Abstract
BACKGROUND:
Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10-19 years receiving second-line anti-TB treatment in a Médecins Sans Frontières (MSF) project in Mumbai, India.
METHODS:
A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under direct observation.
RESULTS:
The median age was 16 (IQR 14-18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB), two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was 162.7 cells/µl (IQR: 84.8-250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire second-line TB or antiretroviral regimens.
CONCLUSIONS:
Early mortality and mortality after default were the most common reasons for poor outcomes in this study. Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous, intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected adolescents will be especially important in designing effective interventions for this vulnerable group.
Adverse Events among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral...Dr.Samsuddin Khan
Abstract
Background
Significant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings.
Methods
Médecins Sans Frontières (MSF) is supporting a community-based treatment program for drug-resistant tuberculosis in HIV-infected patients in a slum setting in Mumbai, India since 2007. Patients are being treated for both diseases and the management of AE is done on an outpatient basis whenever possible. Prospective data were analysed to determine the occurrence and nature of AE.
Results
Between May 2007 and September 2011, 67 HIV/MDR-TB co-infected patients were being treated with anti-TB treatment and ART; 43.3% were female, median age was 35.5 years (Interquartile Range: 30.5–42) and the median duration of anti-TB treatment was 10 months (range 0.5–30). Overall, AE were common in this cohort: 71%, 63% and 40% of patients experienced one or more mild, moderate or severe AE, respectively. However, they were rarely life-threatening or debilitating. AE occurring most frequently included gastrointestinal symptoms (45% of patients), peripheral neuropathy (38%), hypothyroidism (32%), psychiatric symptoms (29%) and hypokalaemia (23%). Eleven patients were hospitalized for AE and one or more suspect drugs had to be permanently discontinued in 27 (40%). No AE led to indefinite suspension of an entire MDR-TB or ART regimen.
Conclusions
AE occurred frequently in this Mumbai HIV/MDR-TB cohort but not more frequently than in non-HIV patients on similar anti-TB treatment. Most AE can be successfully managed on an outpatient basis through a community-based treatment program, even in a resource-limited setting. Concerns about severe AE in the management of co-infected patients are justified, however, they should not cause delays in the urgently needed rapid scale-up of antiretroviral therapy and second-line anti-TB treatment
1) AIDS results from damage to the immune system caused by HIV infection. HIV causes a gradual loss of CD4+ T-cells and immune function.
2) The most affected regions for HIV/AIDS are USA, South Africa, Eastern Africa, and India. The symptoms of AIDS are primarily infections caused by bacteria, viruses, fungi and parasites.
3) HIV can be diagnosed through an antibody test which detects antibodies to HIV, or a PCR test which detects HIV genetic material. Treatment involves taking antiretroviral drugs daily for life to suppress the virus.
Journal of Social Medicine_Dinakar et al._2011Pauline Dinakar
The study found a high prevalence (69.4%) of HIV among 180 male injecting drug users in Chennai, India. Unsafe injection practices like sharing needles, multiple incarcerations, and tattooing were associated with higher odds of HIV infection. Incarceration exposed drug users to shared needle use and increased their risk of HIV. The study calls for urgent and comprehensive HIV prevention programs for injecting drug users, both in and out of prison, to curb further transmission.
1) The study surveyed 298 patients visiting family doctors for acute sore throat pain to understand their reasons for visiting and expectations.
2) The top three reasons patients visited were to establish the cause of symptoms, get pain relief, and learn about the illness course. Hopes for antibiotics ranked 11th out of 13 items.
3) Patients hoping for antibiotics valued pain relief more and felt less well than others. They had more faith in antibiotics and were less convinced sore throat is self-limiting.
4) The desire for pain relief strongly predicted hoping to get an antibiotic prescription, even after adjusting for other factors. This suggests patients wanting antibiotics may believe it is the best pain treatment.
This document presents an evidence-based practice protocol for tuberculosis screening and testing guidelines at Evanston Township High School Health Center. It identifies a lack of detailed TB screening guidelines as a problem. A risk assessment questionnaire and targeted testing based on risk factors is proposed. The protocol recommends using either the tuberculin skin test or interferon-gamma release assay for students who have at least one risk factor identified. Outcome evaluations and cost implications of implementing the new guidelines are discussed.
A very important aspect in determining and studying disease is the knowledge of surveys. Its designs, methods etc. This elaborative presentation gives a detailed insight to the survey procedures used in dentistry. Special section on the WHO oral assessment proforma.
This document summarizes a study that tested a collaborative, multidisciplinary model of care for treating hepatitis C in active drug users recruited from the community. 22 active drug users were enrolled and 16 completed evaluation to be eligible for treatment. 9 initiated antiviral therapy, with favorable tolerability and adherence. Responses to treatment have also been favorable, showing it is feasible to treat active drug users for hepatitis C using this integrated care model.
Adverse Events among HIV/MDR-TB Co-Infected Patients Receiving Antiretroviral...Dr.Samsuddin Khan
Abstract
Background
Significant adverse events (AE) have been reported in patients receiving medications for multidrug- and extensively-drug-resistant tuberculosis (MDR-TB & XDR-TB). However, there is little prospective data on AE in MDR- or XDR-TB/HIV co-infected patients on antituberculosis and antiretroviral therapy (ART) in programmatic settings.
Methods
Médecins Sans Frontières (MSF) is supporting a community-based treatment program for drug-resistant tuberculosis in HIV-infected patients in a slum setting in Mumbai, India since 2007. Patients are being treated for both diseases and the management of AE is done on an outpatient basis whenever possible. Prospective data were analysed to determine the occurrence and nature of AE.
Results
Between May 2007 and September 2011, 67 HIV/MDR-TB co-infected patients were being treated with anti-TB treatment and ART; 43.3% were female, median age was 35.5 years (Interquartile Range: 30.5–42) and the median duration of anti-TB treatment was 10 months (range 0.5–30). Overall, AE were common in this cohort: 71%, 63% and 40% of patients experienced one or more mild, moderate or severe AE, respectively. However, they were rarely life-threatening or debilitating. AE occurring most frequently included gastrointestinal symptoms (45% of patients), peripheral neuropathy (38%), hypothyroidism (32%), psychiatric symptoms (29%) and hypokalaemia (23%). Eleven patients were hospitalized for AE and one or more suspect drugs had to be permanently discontinued in 27 (40%). No AE led to indefinite suspension of an entire MDR-TB or ART regimen.
Conclusions
AE occurred frequently in this Mumbai HIV/MDR-TB cohort but not more frequently than in non-HIV patients on similar anti-TB treatment. Most AE can be successfully managed on an outpatient basis through a community-based treatment program, even in a resource-limited setting. Concerns about severe AE in the management of co-infected patients are justified, however, they should not cause delays in the urgently needed rapid scale-up of antiretroviral therapy and second-line anti-TB treatment
1) AIDS results from damage to the immune system caused by HIV infection. HIV causes a gradual loss of CD4+ T-cells and immune function.
2) The most affected regions for HIV/AIDS are USA, South Africa, Eastern Africa, and India. The symptoms of AIDS are primarily infections caused by bacteria, viruses, fungi and parasites.
3) HIV can be diagnosed through an antibody test which detects antibodies to HIV, or a PCR test which detects HIV genetic material. Treatment involves taking antiretroviral drugs daily for life to suppress the virus.
Journal of Social Medicine_Dinakar et al._2011Pauline Dinakar
The study found a high prevalence (69.4%) of HIV among 180 male injecting drug users in Chennai, India. Unsafe injection practices like sharing needles, multiple incarcerations, and tattooing were associated with higher odds of HIV infection. Incarceration exposed drug users to shared needle use and increased their risk of HIV. The study calls for urgent and comprehensive HIV prevention programs for injecting drug users, both in and out of prison, to curb further transmission.
1) The study surveyed 298 patients visiting family doctors for acute sore throat pain to understand their reasons for visiting and expectations.
2) The top three reasons patients visited were to establish the cause of symptoms, get pain relief, and learn about the illness course. Hopes for antibiotics ranked 11th out of 13 items.
3) Patients hoping for antibiotics valued pain relief more and felt less well than others. They had more faith in antibiotics and were less convinced sore throat is self-limiting.
4) The desire for pain relief strongly predicted hoping to get an antibiotic prescription, even after adjusting for other factors. This suggests patients wanting antibiotics may believe it is the best pain treatment.
This document presents an evidence-based practice protocol for tuberculosis screening and testing guidelines at Evanston Township High School Health Center. It identifies a lack of detailed TB screening guidelines as a problem. A risk assessment questionnaire and targeted testing based on risk factors is proposed. The protocol recommends using either the tuberculin skin test or interferon-gamma release assay for students who have at least one risk factor identified. Outcome evaluations and cost implications of implementing the new guidelines are discussed.
