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Suliman AM, Bek SA, Elkhatim MS, Husain AA, Mismar AY, Eldean MZS, Lengyel Z, Elazzazy S, Rasul KI, Omar NE. Tuberculosis following programmed cell death receptor-1 (PD-1) inhibitor in a patient with non-small cell lung cancer. Case report and literature review. Cancer Immunol Immunother 2021; 70:935-944. [PMID: 33070259 PMCID: PMC7979647 DOI: 10.1007/s00262-020-02726-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/11/2020] [Indexed: 01/11/2023]
Abstract
Immune checkpoint inhibitors (ICIs)-anti-programmed death-1 (PD-1) and their ligands (PD-L1 and PD-L2) have become widely used in the treatment of several malignancies. Many immune-related adverse events (irAEs) have been linked to these agents. Nonetheless, tuberculosis (TB) reactivation during their use is increasingly recognized and reported. Herein, we present a 58-year-old lady with advanced non-small cell lung cancer (NSCLC) ALK-negative, EGFR wild, and PD-L1 immune histochemistry (IHC) strongly positive in 95% of tumor cells, on ongoing treatment with Pembrolizumab as a first-line monotherapy. Our patient presented with 1-week history of productive cough and high-grade fever. Further workup yielded the diagnosis of pulmonary tuberculosis after her Pembrolizumab sixth cycle with positive AFB smear and TB PCR from BAL (rifampin resistance not detected), with negative HIV status. Hence, immunotherapy was held, and patient was commenced on anti-TB regimen. History revealed contact with active TB patient over the past decade, without previous documentation of latent TB or previous TB infection. Her sputum AFB smear remained persistently positive 4 weeks through anti-TB regimen course. Later, the patient was discharged after her sputum was cleared from AFB (two negative sets). In light of pembrolizumab mechanism of action as an immune checkpoint inhibitor, we suspected its implication on reactivating latent TB which was observed in our patient demonstrating features of pulmonary tuberculosis. She was not re-challenged with Pembrolizumab following TB diagnosis.
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Affiliation(s)
- Aasir M Suliman
- Department of internal medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Shaza A Bek
- Department of Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed S Elkhatim
- Department of Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed A Husain
- Department of Infectious Diseases, Communicable Disease Center, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Y Mismar
- Department of internal medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M Z Sharaf Eldean
- Department of Pathology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zsolt Lengyel
- Department of Body Imaging, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Shereen Elazzazy
- Pharmacy Department, National Centre for Cancer Care and Research, Hamad Medical Corporation, 3050, Doha, Qatar
| | - Kakil I Rasul
- Department of Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Nabil E Omar
- Pharmacy Department, National Centre for Cancer Care and Research, Hamad Medical Corporation, 3050, Doha, Qatar.
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Shirzad-Aski H, Hamidi N, Sohrabi A, Abbasi A, Golsha R, Movahedi J. Incidence, risk factors and clinical characteristics of extra-pulmonary tuberculosis patients: a ten-year study in the North of Iran. Trop Med Int Health 2020; 25:1131-1139. [PMID: 32501638 DOI: 10.1111/tmi.13452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the incidence of extra-pulmonary tuberculosis (EPTB) and examine the risk factors and the clinical features of the disease over a ten-year period. METHODS Retrospective study of records of patients who were followed and registered in the TB registry programme in the health district of Gorgan, Iran from January 1, 2008, through December 31, 2017. RESULTS Among 2280 TB records, 609 (26.71%) were EPTB. They were mostly female patients (53.7%) and residents in rural areas (56.5%) with a mean age of 40.55 years [±16]. The average age of female patients (37.55 years [±16.99]) was lower than of male patients (44.07 years [±20.59]). The median of the incidence rate was 7.5 per 100 000 inhabitants for EPTB; biopsy and pathology were the best methods for the detection of EPTB. The most frequent forms of EPTB were lymphatic TB (193/609 = 31.7%) and pleural TB (158/609 = 25.9%). In most cases (245/609 = 40.2%), one to three months elapsed between occurrence of symptoms and final confirmation of EPTB. The outcome of EPTB was weaker than of pulmonary TB (PTB). CONCLUSION Our most important finding was the increasing incidence of EPTB, which shows the importance of attention to this disease. Lymph node and pleural tissue were the most commonly infected tissues. Skeletal TB presents a challenge in the diagnosis and treatment of EPTB.
