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Auswahl der wissenschaftlichen Literatur zum Thema „Individualized treatment regime“
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Zeitschriftenartikel zum Thema "Individualized treatment regime"
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최영근. „Individualized Treatment Regime for Personalized Medicine: A Review“. Quantitative Bio-Science 36, Nr. 1 (Mai 2017): 7–13. http://dx.doi.org/10.22283/qbs.2017.36.1.7.
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Huang, Xinyang, Yair Goldberg und Jin Xu. „Multicategory individualized treatment regime using outcome weighted learning“. Biometrics 75, Nr. 4 (28.08.2019): 1216–27. http://dx.doi.org/10.1111/biom.13084.
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Feshchenko, Yu I., N. A. Litvinenko, N. V. Grankina, M. V. Pogrebna, Yu O. Senko, L. M. Protsyk und R. L. Liubevych. „Treatment of patients with multidrugresistant and extensively drug resistant tuberculosis depending on the composition of individualized regimens: immediate and longterm results“. Tuberculosis, Lung Diseases, HIV Infection, Nr. 4 (15.12.2021): 7–15. http://dx.doi.org/10.30978/tb2021-4-7.
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Objective — to study the effectiveness of treatment of MDR-TB (multidrug-resistant tuberculosis) and preXDR-TB/XDR-TB (pre-extensively and extensively drug resistant tuberculosis), depending on the composition of ITRs (individualized treatment regimens).
Materials and methods. Тhe prospective observational study included 566 patients with MDR/preXDR-TB and XDR-TB during 2016—2020 on the scientific clinical bases of the SI «National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine» and ME «Kryvyi Rih Anti-tuberculosis Dispensary» Dnipropetrovsk Regional Council Department. Patients were prescribed individualized treatment regimens in cases where short (standard or modified) regimens could not be prescribed. Patients were divided into comparison groups: 469 of them were treated with antimycobacterial therapy including bedaquiline and other effective antimycobacterial drugs groups A—C (without delamanid) — group 1. And 97 patients who were treated with the inclusion of both new antimycobacterial drugs (bedaquiline and delamanid) — group 2.
Results and discussion. Regardless of whether the delamanid, in addition to bedaquiline and other drugs selected for the scheme according to WHO recommendations, «effective treatment» was found in 91.3 against 88.6 % of patients. In the remote period (6-month — 4-year follow-up period) there was no recurrence of the disease, regardless of the composition of the regime. The loss of treatment effectiveness was due to deaths from non-tuberculosis reasons and those lost for follow-up.
Conclusions. For highly effective treatment, individualized regimens should include bedaquidine and linezolid from group A, and for previously ineffectively treated patients, clofazimine and carbapenems must be included (possibility to include 4 or more effective AMDs in ITR). For patients with fluoroquinolone resistance, treatment should include delamanid.
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Rich, Benjamin, Erica E. M. Moodie und David A. Stephens. „Influence Re-weighted G-Estimation“. International Journal of Biostatistics 12, Nr. 1 (01.05.2016): 157–77. http://dx.doi.org/10.1515/ijb-2015-0015.
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Abstract Individualized medicine is an area that is growing, both in clinical and statistical settings, where in the latter, personalized treatment strategies are often referred to as dynamic treatment regimens. Estimation of the optimal dynamic treatment regime has focused primarily on semi-parametric approaches, some of which are said to be doubly robust in that they give rise to consistent estimators provided at least one of two models is correctly specified. In particular, the locally efficient doubly robust g-estimation is robust to misspecification of the treatment-free outcome model so long as the propensity model is specified correctly, at the cost of an increase in variability. In this paper, we propose data-adaptive weighting schemes that serve to decrease the impact of influential points and thus stabilize the estimator. In doing so, we provide a doubly robust g-estimator that is also robust in the sense of Hampel (15).
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Olivieri, Martin, Christoph Königs, Christine Heller, Silvia Horneff, Johannes Oldenburg, Susan Halimeh, Karim Kentouche et al. „Prevalence of Obesity in Young Patients with Severe Haemophilia and Its Potential Impact on Factor VIII Consumption in Germany“. Hämostaseologie 39, Nr. 04 (05.02.2019): 355–59. http://dx.doi.org/10.1055/s-0039-1677874.