A very important aspect in determining and studying disease is the knowledge of surveys. Its designs, methods etc. This elaborative presentation gives a detailed insight to the survey procedures used in dentistry. Special section on the WHO oral assessment proforma.
This document summarizes a study that tested a collaborative, multidisciplinary model of care for treating hepatitis C in active drug users recruited from the community. 22 active drug users were enrolled and 16 completed evaluation to be eligible for treatment. 9 initiated antiviral therapy, with favorable tolerability and adherence. Responses to treatment have also been favorable, showing it is feasible to treat active drug users for hepatitis C using this integrated care model.
Homeopathic treatment of elderly patients - a prospective observational study...home
The severity of disease showed marked and sustained improvements under homeopathic treatment,
but this did not lead to an improvement of quality of life. Our findings might indicate that homeopathic medical
therapy may play a beneficial role in the long-term care of older adults with chronic diseases and studies on
comparative effectiveness are needed to evaluate this hypothesis.
This study examined the role of primary care providers in dengue prevention and control. It found that over 80% of patients hospitalized for suspected dengue had first sought treatment at primary care clinics, seeing providers after 1.4 days of fever on average versus 4.9 days for hospitalization. However, less than 5% of patients received advice from primary care providers on preventive measures like avoiding mosquito bites or destroying breeding sites, despite over 50% being told they may have dengue. The study concludes primary care providers are well-positioned to advise early preventive actions but need to provide more education to help control dengue transmission.
This study assessed the knowledge of relatives of burn patients regarding first aid treatment of burns. A survey was conducted of 150 relatives of patients admitted to the burn unit of a hospital in Palestine over one year. The results showed that most relatives had received information about first aid from doctors and nurses or media like TV. However, over half had not received prior first aid training. While two-thirds knew to use cool running water for burns, knowledge regarding timing, duration and other aspects was lower. Females and those informed by healthcare workers had higher overall knowledge scores. The study concluded that greater training is needed for the public, especially on burn first aid, to improve initial management and reduce morbidity from such injuries.
Public Health Questions and Answers for StudentsNayyar Kazmi
This document contains definitions and explanations of key epidemiological concepts and study designs. It discusses topics such as epidemiology and its uses, the epidemiological triad, retrospective and prospective study designs, case-control and cohort studies, randomized controlled trials, sampling methods, epidemic and pandemic diseases, prevalence and incidence rates, and primary and secondary cases.
Practices of Primary Caregivers about Caring Children with Leukemia at Nation...AI Publications
This research was made to assess practices of primary caregivers about caring for children with acute leukemia at the Pediatric Blood Diseases Department, National Institute of Hematology and Blood Transfusion in 2020. Methods: This was analytical-observational research with the design of cross-sectional. Results: Study on 182 primary caregivers having children with acute leukemia treated at the Pediatric Blood Diseases Department, National Institute of Hematology and Blood Transfusion. The unsatisfactory practice of primary caregivers having children with acute leukemia accounting for 53.8%. There were 32.4% primary caregivers almost performed the wrong diet when their children had diarrhea. 38.5% primary caregivers sometimes clean their hands before and after preparing food and 33% primary caregivers sometimes clean their children’s teeth and gums properly. 28% primary caregivers sometimes encourage your children to participate in social activities. There were relationships between the educational level, the marital status, receiving health educational information and practices of primary caregivers, with p <0.05. Conclusions: The practices of primary caregivers having children with acute leukemia were low. There were relationships between educational level, marital status, receiving health educational information and practices of primary caregivers, with p <0.05.
(1) The document examines why patients in Palestine use traditional medicine to treat burns. It conducted a cross-sectional study of 290 burn patients admitted to a hospital in Hebron, Palestine in 2020.
(2) The study found that 29% of admissions used traditional medicine after their burns. The most common reasons for using traditional medicine were believing it does not leave scars after healing (70%), rapid healing (70%), and thinking traditional medicine is better than conventional treatments (57%).
(3) Sources of information about traditional burn treatments included friends (22%), the internet (53.3%), media (16.8%), and family (15%). The study found no significant differences in reasons for using traditional medicine based on
Homeopathic medical practice: Long-term results of a cohort study with 3981 p...home
Disease severity and quality of life demonstrated marked and sustained
improvements following homeopathic treatment period. Our findings indicate that homeopathic
medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.
This study examined early outcomes of decentralized care for rifampicin-resistant tuberculosis (RR-TB) in Johannesburg, South Africa. 214 patients with RR-TB were enrolled and followed until 6 months of treatment or a final outcome. Xpert MTB/RIF was used to diagnose 87% of cases. The median time to treatment initiation was 10 days. Interim outcomes at 6 months found 78% still on treatment, 13% had died, and 14% lost from treatment. Patients who started treatment within 1 week of diagnosis had a lower risk of loss from treatment. HIV co-infection occurred in 83% of patients.
This document provides an overview of epidemiology, including its basic concepts, principles, scope, and measurement tools. Some key points:
- Epidemiology is the study of disease distribution and determinants in populations, and is used to prevent and control health problems. It describes disease patterns and identifies risk factors.
- Epidemiological principles are applied in various areas like clinical research, disease prevention, and health services evaluation. Measurement tools include rates, ratios, and proportions to quantify disease frequency and burden.
- The scope of epidemiology includes measuring mortality, morbidity, disability, births, risk factors, and assessing health needs in populations. Different study designs are used to investigate disease etiology and evaluate interventions.
This study analyzed monthly trends in rates of chlamydia and gonorrhea diagnosis over 57 months using North Carolina surveillance data. For the college-aged group (19-22), diagnosis rates were significantly higher in March compared to other months. This suggests targeting education and prevention efforts before March may help reduce infections. Further research is needed to understand if this pattern reflects natural disease variation or testing behavior.
Quality Use of Medicines means:
• Selecting management options wisely by:
Considering the place of medicines in treating illness and maintaining health, and
recognising that there may be better ways than medicine to manage many disorders.
• Choosing suitable medicines if a medicine is considered necessary so that the best available option is selected by taking into account:
- the individual
- the clinical condition
- risks and benefits
- dosage and length of treatment
- any co-existing conditions
- other therapies
- monitoring considerations
- costs for the individual, the community and the health system as a whole.
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
This study evaluated the effectiveness of different combination antiretroviral therapy (ART) regimens in 100 HIV-positive patients who were injecting drug users in Indonesia. The study found that all ART combinations led to increases in CD4 count and body weight over 6-12 months. The most common side effect was nausea. Adherence to therapy was high, at 94%. While increases in CD4 count did not significantly differ between regimens, the combination of lamivudine, zidovudine and efavirenz had the highest treatment costs. The study concluded that combination ART is effective at improving immune function and health in HIV-positive injecting drug users.
This survey of 1294 students found that over 90% practice self-medication. The most common reasons for self-medicating included having mild problems and not needing a doctor. Herbal tea, vitamins, minerals and non-prescription drugs were the most used treatments. Students reported self-treating common symptoms like headaches, coughs, fatigue without medical guidance. While students had some understanding of appropriate self-medication lengths, over 25% would self-treat all symptoms, which is a concern. The results provide insight despite limitations in response rates and access.
This document summarizes a systematic review of 146 studies on determinants of adherence to antiretroviral therapy (ART) among HIV-positive adults in sub-Saharan Africa. The main findings were:
1) Main determinants of non-adherence included use of alcohol, male gender, use of traditional medicine, dissatisfaction with healthcare, depression, stigma, and poor social support.
2) Promoters of adherence included counseling, education, memory aids, and disclosure of HIV status.
3) Determinants of health status had conflicting effects on adherence.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
This study examined self-medication practices for oral health problems among dental patients in Bangalore, India. The study found that 100% of the 175 dental patients surveyed practiced self-medication. Toothache was the most common triggering factor reported. Analgesics and herbal remedies were commonly used for self-treatment. Most participants consulted pharmacists for advice on self-medication and would see a dentist only if problems persisted after self-medicating. The high prevalence of self-medication indicates a need for education programs to increase awareness of risks.
This document discusses several topics related to health services, quality of life, and client satisfaction among students, faculty, and staff at state universities in Zamboanga City. It provides background information on definitions of health, health services, and quality of life. It also outlines the minimum requirements for medical facilities and services that the Commission on Higher Education mandates for state universities. The document discusses measuring health-related quality of life and its importance for assessing needs, allocating resources, and monitoring interventions. It focuses on examining the provision of health services, perceived quality of life, and client satisfaction at state universities in Zamboanga City.