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Affiliation(s)
| | - Niloofar Hamidi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Ahmad Sohrabi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Abdollah Abbasi
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Roghieh Golsha
- Infectious Diseases Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Jamileh Movahedi
- Tuberculosis laboratory of Health Care Center, Golestan University of Medical Sciences, Gorgan, Iran
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Bennasrallah C, Kacem M, Dhouib W, Zemni I, Ben Fredj M, Abroug H, Djobbi A, Green A, Said SG, Maalel I, Stambouli S, Zhir W, Youssef HBH, Sriha Belguith A. BCG vaccination and tuberculosis prevention: A forty years cohort study, Monastir, Tunisia. PLoS One 2019; 14:e0219991. [PMID: 31381577 PMCID: PMC6682306 DOI: 10.1371/journal.pone.0219991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/04/2019] [Indexed: 11/26/2022] Open
Abstract
We aimed to describe incidence, trends of tuberculosis (TB) over 18 years and to evaluate the impact of the BCG vaccine after four decades of immunization program according to three protocols. We performed a cohort study including declared cases in Monastir from January 1, 2000 to December 31, 2017. We reported 997 cases of TB. The predominant site was pulmonarylocalization (n = 486). The age standardized incidence of pulmonary and lymph node TB per 100,000 inh were 5.71 and 2.57 respectively. Trends were negative for pulmonary TB (PTB) (b = - 0.82; r = -0.67; p<10-3) and positive for lymph node localization (b = 1.31; r = 0.63; p<10-3). We had not notified cases of HIV associated with TB. Crude incidence rate (CIR) of PTB per 100,000 inh was 8.17 in Non-Vaccinated Cohort (NVC) and 2.85 in Vaccinated Cohort (VC) (p < 0.0001). Relative risk reduction (RRR) of BCG vaccination was 65.1% (95%CI:57.5;71.4) for pulmonary localization and 65% (95%CI:55; 73) for other localizations. We have not established a significant RRR of BCG vaccination on lymph node TB. Protocol 3 (at birth) had the highest effectiveness with a RRR of 96.7% (95%CI: 86.6%; 99.2%) and 86% (95%CI:71%;91%) in patients with PTB and other localizations TB respectively. In Cox regression model the HR was 0.061 (95% CI 0.015-0.247) for PTB and 0.395 (95% CI 0.185-0.844) for other localizations TB in patients receiving protocol 3 compared to NVC. For lymph-node TB, HR was 1.390 (95% CI 1.043-1.851) for protocol 1 and 1.849 (95% CI 1.232-2.774) for protocol 2 compared to NVC. Depending on the three protocols, the BCG vaccine had a positive impact on PTB and other TB localizations that must be kept and improved. However, protocols 1 and 2 had a reverse effect on lymph node TB.
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Affiliation(s)
- Cyrine Bennasrallah
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Meriem Kacem
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Wafa Dhouib
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
| | - Amira Djobbi
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Assia Green
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Samia Grira Said
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Issam Maalel
- The Regional Direction of Primary Health of Monastir, Monastir, Tunisia
| | - Sarra Stambouli
- Department of Family Medicine, University of Monastir, Monastir, Tunisia
| | - Wafa Zhir
- Department of Family Medicine, University of Monastir, Monastir, Tunisia
| | | | - Asma Sriha Belguith
- Department of Epidemiology and Preventive Medicine, University of Monastir, Monastir, Tunisia
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Ahmad M, Ibrahim WH, Sarafandi SA, Shahzada KS, Ahmed S, Haq IU, Raza T, Hameed MA, Thomas M, Swehli HAI, Sattar HA. Diagnostic value of bronchoalveolar lavage in the subset of patients with negative sputum/smear and mycobacterial culture and a suspicion of pulmonary tuberculosis. Int J Infect Dis 2019; 82:96-101. [PMID: 30904678 DOI: 10.1016/j.ijid.2019.03.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/10/2019] [Accepted: 03/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The diagnostic value of bronchoalveolar lavage in patients with negative sputum/smear for tuberculous bacilli has been well studied. However, its value in the subset of patients with both negative sputum/smear and culture is seldom reported. METHODS A retrospective study of patients referred for diagnostic bronchoscopy for the suspicion of pulmonary tuberculosis during the period from April 1st, 2015 to March 30th, 2016, and who had negative sputum/smear and culture for tuberculous bacilli. RESULTS One hundred and ninety patients fulfilled the inclusion criteria. Bronchoalveolar lavage detected further 61/190 (32.1%) pulmonary tuberculosis cases. Bronchoalveolar lavage mycobacterial culture and polymerase chain reaction (positive in 60/190 (31.6%) and 58/190 (30.5%) of patients respectively) provided the highest diagnostic yield, whereas direct smear provided the lowest yield. Bronchoalveolar lavage had a sensitivity of 89.7%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 94.6%, and a test accuracy of 96.3% in suspected pulmonary tuberculosis cases with negative sputum/smear and culture. Positive bronchoalveolar lavage yield for tuberculosis was significantly associated with a positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, radiological evidence of upper zone abnormality and patient's origin being from the Indian subcontinent. CONCLUSION Bronchoalveolar lavage should be pursued as a useful diagnostic tool for suspected pulmonary tuberculosis cases when sputum/smear and culture are negative. Its value is higher in the subset of patients with positive QuantiFERON-TB Gold In-Tube test, positive purified protein derivative skin test, upper zone abnormality on radiograph or being from the Indian subcontinent.