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AbstractSimilar to the general population, overweight and obesity have increasingly become a medical and economic burden also in patients with haemophilia in industrialized nations. In this study in seven German haemophilia centres, we identified a prevalence of overweight and obesity of 25.2% among 254 young patients <30 years (median: 13 years; range: 0–30 years) with severe haemophilia A and without a history of inhibitors. The median FVIII dosage based on bodyweight was significantly higher in normal weight compared with overweight or obese patients (96.9 vs. 72.9 IU/kg/week, respectively; p < 0.0001). This suggests that an individualized dosing regime which might be based on FVIII pharmacokinetics, physical activity and pre-existing haemophilic arthropathy is applied rather than dosing by bodyweight only. The bleeding rates observed in obese (median: 1; range: 0–17) versus normal weight patients (median: 2; range: 0–28) did not differ significantly (p = 0.057). Lower bleeding rates might be due to reduced activity or expected higher FVIII plasma levels in overweight patients. Due to the increasing prevalence of overweight/obesity in patients with haemophilia an interdisciplinary approach for individualized haemophilia treatment and weight loss programmes might be helpful for optimal and economical treatment for this group of patients.
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Bidu, Nadielle S., Bruno J. D. Fernandes, Eduardo J. C. Dias, Jucelino N. C. Filho, Regina E. A. Bastos, Ana L. P. C. Godoy, Francine J. Azeredo, Joice N. R. Pedreira und Ricardo D. Couto. „Vancomycin Therapeutic Regime Adjustment in Newborns and Infants with Bacterial Infection: Case Series“. Current Pharmaceutical Biotechnology 20, Nr. 4 (28.05.2019): 346–51. http://dx.doi.org/10.2174/1389201020666190319161511.
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Background: Vancomycin is used mostly to overcome infections caused by methicillinresistant microorganisms. There are no well-established administration protocols for neonates and infants, so the leak of a specific administration regime in that population may lead to serum concentrations beyond the specified range. Objective: This case series evaluated the pharmacokinetics adjustment from a vancomycin therapeutic regimen prescribed to neonates and infants with bacterial infection at a neonatal public hospital intensive- care-unit, with the primary purpose to verify cases of nephrotoxicity. Methods: Three neonates and four infants taking vancomycin therapy, hospitalized in a public hospital from November 2014 to March 2015, were included in the study. Vancomycin serum concentrations were determined by particle-enhanced-turbidimetric inhibition-immunoassay. The vancomycin concentrations were used for dose adjustment by USC*Pack-PC-Collection®, a non-parametric maximization program. The trough serum concentration range of 10 to 20mg.L-1 was considered therapeutic. Results: Three patients had serum concentration outside the reference-range, one with subtherapeutic, and two with supratherapeutic concentrations. All patients had concomitant use of drugs which interfered with vancomycin distribution and excretion pharmacokinetics parameters, including drugs that may enhance nephrotoxicity. One patient showed signs of acute renal damage, by low vancomycin and creatinine estimated clearances. Conclusion: The pharmacokinetic adjustment has been proven to be a useful and necessary tool to increase therapeutic efficacy and treatment benefits. The standard dose of vancomycin can be used to initiate therapy in neonates and infants admitted to the ICU, but after reaching the drug steady state, the dosing regimen should be individualized and guided by pharmacokinetic parameters.
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Hoffmann, Christian, Toke Ringbaek, Anja Eckstein, Wolfgang Deya, Alina Santiago, Martin Heintz, Wolfgang Lübcke et al. „Long-Term Follow-Up of Patients with Conjunctival Lymphoma after Individualized Lens-Sparing Electron Radiotherapy: Results from a Longitudinal Study“. Cancers 15, Nr. 22 (15.11.2023): 5433. http://dx.doi.org/10.3390/cancers15225433.
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Irradiation with electrons is the primary treatment regime for localized conjunctival low-grade lymphomas. However, radiation-induced cataracts are a major cause of treatment-related morbidity. This study investigates whether lens-sparing electron irradiation produces sufficient disease control rates while preventing cataract formation. All consecutive patients with strictly conjunctival, low-grade Ann Arbor stage IE lymphoma treated with superficial electron irradiation between 1999 and 2021 at our department were reviewed. A total of 56 patients with 65 treated eyes were enrolled with a median follow-up of 65 months. The median dose was 30.96 Gy. A lens-spearing technique featuring a hanging rod blocking the central beam axis was used in 89.2% of all cases. Cumulative incidences of 5- and 10-year infield recurrences were 4.3% and 14.6%, incidences of 5- and 10-year outfield progression were 10.4% and 13.4%. We used patients with involvement of retroorbital structures treated with whole-orbit photon irradiation without lens protection—of which we reported in a previous study—as a control group. The cumulative cataract incidence for patients treated with electrons and lens protection was significantly lower (p = 0.005) when compared to patients irradiated without lens protection. Thus, electrons are an effective treatment option for conjunctival low-grade lymphomas. The presented lens-sparing technique effectively prevents cataract formation.