Antibiotic Stewardship and Resistance: Knowledge, Attitude, and Perception of...BRNSS Publication Hub
Introduction: This study aim to evaluate the knowledge, attitude, and perception of undergraduate medical students about antibiotic stewardship. A questionnaire-based survey was conducted among the medical students of Maharajgunj Medical Campus, Nepal from both basic (first two years) and clinical sciences (third year onwards). Materials and Methods: Responses were scored to assess the knowledge level of the students, their attitude and perception towards antibiotic stewardship and resistance. Results: In this study, 231 out of 450 undergraduate medical students (response rate=51.33%) took part. The mean knowledge, attitude and perception scores of the respondents were 2.41±1.103, 5.69±0.917, and 13.10±1.328 respectively. Though their overall attitude [223 (96.5%)] and perception [230 (99.6%)] towards antibiotic stewardship and resistance were good, their knowledge level seemed unsatisfactory [105 (45.5%)]. Statistically significant difference in the scores between basic science and clinical science students (P<0.001) was seen. Discussion: More than half the medical students’ knowledge about antimicrobial stewardship and resistance was inadequate. A perceivable difference between scores of basic and clinical science students was observed, suggesting that the knowledge, attitude, and perception of basic science students get better as they enter clinical phase. Conclusion: Suitable interventions to address the lag in curriculum should be planned right from basic science level to further strengthen their knowledge regarding antibiotic stewardship and resistance.
Assessment of the level of awareness on AIDS/HIV in Johor, MalaysiaSriramNagarajan17
This document summarizes a study that assessed awareness of HIV/AIDS among 396 respondents in Johor, Malaysia. The study found that respondents had moderately high overall knowledge of HIV/AIDS, though some misconceptions remained. Most respondents knew that high-risk behaviors like needle sharing and unprotected sex can transmit HIV, but fewer were aware of risks from activities like tattooing or sharing personal items. While most knew there is no cure for HIV/AIDS, over half believed incorrectly that washing after sex prevents transmission. The study provides insight into awareness levels and information gaps regarding HIV/AIDS in Johor.
This study assessed the knowledge and attitudes regarding care of patients with HIV/AIDS among 207 nurses working at BPKIHS, Nepal. The study found that the majority (92.3%) of nurses had moderately adequate knowledge of HIV/AIDS patient care. Over half (50.7%) of nurses reported having a favorable attitude toward caring for HIV/AIDS patients. No significant associations were found between knowledge, attitude, and socio-demographic or training variables. Knowledge was found to have a significant positive correlation with attitude. The study concluded that nurses generally have adequate knowledge and favorable attitudes, but continuous education is still needed to ensure non-stigmatizing, high-quality care of HIV/AIDS patients.
Homeopathic treatment of elderly patients - a prospective observational study...home
The severity of disease showed marked and sustained improvements under homeopathic treatment,
but this did not lead to an improvement of quality of life. Our findings might indicate that homeopathic medical
therapy may play a beneficial role in the long-term care of older adults with chronic diseases and studies on
comparative effectiveness are needed to evaluate this hypothesis.
This study examined the role of primary care providers in dengue prevention and control. It found that over 80% of patients hospitalized for suspected dengue had first sought treatment at primary care clinics, seeing providers after 1.4 days of fever on average versus 4.9 days for hospitalization. However, less than 5% of patients received advice from primary care providers on preventive measures like avoiding mosquito bites or destroying breeding sites, despite over 50% being told they may have dengue. The study concludes primary care providers are well-positioned to advise early preventive actions but need to provide more education to help control dengue transmission.
This study assessed the knowledge of relatives of burn patients regarding first aid treatment of burns. A survey was conducted of 150 relatives of patients admitted to the burn unit of a hospital in Palestine over one year. The results showed that most relatives had received information about first aid from doctors and nurses or media like TV. However, over half had not received prior first aid training. While two-thirds knew to use cool running water for burns, knowledge regarding timing, duration and other aspects was lower. Females and those informed by healthcare workers had higher overall knowledge scores. The study concluded that greater training is needed for the public, especially on burn first aid, to improve initial management and reduce morbidity from such injuries.
Public Health Questions and Answers for StudentsNayyar Kazmi
This document contains definitions and explanations of key epidemiological concepts and study designs. It discusses topics such as epidemiology and its uses, the epidemiological triad, retrospective and prospective study designs, case-control and cohort studies, randomized controlled trials, sampling methods, epidemic and pandemic diseases, prevalence and incidence rates, and primary and secondary cases.
Practices of Primary Caregivers about Caring Children with Leukemia at Nation...AI Publications
This research was made to assess practices of primary caregivers about caring for children with acute leukemia at the Pediatric Blood Diseases Department, National Institute of Hematology and Blood Transfusion in 2020. Methods: This was analytical-observational research with the design of cross-sectional. Results: Study on 182 primary caregivers having children with acute leukemia treated at the Pediatric Blood Diseases Department, National Institute of Hematology and Blood Transfusion. The unsatisfactory practice of primary caregivers having children with acute leukemia accounting for 53.8%. There were 32.4% primary caregivers almost performed the wrong diet when their children had diarrhea. 38.5% primary caregivers sometimes clean their hands before and after preparing food and 33% primary caregivers sometimes clean their children’s teeth and gums properly. 28% primary caregivers sometimes encourage your children to participate in social activities. There were relationships between the educational level, the marital status, receiving health educational information and practices of primary caregivers, with p <0.05. Conclusions: The practices of primary caregivers having children with acute leukemia were low. There were relationships between educational level, marital status, receiving health educational information and practices of primary caregivers, with p <0.05.
(1) The document examines why patients in Palestine use traditional medicine to treat burns. It conducted a cross-sectional study of 290 burn patients admitted to a hospital in Hebron, Palestine in 2020.
(2) The study found that 29% of admissions used traditional medicine after their burns. The most common reasons for using traditional medicine were believing it does not leave scars after healing (70%), rapid healing (70%), and thinking traditional medicine is better than conventional treatments (57%).
(3) Sources of information about traditional burn treatments included friends (22%), the internet (53.3%), media (16.8%), and family (15%). The study found no significant differences in reasons for using traditional medicine based on
Homeopathic medical practice: Long-term results of a cohort study with 3981 p...home
Disease severity and quality of life demonstrated marked and sustained
improvements following homeopathic treatment period. Our findings indicate that homeopathic
medical therapy may play a beneficial role in the long-term care of patients with chronic diseases.
This study examined early outcomes of decentralized care for rifampicin-resistant tuberculosis (RR-TB) in Johannesburg, South Africa. 214 patients with RR-TB were enrolled and followed until 6 months of treatment or a final outcome. Xpert MTB/RIF was used to diagnose 87% of cases. The median time to treatment initiation was 10 days. Interim outcomes at 6 months found 78% still on treatment, 13% had died, and 14% lost from treatment. Patients who started treatment within 1 week of diagnosis had a lower risk of loss from treatment. HIV co-infection occurred in 83% of patients.
This document provides an overview of epidemiology, including its basic concepts, principles, scope, and measurement tools. Some key points:
- Epidemiology is the study of disease distribution and determinants in populations, and is used to prevent and control health problems. It describes disease patterns and identifies risk factors.
- Epidemiological principles are applied in various areas like clinical research, disease prevention, and health services evaluation. Measurement tools include rates, ratios, and proportions to quantify disease frequency and burden.
- The scope of epidemiology includes measuring mortality, morbidity, disability, births, risk factors, and assessing health needs in populations. Different study designs are used to investigate disease etiology and evaluate interventions.
This study analyzed monthly trends in rates of chlamydia and gonorrhea diagnosis over 57 months using North Carolina surveillance data. For the college-aged group (19-22), diagnosis rates were significantly higher in March compared to other months. This suggests targeting education and prevention efforts before March may help reduce infections. Further research is needed to understand if this pattern reflects natural disease variation or testing behavior.
Quality Use of Medicines means:
• Selecting management options wisely by:
Considering the place of medicines in treating illness and maintaining health, and
recognising that there may be better ways than medicine to manage many disorders.
• Choosing suitable medicines if a medicine is considered necessary so that the best available option is selected by taking into account:
- the individual
- the clinical condition
- risks and benefits
- dosage and length of treatment
- any co-existing conditions
- other therapies
- monitoring considerations
- costs for the individual, the community and the health system as a whole.
