-tuberculosis therapy for pathogen negative TBM previously treated in China.

scholarly journals Linezolid-Containing Regimen Lowers Mortality of Rifampicin/Multidrug-Resistant Tuberculous Meningitis in Shenzhen, China

2020 ◽  
Author(s):  
Mu-tong Fang ◽  
You-feng Su ◽  
Guo-fang Deng ◽  
Pei-ze Zhang ◽  
Hou-ming Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Tuberculous Meningitis ◽  
Migrant Workers ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Therapeutic Effects ◽  
Related Risk ◽  
Significant Difference ◽  
High Risk Factor ◽  
Previously Treated

Abstract Background: The morbidity of rifampicin/multidrug-resistant tuberculous meningitis (RR/MDR-TBM) is increasing in many countries and regions in the world. Its mortality is significantly higher than non rifampicin/multidrug-resistant ones (NRR/MDR-TBM ). This article aims to explore the RR/MDR-TBM related risk factors, and compare the different therapeutic effects to the RR/MDR-TBM patients between linezolid-containing anti-tuberculosis regimen and non linezolid regimen in Shenzhen city. Furthermore, we want to find a better therapy for pathogen negative TBM with RR/MDR-TBM related risk factors. Methods: 137 cases with confirmed TBM (pathogen positive), who were hospitalized in the Third People’s Hospital of Shenzhen from June 2014 to March 2020, were enrolled in this study, all patients were divided into RR/MDR-TBM group (12 cases) and NRR/MDR-TBM group (125 cases) according to the GeneXpert MTB/RIF and (or) phenotypic drug susceptibility test of CSF (cerebral spinal fluid). The risk factors related to RR/MDR-TBM were investigated through comparing the clinical and examination features between the two groups.The mortality of RR/MDR-TBM patients treated with different regimens was analyzed to compare their respective therapeutic effects to the RR/MDR-TBM . P<0.05 differences is considered statistically significant. Results: Most of the patients(111/137, 81%) were from southern or southwestern China, and a large proportion(72/137, 52.55%) is migrant workers. 12 cases were RR/MDR-TBM (12/137,8.8%) in all TBM patients while 125 cases were NRR/MDR-TBM(125/137,91.2%). The proportion of previously treated cases in RR/MDR-TBM group was significantly higher than that in NRR/MDR-TBM group (6/12vs12/125, 50%vs10.5%,P<0.01), while there was no significant difference in other clinical and examination features between the two groups. The mortality of RR/MDR-TBM treated with the linezolid-containing regimen was significantly lower than that treated with non linezolid regimen (P=0.045). Conclusions: The main related high-risk factor of RR/MDR-TBM is the history of anti-tuberculosis treatment. Linezolid -containing regimen appears to lower the mortality of RR/MDR-TBM significantly. Therefore, it is recommended that linezolid-containing regimen can be used as a better empirical anti-tuberculosis therapy for pathogen negative TBM previously treated in China.

scholarly journals Decreased mortality seen in rifampicin/multidrug-resistant tuberculous meningitis treated with linezolid in Shenzhen, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mu-Tong Fang ◽  
You-Feng Su ◽  
Hui-Ru An ◽  
Pei-Ze Zhang ◽  
Guo-Fang Deng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Tuberculous Meningitis ◽  
Migrant Workers ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Therapeutic Effects ◽  
Related Risk ◽  
Significant Difference ◽  
Mdr Tb