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Zhang, Jianzhong, ChaoZhao Liang, Xuejun Shang und Hongjun Li. „Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Disease or Symptom? Current Perspectives on Diagnosis, Treatment, and Prognosis“. American Journal of Men's Health 14, Nr. 1 (Januar 2020): 155798832090320. http://dx.doi.org/10.1177/1557988320903200.
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Definitive diagnosis and selection of effective treatment for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) are frustrations encountered frequently by urology care providers in their practice. Knowledge of etiology and pathophysiology is not sufficient and therapeutic guidelines have not yielded acceptable outcomes and prognoses for both patients and care providers. The authors present updated perspectives on CP/CPPS, including definition, diagnosis, treatment, and prognosis, based on literature review and clinical experience. A key point is to shift the diagnostic and therapeutic focus from a single entity of disease toward associated symptoms of CP/CPPS. An individualized multimodal treatment approach to cope with the course of the disorder is proposed. Communications and personal/family/community supports are emphasized as an important component in the therapeutic regime and rehabilitation of patients with CP/CPPS. The purpose is to improve comprehension on CP/CPPS and to help care providers and patients to achieve the goal of medical intervention—relieving associated symptoms of CP/CPPS and improving the quality of life.
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Frelick, Bill. „What’s Wrong with Temporary Protected Status and How to Fix It: Exploring a Complementary Protection Regime“. Journal on Migration and Human Security 8, Nr. 1 (26.02.2020): 42–53. http://dx.doi.org/10.1177/2331502419901266.
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Executive Summary Temporary Protected Status (TPS) became part of the US protection regime in 1990 to expand protection beyond what had been available under the US Refugee Act of 1980, which had limited asylum to those who met the refugee definition from the United Nations’ 1951 Refugee Convention. The TPS statute authorized the attorney general to designate foreign countries for TPS based on armed conflict, environmental disasters, and other extraordinary and temporary conditions that prevent designated nationals from returning in safety. While providing blanket protection that very likely has saved lives, TPS has nonetheless proven to be a blunt instrument that has frustrated advocates on both sides of the larger immigration debate. This article evaluates the purpose and effectiveness of the TPS statute and identifies inadequacies in the TPS regime and related protection gaps in the US asylum system. It argues that TPS has not proven to be an effective mechanism for the United States to protect foreigners from generalized conditions of danger in their home countries. It calls for changing the US protection regime to make it more responsive to the risks many asylum seekers actually face by creating a broader “complementary protection” standard and a more effective procedure for assessing individual protection claims, while reserving “temporary protection” for rare situations of mass influx that overwhelm the government’s capacity to process individual asylum claims. The article looks at alternative models for complementary protection from other jurisdictions, and shows how the US asylum and TPS system (in contrast to most other jurisdictions) fails to provide a mechanism for protecting arriving asylum seekers who do not qualify as refugees but who nevertheless would be at real risk of serious harm based on cruel, inhuman, or degrading treatment or punishment or because of situations of violence or other exceptional circumstances, including natural or human-made disasters or other serious events that disturb public order, that would threaten their lives or personal security. The article proposes that the United States adopt an individualized complementary protection standard for arriving asylum seekers who are not able to meet the 1951 Refugee Convention standard but who would face a serious threat to life or physical integrity if returned because of a real risk of (1) cruel, inhuman, or degrading treatment or punishment; (2) violence; or (3) exceptional situations, for which there is no adequate domestic remedy.
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Ranade, Manjiri Anil. „Ayurgenomics – A narrative review“. BLDE University Journal of Health Sciences 9, Nr. 1 (Januar 2024): 91–94. http://dx.doi.org/10.4103/bjhs.bjhs_169_23.