Evaluation of Anti-Retroviral Combination Therapy In Patients With HIV/Aids I...iosrphr_editor
This study evaluated the effectiveness of different combination antiretroviral therapy (ART) regimens in 100 HIV-positive patients who were injecting drug users in Indonesia. The study found that all ART combinations led to increases in CD4 count and body weight over 6-12 months. The most common side effect was nausea. Adherence to therapy was high, at 94%. While increases in CD4 count did not significantly differ between regimens, the combination of lamivudine, zidovudine and efavirenz had the highest treatment costs. The study concluded that combination ART is effective at improving immune function and health in HIV-positive injecting drug users.
This survey of 1294 students found that over 90% practice self-medication. The most common reasons for self-medicating included having mild problems and not needing a doctor. Herbal tea, vitamins, minerals and non-prescription drugs were the most used treatments. Students reported self-treating common symptoms like headaches, coughs, fatigue without medical guidance. While students had some understanding of appropriate self-medication lengths, over 25% would self-treat all symptoms, which is a concern. The results provide insight despite limitations in response rates and access.
This document summarizes a systematic review of 146 studies on determinants of adherence to antiretroviral therapy (ART) among HIV-positive adults in sub-Saharan Africa. The main findings were:
1) Main determinants of non-adherence included use of alcohol, male gender, use of traditional medicine, dissatisfaction with healthcare, depression, stigma, and poor social support.
2) Promoters of adherence included counseling, education, memory aids, and disclosure of HIV status.
3) Determinants of health status had conflicting effects on adherence.
SELF MEDICATION PRACTICES FOR ORAL HEALTH PROBLEMS AMONG DENTAL PATIENTS IN B...iosrphr_editor
This study examined self-medication practices for oral health problems among dental patients in Bangalore, India. The study found that 100% of the 175 dental patients surveyed practiced self-medication. Toothache was the most common triggering factor reported. Analgesics and herbal remedies were commonly used for self-treatment. Most participants consulted pharmacists for advice on self-medication and would see a dentist only if problems persisted after self-medicating. The high prevalence of self-medication indicates a need for education programs to increase awareness of risks.
This document discusses several topics related to health services, quality of life, and client satisfaction among students, faculty, and staff at state universities in Zamboanga City. It provides background information on definitions of health, health services, and quality of life. It also outlines the minimum requirements for medical facilities and services that the Commission on Higher Education mandates for state universities. The document discusses measuring health-related quality of life and its importance for assessing needs, allocating resources, and monitoring interventions. It focuses on examining the provision of health services, perceived quality of life, and client satisfaction at state universities in Zamboanga City.
Antibiotic Stewardship and Resistance: Knowledge, Attitude, and Perception of...BRNSS Publication Hub
Introduction: This study aim to evaluate the knowledge, attitude, and perception of undergraduate medical students about antibiotic stewardship. A questionnaire-based survey was conducted among the medical students of Maharajgunj Medical Campus, Nepal from both basic (first two years) and clinical sciences (third year onwards). Materials and Methods: Responses were scored to assess the knowledge level of the students, their attitude and perception towards antibiotic stewardship and resistance. Results: In this study, 231 out of 450 undergraduate medical students (response rate=51.33%) took part. The mean knowledge, attitude and perception scores of the respondents were 2.41±1.103, 5.69±0.917, and 13.10±1.328 respectively. Though their overall attitude [223 (96.5%)] and perception [230 (99.6%)] towards antibiotic stewardship and resistance were good, their knowledge level seemed unsatisfactory [105 (45.5%)]. Statistically significant difference in the scores between basic science and clinical science students (P<0.001) was seen. Discussion: More than half the medical students’ knowledge about antimicrobial stewardship and resistance was inadequate. A perceivable difference between scores of basic and clinical science students was observed, suggesting that the knowledge, attitude, and perception of basic science students get better as they enter clinical phase. Conclusion: Suitable interventions to address the lag in curriculum should be planned right from basic science level to further strengthen their knowledge regarding antibiotic stewardship and resistance.
Assessment of the level of awareness on AIDS/HIV in Johor, MalaysiaSriramNagarajan17
This document summarizes a study that assessed awareness of HIV/AIDS among 396 respondents in Johor, Malaysia. The study found that respondents had moderately high overall knowledge of HIV/AIDS, though some misconceptions remained. Most respondents knew that high-risk behaviors like needle sharing and unprotected sex can transmit HIV, but fewer were aware of risks from activities like tattooing or sharing personal items. While most knew there is no cure for HIV/AIDS, over half believed incorrectly that washing after sex prevents transmission. The study provides insight into awareness levels and information gaps regarding HIV/AIDS in Johor.
This study assessed the knowledge and attitudes regarding care of patients with HIV/AIDS among 207 nurses working at BPKIHS, Nepal. The study found that the majority (92.3%) of nurses had moderately adequate knowledge of HIV/AIDS patient care. Over half (50.7%) of nurses reported having a favorable attitude toward caring for HIV/AIDS patients. No significant associations were found between knowledge, attitude, and socio-demographic or training variables. Knowledge was found to have a significant positive correlation with attitude. The study concluded that nurses generally have adequate knowledge and favorable attitudes, but continuous education is still needed to ensure non-stigmatizing, high-quality care of HIV/AIDS patients.
The document summarizes a study examining HIV stigma among opioid-dependent individuals under community supervision. It describes high HIV rates in Washington D.C. and the criminal justice system. The study used a stigma scale to assess stigma in 16 participants. Females and homosexuals reported higher levels of stigma than males and heterosexuals, particularly around disclosure concerns. The study aims to reduce stigma and HIV risk through counseling in Project STRIDE, which provides medication-assisted treatment for opioid dependence and HIV.
A bridge too near injecting drug users' sexual behaviourMd. Nakebul Kausar
This document summarizes a study on the personal profiles and health seeking behaviors of injecting drug users (IDUs) in Dhaka, Bangladesh. The study involved interviews with 120 IDUs attending a drug treatment center between March and September 2005. Key findings included: 1) Most respondents (60%) had little knowledge about diseases spread by injecting drugs or needle sharing, with only 17.5% mentioning HIV/AIDS. 2) Regarding protection, 29.2% mentioned not injecting drugs anymore while 34.2% mentioned using sterile needles/syringes. 3) The majority (60%) had never participated in a needle exchange program, with lack of awareness being a key barrier.
Global HIV cohort studies among IDU and future vaccine trialsThira Woratanarat
The author reviewed data on the global HIV epidemic among injecting drug users (IDUs) and identified potential cohorts of IDUs that could participate in future HIV vaccine trials. High HIV prevalence rates were observed among IDUs in many countries in Asia, Eastern Europe, Latin America, and parts of Africa and North America. Several cohort studies also showed high HIV incidence rates among IDUs in China, Thailand, Canada, and Spain. These findings emphasize the seriousness of the IDU epidemic globally and the potential for IDU cohorts to participate in HIV vaccine trials due to demonstrated high participation and retention rates in past studies.
This document discusses the importance of adult immunization and provides guidelines for vaccination against various diseases. It begins by noting that while childhood immunization is well-known, adult immunization is less understood but still important. It then reviews literature on vaccination protocols for adults, including for travel, communicable diseases, hepatitis B, shingles, and more. The document focuses in depth on recommended vaccination for human papillomavirus (HPV), hepatitis, and human immunodeficiency virus (HIV). It provides vaccination schedules, target groups, and notes the need to increase awareness of adult immunization among healthcare professionals and the public.
Levels of Utilization and Socio - Economic Factors Influencing Adherence to U...inventionjournals
This document analyzes levels of utilization and socio-economic factors influencing adherence to antiretroviral therapy (ART) among people living with HIV/AIDS in Dodoma Municipality and Kongwa District, Tanzania. The study found that ART usage rates ranged from 100% at some facilities to 40% at others. Common reasons for dropping out of ART programs included side effects like vomiting (25.1%) and frequent sickness (19.9%), as well as lack of employment support (66.7%) and lack of confidentiality (50%). The document concludes that improving adherence requires addressing side effects, providing income assistance, and ensuring confidentiality in HIV services.
1) The document discusses a study evaluating the impact of a biometric fingerprint scanning system used to track patient attendance and medication adherence at tuberculosis treatment centers in slum communities in India.
2) Interviews with health workers, center owners, and patients suggest that the biometric system helps draw patients to the centers and improves their medication adherence by making in-person visits and monitored dosing more important.
3) While some inconvenience was reported, overall the biometric system was perceived positively and as creating solidarity between health workers and patients in ensuring proper treatment.