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Affiliation(s)
- Mushtaq Ahmad
- Department of Medicine, Hamad General Hospital, Weill-Cornell Medical College, Doha, Qatar.
| | - Wanis H Ibrahim
- Hamad General Hospital, Qatar University and Weill-Cornell Medical College, Doha, Qatar.
| | | | | | - Shakeel Ahmed
- Department of Medicine, Hamad General Hospital, Doha, Qatar.
| | - Irfan Ul Haq
- Department of Medicine, Hamad General Hospital, Doha, Qatar.
| | - Tasleem Raza
- Hamad General Hospital, Weill-Cornell Medical College, Doha, Qatar.
| | | | - Merlin Thomas
- Department of Medicine, Hamad General Hospital, Doha, Qatar.
| | | | - Hisham A Sattar
- Department of Medicine, Hamad General Hospital, Doha, Qatar.
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Jallow E, Al Hail H, Han TS, Sharma S, Deleu D, Ali M, Al Hussein H, Abuzaid HO, Sharif K, Khan FY, Sharma P. Current status of stroke in Qatar: Including data from the BRAINS study. JRSM Cardiovasc Dis 2019; 8:2048004019869160. [PMID: 31452875 PMCID: PMC6700866 DOI: 10.1177/2048004019869160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/06/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Qatar is located on the north-eastern coast of the Arabian Peninsula. Qatari natives account for less than 15% of the population while the largest migrant group comprising 60% derives from South Asia. Despite projections that stroke burden in Qatar will increase with population ageing, epidemiological studies focusing on stroke in Qatar are relatively scarce. METHOD We reviewed the available epidemiological publications relating to Qatar. In addition, we have added to this knowledge by incorporating Qatari data from the on-going Bio-Repository of DNA in Stroke, an independent multinational database of stroke patients. RESULTS Qatar has low reported incidence and mortality rates of 58 and 9.17 per 100,000 per year, respectively, which may be explained by its middle-aged migrant worker majority population. Correspondingly, South Asian migrants in Qatar suffered younger strokes than Qatari natives (48.7 vs 63.4 years, P < 0.001). Among the most common risk factors identified in stroke patients were hypertension (77.9%), diabetes (43.8%) and hypercholesterolemia (28.5%). Ischaemic stroke was the most frequent subtype amongst migrant South Asians (71.1%). The majority of stroke cases had computed tomography and/or magnetic resonance imaging scans, but only 11.1% of ischaemic strokes were thrombolysed. Qataris on one-year follow up were more often found to have died (6.5% vs 0.3%) and had further stroke/transient ischaemic attack events (17.4% vs 6.4%, P = 0.009) compared to South Asians. CONCLUSION The burden of stroke is increasing in Qatar, and considerable disparities are observed between the native and migrant populations which likely will require different approaches to management by its healthcare system.
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Affiliation(s)
- Ebrima Jallow
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | | | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | - Sapna Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | | | - Musab Ali
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
- Ashford & St Peters Hospital NHS Foundation Trust, Surrey, UK
- Imperial College Healthcare NHS Trust, London, UK
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Thomas M, Ibrahim WH, Raza T, Mushtaq K, Arshad A, Ahmed M, Taha S, Al Sarafandi S, Karim H, Abdul-Sattar HA. Medical thoracoscopy for exudative pleural effusion: an eight-year experience from a country with a young population. BMC Pulm Med 2017; 17:151. [PMID: 29166899 PMCID: PMC5700680 DOI: 10.1186/s12890-017-0499-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/14/2017] [Indexed: 02/08/2023] Open
Abstract
Background With the exception of areas with high prevalence of tuberculosis, medical thoracoscopy is becoming the diagnostic modality of choice for exudative pleural effusions. The aims of this study were to determine the diagnostic yield and safety of medical thoracoscopy for exudative pleural effusions and ascertain the etiology of such effusions in Qatar. Methods This is a retrospective-descriptive study of 407 patients who underwent diagnostic medical thoracoscopy for exudative pleural effusions from January, 2008 till December, 2015 at the only tertiary referral center performing this procedure in Qatar. Results Tuberculosis was the most common etiology of exudative pleural effusions in Qatar accounting for 84.5% of all causes. Around 85% of patients were young males (mean age of 33 ± 12.1 years). The diagnostic yield of medical thoracoscopy for tuberculous pleural effusion was 91.4%. Malignant pleural effusions accounted for 5.2% of cases. Minor bleeding occurred in 1.2% of cases with no procedure-related mortality observed. Conclusion Medical thoracoscopy is a very safe procedure. Tuberculous pleuritis is by far the most common etiology of exudative pleural effusions in Qatar. Closed needle biopsy is a worth consideration as an initial safe, easy and low-cost diagnostic modality for exudative pleural effusions in this country.
