Hepatitis associated anti-tuberculous treatment（HATT） has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus（HBV）. Therefore, we evaluated the factors relat...Hepatitis associated anti-tuberculous treatment（HATT） has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus（HBV）. Therefore, we evaluated the factors related to the severity of adverse effects during HATT, especially those associated with liver failure. A retrospective study was carried out at Tongji Hospital from 2007 to 2012. Increases in serum transaminase levels of 〉3, 5, and 10 times the upper limit of normal（ULN） were used to define liver damage as mild, moderate, and severe, respectively. Patients with elevated total bilirubin（TBil） levels that were more than 10 times the ULN（〉171 μmol/L） with or without decreased（〈40%） prothrombin activity（PTA） were diagnosed with liver failure. A cohort of 87 patients was analyzed. The incidence of liver damage and liver failure was 59.8%（n=52） and 25.3%（n=22）, respectively. The following variables were correlated with the severity of hepatotoxicity： albumin（ALB） levels, PTA, platelet counts（PLT）, and the use of antiretroviral therapies（P〈0.05）. Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure, and high viral loads were a significant risk factor with an odds ratio（OR） of 2.066. Judicious follow-up of clinical conditions, liver function tests, and coagulation function, especially in patients with high HBV loads and hypoalbuminemia is recommended. It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.展开更多
AIM： To evaluate the ability of Curcuma Ionga （CL） and Tinospora cordifolia （TC） formulation to prevent anti-tuberculosis （TB） treatment （ATT） induced hepatotoxicity. METHODS： Patients with active TB diagnos...AIM： To evaluate the ability of Curcuma Ionga （CL） and Tinospora cordifolia （TC） formulation to prevent anti-tuberculosis （TB） treatment （ATT） induced hepatotoxicity. METHODS： Patients with active TB diagnosis were randomized to a drug control group and a trial group on drugs plus an herbal formulation. Isoniazid, rifampicin, pyrazinamide and ethambutol for first 2 mo followed by continuation phase therapy excluding Pyrazinamide for 4 mo comprised the anti-tuberculous treatment. Curcumin enriched （25%） CL and a hydro-ethanolic extract enriched （50%） TC 1 g each divided in two doses comprised the herbal adjuvant. Hemogram, bilirubin and liver enzymes were tested initially and monthly till the end of study to evaluate the result. RESULTS： Incidence and severity of hepatotoxicity was significantly lower in trial group （incidence： 27/192 vs 2/316, P 〈 0.0001）. Mean aspartate transaminase （AST） （195.93 ± 108.74 vs 85 ± 4.24, P 〈 0.0001）, alanine transaminase （ALT） （75.74 ± 26.54 vs 41 ± 1.41, P 〈 0.0001） and serum bilirubin （5.4 ±3.38 vs 1.5 ±0.42, P 〈 0.0001）. A lesser sputum positivity ratio at the end of 4 wk （10/67 vs 4/137, P = 0.0068） and decreased incidence of poorly resolved parenchymal lesion at the end of the treatment （9/152 vs 2/278, P = 0.0037） was observed. Improved patient compliance was indicated by nil drop-out in trial vs 10/192 in control group （P 〈 0.0001）. CONCLUSION： The herbal formulation prevented hepatotoxicity significantly and improved the disease outcome as well as patient compliance without any toxicity or side effects.展开更多
It is important that surgeons are familiar with the various manifestations of tuberculosis(TB). Although TB has been declining in incidence in the developed world, itremains an important problem in endemic areas of th...It is important that surgeons are familiar with the various manifestations of tuberculosis(TB). Although TB has been declining in incidence in the developed world, itremains an important problem in endemic areas of the developing world. The aim of the review was to elucidate the natural history and characteristics of abdominal TB and ascertain the indications for surgery. TB can affect the intestine as well as the peritoneum and the most important aspect of abdominal TB is to bear in mind the diagnosis and obtain histological evidence. Abdominal TB is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. Due to the challenges of early diagnosis, patients should be managed in collaboration with a physician familiar with anti-tuberculous therapy. An international expert consensus should determine an algorithm for the diagnosis and multidisciplinary management of abdominal TB.展开更多