A Study Regarding Knowledge of Anti Biotic Resistance among Engineering Stude...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Running head: TUBERCULOSIS 1
TUBERCULOSIS 2
Tuberculosis
NRS-427VN | Epidemiology and Communicable Disease
8/26/18
Tuberculosis
About 33% in our existence's people is considered to have been tainted with tuberculosis (TB), new attacks are symbolized in no under 1% of the people every year". In 2016, a standard 1.5 million fatalities associated with TB have took place, the lion's talk about which are from younger looking countries over the world. As this quantity has been reducing, unnecessarily various have been sullied. The best center is situated in the Asian and African countries, at 80%. Within the USA, 5-10% of the individuals studies constructive. With tuberculosis taking after second behind HIV/Helps in most common deaths from powerful ailment, they have transformed into an over-all exchange. Understanding the annals, seeing the signals and appearances, evolved treatment alternatives, and neutralizing activity, will spread this disease to an even of control.
Since the start, tuberculosis has been accessible. Most quick unambiguous affirmation of the malady has been dated around 17,000 years before, in stays of a bison in Wyoming. Effective treatment of tuberculosis has finished up being bothersome and long. Chemical manifestations of the mycobacterium cell dividers and bizarre form, restricts most against microbial alternatives. Most typically used is Isoniazid and Rifampicin. Advised estimations of treatment, for new starting point, are half a year of blend hostile to infections operators. 8 weeks of rifampicin, isoniazid, pyrazinamide, and ethambutol drugs. Together with the latest four a few months of just rifampicin and isoniazid"(Wikipedia, 2015, p. 12).For the individuals who have idle TB receive only a sole against microbial.
This estimation ruins the inert TB to wrap up aspect. As this move out estimations of hostile to infections specialists can be difficult, direct observed treatment is preferred by WHO (World Health Corporation, 2015). Facts have exhibited that folks, who are depended after to adopt their medicine, will miss organized estimations. Immediate discernment treatment contains having an interpersonal protection employee watch the individual taking their remedies. As this is dreary, using diverse contraptions of acknowledgment is necessary. Such overhauls can sign up for booked calls or digital notices. By not doing medication regimens, put others at peril to finding this sickness.
Those in close closeness to specific with tuberculosis are in an especially high danger to finding the opportunity to be debased. Besides, with HIV/Supports hold the most hoisted risk element of all. Early on area and treatment, with fitted hindrances of these polluted is an integral.
Friendly determinants ...
This document summarizes a study on factors influencing adherence to antiretroviral therapy (ART) among people living with HIV in Tanzania. The study analyzed data from 943 HIV-positive patients attending care and treatment centers in urban Dar es Salaam and rural Iringa regions of Tanzania. Adherence based on appointment keeping was 65% and based on patient self-reports of doses taken in the past month was 70-83%. Factors associated with better adherence included satisfaction with healthcare services, social support, knowledge of ART use, early presentation to care, and being on ART for over one year. Being in an urban area, using traditional medicine, experiencing side effects, and alcohol use were linked to poorer adherence
Patients from the urban Dar es Salaam region were less likely to be married, have social support, earn less than $150 USD per month, have lower education levels, receive pre-ART counseling, be on first-line ART, experience side effects, and be satisfied with clinic services compared to patients from the rural Iringa region. Patients from Dar es Salaam were more likely to pay less than $0.50 for transport to the clinic, delay registering at the clinic, and take additional medications for opportunistic infections. Adherence based on appointment keeping was higher in Dar es Salaam while adherence based on self-report was higher in Iringa.
Patients from the urban Dar es Salaam region were less likely to be married, have social support for medication reminders, earn less than $150 USD per month, have lower education levels, and consume alcohol compared to the rural Iringa region. Urban patients were also more likely to experience delays in registering for care, pay less for transportation to clinics, and take additional medications for opportunistic infections. Adherence based on appointment keeping was higher in the urban region, while adherence based on self-reported dosage in the past month was higher in the rural region. Factors associated with adherence differed between the urban and rural settings in Tanzania.
Factors associated to adherence to DR-TB treatment in Georgia, Policy Brief (...Ina Charkviani
Tuberculosis (TB) is a widely spread disease globally that causes millions of people’s death worldwide. Treatment for TB is complex and usually involves taking several antibiotics at once for a long time (sometimes up to two years). Considering the severity of the treatment regimen, it becomes hard for the patients to adhere and complete proposed treatment and particularly for those who are infected with drug-resistant strain of TB. Poor adherence to treatment remains significant problem that prevents countries from obtaining high treatment success rates that is essential for health systems to control the epidemic and decrease spread of the disease. A new study from Georgia looks at adherence to treatment factors among drug resistant TB (DR-TB) patients and provides evidence that may help policy-makers develop effective strategies for improving treatment outcomes among DR-TB patients. The study findings might be helpful for other countries in the region where TB burden is also high.
Un estudio sobre las caracteristicas del tratamiento sde la TB XDR en sudafrica y el pronostico de vida de los pacientes segun las estrategias terapeuticas
Background- Multidrug-resistant tuberculosis (MDR-TB) is caused by strain of Mycobacterium tuberculosis, it is transmitted through air droplets from infected person and Close contacts of MDR-TB patients have a high potential to developing TB. This study aims to determine the profile of TB/multidrug-resistant TB (MDR-TB) among household contacts of MDR-TB patients. Material and Methods- The cases were recruited from the King George’s Medical University, Lucknow, India. In this cross-sectional study, Close contacts of MDR-TB patients were screened for tuberculosis. clinical, radiological and bacteriological experiments were performed to find out the evidence of TB/MDR-TB. Results- The cases were enrolled Between December 2015 to December 2016, a total of 100 index MDR-TB patients were recruited which initiated on MDR-TB treatment. A total of 428 contacts who could be studied, 11 (2.57%) were diagnosed with MDR-TB and 4 (0.93%) had TB. The most frequent symptoms observed in patients were cough, chest pain and fever. Conclusions- Tracing symptomatic contacts of MDR-TB cases could be a high yield strategy for early detection and treatment of MDR-TB cases to contribute to reduced morbidity, mortality and to cut the chain of transmission of infection in the community. The approach should be bringing about for wider implementation and dissemination. Key-words- TB, MDR-TB, Symptomatic, Household, Transmission
Assessing the Quality of Life of HIV/AIDS Patients attending Anti-Retroviral ...RosyPurakayastha
This document describes a study that assessed the quality of life of 150 HIV/AIDS patients attending an anti-retroviral clinic using the WHOQOL-HIV BREF scale. The scale measures quality of life across 6 domains: physical, psychological, independence, social relationships, environment, and spirituality. A literature review found that HIV/AIDS negatively impacts quality of life in all domains. The study aimed to identify quality of life issues in these domains and how they relate to socio-demographic factors, to help allocate resources and address patient needs. Patients were interviewed using the WHOQOL-HIV BREF scale to measure their perceptions in each domain.
The document provides an overview of research activities and outputs from Clinical Research Centres (CRCs) in Perak, Malaysia from 2018-2020. Key points include:
- CRCs in Ipoh, Seri Manjung and Taiping have seen increases in research projects, publications, and consultations from 2018-2020, with the largest CRC in Ipoh leading research activities.
- Investigator initiated research projects have increased year-over-year across all three CRCs, resulting in growth of local/international publications and presentations.
- Industry-sponsored clinical trials have also increased at two of the three CRCs over the period.
- CRCs provide important research services like ethics appro
Similar to Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for Multidrug-Resistant Tuberculosis in Mumbai, India. (20)
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for Multidrug-Resistant Tuberculosis in Mumbai, India.
1. Poor Outcomes in a Cohort of HIV-Infected Adolescents
Undergoing Treatment for Multidrug-Resistant
Tuberculosis in Mumbai, India
Petros Isaakidis1
*, Roma Paryani1
, Samsuddin Khan1
, Homa Mansoor1
, Mamta Manglani2
,
Asmaa Valiyakath1
, Peter Saranchuk3
, Jennifer Furin4
1 Me´decins Sans Frontie`res, Mumbai, India, 2 Pediatric Centre of Excellence for HIV Care, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai,
India, 3 Southern Africa Medical Unit, Me´decins Sans Frontie`res, Cape Town, South Africa, 4 Tuberculosis Research Unit, Case Western Reserve University, Cleveland, Ohio,
United States of America
Abstract
Background: Little is known about the treatment of multidrug-resistant tuberculosis (MDR-TB) in HIV-co-infected
adolescents. This study aimed to present the intermediate outcomes of HIV-infected adolescents aged 10–19 years
receiving second-line anti-TB treatment in a Me´decins Sans Frontie`res (MSF) project in Mumbai, India.
Methods: A retrospective review of medical records of 11 adolescents enrolled between July 2007 and January 2013 was
undertaken. Patients were initiated on either empirical or individualized second-line ambulatory anti-TB treatment under
direct observation.
