Antituberculous Therapy Research Articles

THE ADVERSE DRUG REACTIONS OF INTERMITTENT AND DAILY REGIMENS IN THE TREATMENT OF THE INTENSIVE PHASE OF TUBERCULOSIS

Objective: To study the adverse drug reactions (ADRs) of intermittent and daily anti-tubercular therapy in intensive phase (IP), in patients attending the RNTCP unit, Government Medical College (GMC), Thrissur. Methods: A prospective observational study was done at the RNTCP unit, GMC, Thrissur, during October 2016-2017. Two hundred and thirty-five patients satisfying inclusion criteria, receiving anti-tubercular therapy as intermittent and daily regimens were selected. Demographic data, risk factors, comorbidities, and investigations were recorded and patients were followed up for IP. Results of investigations, treatment outcome, and ADRs recorded after IP. ADRs were monitored and its causality and severity were assessed. Data were entered in MS Excel and analyzed using SPSS. Qualitative variables are represented as proportions and quantitative as mean and standard deviation. Associations were analyzed using appropriate statistical tests. Analysis was performed using paired t-test p<0.05 taken as significant. Results: Orange-red urine and secretions were the most common ADR, followed by nausea, fatigue, heartburn, etc. Significant increase in random blood sugar, renal function tests (RFTs), and liver function tests (LFT) after treatment, then before noticed. 84.4% of patients from the daily group and 78% of patients from the intermittent group experienced ADRs. Causality was assessed using Naranjo’s algorithm and severity using a modified Hartwig and Siegel scale. Conclusion: The majority of patients developed ADRs, which were mild and managed symptomatically. Some reactions required alteration of therapy, reduction of drug dose, or change of suspected drug. To conclude, meticulous monitoring of ADRs in patients on anti-tubercular drugs is mandatory.

Pancreatic Tuberculosis With Duodenal Fistula Presenting as Life-Threatening Gastrointestinal Bleeding

ABSTRACT Pancreatic tuberculosis (TB) warrants heightened suspicion in individuals with pancreatic lesions and risk factors such as HIV, organ transplantation, or pertinent immigration history. We present a 38-year-old man who presented with hemodynamically unstable gastrointestinal bleeding. He was found to have pancreatic TB complicated by a duodenal ulcer with fistula. Following 1 month of antitubercular therapy, he experienced complete resolution of symptoms, healing of the duodenal ulcer, closure of the fistulous tract, and a decrease in the size of the pancreatic lesion as observed on imaging. Our case highlights the importance of early diagnosis and treatment of pancreatic TB.

Clinico-Laboratory Profile of Tuberculides: An Experience at a Tertiary Care Centre from Chandigarh, India.

Tuberculides are characterised by delayed-type of immunologic reactions to Mycobacterium tuberculosis or its products in immuno-competent individuals. We herein describe clinico-epidemiological features and response to treatment in patients with tuberculides from a tertiary care centre from North India. This was a retrospective analysis of the clinical records of all the cutaneous tuberculosis (TB) patients (year 2000-2019) enrolled in the TB clinic. The patient records fulfilling the diagnostic criteria of tuberculides were considered for analysis. A total of 225 patients attended the tuberculosis clinic; out of this, 34 were diagnosed as tuberculides. Out of these 34 cases, 21 were identified as LS, 2 erythema induratum of Bazin, 1 papulonecrotic tuberculide, and 10 erythema nodosum. History of contact to open cases of TB was present in 15/34 (44.1%) patients. History of BCG vaccination was found in 15/34 (44.1%) patients. The focus of underlying TB could be identified in 20/34 (58.8%) patients. Skin biopsy was performed in all patients. In all patients, the diagnosis was confirmed by clinico-pathological correlation, positive TST, and the underlying focus of TB. All patients received 6 months regimen of anti-tubercular therapy with first-line drugs. In this study, we demonstrated various forms of tuberculides; lichen scrofulosorum was the most common form. We also included erythema nodosum cases also, which responded well to ATT. Observation from our study showed that tuberculides are important cutaneous markers for underlying tuberculosis infection, which helps in early detection of occult tuberculosis and timely management.