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Abstract: Ayurgenomics is the integration of Ayurvedic principles with genomics to provide personalized approaches for the predictive, preventive, and curative aspects of medicine. It focuses on the interindividual variability due to genetic variability in humans, using the concept of Prakriti, which is a fusion of the comparative proportion of three main things, i.e., Tridoshas, namely, Vata, Pitta, and Kapha. Prakriti is used to define physical, physiological, and psychological traits of an individual and is the template for individualized diet, lifestyle counseling, and treatment. Ayurgenomics is an emerging field of interest where the therapeutic and lifestyle regime selection is made on the basis of clinical assessment of an individual maintaining one’s Prakriti. It is a novel concept of genomics suitable for one’s genetic makeup with the help of Ayurveda. It is possible that as Ayurveda gains more recognition and acceptance in mainstream health care, practitioners may incorporate more Ayurvedic principles and techniques in their practices, including categorizing patients based on Ayurvedic theories such as Prakriti. However, it is important to note that Ayurveda and allopathic medicine are based on different principles and may not always be compatible, so it is important for practitioners to have proper training and understanding of both systems before combining them in treatment. It is also important to note that while some studies have found correlation between Prakriti and genetics, more research is needed to establish the validity of Ayurgenomics as a field. Therefore, practitioners should be cautious in using Ayurvedic principles to make treatment decisions without thorough understanding of the patient’s condition and the potential risks and benefits of the treatment.
Dissertationen zum Thema "Individualized treatment regime"
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Yazzourh, Sophia. „Apprentissage par renforcement et outcome-weighted learning bayésien pour la médecine de précision : Intégration de connaissances médicales dans les algorithmes de décision“. Electronic Thesis or Diss., Université de Toulouse (2023-....), 2024. http://www.theses.fr/2024TLSES139.
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La médecine de précision vise à adapter les traitements aux caractéristiques de chaque patient en s'appuyant sur les formalismes des "Individualized Treatment Regimes" (ITR) et des "Dynamic Treatment Regimes" (DTR). Les ITR concernent une seule décision thérapeutique, tandis que les DTR permettent l'adaptation des traitements au fil du temps via une séquence de décisions. Pour être pertinentes, ces approches doivent être en mesure de traiter des données complexes et d'intégrer les connaissances médicales, essentielles pour permettre une utilisation clinique réaliste et sans risques. Cette thèse présente trois projets de recherche. Premièrement, un état de l'art des méthodes d'intégration des connaissances médicales dans les modèles de "Reinforcement Learning" (RL) a été réalisé, en tenant compte du contexte des DTR et de leurs contraintes spécifiques pour une application sur des données observationnelles. Deuxièmement, une méthode probabiliste de construction des récompenses a été développée pour les modèles de RL, s'appuyant sur les préférences des experts médicaux. Illustrée par des études de cas sur le diabète et le cancer, cette méthode génère des récompenses de manière à exploiter les données, le savoir de l'expert médical et les relations entre les patients, évitant les biais de construction "à la main" et garantissant une cohérence avec les objectifs médicaux. Troisièmement, un cadre bayésien pour la méthode "Outcome-Weighted Learning" (OWL) a été proposé afin de quantifier l'incertitude dans les recommandations de traitement, renforçant ainsi la robustesse des décisions thérapeutiques, et a été illustré à travers de simulations de données. Les contributions de cette thèse visent à améliorer la fiabilité des outils de prise de décision en médecine de précision, d'une part en intégrant les connaissances médicales dans les modèles de RL, et d'autre part en proposant un cadre bayésien pour quantifier l'incertitude dans le modèle OWL. Ces travaux s'inscrivent dans une perspective globale de collaboration interdisciplinaire en particulier entre les domaines de l'apprentissage automatique, des sciences médicales et des statistiquesPrecision medicine aims to tailor treatments to the characteristics of each patient by relying on the frameworks of Individualized Treatment Regimes (ITR) and Dynamic Treatment Regimes (DTR). ITRs involve a single therapeutic decision, while DTRs allow for the adaptation of treatments over time through a sequence of decisions. For these approaches to be effective, they must be capable of handling complex data and integrating medical knowledge, which is essential for enabling realistic and safe clinical use. This work presents three research projects. First, a state-of-the-art review of methods for integrating medical knowledge into Reinforcement Learning (RL) models was conducted, considering the context of DTR and their specific constraints for application to observational data. Second, a probabilistic method for constructing rewards was developed for RL models, based on the preferences of medical experts. Illustrated by case studies on diabetes and cancer, this method generates data-driven rewards, avoiding the biases of "manual" construction and ensuring consistency with medical objectives in learning treatment recommendation strategies. Third, a Bayesian framework for the Outcome-Weighted Learning (OWL) method was proposed to quantify uncertainty in treatment recommendations, thereby enhancing the robustness of therapeutic decisions, and was illustrated through simulations studies. This contributions aim to improve the reliability of decision-making tools in precision medicine, by integrating medical knowledge into RL models on one hand, and proposing a Bayesian framework to quantify uncertainty in the OWL model on the other. This work is part of a global perspective of interdisciplinary collaboration, particularly among the fields of machine learning, medical sciences, and statistics
Bücher zum Thema "Individualized treatment regime"
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Thakur, Siddarth, und Salahadin Abdi. Cervical Spine. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190626761.003.0007.
