Primary Naso-Sinus Tuberculosis (NST) at the ORL and Cervico Facial Surgery Department of the University Hospital of Cocody: About a Case

Objective: To report a case of naso-sinus tuberculosis and discuss its diagnosis and management in our context. Clinical Case: A 37-year-old patient, with no previous history, visited us for a swelling under left orbital including a nasal obstruction and intermittent frontal headaches, which has been developed since about one year. Clinical Examination: The anamnesis founds no notion of epistaxis, visual disability, nor notion of fever. It has been noted a swelling under left angulo orbital during physical examination, a burgeoning mass filling the left nasal including a Lymphadenopathy under homolateral mandibular. Para clinical investigations in particular CT scan of the sinuses have highlighted a tissue process under orbital with a left naso-ethmoido-maxillary extension. The anatomical pathologic examination of the biopsy carried out through endoscopy permitted to highlight epithelioid giganto-cell granulomas with caseous necrosis evoking tuberculosis. The patient has been prescribed an anti-tuberculosis treatment. The course of illness is marked by the healing of the patient.

FOLFIRI3-aflibercept in previously treated patients with metastatic colorectal cancer

AIM To evaluate the efficacy and safety of the modified FOLFIRI3-aflibercept as second-line therapy in patients with metastatic colorectal cancer.METHODS This is a retrospective multicenter cohort, evaluating the efficacy and safety of the association of aflibercept with FOLFIRI3(day 1: aflibercept 4 mg/kg, folinic acid 400 mg/m^2, irinotecan 90 mg/m^2, 5-fluorouracil infusion 2400 mg/m^2 per 46 h; day 3: irinotecan 90 mg/m^2) in patients with previously treated metastatic colorectal cancer. The primary endpoint was overall response rate(ORR). Secondary endpoints were disease control rate(DCR), progression-free survival(PFS), overall survival(OS), and safety.RESULTS Among 74 patients treated in four French centers, nine were excluded due to prior use of aflibercept(n = 3), more than one prior treatment line in irinotecanna?ve patients(n = 3), and inadequate liver function(n = 3). In the "irinotecan-na?ve" patients(n = 30), ORR was 43.3% and DCR was 76.7%. Median PFS and OS were 11.3 mo(95%CI: 6.1-29.0) and 17.0 mo(95%CI: 13.0-17.3), respectively. The most common(> 5%) grade 3-4 adverse events were diarrhea(37.9%), neutropenia(14.3%), stomatitis and anemia(10.4%), and hypertension(6.7%). In the "pre-exposed irinotecan" patients(n = 35), 20(57.1%) received ≥ 2 prior lines of treatment. ORR was 34.3% and DCR was 60.0%. Median PFS and OS were 5.7 mo(95%CI: 3.9-10.4) and 14.3 mo(95%CI: 12.8-19.5), respectively.CONCLUSION Minimally modified FOLFIRI has improvement dramatically the FOLFIRI3-aflibercept efficacy, whatever prior use of irinotecan. A prospective randomized trial is warranted to compare FOLFIRI-aflibercept to FOLFIRI3-aflibercept.

Sensorineural Hearing Loss in Multidrug-Resistant Tuberculosis Patients in Kinshasa (Democratic Republic of Congo): Prospective Cohort Study of Therapeutic Regimen with Aminoglycoside versus Bedaquiline

Context: Multidrug-resistant tuberculosis (MDR-TB) remains a major public health problem in developing countries such as the Democratic Republic of Congo (DRC), which continues to face the emergence of MDR-TB cases. Because of the ototoxic effects of AGs, the World Health Organization (WHO) has recommended the introduction of the bedaquiline regimen. However, very few data are available regarding the susceptibility of bedaquiline to induce hearing loss, hence the present study set out to compare the AG-based regimen and the bedaquiline-based regimen in the occurrence of hearing loss in MDR-TB patients. Methods: This is a prospective multicenter cohort study that included 335 MDR-TB patients, performed in Kinshasa (DRC) during the period from January 2020 to January 2021. Sociodemographic, clinical, biological and audiometric data were analyzed using Stata 17. Repeated-measures analysis of variance was used to compare changes in the degree of hearing loss over time between the two groups of patients on AG and bedaquiline regimens. The double-difference method was estimated using regression with fixed-effects. A p value < 0.05 was considered the threshold for statistical significance. Results: The degree of hearing loss was similar between the two groups at the first month [AGs (28 dB) vs BDQ (30 dB);p = 0.298]. At six months, the mean degree of hearing loss was significantly greater in the aminoglycoside regimen group [AGs (60.5 dB) vs BDQ (44 dB);p < 0.001]. The double difference was significant, with a greater increase in hearing loss in the AGs group (diff-in-diff 18.3;p < 0.001). After adjustment for age and serum albumin, the group receiving the AG-based regimen had a 2-point greater worsening than those with bedaquiline at the sixth month (diff-in-diff 19.8;p Conclusion: Hearing loss is frequent with both treatment regimens, but more marked with the Aminoglycoside-based regimen. Thus, bedaquiline should also benefit for audiometric monitoring in future MDR-TB patients.

Determinants of the Sensorineural Hearing Loss in Patients with Multidrug-Resistant Tuberculosis in Kinshasa (Democratic Republic of the Congo): A Prospective Cohort Study

Background: The onset of the hearing loss is a major challenge during the treatment of multidrug-resistant tuberculosis (MDR-TB). Aminoglycoside-based regimens, to a lesser extent based on bedaquiline, induce ototoxic sensorineural hearing loss. Research on risk factors is essential to enable high-risk individuals to benefit from preventive measures in settings with limited resources. Objective: This study aimed to assess the determinants of the hearing loss in patients with MDR-TB. Methods: This prospective multicenter cohort study included 337 patients with MDR-TB. It was performed in Kinshasa (Democratic Republic of the Congo) between January 2020 and January 2021. Sociodemographic, clinical, biological, therapeutic, and audiometric data were exported and analyzed using Stata 17 and MedCalc. The fixed-effect linear regression panel model was used to assess the degree of the hearing loss over time according to the following covariates: therapeutic regimen (aminoglycosides, bedaquiline, or alternate), stage of chronic kidney disease (CKD), age at inclusion, body mass index, serum albumin level, HIV status, alcohol intake, hypertension, and hemoglobin level. The Hausman test was used to select between fixed- and random-effect estimators. The threshold for statistical significance was set at p Result: A total of 236 patients (70%) received an aminoglycoside-based regimen, 61 (18%) received a bedaquiline-based regimen, and 40 (12%) received aminoglycosides relayed by bedaquiline. The frequency of the hearing loss increased from 62% to 96.3% within six months for all therapeutic regimens. The Hearing loss worsened, with moderate (72.4%) and profound (16%) deafness being predominant. An Exposure to the treatment for more than one month (β coeff: 27.695, Se: 0.793, p β coeff: 6.102, Se: 1.779, p β coeff: 5.610, Se: 1.682, p = 0.001), and an eGFR β coeff: 6.730, Se: 2.70, p = 0.013) were the independent risk factors associated with the hearing loss in patients with MDR-TB. Conclusions: The Hearing loss was more prevalent and worsened during the treatment of the patients with MDR-TB. An Exposure for more than one month, AG-based regimens, advanced age, hypoalbuminemia, and CKD have emerged as the main determinants of the worsening of the hearing loss.