Abstract Background The morbidity of rifampicin/multidrug-resistant tuberculous meningitis (RR/MDR-TBM) has shown an increasing trend globally. Its mortality rate is significantly higher than that of non-rifampicin/multidrug-resistant tuberculous meningitis (NRR/MDR-TBM). This article aimed to explore risk factors related to RR/MDR-TBM, and compare therapeutic effects of linezolid (LZD)- and non-linezolid-containing regimen for RR/MDR-TB patients in Shenzhen city. Furthermore, we aimed to find a better therapy for pathogen-negative TBM with RR/MDR-TBM related risk factors. Methods We conducted a retrospective study enrolling 137 hospitalized cases with confirmed TBM from June 2014 to March 2020. All patients were divided into RR/MDR-TBM group (12 cases) and NRR/MDR-TBM group (125 cases) based on GeneXpert MTB/RIF and (or) phenotypic drug susceptibility test results using cerebral spinal fluid (CSF). The risk factors related to RR/MDR-TBM were investigated through comparing clinical and examination features between the two groups. The mortality rate of RR/MDR-TBM patients treated with different regimens was analyzed to compare their respective therapeutic effects. A difference of P < 0.05 was considered statistically significant. Results Most patients (111/137, 81%) were from southern or southwestern China, and a large proportion (72/137, 52.55%) belonged to migrant workers. 12 cases were RR/MDR-TBM (12/137, 8.8%) while 125 cases were NRR/MDR-TBM (125/137, 91.2%). The proportion of patients having prior TB treatment history in the RR/MDR-TBM group was significantly higher than that of the NRR/MDR-TBM group (6/12 vs. 12/125, 50% vs. 10.5%, P < 0.01). No significant difference was observed on other clinical and examination features between the two groups. Mortality was significantly lower in RR/MDR-TBM patients on linezolid-containing treatment regimen than those who were not (0/7 versus 3/5, 0% versus 60%, P = 0.045). Conclusions The main related risk factor of RR/MDR-TBM is the history of anti-tuberculosis treatment. Linezolid-containing regimen appears to lower mortality rate of RR/MDR-TBM significantly in our study. We think Linezolid should be evaluated prospectively in the treatment of RR/MDR-TBM.

scholarly journals Analysis of factors related to recurrence of paediatric hepatoblastoma -A single centre retrospective study

2019 ◽  
Author(s):  
Wei Yang ◽  
Yiwei Chen ◽  
Yijin Huang ◽  
Huanmin Wang
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Retrospective Study ◽  
Neoadjuvant Chemotherapy ◽  
Tumor Recurrence ◽  
Tumour Size ◽  
Alpha Fetoprotein ◽  
Therapeutic Effects ◽  
Significant Difference ◽  
Prognostic Risk Factors

Abstract Purpose: This study was performed to identify risk factors associated with recurrence of hepatoblastoma. Methods: A retrospective study was conducted on 56 patients with hepatoblastoma from 2012 to 2015 in Beijing Children’s Hospital. PRETEXT stage, serum alpha fetoprotein (AFP) value, change trend of tumors after treatment and some other clinical characteristics were collected and analyzed. The comparison of independent variables that were not distributed normally was performed with the log-rank test. Results: 28 patients with tumor recurrence and 28 non-recurrence patients were included in this study, the median age at presentation was 46.5 (26, 71.5) months. There was a significant difference in the 3-year recurrence free survival (RFS) probability between the patients over 54 months and those younger than 54 months (p=0.007). After neoadjuvant chemotherapy, the chance of recurrence in PR patients was shown to be significantly lower than that in SD patients (p=0.004). The 3-year RFS of patients with a decrease in AFP of more than 60% after neoadjuvant chemotherapy was significantly higher than that of patients with a decrease rate of less than 60% (p=0.005). Postoperative follow-up revealed that patients whose postoperative AFP fell to normal levels within six months of the start of treatment had a three-year RFS of 68.6%, which is higher than that of patients whose AFP fell below the normal range after six months (p=0.0005). Finally, multivariate analysis by Cox regression showed that AFP that decreased by less than 60% and tumour size that decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors for 3-year RFS. Other clinical features were not significantly associated with tumor recurrence in this study. Conclusion: Through this study, we concluded that the prognosis of childhood HB is related to the age at presentation and the response of chemotherapy. The results of the multivariate analysis showed that AFP that decreased by less than 60% and tumour size that decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors. These findings can be helpful to evaluate therapeutic effects and predict prognosis. Key words: hepatoblastoma; alpha fetoprotein; risk factor

Su1689 MULTIDRUG RESISTANT BACTERIAL INFECTION CHARACTERISTICS AND RELATED RISK FACTORS IN PATIENTS WITH DECOMPENSATED CIRRHOSIS