Results: The median age was 16 (IQR 14–18) years and 54% were female. Five (46%) adolescents had pulmonary TB (PTB),
two (18%) extrapulmonary disease (EPTB) and four (36%) had both. Median CD4 count at the time of MDR-TB diagnosis was
162.7 cells/ml (IQR: 84.8–250.5). By January 2013, eight patients had final and 3 had interim outcomes. Favourable results
were seen in four (36.5%) patients: one was cured and three were still on treatment with negative culture results. Seven
patients (64%) had poor outcomes: four (36.5%) died and three (27%) defaulted. Three of the patients who died never
started on antiretroviral and/or TB treatment and one died 16 days after treatment initiation. Two of the defaulted died soon
after default. All patients (100%) on-treatment experienced adverse events (AEs): two required permanent discontinuation
of the culprit drug and two were hospitalized due to AEs. No patient required permanent discontinuation of the entire
second-line TB or antiretroviral regimens.
Conclusions: Early mortality and mortality after default were the most common reasons for poor outcomes in this study.
Early mortality suggests the need for rapid diagnosis and prompt treatment initiation, and adolescents might benefit from
active contact-tracing and immediate referral. Default occurred at different times, suggesting the need for continuous,
intensified and individualized psychosocial support for co-infected adolescents. Operational research among co-infected
adolescents will be especially important in designing effective interventions for this vulnerable group.
Citation: Isaakidis P, Paryani R, Khan S, Mansoor H, Manglani M, et al. (2013) Poor Outcomes in a Cohort of HIV-Infected Adolescents Undergoing Treatment for
Multidrug-Resistant Tuberculosis in Mumbai, India. PLoS ONE 8(7): e68869. doi:10.1371/journal.pone.0068869
Editor: Robert J. Wilkinson, Institute of Infectious Diseases and Molecular Medicine, South Africa
Received March 21, 2013; Accepted June 1, 2013; Published July 19, 2013
Copyright: ß 2013 Isaakidis et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: No current external funding sources for this study.
Competing Interests: The authors have declared that no competing interests exist.
* E-mail: msfocb-asia-epidemio@brussels.msf.org
Introduction
Multidrug-resistant tuberculosis (MDR-TB)–defined as strains
of TB with in vitro resistance to at least isoniazid and rifampin–is a
major public health problem [1]. In 2010, it was estimated that
there were 650,000 prevalent MDR-TB cases, few of which were
actually diagnosed and treated. In fact, fewer than 40,000 patients
have been put on World Health Organization (WHO)-recom-
mended therapy in the last decade [2]. Inadequate diagnosis and
treatment of MDR-TB is even worse in children, who represent an
estimated 10–20% of all cases, up to 80,000 each year [3–4]. The
published literature reports only a small number of pediatric
patients receiving treatment, and a recent meta-analysis of
pediatric MDR-TB treatment outcomes included only 315
children [5].
What little pediatric data does exist tends to group all outcomes
together, despite the fact that the data represents children as young
as a few months old and others up to 18 years of age [6]. It is
widely acknowledged that younger children face more challenges
in terms of diagnosis and medication dosing [7] while older
children, especially those in what is known as the ‘‘adolescent’’ age
group (defined by the World Health Organization as those aged
10–19 years [8]), may face more challenges with adherence given
their developmental state [9]. The literature on chronic disease
management in adolescents has shown that this population has
special physical and psychological needs [10–12]. Adolescents
PLOS ONE | www.plosone.org 1 July 2013 | Volume 8 | Issue 7 | e68869
2. often experience spurts of growth that may lead to under-dosing
with their medication [13]. Certain diseases, including TB, may
also present more aggressively in this population [14–15]. Perhaps
more significantly, adolescence is defined as a period of emotional
and psychological upheaval that can affect relationships with
health care providers and caregivers and ultimately adherence to
medical regimens [16–17]. In addition, adolescence is a time
period during which children must transition into adult roles; there
may be increased time constraints due to school, work or family
responsibilities [18–20]. All of these issues can affect the health
outcomes of adolescent populations with chronic diseases, such as
MDR-TB.
To date, there are no published reports characterizing MDR-
TB treatment outcomes in the adolescent population. This paper
fills that gap by presenting data from a cohort of 11 adolescent
patients diagnosed with MDR-TB in Mumbai, India, all of whom
were co-infected with HIV. The cohort is relatively small, but is
being reported here because it demonstrates some concerning
findings in the adolescent population undergoing treatment for
MDR-TB. Targeted interventions to improve MDR-TB treatment
outcomes in adolescents are also discussed.
Methods
Study Design, Setting and Study Population
This is a retrospective review of the medical records of HIV-
infected adolescents aged 10–19 years with culture-confirmed or
suspected MDR-TB, undertaken as part of a larger study on
MDR-TB treatment outcomes in Mumbai, India [21]. All patients
were enrolled to receive treatment with second-line anti-TB
medications in a Me´decins Sans Frontie`res (MSF) clinic. Patients
were referred to the clinic by public antiretroviral treatment
centers (ART Centers), including the Regional Pediatric ART
Centre, L.T.M. Medical College, Sion, Mumbai, which serves as
one of the Centres Of Excellence in Pediatric HIV Care in India.
Patients were also referred to the clinic by a network of community
non-governmental organizations. Eleven (11) adolescents enrolled
in care between July 2007 and January 2013 are included in this
analysis.
Treatment Protocol and Follow-up
The ambulatory, community-based MDR-TB treatment pro-
gram has been described in detail in a previous publication [21].
Individualized treatment regimens are designed for each patient,
based on drug susceptibility testing (DST) and prior treatment
history. Standardized empiric treatment is given to patients who
require immediate initiation due to disease severity or for those in
whom a DST result is not available but in whom MDR-TB is
diagnosed based on clinical findings, past TB treatment history
and/or history of contact with a known or suspected MDR-TB
patient. The standardized regimen follows international recom-
mendations [22] and includes six drugs: pyrazinamide, capreo-
mycin, moxifloxacin, ethionamide, cycloserine and p-aminosa-
licylic acid (PAS) and is modified as necessary if DST results
become available. Blood test monitoring was done every month
and sputum smear and culture every month during the intensive
phase and every three months during the continuation phase.
Treatment is continued for a minimum total duration of 18–20
months, including a minimum of 6–8 months intensive phase that
includes an injectable agent. Antiretroviral therapy (ART) against
HIV includes two nucleoside/tide reverse transcriptase inhibitors
(NRTIs) and one non-nucleoside reverse transcriptase inhibitor
(NNRTI) in a first-line ART regimen, while patients in need of
second-line ART receive a protease inhibitor-based regimen along
with NRTIs that are likely to be effective, based on HIV resistance
testing results.
The adolescent patients were evaluated and followed by a
multidisciplinary team of doctors, nurses, a psychologist and a
social worker. They were clinically evaluated every two weeks
during the first month of treatment and once a month thereafter.
Home visits were conducted by the clinic team as necessary in
order to provide social and emotional support to the adolescents
and their families. At the community level, a network of public and
private health structures and non-governmental organizations
(NGOs) acted as providers of directly observed therapy (DOT) for
the MDR-TB medication. DOT providers were given training on
adverse events, adherence monitoring and pill counts, and referral
pathways for patients with poor adherence.
Data Collection and Analysis
Demographic and clinical information were systematically
recorded in clinical files and entered into an electronic database.
Information on HIV and antiretroviral therapy was collected in
the same patient file but entered in a separate database. Each
patient had a unique identification code that was used in both
databases. Possible outcomes, defined according to WHO
guidelines, included: cure, treatment completed, death, default,
transfer out, treatment failure, and ‘alive and on treatment’.
Ethics
This study has met the criteria for analysis of routinely collected
program data of the MSF Ethics Review Board, Geneva,
Switzerland. As this was a study of routinely collected monitoring
data, informed consent from the patients was not obtained. The
named ethics committee waived the need for consent.
Results
Eleven adolescents, aged 10 to 19 years, diagnosed with MDR-
TB and co-infected with HIV are reported here. All had
perinatally acquired HIV. The median age was 16 [Interquartile
Range (IQR): 14–18] and 54 percent were female. All except one
had a past history of TB treatment and four of them were contacts
of known drug-resistant TB patients. Five (46%) adolescents had
pulmonary TB, two (18%) had extrapulmonary disease and four
(36%) had both pulmonary and extrapulmonary TB (Table 1).
The median CD4 count at the time of MDR-TB diagnosis was
162.7 cells/ml (IQR: 84.8–250.5). Five patients were on ART at
the time of the MDR-TB diagnosis: two of them were on ART for
more than 2 years and three of them for six months or less.