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Pain emanating from the cervical spine represents a significant diagnostic and therapeutic challenge for clinicians. The precise etiology of the pain may be difficult to identify because there are many potential pain-generating structures in the cervical spine and surrounding region. It is helpful to delineate the patient’s symptoms as axial- or radicular-predominant in order to guide the investigation prior to initiating treatment. The evidence for many commonly used treatment regimens is variable, and therefore an individualized plan is often necessary. Although it is conceptually accommodating to compartmentalize the etiology of cervical spine pain from a single source, the reality is that multiple structures are often involved, given the complex anatomy of the cervical spine. This chapter discusses cervical spine anatomy and biomechanics, as well as the etiology, pathophysiology, and management options for axial and radicular neck pain.
Buchteile zum Thema "Individualized treatment regime"
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Zhou, Wenzhuo, Yuhan Li und Ruoqing Zhu. „Policy Learning for Individualized Treatment Regimes on Infinite Time Horizon“. In ICSA Book Series in Statistics, 65–100. Cham: Springer International Publishing, 2024. http://dx.doi.org/10.1007/978-3-031-50690-1_4.
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Jones, Roger D., und Alan M. Jones. „A Proposed Mechanism for in vivo Programming Transmembrane Receptors“. In Communications in Computer and Information Science, 123–37. Cham: Springer Nature Switzerland, 2024. http://dx.doi.org/10.1007/978-3-031-57430-6_11.
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AbstractTransmembrane G-protein coupled receptors (GPCRs) are ideal drug targets because they resemble, in function, molecular microprocessors for which outcomes (e.g. disease pathways) can be controlled by inputs (extracellular ligands). The inputs here are ligands in the extracellular fluid and possibly chemical signals from other sources in the cellular environment that modify the states of molecular switches, such as phosphorylation sites, on the intracellular domains of the receptor. Like in an engineered microprocessor, these inputs control the configuration of output switch states that control the generation of downstream responses to the inputs.Many diseases with heterogeneous prognoses including, for example, cancer and diabetic kidney disease, require precise individualized treatment. The success of precision medicine to treat and cure disease is through its ability to alter the microprocessor outputs in a manner to improve disease outcomes. We previously established ab initio a model based on maximal information transmission and rate of entropy production that agrees with experimental data on GPCR performance and provides insight into the GPCR process. We use this model to suggest new and possibly more precise ways to target GPCRs with potential new drugs.We find, within the context of the model, that responses downstream of the GPCRs can be controlled, in part, by drug ligand concentration, not just whether the ligand is bound to the receptor. Specifically, the GPCRs encode the maximum ligand concentration the GPCR experiences in the number of active phosphorylation or other switch sites on the intracellular domains of the GPCR. This process generates a memory in the GPCR of the maximum ligand concentration seen by the GPCR. Each configuration of switch sites can generate a distinct downstream response bias. This implies that cellular response to a ligand may be programmable by controlling drug concentration. The model addresses the observation paradox that the amount of information appearing in the intracellular region is greater than amount of information stored in whether the ligand binds to the receptor. This study suggests that at least some of the missing information can be generated by the ligand concentration. We show the model is consistent with assay and information-flow experiments.In contrast to the current view of switch behavior in GPCR signaling, we find that switches exist in three distinct states: inactive (neither off nor on), actively on, or actively off. Unlike the inactive state, the active state supports a chemical flux of receptor configurations through the switch, even when the switch state is actively off. Switches are activated one at a time as ligand concentration reaches threshold values and does not reset because the ligand concentration drops below the thresholds. These results have clinical relevance. Treatment with drugs that target GPCR-mediated pathways can have increased precision for outputs by controlling switch configurations. The model suggests that, to see the full response spectrum, fully native receptors should be used in assay experiments rather than chimera receptors.Inactive states allow the possibility for novel adaptations. This expands the search space for natural selection beyond the space determined by pre-specified active switches.