2020 ◽  
Vol 158 (6) ◽  
pp. S-616
Author(s):  
Edgar S. García Jiménez ◽  
Jose Antonio Velarde Ruiz Velasco ◽  
Guillermo A. Díaz Ventura ◽  
Miguel Á. Ibarra Estrada ◽  
Adolfo Gomez Quiroz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bacterial Infection ◽  
Multidrug Resistant ◽  
Decompensated Cirrhosis ◽  
Related Risk

scholarly journals Diagnostic Value of GeneChip for Detection of Resistant Mycobacterium tuberculosis in Patients with Differing Treatment Histories

2014 ◽  
Vol 53 (1) ◽  
pp. 131-135 ◽  
Author(s):  
Limei Zhu ◽  
Qiao Liu ◽  
Leonardo Martinez ◽  
Jinyan Shi ◽  
Cheng Chen ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Diagnostic Value ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Drug Susceptibility Testing ◽  
Standard Drug ◽  
Related Data ◽  
Resistant Tuberculosis ◽  
Mdr Tb ◽  
Previously Treated

The increasing burden of drug-resistant tuberculosis (TB) poses an escalating threat to national TB control programs. To assist appropriate treatment for TB patients, accurate and rapid detection of drug resistance is critical. The GeneChip test is a novel molecular tool for the diagnosis of TB drug resistance. Performance-related data on GeneChip are limited, and evaluation in new and previously treated TB cases has never been performed. We evaluated the diagnostic performance of GeneChip in detecting resistance to rifampin (RMP) and isoniazid (INH) and in detecting multidrug-resistant tuberculosis (MDR-TB) in comparison with standard drug susceptibility testing (DST) and compared the results in a group of previously treated and newly detected TB patients in an urban area in southeastern China. One thousand one hundred seventy-three (83.8%) new cases and 227 (16.2%) previously treated cases were collected between January 2011 and September 2013. The GeneChip showed a specificity of 97.8% and a sensitivity of 94.8% for detection of RMP resistance and 97.3% and 70.9%, respectively, for INH resistance in new cases. For previously treated cases, the overall sensitivity, specificity, and agreement rate are 94.6%, 91.3%, and 92.1%, respectively, for detection of RMP resistance and 69.7%, 95.4%, and 86.8%, respectively, for INH resistance. The sensitivity and specificity of MDR-TB were 81.8% and 99.0% in new cases and 77.8% and 93.4% in previously treated cases, respectively. The GeneChip system provides a simple, rapid, reliable, and accurate clinical assay for the detection of TB drug resistance, and it is a potentially important diagnostic tool in a high-prevalence area.

Procedure and Patient-Related Risk Factors for Post-ERCP Pancreatitis Associated with Prophylactic Pancreatic Stent and Rectal Indomethacin

2020 ◽  
Author(s):  
Hossein Ghalehnoei ◽  
Ahmad Hormati ◽  
Amir Houshang Mohammad Alizadeh ◽  
Sajjad Ahmadpour ◽  
Hassan Abedi
Keyword(s):  
Risk Factors ◽  
Pancreatic Duct ◽  
Univariate Analysis ◽  
Pancreatic Stent ◽  
Endoscopic Retrograde ◽  
Significant Incidence ◽  
Related Risk ◽  
Significant Difference ◽  
Prophylactic Pancreatic Duct Stents ◽  
Rectal Indomethacin