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Affiliation(s)
- Merlin Thomas
- Pulmonary Division, Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar.
| | - Wanis H Ibrahim
- Pulmonary Division, Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
| | - Tasleem Raza
- Pulmonary Division, Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
| | - Kamran Mushtaq
- Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
| | - Adeel Arshad
- Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
| | - Mushtaq Ahmed
- Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
| | - Salma Taha
- Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
| | - Saber Al Sarafandi
- Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
| | - Hanfa Karim
- Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
| | - Hisham A Abdul-Sattar
- Pulmonary Division, Department of Medicine, Hamad General Hospital, P.O.BOX 3050, Doha, Qatar
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Ben Abid F, Abukhattab M, Karim H, Agab M, Al-Bozom I, Ibrahim WH. Primary Pituitary Tuberculosis Revisited. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:391-394. [PMID: 28400550 PMCID: PMC5398251 DOI: 10.12659/ajcr.903233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Female, 45 Final Diagnosis: Primary pituitary tuberculosis Symptoms: Headache • vomiting • vomiting Medication: — Clinical Procedure: Pituitary biospy Specialty: Endocrinology and Metabolic
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Affiliation(s)
- Fatma Ben Abid
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mohammed Abukhattab
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Hanfa Karim
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Mohamed Agab
- Division of Infectious Disease, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Issam Al-Bozom
- Department of Pathology, Hamad General Hospital, Doha, Qatar
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Al-Shaer MH, Mansour H, Elewa H, Salameh P, Iqbal F. Treatment outcomes of fixed-dose combination versus separate tablet regimens in pulmonary tuberculosis patients with or without diabetes in Qatar. BMC Infect Dis 2017; 17:118. [PMID: 28152986 PMCID: PMC5290647 DOI: 10.1186/s12879-017-2231-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/27/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Tuberculosis is considered the second most common cause of death due to infectious agent. The currently preferred regimen for treatment of pulmonary tuberculosis (PTB) is isoniazid, rifampin, pyrazinamide, and ethambutol, which has been used either as separate tablets (ST) or as fixed-dose combination (FDC). To date, no studies have compared both regimens in Qatar. We aim to evaluate the safety and effectiveness of FDC and ST regimen for treating PTB, in addition to comparing safety and efficacy of FDC and ST regimens in patients with diabetes treated for TB. METHODS A retrospective observational study was conducted in two general hospitals in Qatar. Patients diagnosed with PTB received anti-tuberculosis medications (either as FDC or ST) administered by the nurse. Sputum smears were tested weekly. We assessed the time to negative sputum smear and incidence of adverse events among FDC and ST groups. RESULTS The study included 148 patients. FDC was used in 90 patients (61%). Effectiveness was not different between FDC and ST regimens as shown by mean time to sputum conversion (29.9 ± 18.3 vs. 35.6 ± 23 days, p = 0.12). Similarly, there was no difference in the incidence of adverse events, except for visual one that was higher in ST group. Among the 33 diabetic patients, 19 received the FDC and had faster sputum conversion compared to those who received ST (31 ± 12 vs. 49.4 ± 30.9 days, p = 0.05). Overall, diabetic patients needed longer time for sputum conversion and had more hepatotoxic and gastric adverse events compared to non-diabetics. CONCLUSION ST group had higher visual side effects compared to FDC. FDC may be more effective in diabetic patients; however, further studies are required to confirm such finding.
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Affiliation(s)
- Mohammad H. Al-Shaer
- Department of Pharmacy, Al Wakra Hospital – Hamad Medical Corporation, Doha, Qatar
- Present address: Department of Pharmacotherapy and Translational Research, Infectious Disease Pharmacokinetics Laboratory, College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610 USA
| | - Hanine Mansour
- School of Pharmacy, Lebanese American University, P.O Box 36-S 23, Byblos, Lebanon
| | - Hazem Elewa
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Pascale Salameh
- School of Pharmacy, Lebanese American University, P.O Box 36-S 23, Byblos, Lebanon
- Present address: Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Fatima Iqbal
- Department of Pharmacy, Rumailah Hospital – Hamad Medical Corporation, Doha, Qatar
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