Conservative management of tubercular intestinal obstruction with antitubercular drugs and steroid

Objective: Tubercular intestinal obstruction is a challenging condition often necessitating surgical intervention. This case study aims to evaluate the effectiveness of conservative management, including antitubercular therapy, short-course steroids, and dietary modifications, in resolving acute and complete intestinal obstruction caused by tuberculosis. Case Description: A 17-year-old malnourished male presented with acute abdominal pain, vomiting, and constipation. Imaging revealed mid-ileal intestinal obstruction due to tuberculosis. Conservative management, involving intravenous antibiotics, nasogastric decompression, steroids, and antitubercular treatment, led to gradual resolution. The patient experienced recurrent partial obstruction episodes, each managed conservatively with antibiotics, steroids, and dietary adjustments. A slow transition from liquid to solid diet accompanied recovery. After a year of treatment, the patient achieved recovery with weight gain. Conclusion: Tubercular intestinal obstruction, challenging to treat medically, often requires surgery. However, this case demonstrates the successful outcome through a comprehensive conservative approach. The inclusion of steroids alongside antitubercular treatment played a crucial role. Additionally, a cautious transition from liquid to solid diet post-resolution proved effective in preventing recurrence. Conservative management, when tailored to the patient's nutritional needs and disease course, can lead to favorable outcomes in tubercular intestinal obstruction.

Membranous Nephropathy and Pulmonary Tuberculosis: An Uncommon Combination: Case Report

It is imperative to evaluate for secondary causes of membranous glomerulonephritis, from infections such as hepatitis B and C, viruses and parasites, autoimmune diseases like systemic lupus erythematosus, and other neoplasms. Tuberculosis associated with membranous glomerulonephritis is rare. The authors report a case of microbiologically proven pulmonary tuberculosis and membranous nephropathy occurring concurrently in the same patient. Antitubercular therapy alone was sufficient to cause improvement in the patient. Tuberculosis should be recognised as a potentially treatable infectious cause of secondary membranous nephropathy.

Tuberculosis-related episcleritis: a case report

Introduction : Tuberculosis (TB) is a leading cause of infectious disease in developing and highly endemic countries. Primarily affects the lungs, but also invariably involves ocular tissue. Association of TB and episcleritis is very rarely documented and no such case has been reported in Indonesia.
 Case Illustration : A 39-year-old female presented with unilateral mild pain and redness of right eye two weeks before admission. It was her fourth episode in one year. Previous steroid and non- steroidal anti- inflammatory drug (NSAID) treatment partially ended her symptoms before reappeared. Rheumatoid disease also TB history of her and her family were denied. There was nodular episcleritis in the inferior part of the right eye. Systemic investigation showed leukocyte and erythrocyte sedimentation rate (ESR) elevation, positive Mantoux test, with normal chest radiograph. Later symptoms and lesion resolved after anti tubercular therapy (ATT).
 Discussion : Episcleritis is mostly idiopathic, only one third of cases are found to be related with systemic condition. Association of tuberculosis with episcleritis is very rare, only a few cases have been reported worldwide. We encountered a case of tubercular episcleritis by the history of recurrent episode which not responding with regular medication, positive Mantoux test and Indonesia’s TB endemic status. Additionally, improvement after ATT also confirmed the diagnosis.
 Conclusion : This case suggests that TB can cause episcleritis, especially in TB endemic countries. TB should be considered in facing recurrent episcleritis cases to avoid unnecessary complications.

The first-in-class pyrazole-based dual InhA-VEGFR inhibitors towards integrated antitubercular host-directed therapy