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Merlo, Gia. „Substance Use Disorders and the Impaired Physician“. In Principles of Medical Professionalism, 211–22. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780197506226.003.0012.
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Patient safety is jeopardized when healthcare services are provided by physicians who suffer from substance use disorders (SUDs). When focusing on the problem of substance abuse and dependence among physicians, certain factors inherent in the medical field, such as long hours, the high-stress nature of the work, and the ease of access to drugs, make physicians more susceptible to abusing or becoming dependent on prescription drugs and alcohol. SUDs may differ in severity. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (Washington, DC: American Psychiatric Association, 2013) provides three severity specifiers: mild, moderate, and severe. Severe SUDs are also known as addictive disorders. To make matters worse, a culture of silence exists among colleagues, who often seek to protect the compromised physician from the legal consequences of abusing drugs. Luckily, the compromised physician can be provided with an intense and individualized treatment regime through physician health programs that aim for rehabilitation over termination of employment.
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Bartlett, John G., Robert R. Redfield und Paul A. Pham. „Antiretroviral Therapy“. In Bartlett's Medical Management of HIV Infection, 175–262. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190924775.003.0004.
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Abstract: This chapter is about antiretroviral therapy (ART). It includes the goals of antiretroviral therapy (according to the 2018 Department of Health and Human Services [DHHH] guidelines), and it covers recommendations for antiretroviral therapy, special co-factor considerations, and what antiretroviral regimen to start. The chapter includes a detailed discussion on the selection of the initial third ART drug, individualized selection of the initial regimen, initiating ART in a patient with HIV-associated complications, treatment of HIV-2 infection, factors that influence the probability of prolonged viral suppression and regimen tolerability, the rapidity of virologic response, clinical failure, treatment strategies in selected situations, and treatment strategies in the setting of immunologic failure. The chapter concludes with a summary of pivotal antiretroviral trials.
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Chudakova, Tatiana. „“Treating Not the Illness, but the Patient”“. In Mixing Medicines, 157–93. Fordham University Press, 2021. http://dx.doi.org/10.5422/fordham/9780823294312.003.0005.
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Chapter four follows Tibetan medicine into the clinic. It tracks patients and practitioners’ strategies of managing health in a clinical space that offers a mixture of therapeutic interventions and leaves the body radically open-ended. Here, Tibetan medicine is made to align with older rationales of Soviet-era biomedicine about health being the direct condensation of detrimental and beneficial environmental exposures, and the ailing body becomes narrated as an accumulation of collective pathogenic time, which these treatment regimes aim to redress or revert. Tracking how patients and doctors negotiate this sutured therapeutic orientation, this chapter also attends to the toggling between individualized care and apprehensions of embodied collectivity.
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„Insulin Administration and Use Considerations“. In Practical Insulin: A Handbook for Prescribing Providers, 19–28. American Diabetes Association, 2023. http://dx.doi.org/10.2337/9781580407632.ch04.
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When selecting an individualized insulin regimen for a person with diabetes, there are a variety of factors to consider. Such factors include, but are not limited to cost and access considerations, self-management capabilities, and person-specific treatment goals. On a product level, individual insulin products are available in a variety of different delivery devices and have different recommendations for storage and use. Table 3 provides a summary of current insulin product availability and storage recommendations from the manufacturers. This section will discuss several insulin use considerations, including the selection of an insulin delivery method, key counseling regarding injection technique, and insulin storage recommendations.
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Ali, Asad, Zeeshan Ahmad, Usama Ahmad, Mohd Muazzam Khan, Md Faheem Haider und Juber Akhtar. „Integrating Nanotherapeutic Platforms to Image Guided Approaches for Management of Cancer“. In Molecular Pharmacology. IntechOpen, 2020. http://dx.doi.org/10.5772/intechopen.94391.
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Cancer is a leading cause of mortality worldwide, accounting for 8.8 million deaths in 2015. The landscape of cancer therapeutics is rapidly advancing with development of new and sophisticated approaches to diagnostic testing. Treatment plan for early diagnosed patients include radiation therapy, tumor ablation, surgery, immunotherapy and chemotherapy. However the treatment can only be initiated when the cancer has been diagnosed thoroughly. Theranostics is a term that combines diagnostics with therapeutics. It embraces multiple techniques to arrive at comprehensive diagnosis, molecular images and an individualized treatment regimen. Recently, there is an effort to tangle the emerging approach with nanotechnologies, in an attempt to develop theranostic nanoplatforms and methodologies. Theranostic approach to management of cancer offers numerous advantages. They are designed to monitor cancer treatment in real time. A wide variety of theranostic nanoplatforms that are based on diverse nanostructures like magnetic nanoparticles, carbon nanotubes, gold nanomaterials, polymeric nanoparticles and silica nanoparticles showed great potential as cancer theranostics. Nano therapeutic platforms have been successful in integrating image guidance with targeted approach to treat cancer.
