Anti-Tuberculosis Therapy-Induced Hepatotoxicity among Ethiopian HIV-Positive and Negative Patients

Background: To assess and compare the prevalence, severity and prognosis of anti-TB drug induced hepatotoxicity (DIH) in HIV positive and HIV negative tuberculosis (TB) patients in Ethiopia. Methodology/Principal Findings: In this study, 103 HIV positive and 94 HIV negative TB patients were enrolled. All patients were evaluated for different risk factors and monitored biochemically and clinically for development of DIH. Sub-clinical hepatotoxicity was observed in 17.3 % of the patients and 8 out of the 197 (4.1%) developed clinical hepatotoxicity. Seven of the 8 were HIV positive and 2 were positive for HBsAg. Conclusions/Significance: Sub-clinical hepatotoxicity was significantly associated with HIV co-infection (p = 0.002), concomitant drug intake (p = 0.008), and decrease in CD4 count (p = 0.001). Stepwise restarting of anti TB treatment was also successful in almost all the patients who developed clinical DIH. We therefore conclude that anti-TB DIH is a major problem in HIV-associated TB with a decline in immune status and that there is a need for a regular biochemical and clinical follow up for those patients who are at risk

Design of the Anti-tuberculosis Drugs induced Adverse Reactions in China National Tuberculosis Prevention and Control Scheme Study (ADACS)

<p>Abstract</p> <p>Background</p> <p>More than 1 million tuberculosis (TB) patients are receiving the standard anti-TB treatment provided by China National Tuberculosis Prevention and Control Scheme (CNTS) in China every year. Adverse reactions (ADRs) induced by anti-TB drugs could both do harm to patients and lead to anti-TB treatment failure. The ADACS aimed to explore ADRs' incidences, prognoses, economical and public health impacts for TB patients and TB control, and build a DNA bank of TB patients.</p> <p>Methods/Design</p> <p>Multiple study designs were adopted. Firstly, a prospective cohort with 4488 sputum smears positive pulmonary tuberculosis patients was established. Patients were followed up for 6-9 months in 52 counties of four regions. Those suspected ADRs should be checked and confirmed by Chinese State Food and Drug Administration (SFDA). Secondly, if the suspected ADR was anti-TB drug induced liver injury (ATLI), a nested case-control study would be performed which comprised choosing a matched control and doing a plus questionnaire inquiry. Thirdly, health economical data of ADRs would be collected to analyze financial burdens brought by ADRs and cost-effectiveness of ADRs' treatments. Fourthly, a drop of intravenous blood for each patient was taken and saved in FTA card for DNA banking and genotyping. Finally, the demographic, clinical, environmental, administrative and genetic data would be merged for the comprehensive analysis.</p> <p>Discussion</p> <p>ADACS will give an overview of anti-TB drugs induced ADRs' incidences, risk factors, treatments, prognoses, and clinical, economical and public health impacts for TB patients applying CNTS regimen in China, and provide suggestions for individualized health care and TB control policy.</p

Regret: A Theoretical and Conceptual Analysis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73569/1/j.1468-5914.1987.tb00092.x.pd

Será possível acabar de uma vez por todas com o exílio? "O xale", de Cynthia Ozick Can we finish with exile? "The shawl" by Cynthia Ozick

O exílio, do francês antigo essil, que provém do latim exsillum, significa a expulsão de alguém de sua pátria, com proibição de retornar. É a obrigação de residir fora de um lugar, longe de uma pessoa cuja ausência é lamentada. No conto "The shawl" [O xale] da escritora norte-americana Cynthia Ozick, o xale do bebê pode ser bebido como um líquido, como se o sujeito fosse uma criança, como se fosse seu próprio filho. Nós não podemos sair de uma vez por todas de nossa condição de infans, aquele que não fala. Não há paraíso perdido do qual estaríamos exilados - nossa infância, por exemplo.<br>Can we finish with exile? Exile, from the old French essil, which comes from the Latin exsillum, means the expelling of someone from his/her homeland and the forbidding to return. It's the enforcement to living out of a place, away from someone whose absence is mourned. In the novel The Shawl, by the American novelist Cynthia Ozick, the baby's shawl can be drunk as if it was liquid, as if one were a baby, one's own child. We cannot leave once and forever our condition of infans, that which doesn't speak. There's no lost paradise from where we were exiled - our childhood, for instance