Several facets of the host response to tuberculosis have been tapped for clinical investigation, especially targeting angiogenesis mediated by VEGF signaling from infected macrophages. Herein, we rationalized combining the antiangiogenic effects of VEGFR-2 blockade with direct antitubercular InhA inhibition in single hybrid dual inhibitors as advantageous alternatives to the multidrug regimens. Inspired by expanded triclosans, the ether ligation of triclosan was replaced by rationalized linkers to assemble the VEGFR-2 inhibitors thematic scaffold. Accordingly, new series of 3-(p-chlorophenyl)-1-phenylpyrazole derivatives tethered to substituted ureas and their isosteres were synthesized, evaluated against Mycobacterium tuberculosis virulent cell line H37Rv, and assessed for their InhA inhibitory activities. The urea derivatives 8d and 8g exhibited the most promising antitubercular activity (MIC = 6.25 µg/mL) surpassing triclosan (MIC = 20 µg/mL) with potential InhA inhibition, thus identified as the study hits. Interestingly, both compounds inhibited VEGFR-2 at nanomolar IC50 (15.27 and 24.12 nM, respectively). Docking and molecular dynamics simulations presumed that 8d and 8g could bind to their molecular targets InhA and VEGFR-2 posing essential stable interactions shared by the reference inhibitors triclosan and sorafenib. Finally, practical LogP, Lipinski’s parameters and in silico ADMET calculations highlighted their drug-likeness as novel leads in the arsenal against TB.

An unusual case of primary tuberculosis of the patella and patellar tendon masquerading as gout.

Tuberculosis (TB), an infection caused by Mycobacterium tuberculosis, accounts for significant morbidity and mortality worldwide. While primary TB predominantly involves the respiratory system, approximately 10-19% patients have musculoskeletal involvement. We present a case of a 54-year-old year gentleman with insidious onset of anterior knee pain. Imaging demonstrated a soft tissue lesion involving the patellar tendon and eroding the inferior pole of the patella. The imaging features, particularly ultrasound, resembled those that are typically seen with gout. Ultrasound guided biopsy revealed this to be TB of the patella. The patient was successfully treated with antitubercular therapy. Musculoskeletal TB, while usually not a primary form of TB, is an important consideration particularly in patients with risk factors for the disease. Its imaging features can mimic other forms of arthropathy such as gout. Moreover, while the knee is a relatively common site for TB infection, isolated involvement of the patella and patellar tendon is extremely rare. The case highlights the possibility of rare musculoskeletal manifestation of TB as a well as a potential imaging pitfall of TB infection mimicking gout, which is an important consideration in clinical practice.

Diagnostic pitfalls and therapeutic challenges of hypercalcaemia in chronic kidney disease: a case report and a narrative review

BackgroundEvaluation of hypercalcaemia in a patient with chronic kidney disease (CKD) is challenging, especially in low-resource settings. Hormone assays should be interpreted with caution as CKD affects both parathyroid hormone (PTH) and vitamin D. Therapies such as bisphosphonates are contraindicated in CKD, while fluid resuscitation can lead to volume overload. We report the diagnostic workup of a patient with stage V CKD who presented with symptomatic hypercalcaemia and discuss the diagnostic pitfalls and therapeutic challenges.Case presentationA 72-year-old Sri Lankan woman with stage V, non-oliguric CKD presented with a 2-week history of worsening lassitude, increased thirst and constipation. She was clinically euvolemic and did not have signs of uraemia. Bilateral lung fields had occasional coarse crepitations. The rest of the physical examination was normal. Her serum creatinine level was similar to her baseline (4.7 mg/dl, eGFR 9 ml/min). She was found to have a high serum calcium (14.3 mg/dl) and phosphate (5.0 mg/dl) levels. Her PTH level was 24.1 pg/ml (15–68), and she was deficient in 25-hydroxycholecalciferol (9 mg/ml (30–100)). She was not on calcium or vitamin D supplementation. Disseminated tuberculosis was diagnosed after detecting granulomata in the lungs and abdomen in the contrast-enhanced computed tomography (CECT) and mycobacterial DNA in sputum. She was hydrated with 0.9% NaCl with meticulous use of frusemide. The effect of frusemide waned off by the 10th day, requiring haemodialysis to control the hypercalcaemia. Vitamin D was replaced intramuscularly with 200,000 IU, after which the calcium levels increased. She was treated with IV pamidronate 30 mg, and the calcium levels started reducing drastically. Antituberculous therapy (ATT) was initiated 7 days after pamidronate treatment. The calcium levels normalised 2 days after ATT and sustained beyond 2 months.ConclusionInterpretation of PTH and phosphate levels should be done with caution when evaluating hypercalcaemia in patients with advanced chronic kidney disease. First- and second-generation assays detect PTH fragments which accumulate in CKD, leading to false positives. Hypophosphataemic effects of PTH/PTHrP can be masked by accumulation of phosphate in CKD. Bisphosphonates might have a role in treating calcitriol-induced hypercalcaemia, although this needs further evaluation.