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Garg, Tushar. „DOTS-Plus“. In 50 Studies Every Global Health Provider Should Know, herausgegeben von Andrea Walker, Anup Agarwal und Yogesh Jain, 43–47. Oxford University PressNew York, 2023. http://dx.doi.org/10.1093/med/9780197548721.003.0009.
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Abstract Multidrug-resistant tuberculosis (TB) is a major issue in global health, prompting concerns from multilateral agencies and donor organizations about the ability of low- and middle-income countries (LMICs) to effectively treat patients with this disease as a result of poor health infrastructure and the perceived inability to ensure that patients receive and take their specialized antibiotic regimens. The DOTS-Plus program for patients with drug-resistant TB described in this study provides individualized, patient-centered care in a community-based, outpatient, and low-resource environment. With this program, 83% of the patients completing at least 4 months of treatment achieved a probable cure. This study catalyzed changes to guidelines and practice of treating every drug-resistant case in an in-patient hospital setting and highlighted the limits of the standardized short-course approach to TB treatment.
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Pariyadath, Vani, Martin P. Paulus und Elliot A. Stein. „Brain, Reward, and Drug Addiction“. In Neurobiology of Mental Illness, herausgegeben von Antonello Bonci und Nora D. Volkow, 732–41. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199934959.003.0055.
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Drug addiction is an important health and societal issue. Dysregulation of reward, such as increased sensitization of incentive salience or greater sensitivity to the withdrawal from reward-related drug effects, has been implicated in this complex and multifaceted disease. Research from the past several years has de-emphasized the role of dopaminergic function within the basal ganglia in favor of an expanding reward network with extensive connectivity between multiple reward circuit nodes and utilizing multiple transmitter systems. Such a paradigm shift has required a reformulation in understanding the neural mechanisms underlying positive and negative reinforcement. Neuroimaging provides unique opportunities for probing multi-node interactions, and thus can assist in better understanding reward and "anti-reward" mechanisms underlying the normal and addiction phenotype. The goal for future neuroimaging research is to better inform the clinical aspect of drug addiction by determining the propensity to develop drug addiction, assessing severity of addiction, predicting treatment outcome, and facilitating individualized treatment regimens.
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Asim, Muhammad. „Exercise and physical therapy“. In Ankylosing Spondylitis and Axial Spondyloarthritis, 88—C14.P31. 2. Aufl. Oxford University PressOxford, 2023. http://dx.doi.org/10.1093/oso/9780198864158.003.0014.
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Abstract Regular range of motion exercise is of fundamental importance in preventing or minimizing stiffness and deformity. A life-long regular physical exercise regimen and proper posture control are of fundamental importance in the successful long-term management of AS/axSpA. Unsupervised exercises at home or supervised single or group physical exercises (on ground and/or in water) are necessary to complement the increasing number of currently available and remarkably effective pharmacological therapies. But such physical exercises and other non-pharmacological measures are generally under-utilized by both patients as well as their healthcare providers. Randomized controlled trials have shown that physiotherapy with disease education is effective in the treatment of people with AS, and group physical therapy is cost-effective compared to individualized therapy. Patients’ posture problems and difficulties in performing activities of daily living should be identified, and workplace modifications may be needed.
Konferenzberichte zum Thema "Individualized treatment regime"
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Brown, Erika, Marshall Pickarts, Jose Delgado-Linares, Hao Qin, Carolyn Koh, Sumil Thapa, Nakatsuka Matthew und Vinod Veedu. „Scale-Up and Modeling Efforts Using an Omniphobic Surface Treatment for Mitigating Solids Deposition“. In Offshore Technology Conference. OTC, 2022. http://dx.doi.org/10.4043/32059-ms.