Another three patients were started on ART following initiation of
DR-TB treatment: two patients after seven months and one
patient after one month of TB treatment (Table 2). The median
time from diagnosis of MDR-TB to initiation of second-line
treatment was 10 days (IQR: 7–12). Three patients did not start
antiretroviral and second-line TB treatments as they died soon
after enrolment (Figure 1). Routine HIV viral load monitoring was
not available during the early years of the program.
By January 2013, eight patients had final outcomes and three
had interim outcomes (Table 3). Favourable outcomes were seen
in 4 (36%) of the patients, one of whom was cured and three of
whom were still on treatment with negative smears and/or
cultures and improving clinical signs. Two of these latter patients
were about to complete their course of second-line anti-TB
treatment at the time of this analysis and they were doing very
well.
The remaining 7 patients (64%) had poor treatment outcomes:
four of these patients (36.5%) died and three of them (27%)
Outcomes in HIV/MDR-TB Co-Infected Adolescents
PLOS ONE | www.plosone.org 2 July 2013 | Volume 8 | Issue 7 | e68869
3. defaulted treatment. Of the four who died, three never started on
MDR-TB and ART treatments and one died 16 days after
treatment initiation. Treatment interruptions were recorded in all
three patients who defaulted treatment. Two of the adolescents
who defaulted died soon after they abandoned treatment at 3 and
17 months, reportedly due to adverse events and social problems
respectively. One patient, a 15 year-old female, defaulted three
weeks before treatment completion (at 21 months). The girl
declined both antiretroviral and anti-TB treatments despite an
excellent clinical response and lack of adverse events. We traced
the patient and identified a non-supportive, problematic family
environment (parental death, history of sexual abuse). Her elder
sister, also HIV/MDR-TB co-infected and part of this same
cohort, had died. The girl had a partner to whom she was initially
unwilling to disclose her status, but eventually did give her consent
for couple counseling.
Refusal to start treatment and treatment interruptions were
frequently (4/8) observed in this cohort of adolescents. An
example illustrating the complexity of treatment acceptance and
adherence is an orphan male patient who had started anti-TB
treatment but refused to start on antiretroviral treatment. He later
abandoned his anti-TB treatment only to restart 5 months later as
his condition had deteriorated. He is presently on both treatment
regimens. However the family is worried about TB transmission
and is trying to send him to a hospice. As a result, the patient is
experiencing behavioral issues due to a perceived fear of
abandonment. Constant supportive counseling has thus far
ensured that he stays on treatment, while additional family
counseling is being offered.
All eight patients (100%) who started on treatment experienced
adverse events (AE); 2 required permanent discontinuation of the
culprit drug and 2 patients had to be hospitalized due to AEs (both
for hypokalaemia). The most common adverse events were
gastrointestinal intolerance (5/8 patients) followed by peripheral
neuropathy (3/8) and psychiatric events (3/8). Adverse events and
the time of occurrence are shown in Table 4. None of the eight
patients has required permanent discontinuation of the entire
second-line anti-TB or antiretroviral regimen.
Discussion
This study shows poor treatment outcomes in a cohort of HIV-
infected adolescents being treated for MDR-TB. Compared with
their adult counterparts in a previous publication [23], these
adolescents have both higher rates of death and default. These
results are of concern and suggest the need for urgent interven-
tions.
The majority of the adolescents (6/11) in this cohort died, and
there may be several explanations for this. First, HIV co-infection
has been shown to be a risk factor for mortality among persons
with MDR-TB [24]. Co-infected patients may have severe forms
of Immune Reconstitution Inflammatory Syndrome (IRIS)
following ART initiation that can be associated with mortality
[25]. There may be drug-drug interactions between second-line
anti-TB medications and ART that could result in decreased
efficacy of therapy [26]. Second, extent of disease and drug
resistance, particularly to the fluoroquinolones, have also been
associated with worse treatment outcomes in other cohorts [27–
28] and may have played a role here, given that 75% of available
DST results showed resistance to this group of drugs.
While these factors may have played a role in the high mortality
seen in this study, it should be noted that four of the six patients
who died did so either prior to or within three weeks of initiating
therapy. Such ‘‘early deaths’’ have been described in other cohorts
and are usually considered ‘‘failure to treat’’ as opposed to
‘‘treatment failures’’ [29]. These deaths can generally be ascribed
to problems with timely diagnosis and referral rather than
ineffective treatment practices [30]. The high early mortality in
this cohort suggests that special strategies should be deployed to
diagnose and refer adolescents with suspected MDR-TB early in
the course of their disease [31]. Although adolescents may be able
to more easily provide sputum samples for diagnosis when
compared with children, they may be less likely to follow up on
referrals [32]. A potential strategy for earlier diagnosis is active
screening and immediate clinical referral of all household contacts
of persons with MDR-TB [33], given that more than one-third of
the adolescents in this study had a known MDR-TB contact; had
Table 1. Demographic and Clinical Characteristics of the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013 (N = 11).
Characteristic n (%)
Age, median (IQR) years 16 (14–18)
Female gender 6 (54)
Site of disease
Pulmonary 5 (46)
Extrapulmonary 2 (18)
Pulmonary+Extrapulmonary 4 (36)
Previous TB treatment 10/11 (91)
MDR-TB Contact 4/11 (37)
Resistance (when DST available)
H 9/9 (100)
R 9/9 (100)
E 7/9 (78)
FQ 6/8 (75)
Injectable 1/8 (13)
CD4 count at time of MDR-TB diagnosis, cells/ml, median (IQR) 162.7 (84.8–250.5)
IQR: interquartile range; H: isoniazid; R: rifampicin; E: ethambutol; FQ: fluoroquinolones.
doi:10.1371/journal.pone.0068869.t001
Outcomes in HIV/MDR-TB Co-Infected Adolescents
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4. Figure 1. Flowchart of the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013.
doi:10.1371/journal.pone.0068869.g001
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5. they been identified through an active case-finding strategy,
perhaps they would have been diagnosed more quickly and
benefitted from earlier treatment.
Discontinuation of therapy was also frequently reported in this
study, with three (37.5%) of eight adolescents starting both
antiretroviral and anti-TB therapy eventually defaulting. This is
compared with a general loss to follow-up rate in this HIV
programme of less than 3% [34]. HIV co-infection may have been
a factor in patient discontinuation of therapy due to increased pill
burden on ART or the occurrence of adverse events [35–37] that
may result from interactions between TB and HIV drugs, or
additive drug-related side effects. In addition to the complications
of HIV co-infection, this adolescent cohort has had other risk
factors for default from therapy, including family and social
problems, unwillingness to disclose their status, and discrimina-
tion.
The story of the adolescent patient who defaulted just a few
weeks before treatment completion clearly illustrates the complex-
ity of factors that influence the behavior of adolescents who are
HIV-infected and at the same time have to go through a long
course of an intolerable and toxic treatment regimen. We have
observed that patients that begin to feel better while on treatment
prefer to get back to their normal routine: these activities of daily
living then take priority over their health. All adolescents in this
Mumbai cohort attended school at some point; it is interesting to
mention that none of them has disclosed their status at school.
All patients on treatment in this adolescent cohort experienced
similar adherence issues: they all reported the high pill burden, the
side effects, and the long duration of the treatment as major
Table 2. Clinical Characteristics of the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013.
Age/Sex CD4* ART Regimen ART Started TB Site Smear Culture Resistance DR Type 2nd
-Line TB Regimen
1 14/M 243 D4T+3TC+EFV 5 months prior P+EP (Abd LN) NEG POS S,H,R,E,Km,PAS,Ofx,Eto XDR Cm,Lfx,Eto,Cs,Amcl
2 10/M 273 D4T+3TC+NVP 7 months after P NEG POS S,H,R,E,Ofx,Eto Pre-XDR Km,Mfx,Eto,Cs,PAS,Z,Amcl
3 18/F 125 TDF+3TC+EFV 5 months prior P POS POS S,H,R,E,Ofx Pre-XDR Km,Mfx,Eto,Cs,PAS
4 13/F 147 No ART Never EP (LN) POS POS S,H,R,E,Ofx Pre-XDR
5 18/F No ART Never P POS POS S,H,R,E MDR
6 16/F 92 D4T+3TC+EFV 6 months prior P+EP (Cereb) POS POS S,H,R,E,PAS,Z MDR Cm,Mfx,Eto,PAS,Z,H,Amcl
7 15/F 199 AZT+3TC+NVP 7 months after P POS POS S,H,R,E,PAS,Z MDR Km,Mfx,Eto,Cs,Amcl,H,E
8 19/F 290 TDF+3TC+ATV/r 28 months prior P NEG POS S,H,R,E,Ofx,PAS Pre-XDR Cm,Mfx,Eto,Cs,H,Cfz,Z
9 14/M 159 ABC+3TC+LPV/r 71 months prior EP Abd NEG NEG _ Empirical Cm,Mfx,Eto,Cs,PAS,Z
10 16/M 36 No ART Never P+EP (Abd LN) NEG NEG _ Empirical
11 18/M 63 TDF+3TC+EFV 1 month after P+EP (Abd) NEG POS S,H,R,E,Ofx,PAS,Mfx,Z Pre-XDR Cm,Lfx,Eto,Cs,Amcl,Hh,Cfz
M: male; F: female; D4T: stavudine; 3TC: lamivudine; EFV: efavirenz; TDF: tenofovir; AZT: zidovudine; ABC: abacavir; NVP: nevirapine; ATV/r: atazanavir/ritonavir; LPV:
lopinavir; PTB: pulmonary tuberculosis; EPTB: extra-pulmonary tuberculosis; Abd; abdominal; Cereb; cerebral, LN: lymph node; NEG: negative; POS: positive; S:
streptomycin; Cm: capreomycin; Km: kanamycin; Lfx: levofloxacin; Eto: ethionamide; CS: cycloserine; Amcl: amoxicillin/clavulanic acid; Mfx: moxifloxacin; Ofx; ofloxacin;
PAS; para-aminosalicylic acid; Z: pyrazinamide; H: isoniazid; Hh: high dose isoniazid; E: ethambutol; Cfz: clofazimine; XDR: extensively drug-resistant; MDR: multidrug-
resistant.
