Frequency and risk factors of drug-induced liver injury during treatment of multidrug-resistant tuberculosis

OBJECTIVES

To investigate the risk factors for drug-induced liver injury (DILI) during the treatment of multidrug-resistant tuberculosis (MDR-TB) and to compare the frequency of DILI in patients with and those without chronic liver disease (CLD).

SETTING

This was a retrospective observational cohort study including 299 consecutive patients who started MDR-TB treatment from January 2009 to December 2013.

DESIGN

Of the 299 patients, 35 had alcoholic liver disease (ALD group), 16 had hepatitis B virus infection (HBV group) and 11 had hepatitis C virus infection (HCV group). The remaining 237 patients without CLD were selected as the control group.

RESULTS

DILI occurred in 29 (9.7%) patients. The frequency of DILI was significantly higher in the ALD (17.1%, P = 0.038), HBV (31.3%, P = 0.005) and HCV groups (27.3%, P = 0.037) than in the control group (6.3%). Among all patients taken together, having HBV and HCV infection were independent risk factors for the occurrence of DILI during MDR-TB treatment.

CONCLUSION

DILI during MDR-TB treatment occurred more frequently in patients with CLD due to ALD, HBV and HCV infection than in those without CLD.

The impact of hepatitis B virus (HBV) infection on clinical outcomes of patients with diffuse large B-cell lymphoma

We performed a retrospective study to analyse the characteristics and clinical outcomes of diffuse large B-cell lymphoma (DLBCL) patients with hepatitis B virus (HBV) infection and compare with those without HBV infection. The occurrence of hepatitis after withdrawal of prophylactic antiviral treatment on completion of chemotherapy was also assessed. The HBsAg-positive patients were given prophylactic antiviral treatment until 6 months after finishing chemotherapy. A total of 81 patients were recruited with 16 in the HBsAg-positive group and 65 in the HBsAg-negative group. The clinical characteristics were similar in both groups of patients. There was no significant difference in complete remission rate between the two groups (63% in HBsAg-positive group vs. 54% in HBsAg-negative group, P = 0.59). There was also no statistically significant difference in overall survival between the two groups (P = 0.23). Four of the 16 HBsAg-positive patients (25%) had hepatitis after cessation of chemotherapy and prophylactic lamivudine. The mean time of onset of hepatitis was 3 months after stopping lamivudine. In conclusion, HBV infection did not appear to affect the prognosis of DLBCL patients given antiviral prophylaxis. It is reasonable to consider prophylactic antiviral therapy to extend to at least one year on completion of chemotherapy.

[Analysis of terpene/maleic anhydride adduct and its derivatives by GC]

The retention behaviors of terpene/maleic anhydride adduct(TMA, 1) and its esterification derivatres(2) on OV-17 and SE-30 columns has been studied. The relationships between adjusted retention time and column temperature for the two compounds were linear. The shape of both peaks was more symmetrical on OV-17 column than on SE-30 column. It was found that the peak area was unaffected when the temperature of injector was higher than 260 degrees C.

Human autonomic rhythms: vagal cardiac mechanisms in tetraplegic subjects

1. We studied eight young men (age range: 20-37 years) with chronic, clinically complete high cervical spinal cord injuries and ten age-matched healthy men to determine how interruption of connections between the central nervous system and spinal sympathetic motoneurones affects autonomic cardiovascular control. 2. Baseline diastolic pressures and R-R intervals (heart periods) were similar in the two groups. Slopes of R-R interval responses to brief neck pressure changes were significantly lower in tetraplegic than in healthy subjects, but slopes of R-R interval responses to steady-state arterial pressure reductions and increases were comparable. Plasma noradrenaline levels did not change significantly during steady-state arterial pressure reductions in tetraplegic patients, but rose sharply in healthy subjects. The range of arterial pressure and R-R interval responses to vasoactive drugs (nitroprusside and phenylephrine) was significantly greater in tetraplegic than healthy subjects. 3. Resting R-R interval spectral power at respiratory and low frequencies was similar in the two groups. During infusions of vasoactive drugs, low-frequency R-R interval spectral power was directly proportional to arterial pressure in tetraplegic patients, but was unrelated to arterial pressure in healthy subjects. Vagolytic doses of atropine nearly abolished both low- and respiratory-frequency R-R interval spectral power in both groups. 4. Our conclusions are as follows. First, since tetraplegic patients have significant levels of low-frequency arterial pressure and R-R interval spectral power, human Mayer arterial pressure waves may result from mechanisms that do not involve stimulation of spinal sympathetic motoneurones by brainstem neurones. Second, since in tetraplegic patients, low-frequency R-R interval spectral power is proportional to arterial pressure, it is likely to be mediated by a baroreflex mechanism. Third, since low-frequency R-R interval rhythms were nearly abolished by atropine in both tetraplegic and healthy subjects, these rhythms reflect in an important way rhythmic firing of vagal cardiac motoneurones.