Influence of N-acetyltransferase 2 polymorphisms and clinical variables on liver function profile of tuberculosis patients

ABSTRACT Background Single nucleotide polymorphisms (SNPs) in the N-acetyltransferase 2 (NAT2) gene as well as several other clinical factors can contribute to the elevation of liver function test values in tuberculosis (TB) patients receiving antitubercular therapy (ATT). Research design and methods A prospective study involving dynamic monitoring of the liver function tests among 130 TB patients from baseline to 98 days post ATT initiation was undertaken to assess the influence of pharmacogenomic and clinical variables on the elevation of liver function test values. Genomic DNA was extracted from serum samples for the assessment of NAT2 SNPs. Further, within this study population, we conducted a case control study to identify the odds of developing ATT-induced drug-induced liver injury (DILI) based on NAT2 SNPs, genotype and phenotype, and clinical variables. Results NAT2 slow acetylators had higher mean [90%CI] liver function test values for 8–28 days post ATT and higher odds of developing DILI (OR: 2.73, 90%CI: 1.05–7.09) than intermediate acetylators/rapid acetylators. Conclusion The current study findings provide evidence for closer monitoring among TB patients with specific NAT2 SNPs, genotype and phenotype, and clinical variables, particularly between the period of more than a week to one-month post ATT initiation for better treatment outcomes.

Antitubercular drug-induced lichen planus: A case study with a mini literature review.

Drug-induced lichen planus is a cutaneous adverse effect that manifests as a systemic eruption of flat-topped, erythematous, or violaceous papules resembling lichen planus on the trunk and extremities. Although antitubercular therapy has been linked to cutaneous hypersensitivity reactions, the literature on such cases is scarce. Here, we present a case to contribute to this field, reporting on its presentation and management, and reviewing previous case studies. Our patient, a 63-year-old male, presented with black pigmented patches on the skin, having been diagnosed with pulmonary tuberculosis and on antitubercular therapy for the past two months. A diagnosis of ATT-induced lichen planus was made, and all ATT was stopped. The patient was treated with antihistamines, apremilast, tacrolimus, and corticosteroids, and rechallenge of each drug was performed consecutively. No new lesions appeared after rechallenge with isoniazid and rifampicin. However, ethambutol was not reintroduced due to strong suspicion, by exclusion, that it was the offending agent, whereas on rechallenge with isoniazid and rifampicin, the patient's skin lesions gradually improved with eventual resolution of hyperpigmentation. Lichenoid drug eruptions are characterized by type IV hypersensitivity reactions, and rechallenge is required to ensure safer treatment since the risk of disseminated and multi-drug-resistant tuberculosis increases with the cessation of antitubercular therapy.

Osteoarticular tuberculosis in infants: A diagnostic and management challenge

Objectives: Musculoskeletal manifestations of tuberculosis in infants are rare and different both in etiopathological mechanism and clinical presentation. Radiological diagnosis of osteoarticular tuberculosis (TB) in infants is tricky due to the various differentials of a cystic lesion. Literature also mention it only in isolated case reports. We carried out this study with an aim to collate and study patterns of osteoarticlular TB in the appendicular skeleton and to highlight the difficulties in diagnosis and management. Material and Methods: We retrospectively reviewed the data at our hospital over the past 8 years. Microbiologically confirmed osteoarticular tuberculosis affecting appendicular skeleton in children below 1 year of age were included in the study. Cases with spine involvement were excluded. The delay to diagnosis from the onset of symptoms, the initial diagnosis and treatment given were noted. The resolution of radiological presentation and occurrence of deformities at the final follow up (atleast 1 year) were noted. Results: During the study period, 8 infants were diagnosed to have osteoarticular tuberculosis with median age at presentation of 8.7 months (range 3 to 12 months). Average duration of follow up was 4 years (range 1 to 8 years). Cystic, Erosive, infiltrative, spina ventosa and mortar pestle were the radiological appearances found. Three of the 8 cases were referred as suspected malignancy. All but one case were vaccinated with BCG. Curettage and anti-tubercular therapy (ATT) were the treatment in all cases. Three cases with a delay in diagnosis of more than 2 months, developed complications: 1 had limb length discrepancy (LLD) due to physeal involvement, 1 developed angular deformity and 1 child had perthe’s disease as a sequelae. Conclusion: Osteoarticular tuberculosis is an increasing possibility, shockingly, even in infancy and should be a differential in an endemic country like India. A delay to diagnosis of even 2 months of this condition can lead to devastating complications. Being mindful of the diagnosis and early treatment gives rewarding results.