基金supported in part by the Organization Department of the Central Committee of the Communist Party of China 2015“sunshine of the west”visiting scholar program(No.2903)
文摘Hepatitis associated anti-tuberculous treatment（HATT） has been a main obstacle in managing patients co-infected with Mycobacterium tuberculosis and hepatitis B virus（HBV）. Therefore, we evaluated the factors related to the severity of adverse effects during HATT, especially those associated with liver failure. A retrospective study was carried out at Tongji Hospital from 2007 to 2012. Increases in serum transaminase levels of 〉3, 5, and 10 times the upper limit of normal（ULN） were used to define liver damage as mild, moderate, and severe, respectively. Patients with elevated total bilirubin（TBil） levels that were more than 10 times the ULN（〉171 μmol/L） with or without decreased（〈40%） prothrombin activity（PTA） were diagnosed with liver failure. A cohort of 87 patients was analyzed. The incidence of liver damage and liver failure was 59.8%（n=52） and 25.3%（n=22）, respectively. The following variables were correlated with the severity of hepatotoxicity： albumin（ALB） levels, PTA, platelet counts（PLT）, and the use of antiretroviral therapies（P〈0.05）. Hypo-proteinemia and antiretroviral therapy were significantly associated with liver failure, and high viral loads were a significant risk factor with an odds ratio（OR） of 2.066. Judicious follow-up of clinical conditions, liver function tests, and coagulation function, especially in patients with high HBV loads and hypoalbuminemia is recommended. It may be advisable to reconsider the use of antiviral drugs failure during the course of anti-tuberculous treatment of HBV infection patients to avoid the occurrence of furious liver failure.
文摘AIM： To evaluate the ability of Curcuma Ionga （CL） and Tinospora cordifolia （TC） formulation to prevent anti-tuberculosis （TB） treatment （ATT） induced hepatotoxicity. METHODS： Patients with active TB diagnosis were randomized to a drug control group and a trial group on drugs plus an herbal formulation. Isoniazid, rifampicin, pyrazinamide and ethambutol for first 2 mo followed by continuation phase therapy excluding Pyrazinamide for 4 mo comprised the anti-tuberculous treatment. Curcumin enriched （25%） CL and a hydro-ethanolic extract enriched （50%） TC 1 g each divided in two doses comprised the herbal adjuvant. Hemogram, bilirubin and liver enzymes were tested initially and monthly till the end of study to evaluate the result. RESULTS： Incidence and severity of hepatotoxicity was significantly lower in trial group （incidence： 27/192 vs 2/316, P 〈 0.0001）. Mean aspartate transaminase （AST） （195.93 ± 108.74 vs 85 ± 4.24, P 〈 0.0001）, alanine transaminase （ALT） （75.74 ± 26.54 vs 41 ± 1.41, P 〈 0.0001） and serum bilirubin （5.4 ±3.38 vs 1.5 ±0.42, P 〈 0.0001）. A lesser sputum positivity ratio at the end of 4 wk （10/67 vs 4/137, P = 0.0068） and decreased incidence of poorly resolved parenchymal lesion at the end of the treatment （9/152 vs 2/278, P = 0.0037） was observed. Improved patient compliance was indicated by nil drop-out in trial vs 10/192 in control group （P 〈 0.0001）. CONCLUSION： The herbal formulation prevented hepatotoxicity significantly and improved the disease outcome as well as patient compliance without any toxicity or side effects.
文摘It is important that surgeons are familiar with the various manifestations of tuberculosis(TB). Although TB has been declining in incidence in the developed world, itremains an important problem in endemic areas of the developing world. The aim of the review was to elucidate the natural history and characteristics of abdominal TB and ascertain the indications for surgery. TB can affect the intestine as well as the peritoneum and the most important aspect of abdominal TB is to bear in mind the diagnosis and obtain histological evidence. Abdominal TB is generally responsive to medical treatment, and early diagnosis and management can prevent unnecessary surgical intervention. Due to the challenges of early diagnosis, patients should be managed in collaboration with a physician familiar with anti-tuberculous therapy. An international expert consensus should determine an algorithm for the diagnosis and multidisciplinary management of abdominal TB.