Abstract Background: Pancreatitis is one of the most crucial complications following endoscopic retrograde cholangiopancreatography (ERCP). The purpose of the current study was to investigate a potential procedure and patient-related risk factors for post-ERCP pancreatitis (PEP) in two groups: prophylactic pancreatic stent and rectal indomethacin.Methods: Two different prophylactic modalities were planned and complications were assessed based on defined inclusion criteria. In this study, the patients were evaluated for the procedure and patient-related risk factors in post-ERCP pancreatitis in the recipient groups of the prophylactic pancreatic stent or rectal indomethacin.Results: Pancreatitis was confirmed in 27 of all 175 selected patients after ERCP. By univariate analysis, two variables were significant with the development of PEP. Regarding the patient-related risk factors, unique subjects with common bile duct(CBD) dilated 10mm were more exposed to an increased chance of PEP (p=0. 015); meanwhile, other factors didn’t correlate with the increased possibility of PEP in both groups. The only procedure-related risk factor for PEP was deep cannulation of the pancreatic duct in both groups during the procedure with an incremental significant incidence of pancreatitis (p=0.005). Prophylactic pancreatic stent and rectal indomethacin showed no effects on reducing post ERCP pancreatitis. Additionally, there was no significant difference between these two strategies in the rate of PEP.Conclusion: Prophylactic pancreatic duct stents and administration of rectal indomethacin cannot have particular methods for reducing the occurrence of PEP. The increase in time of deep cannulation and the presence of CBD dilation <10mm could be considered as important risk factors.

scholarly journals Analysis of factors related to recurrence of paediatric hepatoblastoma - a single Centre retrospective study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Wei Yang ◽  
Yiwei Chen ◽  
Yijin Huang ◽  
Huanmin Wang
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Retrospective Study ◽  
Neoadjuvant Chemotherapy ◽  
Cox Regression ◽  
Tumour Size ◽  
Tumour Recurrence ◽  
Therapeutic Effects ◽  
Significant Difference ◽  
Prognostic Risk Factors

Abstract Background This study was performed to identify risk factors associated with recurrence of hepatoblastoma. Methods A retrospective study was conducted on 56 patients with hepatoblastoma from 2012 to 2015 in Beijing Children’s Hospital. Pretreatment extension stage (PRETEXT), serum alpha fetoprotein (AFP) value, change trend of tumors after treatment and some other clinical characteristics were collected and analyzed. The comparison of independent variables that were not distributed normally was performed with the log-rank test. Results Twenty-eight patients with tumour recurrence and 28 patients without recurrence were included in this study, and the median age at presentation was 46.5 (26, 71.5) months. There was a significant difference in the 3-year recurrence-free survival (RFS) probability between patients aged over 54 months and those younger than 54 months (p = 0.007). After neoadjuvant chemotherapy, the chance of recurrence in partial response (PR) patients was significantly lower than that in stable disease (SD) patients (p = 0.004). The 3-year RFS rate of patients with a reduction in AFP of more than 60% after neoadjuvant chemotherapy was significantly higher than that of patients with a reduction of less than 60% (p = 0.005). The postoperative follow-up revealed that patients whose postoperative AFP fell to normal levels within 6 months of the start of treatment had a 3-year RFS rate of 68.6%, which is higher than that of patients whose AFP fell below the normal range after 6 months (p = 0.0005). Finally, the multivariate analysis by Cox regression showed that AFP decreased by less than 60% and tumour size decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors for the 3-year RFS rate. The other clinical features were not significantly associated with tumour recurrence in this study. Conclusions Through this study, we concluded that the prognosis of childhood HB is related to the age at presentation and the response of chemotherapy. The results of the multivariate analysis showed that AFP decreased by less than 60% and tumour size decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors. These findings can be helpful to evaluate therapeutic effects and predict prognosis.

scholarly journals Risk factors for implant failure of proximal femoral nail anti-rotation (PFNA –II) in the treatment of intertrochanteric fractures (AO/OTA 31 A1 and A2)

2020 ◽  
Author(s):  
Shaobo Nie ◽  
Hui Ji ◽  
ming li ◽  
di yang ◽  
Yeqing Qi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intertrochanteric Fracture ◽  
Implant Failure ◽  
Proximal Femoral Nail ◽  
Coxa Vara ◽  
Therapeutic Effects ◽  
Intertrochanteric Fractures ◽  
Failure Group ◽  
Femoral Nail ◽  
Significant Difference