Antibiotics for inflammatory bowel disease: Current status.

There is abundant literature reporting about the use of antibiotics in inflammatory bowel disease (IBD), but their role in the management of IBD is not entirely clear. Diverse infectious organisms have been implicated in the pathogenesis of Crohn's disease. Also, infections are believed to be a trigger for flares of ulcerative colitis. The benefit of the routine use of antibiotics in IBD is equivocal. However, there are certain situations, where antibiotics have a clear role and evidence of benefit: perianal fistula, intra-abdominalabscesses in Crohn's disease, acute pouchitis and infection-related flares. However, there is a lack of supportive evidence for the routine use of antibiotics in all disease-related flares. Evidence indicates a lack of benefit of intravenous antibiotics in acute severe ulcerative colitis and only limited benefit in active ulcerative colitis. Limited evidence suggests the role of a combination of oral antibiotics in pediatric ulcerative colitis. Certain targeted antibiotic regimens have been used in IBD. In ulcerative colitis, limited evidence suggests the benefit of the use of an antibiotic cocktail directed against Fusobacterium varium. Therapy directed against Escherichia coli does not seem to have a benefit in inflammatory Crohn's disease. In Crohn's disease, antimycobacterial therapy may result in symptomatic improvement but no durable benefit. Antitubercular therapy (ATT), on the contrary, may result in fibrotic transformation, suggesting a need to avoid misdiagnosis and limit the duration of ATT in Crohn's disease. This review assesses the published literature with respect to antibiotic use and provides guidance to clinicians in appropriate antibiotic use in various situations in the setting of IBD.

Recent Advances in Nanotechnology-Based Strategies for Bone Tuberculosis Management.

Bone tuberculosis, an extrapulmonary manifestation of tuberculosis, presents unique treatment challenges, including its insidious onset and complex pathology. While advancements in anti-tubercular therapy have been made, the efficacy is often limited by difficulties in achieving targeted drug concentrations and avoiding systemic toxicity. The intricate bone structure and presence of granulomas further impede effective drug delivery. Nano-drug delivery systems have emerged as a promising alternative, offering the enhanced targeting of anti-tubercular drugs. These systems, characterized by their minute size and adaptable surface properties, can be tailored to improve drug solubility, stability, and bioavailability, while also responding to specific stimuli within the bone TB microenvironment for controlled drug release. Nano-drug delivery systems can encapsulate drugs for precise delivery to the infection site. A significant innovation is their integration with prosthetics or biomaterials, which aids in both drug delivery and bone reconstruction, addressing the infection and its osteological consequences. This review provides a comprehensive overview of the pathophysiology of bone tuberculosis and its current treatments, emphasizing their limitations. It then delves into the advancements in nano-drug delivery systems, discussing their design, functionality, and role in bone TB therapy. The review assesses their potential in preclinical research, particularly in targeted drug delivery, treatment efficacy, and a reduction of side effects. Finally, it highlights the transformative promise of nanotechnology in bone TB treatments and suggests future research directions in this evolving field.

