Audiologic monitoring of multi-drug resistant tuberculosis patients on aminoglycoside treatment with long term follow-up

<p>Abstract</p> <p>Background</p> <p>Multi-drug resistant tuberculosis has emerged as a significant problem with the resurfacing of tuberculosis and thus the need to use the second line drugs with the resultant increased incidence of adverse effects. We discuss the effect of second line aminoglycoside anti-tubercular drugs on the hearing status of MDR-TB patients.</p> <p>Methods</p> <p>Sixty four patients were put on second line aminoglycoside anti-TB drugs. These were divided into three groups: group I, 34 patients using amikacin, group II, 26 patients using kanamycin and group III, 4 patients using capreomycin.</p> <p>Results</p> <p>Of these, 18.75% of the patients developed sensorineural hearing loss involving higher frequencies while 6.25% had involvement of speech frequencies also. All patients were seen again approximately one year after aminoglycoside discontinuation and all hearing losses were permanent with no threshold improvement.</p> <p>Conclusion</p> <p>Aminoglycosides used in MDR-TB patients may result in irreversible hearing loss involving higher frequencies and can become a hearing handicap as speech frequencies are also involved in some of the patients thus underlining the need for regular audiologic evaluation in patients of MDR-TB during the treatment.</p

Plasma and liver carnitine levels of children with chronic hepatitis B

WOS: 000188547200009PubMed ID: 14745287Background: Carnitine status of children with chronic hepatitis B is not yet clear. Because it is well-known that carnitine interferes with T-cell immunity, which is closely related to spontaneous or treatment-induced seroconversion in hepatitis B, it was hypothesized that carnitine status would be effective on the end of therapy response (ETR). The aim of this study is to investigate both carnitine status of children with chronic HBV infection and its probable effects on liver histology and ETR. Methods: Thirty-one children with chronic HBV infection, and age and sex matched 20 healthy children were included in the study. Plasma and liver free carnitine level determination was performed before IFN-alpha and lamivudine combination therapy in children with chronic hepatitis B. Mean plasma carnitine level of healthy children was used as control. IFN-alpha was injected as 5 million U/m(2) subcutaneously 3 times a week for 6 months and lamivudine 4 mg/kg per day orally, maximum of 100 mg, for 1 year. Results: The mean plasma carnitine level of patients with chronic HBV infection was significantly lower than that of controls (P < 0.001) The ETR was achieved in 14 (45.2%) patients. While plasma carnitine level was inversely correlated with portal inflammation score (P < 0.05), liver carnitine level was inversely correlated with fibrosis score (P < 0.05). Conclusion: It was found that plasma carnitine level was lower in children with chronic hepatitis B compared with healthy ones and carnitine was inversely correlated with liver portal inflammation and fibrosis scores. The role of carnitine in immunopathogenesis and histology of HBV needs to be clarified with further studies

Low plasma apolioporotein A-I level: new prognostic criterion in childhood cirrhosis?

WOS: 000172553600007PubMed ID: 11765160Apolipoprotein A-I (apo A-I) has been found to be decreased in adults with cirrhosis, but it has not been routinely used for prognostic purposes thus far. This study was performed to determine apo A-I levels in childhood cirrhosis and to establish some prognostic cut-off values. Apo A-I levels of 78 children with chronic liver disease, 38 of whom had cirrhosis as well, were studied. Mean values of cirrhotic, non-cirrhotic and healthy children were not different (p > .05). However, in cirrhotic children, the highest value was detected in the Child-Pugh A group, and it was different from those of the B and C groups (p < .05 and p < .001, respectively). Apo A-I was the lowest in the moderate risk group of Malatack's model, and was significantly different from the low risk group (p < .05). Apo A-I was inversely correlated with Malatack score, Child-Pugh score, total bilirubin, conjugated bilirubin, and prothrombin time (p < .01, p < .01, p < .01, p < .01, p < .05, respectively). In cirrhotic children with cholestasis, apo A-I was lower than in non-cholestatic children (p < .05). Apo A-I value < 80 mg/dl had 84% specificity and 84% negative predictive value for the high risk group of Malatack's model. Similarly, Apo A-I value < 83 mg/dl had 95% specificity and 87% negative predictive value for the Child-Pugh C group. We concluded that Apo A-I is a sensitive parameter of poor prognosis in childhood cirrhosis

Lipid parameters in childhood cirrhosis and chronic liver disease

WOS: 000177028800011PubMed ID: 12139565Background : Alterations in lipid metabolism are well defined in liver disease. As there has not been an ample amount of work published regarding this topic in children, especially about apolipoprotein A-I (apo A-I) and apolipoprotein B (apo B), theoretical knowledge depends on adult studies. In this study, we investigated serum lipid parameters of children with chronic liver disease and cirrhosis. Methods : Serum triglyceride, cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), plasma apo A-I and apo B levels of 82 children with chronic liver disease, 41 of whom had cirrhosis as well, were investigated. Twenty healthy children were selected as controls. Results : While mean serum triglyceride and cholesterol levels were not different in chronic hepatitis, cirrhosis and healthy children, mean apo B level of cirrhotic group was higher than that of the control group (P 0.05). The mean HDL value of Child-Pugh B group was significantly lower when compared to Child-Pugh A group (P < 0.05). The mean apo A-I value of Child-Pugh A group was higher than those of Child-Pugh B and C groups (P < 0.05 and P < 0.001). Conclusion : Consequently, we found that among lipid parameters apo A-I was the most affected parameter in liver injury. Whether apo A-I level can be used as a prognostic criterion in childhood cirrhosis may require further study

Plasma and liver carnitine status of children with chronic liver disease and cirrhosis

WOS: 000175879800013PubMed ID: 11472585Background: Carnitine is an essential cofactor in the transfer of long-chain fatty acids across the inner mitochondrial membrane for oxidation. As its synthesis is performed in the liver, alterations in carnitine metabolism is expected in liver diseases, especially in cirrhosis. Methods: In this study, we investigated plasma and liver carnitine concentrations of 68 children with chronic liver disease, 36 of whom had cirrhosis as well. Carnitine level was determined by enzymatic method. Results: Plasma and liver carnitine concentrations were not correlated. Mean plasma carnitine level of cirrhotic children was significantly lower than that of the control group (P 0.05), mean plasma level of cirrhotics were lower (P < 0.05). Plasma carnitine was correlated with albumin, triglyceride and gamma glutamyl transpeptidase (GGT) in patients with chronic liver disease (P < 0.05). Liver carnitine was correlated with GGT in cirrhotic patients (P < 0.005). Children with malnutrition had higher plasma and liver carnitine levels (P < 0.05). The highest plasma and liver carnitine levels were detected in children with biliary atresia and criptogenic cirrhosis, respectively. Both the lowest plasma and liver carnitine levels were detected in Wilson's disease. Conclusion: Children with cirrhosis have low plasma carnitine concentrations. This finding is prominent in children with Wilson's disease. As carnitine is an essential factor in lipid metabolism, the carnitine supplementation for patients with cirrhosis in childhood, especially with Wilson's disease, seems to be mandatory