Surgical decompression of impingement in the weightbearing shoulder

Shoulder pain is a common affliction, posing particular limitations on the spinal cord injured person. Abnormalities of the rotator cuff mechanism are a common cause of shoulder injury in the general population and it has recently been observed that a large percentage of persons with paraplegia suffer from chronic shoulder pain. This report describes six cases of impingement syndrome in four spinal cord injured persons who depend on upper extremity function for the execution of activities of daily living and mobility. All had failed prolonged trials of conservative therapy and subsequently underwent anterior acromioplasty and when indicated, repair of the supraspinatus tendon. In each case, functional capacity that approached or equalled premorbid levels was achieved. Pain complaints also markedly decreased from preoperative levels. It is suggested that surgical decompression of shoulder impingement and rotator cuff repair may be beneficial in spinal cord injured persons who have failed conservative therapy. Further study is required to determine the long-term efficacy of surgical intervention in this population.

Changes of lactate dehydrogenase and its isoenzyme activity in renal diseases

Analysis of the five different serum isoenzymes of lactate dehydrogenase (LDH) is of great value in the differential diagnosis of various diseases. In order to investigate the changes of serum LDH isoenzymes in several renal diseases, 44 patients with Korean hemorrhagic fever, 10 patients with chronic renal failure, 10 patients with nephrotic syndrome, and 15 healthy subjects were studied. The isoenzymes of LDH were determined by the Helena LDH isoenzyme electrophoresis procedure. LDH1 was 22.3 +/- 2.8, LDH2 29.4 +/- 5.1, LDH3 20.8 +/- 4.5, LDH4 9.0 +/- 2.7 and LDH5 8.8 +/- 3.2 mU/ml in healthy subjects. In patients in the oliguric stage of Korean hemorrhagic fever, LDH1 was 63.4 +/- 28.5, LDH2 99.7 +/- 40.7, LDH3 107.5 +/- 39.0, LDH4 41.9 +/- 32.8 and LDH5 37.2 +/- 26.3 mU/ml, while LDH1 was 23.8 +/- 11.7, LDH2 38.9 +/- 14.6, LDH3 36.0 +/- 18.7, LDH4 13.8 +/- 13.0 and LDH5 12.7 +/- 7.6 mU/ml in nonoliguric patients. In patients with chronic renal failure LDH1 was 33.2 +/- 10.8, LDH2 41.9 +/- 13.3, LDH3 27.7 +/- 8.5, LDH4 12.1 +/- 6.2 and LDH5 12.3 +/- 5.8 mU/ml. In patients with nephrotic syndrome, LDH1 was 25.1 +/- 4.3, LDH2 33.5 +/- 4.9, LDH3 23.1 +/- 6.2, LDH4 8.4 +/- 3.7 and LDH5 8.4 +/- 3.4 mU/ml. In summary, LDH3 activity was elevated in the oliguric stage of Korean hemorrhagic fever and LDH2 was elevated in chronic renal failure; those values were correlated with the BUN level.

Primary choriocarcinoma of the lung

Choriocarcinoma was found in the lung of a 33-year-old woman. It was detected by percutaneous needle lung biopsy in the right lung and severe elevation of B-HCG in serum (200,000 IU/L). Primary choriocarcinoma of the lung is an extremely rare disease. Thus the patient was fully examined, especially the genital tract in order to find the choriocarcinoma foci, but this failed to disclose foci of the choriocarcinoma. After chemotherapy (MTX, actinomycin-D, Cyclophosphamide) the level of B-HCG in serum decreased. Thus we conclued that the choriocarcinoma of the lung was the primary tumor.