*at time of MDR-TB diagnosis.
doi:10.1371/journal.pone.0068869.t002
Table 3. Outcomes of the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013.
NoAge/Sex MDR Tx Start Date Outcome Time on Treatment Reason for default/Cause of death/Comments
1 14/M 27.07.2007 Defaulted 17 Months Patient defaulted after 17 months of treatment and then died 1 month after
default. Convulsions, Brain Tuberculoma.
2 10/M 31.08.2007 Cured 18 Months
3 18/F 19.06.2008 Defaulted 3 Months Patient died 1.5 months after default. Reason for default: adverse events & social
issues. Cause of death not ascertained.
4 13/F Never Died 0 Months Died before treatment, 1 month after enrolment
5 18/F Never Died 0 Months Patient declined treatment and died 2 months later
6 16/F 15.02.2011 Died 16 Days Brain Tuberculoma
7 15/F 22.02.2011 Defaulted 21 Months Patient defaulted a few weeks before treatment completion due to social issues
(family deaths, sexual abuse) & personal issues (sexual debut, not willing to
disclose status to partner)
8 19/F 12.05.2011 Alive on Treatment 21 Months Patient has culture converted, about to complete treatment
9 14/M 24.11.2011 Alive on Treatment 15 Months Patient in excellent clinical condition
10 16/M Never Died 0 Months Died before treatment, 1 month after enrolment. Acute renal failure.
11 18/M 23.10.2012 Alive on Treatment 4 Months Adherence problems (behavioral issues, adverse events)
doi:10.1371/journal.pone.0068869.t003
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6. challenges in their daily life. As expected, patients with good
support and patients who experienced low to no discrimination
demonstrated better adherence. We have found that supportive
counseling is important not just for the patient but also for the
family. Education about treatment and adherence issues is
important for the family and the caretakers so that they
understand the need to support the patient through this difficult
treatment. On the other hand, adolescents expressed that ‘‘the
constant nagging of the caretaker’’ worked against their adher-
ence. Despite the degree of support and the exposure to stigma
and discrimination, all adolescents were conscious of how
conspicuous they were during their daily visit to DOT centers,
so much so that some preferred to avoid going to the DOT centers
at the expense of their health. Adolescents want to experience
‘‘normal’’ lives and ‘‘pretended to be normal’’ rather than ‘‘taking
the steps to a better health’’ (patients quotes recorded during
routine counseling sessions).
Adverse events were frequent in this cohort and psychiatric
events were worryingly common. We have recently introduced a
baseline mental health evaluation in order to screen for depression
and other mental health issues. We have also found that aggressive
management of adverse events is necessary to ensure short and
long term adherence.
This study has a number of limitations, most of which are
related to the small sample size. Clearly, there is a need to evaluate
adolescents undergoing treatment for MDR-TB on a larger scale.
Second, all of the patients were infected with HIV and thus the
results are not likely generalizable to HIV-negative adolescents
with MDR-TB. Finally, this was a retrospective review of medical
records that is subject to all the biases inherent with such
methodology. In spite of these limitations, the trends identified in
this small cohort are of sufficient concern to be reported to the
scientific community so that increased attention can be given to
adolescent populations with MDR-TB.
Conclusion
Treatment outcomes seen in HIV-infected adolescents receiving
community-based MDR-TB treatment in Mumbai, India were
overwhelming poor, with a majority of patients either dying or
defaulting from therapy. While some of this may have been due to
the complicated treatment regimens required for people with HIV
and MDR-TB in general, the data suggest the need for targeted
interventions focused on adolescents. Active case-finding, espe-
cially among younger contacts of DR-TB cases, and shepherded
referrals into treatment could decrease mortality from the disease.
Targeted adherence counseling and social support around life
events that are common in adolescence could also be a strategy for
reducing discontinuation of therapy. Excellent treatment outcomes
should be possible for adolescents suffering from MDR-TB, given
the encouraging treatment results seen in both pediatric and adult
cohorts with the disease. Operational research looking at
interventions to improve outcomes in adolescents is sorely needed.
Strategies that account for the unique needs of this population
should be developed and adapted to ensure a safe and healthy
transition into adulthood.
Table 4. Treatment-related adverse events in the Mumbai HIV/MDR-TB co-infected adolescent cohort, 2007–2013.
Age/Sex 2ND
line TB Regimen ART Regimen Adverse events (AEs) Grade
Possible culprit
drug Time (weeks)
1 14/M Cm,Lfx,Eto,Cs,Amcl D4T+3TC+EFV Convulsions severe Cs 5
GI Intolerance mild Eto 9
Peripheral Neuropathy mild D4T, Cs 56
2 10/M Km,Mfx,Eto,Cs,PAS,Z,Amcl D4T+3TC+NVP Hearing Loss mild Km 4
3 18/F Km,Mfx,Eto,Cs,PAS TDF+3TC+EFV (previously
on d4T)
Peripheral Neuropathy moderate D4T 4
4 13/F No TB Treatment No ART
5 18/F No TB Treatment No ART
6 16/F Cs,Mfx,Eto,PAS,Z,H,Amcl D4T+3TC+EFV GI Intolerance mild Eto, PAS 1
Psychiatric (Psychosis) severe Cs, EFV 2
7 15/F Km,Mfx,Eto,Cs,Amcl,H,E AZT+3TC+NVP GI Intolerance moderate Eto, Amcl 2
Anxiety Disorder mild Cs 2
8 19/F Cm,Mfx,Eto,Cs,H,Cfz,Z TDF+3TC+ATV/r Nephrotoxicity mild Cm, TDF 4
Psychiatric (Psychosis) severe Cs 20
9 14/M Cm,Mfx,Eto,Cs,PAS,Z ABC+3TC+LPV/r GI Intolerance moderate Eto, PAS 4
Hypothyroidism mild Eto, PAS 12
Hypokalemia mild Cm 40
10 16/M No TB Treatment No ART
11 18/M Cm,Lfx,Eto,Cs,Amcl,Hh,Cfz TDF+3TC+EFV GI Intolerance mild Eto, Amcl 1
Hypokalemia moderate Cm 4
Peripheral Neuropathy mild Cs, Eto 9
Hypothyroidism mild Eto 11
M: male; F: female; S: streptomycin; Cm: capreomycin; Km: kanamycin; Lfx: levofloxacin; Eto: ethionamide; CS: cycloserine; Amcl: amoxicillin/clavulanic acid; Mfx:
moxifloxacin; PAS: para-aminosalicylic acid; Z: pyrazinamide; H: isoniazid; Hh: high dose isoniazid; E; ethambutol, Cfz: clofazimine; GI: gastrointestinal; CrCl: creatinine
clearanc.
doi:10.1371/journal.pone.0068869.t004
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7. Acknowledgments
The authors wish to acknowledge the contribution of health care workers
from the MSF project, staff from the LTMG Hospital, Sion, as well as the
teenagers suffering from HIV and MDR-TB and their families. We are
grateful to Tony Reid for his support with the ethics clearance and his
editorial support.
Author Contributions
Conceived and designed the experiments: PI. Performed the experiments:
SK HM AV RP. Analyzed the data: PI SK RP. Contributed reagents/
materials/analysis tools: MM PS JF. Wrote the paper: PI JF SK.
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