Abstract Background Intertrochanteric fracture is associated with severe morbidity and mortality. The results of postoperative implant failure are catastrophic. The aim of this study was to determine risk factors for implant failure in intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA–II) through the assessment of early therapeutic effects. Methods A single-center retrospective study was conducted on a continuous series of 123 intertrochanteric fracture patients treated with PFNA-II between Dec 2018 and Oct 2019. Perioperative medical and imaging data were collected. The patients were divided into two groups according to whether implant failure of not. The differences in reduction quality, nail length and tip apex distance (TAD) were analyzed to determine the risk factors of implant failure. Results A total of 80 patients were enrolled, with an average age of 80.2 years old. There were 6 patients with implant failure. There was no significant difference in demographic index between the two groups. The reduction quality of failure group was good, accept and poor with each 2 patients, and that of the non-failure group was 35, 35 and 4 patients respectively. The difference of reduction quality between the two groups was statistically significant. The risk of postoperative implant failure in patients with poor reduction quality was 8.75 times that of patients with good and acceptable reduction from the Logistic regression analysis(OR = 8.75,95%CI 1.215–62.99). The differences in nail length, ASA and bone quality were not statistically significant. Conclusion Reduction quality is a risk factor of implant failure in intertrochanteric fractures treated with PFNA-II. Even if the medial femoral cortex is anatomically reduced, there will be a triangular void area between the nail and the medial femur, which are prone to coxa vara and implant failure. Therefore, good reduction is the key to treat intertrochanteric fracture.

scholarly journals Risk factors associated with multidrug resistant tuberculosis among patients referred to Kibong’oto Infectious Disease Hospital in northern Tanzania

2016 ◽  
Vol 18 (4) ◽  
Author(s):  
Nsiande A. Lema ◽  
Peter M. Mbelele ◽  
Mtebe Majigo ◽  
Ahmed Abade ◽  
Mecky I. Matee
Keyword(s):  
Risk Factors ◽  
Previous History ◽  
Drug Susceptibility ◽  
Multidrug Resistant ◽  
Second Line ◽  
Factors Associated ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
History Of

Background: Multidrug resistant tuberculosis (MDR-TB) remains is an important public health problem in developing world. We conducted this study to determine risk factors associated with MDR-TB and drug susceptibility pattern to second line drug among MDR TB patients in Tanzania.Methods: Unmatched case control study was conducted at Kibong’oto Infectious Diseases Hospital in Tanzania in 2014. A case was defined as any patient whose sputum yielded Mycobacterium tuberculosis that were resistance to at least rifampin (RFP) and isoniazid (INH) whereas control was defined as those sensitive to rifampin (RFP) + isoniazid (INH).  One morning sputum sample was collected from each study subject and cultured on Löwenstein-Jensen (LJ) media for M. tuberculosis. Drug susceptibility testing of isolated M. tuberculosis was done for rifampicin, isoniazid, kanamycin and ofloxacin. A semi-structured questionnaire was used to collect socio-demographic and risk factors information for MDR-TB. Results: A total of 102 cases and 102 controls were enrolled. The predominant age group was 31- 40 years, of whom cases and controls accounted for 38 (37.3%) and 35 (34.3%) of the study subjects, respectively. Majority of participants (69% cases and 71% control) were males and self-employed (62.7% cases and 84.4% controls). More than half (52%) and approximately a quarter (24.5%) of cases and control had HIV infection, respectively. About two-thirds of cases (62.7%) were cigarette smokers compared to controls (42.2%). Previous history of TB treatment accounted for approximately three folds in cases (72.5%) and only 24.5% in controls. Risk factors independently associated with MDR-TB were previous history of treatment with first line anti-TB (OR= 3.3, 95% CI 1.7-6.3), smoking (OR=1.9, 95% CI 1.0-3.5), contact with TB case (OR=2.7, 95% CI 1.4-5.1) and history of TB. All MDR TB isolates were sensitive to kanamycin and ofloxacin.Conclusion: MDR-TB among patients referred to Kibong’oto Infectious Diseases Hospital is associated with previous history of TB contact, smoking habit, and contact with TB case. All MDR TB isolates were sensitive to the tested second line drugs, Kanamycin and Ofloxacin.

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