Tubercular Meningitis Mimicking Acute Disseminated Encephalomyelitis (ADEM)- A Case Report

Tuberculosis remains endemic in India, and its manifestation in the central nervous system (CNS) poses significant challenges in diagnosis and management. We present a rare case of a 65-year-old male with tubercular meningitis exhibiting atypical features of acute disseminated encephalomyelitis (ADEM). The patient presented with a month-long history of fever, severe headache, altered sensorium, and neurological signs including brisk reflexes, neck rigidity, and bilateral motor weakness. Initial investigations revealed elevated inflammatory markers and abnormal cerebrospinal fluid (CSF) findings consistent with tubercular meningitis. Despite negative CSF culture and nucleic acid amplification tests (NAATs) for Mycobacterium tuberculosis, the patient displayed characteristic asymmetrical bilateral cerebral lesions on MRI suggestive of ADEM. Given the diagnostic ambiguity and a high suspicion of CNS tuberculosis with concurrent ADEM, the patient was treated with anti-tubercular therapy (ATT) and a course of intravenous methylprednisolone followed by oral prednisolone. Subsequent clinical improvement prompted gradual tapering of prednisolone, leading to a full recovery at discharge. This case highlights the complexity of diagnosing CNS tuberculosis coexisting with ADEM, emphasizing the importance of a comprehensive clinical assessment and tailored therapeutic interventions in managing such intricate neurological presentations.

Kidney transplantation in patients on anti-tubercular therapy: A single centre observational study.

Tuberculosis (TB) is a common infection in chronic kidney disease. The prolonged therapy of TB can delay kidney transplantation in patients on antitubercular therapy (ATT). This was a retrospective single-center study to analyze the safety of kidney transplantation and its outcomes in patients undergoing transplantation while on the continuation phase of ATT. Between 2013 and 2022, 30 patients underwent kidney transplantation while on ATT. Median age was 38 years and 70% were males. Majority of the patients (86.7%) had extrapulmonary tuberculosis, most common site of involvement being tubercular lymphadenitis. 14/30 patients had microbiological/histopathological diagnosis of TB and the rest were diagnosedby ancillary tests. Patients were treated with 4 drug ATT (isoniazid, rifampicin, pyrazinamide, ethambutol) before transplantation for aminimum of 2 months. Post-transplantation fluoroquinolone-based non-rifamycin ATT was used (median duration 11 months). All patients completed therapy. At 2 years, there was 100% patient survival and 96.7% graft survival. Median eGFR at 6, 12, and 24 months post-transplantation was 71.9, 64.7, and 67mL/min/1.73m2, respectively. The percentage of patients suffering a biopsy proven acute rejection at 6, 12, and 24 months was 3.3%, 6.7%, and 6.7%. Kidney transplantation can be done in patients with TB who have a satisfactory response to the intensive phase of the ATT. The decision for transplantation while on the continuation phase ofATT should be individualized. In our experience, there is excellent patient and graft survival in these patients with a low risk of failure of ATT or relapse of TB.

Tuberculous otomastoiditis: analysis of otological tuberculosis with intact tympanic membrane

In recent years extra pulmonary tuberculosis has more frequently been associated with mastoiditis in patients with immunodeficiency state. Although tuberculosis of the mastoid or otomastoiditis is a very rare complication of tuberculosis today, when occurs it may cause significant morbidity. Complications such as facial paralysis and permanent hearing loss may develop. Our purpose was to evaluate the differential findings of tuberculous otomastoiditis and evaluation of outcomes in patients undergoing surgery along with anti-tubercular therapy rather than patients receiving only anti-tubercular therapy. We reviewed 12 cases of TOM, all of which had been confirmed on sputum and pathological examination following middle ear mucosal biopsy. Neuroradiologists analyzed the typical findings of HRCT temporal bone. Tympanomastoid ear surgery was planned according to the extent of the disease involved. The soft tissue attenuation in the entire middle ear cavity and extension to the external auditory canal (EAC) or mucosal thickening of the bony EAC, erosion of the ossicles and scutum was clinically significant. Patients who underwent tympanomastoid surgery showed better prognosis than the patients receiving anti tubercular drugs alone. Patients with extra-pulmonary tuberculosis, especially otomastoiditis should get operated to remove the disease along with anti-tubercular treatment to prevent complications.

Outcome of anti-tubercular therapy on rifampicin sensitive non-HIV patients with tubercular cervical lymphadenopathy in Bangladesh

Background: Tuberculosis (TB) remains a significant public health concern, particularly in developing countries like Bangladesh. The study aims to evaluate the outcomes of a six-month anti-tubercular therapy in rifampicin (RIF)-sensitive, non-HIV patients with tubercular cervical lymphadenopathy (TCL), and to challenge the conventional wisdom of extended treatment durations. Methods: This retrospective observational study was conducted at Dhaka medical college, Dhaka, Bangladesh, from July 2019 to July 2023. A total of 189 patients diagnosed with TCL were included, adhering to specific inclusion and exclusion criteria. Various socio-demographic characteristics, clinical presentations, and treatment outcomes were analyzed. Results: The majority of the participants were aged 15-30 (71.43%) and were female (68.25%). Fever was the most common clinical presentation, affecting 66.67% of the participants. After six months of therapy, 33.86% showed a complete response, and various clinical presentations were observed, with neck pain being the most common (11.64%). Among the 64 with complete response after 6 months, only 7.81% showed relapse at follow-up. Conclusions: Our study suggests that a six-month treatment regimen can yield significant responses in TB patients. It challenges the prevailing notion that extended treatment durations are universally necessary. Treatment plans should be individualized, taking into account the clinical conditions of each patient, and should be advised by a clinician or a respected doctor.

Acute myeloid leukemia patient with active disseminated tuberculosis bridged to transplant with reduced 14-day venetoclax and azacitidine schedule

SummaryA 59-year-old female patient was diagnosed with acute myeloid leukemia and tuberculosis. As a further complication, she developed idiopathic bowel perforation. Her infectious and intestinal situation demanded shorter periods of neutropenia and did not permit a high-dose, curative therapy regimen. Moreover, simultaneous administration of venetoclax and antitubercular therapy with rifampicin causes CYP3A4 interactions and thereby higher levels of toxicity. She was treated with a shortened, 14-day therapy regimen with azacitidine and venetoclax as antileukemic treatment together with ethambutol, pyrazinamide, isoniazid, and rifampicin as antitubercular therapy, which resulted in a complete remission and to an improvement of the tuberculosis without any greater toxicity or other adverse events.

A retrospective and observational study of the adverse drug reactions reported in a tertiary care hospital

Background: Adverse drug reaction (ADR) is considered a common cause of prolonged hospitalization and death among patients. Pharmacovigilance is essential in the surveillance of adverse drug reactions. The responsibility of a healthcare professional is to report any adverse reaction that occurs with the use of drugs. This helps in providing a database and improving the safety of patients. The aim of the study was to determine the incidence of ADR, assess causality, severity, and preventability of the submitted adverse drug reactions, increase the awareness of preventability of adverse drug reactions in health care professionals by conducting regular workshops on ADR, and document occurrence of a rare ADR. Methods: A retrospective observational study was conducted to assess the ADR reported to the ADR monitoring Centre, for the past 6 years included in the study. The data were entered into Microsoft excel and analyzed using descriptive statistics. Mean and standard deviation were calculated for the categorical data. Drugs were classified according to the class. Reactions were analyzed using scales and presented in descriptive statistics. Results: A total of 95 ADR reports were received and reported. These ADRs were associated with a total of 108 drugs that were prescribed- the occurrence of ADRs dominated among females 60% (57). Antimicrobials were causing the highest number of adverse reactions 21 (19.44%) and antituberculosis drugs and radiocontrast media were associated with the following larger number of the ADRs 19 (17.59%). Intravenous at 40% was the most common route related to the development of ADR. The most common ADR caused by antimicrobials was rash (9), antitubercular therapy commonly caused hepatitis, and chills and rigors were more common with radiocontrast media. Most of the reactions observed in the patients were moderate reactions at 52.63% with 3.16% fatal ones. Conclusions: In this study, the predominant causative drugs associated with ADR were antimicrobials, antitubercular drugs, and radiocontrast media. The number of ADRs reported though was less there was a wide range of drugs causing ADR that were reported which gave a broader spectrum for analysis. There is a requirement for active monitoring of ADRs to understand the occurrence as well as help in prevention.