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Abstract Gas hydrates, waxes and asphaltenes represent some of the most significant flow assurance challenges, especially in subsea lines, where treatment options can be limited. Currently, complete avoidance is the primary strategy for hydrate management, while chemical or mechanical flushing/pigging may be utilized for other solids. Each system must also be treated with individualized solutions, as there have been no proved one-size-fits-all technologies demonstrated to date. As an alternative to constant chemical injection or thermodynamic controls such as insulation or heating, a robust omniphobic surface treatment material has been developed which has been shown in previous studies to significantly reduce the adhesion of flow assurance solids, resulting in lower risk for deposition and plugging of gas hydrates, waxes, and asphaltenes. As part of a Department of Energy study, laboratory scale tests were performed on a variety of apparatuses ranging from micromechanical force (micron scale) to laboratory flow loop testing (meter scale). While the results from these tests have been promising, there can be some disconnects between lab-scale observations and field-scale testing. Several factors can result in discrepancies between small-scale bench-top studies and deployment-scale efforts. These include flow conditions (Reynolds number, flow regime), chemistry (synthetic vs. crude oils, gas composition, and additives), physical differences (pipeline material, size, and geometry), etc. This work will describe the actions taken to better understand the deployment and performance of a material such as this omniphobic surface treatment in field scenarios, and to build confidence for deployment in a production scenario. These efforts include modeling field production scenarios using models developed from lab observations, application of the material to field-scale equipment to better understand application challenges, and expanded survivability and longevity testing. Understanding the bridge between laboratory testing and full-scale deployment allows for better technique and risk mitigation for field scale testing.
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Brown, Erika, Marshall Pickarts, Jose Delgado-Linares, Hao Qin, Carolyn Koh, Sumil Thapa, Nakatsuka Matthew und Vinod Veedu. „Scale-Up and Modeling Efforts Using an Omniphobic Surface Treatment for Mitigating Solids Deposition“. In Offshore Technology Conference. OTC, 2022. http://dx.doi.org/10.4043/32059-ms.
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Abstract Gas hydrates, waxes and asphaltenes represent some of the most significant flow assurance challenges, especially in subsea lines, where treatment options can be limited. Currently, complete avoidance is the primary strategy for hydrate management, while chemical or mechanical flushing/pigging may be utilized for other solids. Each system must also be treated with individualized solutions, as there have been no proved one-size-fits-all technologies demonstrated to date. As an alternative to constant chemical injection or thermodynamic controls such as insulation or heating, a robust omniphobic surface treatment material has been developed which has been shown in previous studies to significantly reduce the adhesion of flow assurance solids, resulting in lower risk for deposition and plugging of gas hydrates, waxes, and asphaltenes. As part of a Department of Energy study, laboratory scale tests were performed on a variety of apparatuses ranging from micromechanical force (micron scale) to laboratory flow loop testing (meter scale). While the results from these tests have been promising, there can be some disconnects between lab-scale observations and field-scale testing. Several factors can result in discrepancies between small-scale bench-top studies and deployment-scale efforts. These include flow conditions (Reynolds number, flow regime), chemistry (synthetic vs. crude oils, gas composition, and additives), physical differences (pipeline material, size, and geometry), etc. This work will describe the actions taken to better understand the deployment and performance of a material such as this omniphobic surface treatment in field scenarios, and to build confidence for deployment in a production scenario. These efforts include modeling field production scenarios using models developed from lab observations, application of the material to field-scale equipment to better understand application challenges, and expanded survivability and longevity testing. Understanding the bridge between laboratory testing and full-scale deployment allows for better technique and risk mitigation for field scale testing.
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Saha, Avinandan, Preyas J. Vaidya, Vinod B. Chavhan, Kamlesh V. Pandey, Arvind H. Kate, Joerg D. Leuppi, Michael Tamm und Prashant N. Chhajed. „Factors affecting outcomes of individualised treatment for drug resistant tuberculosis in an endemic region>“. In ERS International Congress 2017 abstracts. European Respiratory Society, 2017. http://dx.doi.org/10.1183/1393003.congress-2017.pa2728.
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Liao, Chih-Yi, Benny Johnson, Alexander Spira, David Carbone, Brian Henick, Michael Overman, Blase Polite et al. „660 Clinicopathologic characteristics of patients with metastatic colorectal cancer with molecular responses following treatment with an individualized neoantigen vaccine regimen“. In SITC 37th Annual Meeting (SITC 2022) Abstracts. BMJ Publishing Group Ltd, 2022. http://dx.doi.org/10.1136/jitc-2022-sitc2022.0660.
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Yatskevich, N., H. Hurevich, V. Solodovnikova, E. Garsevanidze, N. Lachenal, JL Alvarez, N. Sitali, A. Sinha und A. Skrahina. „Preliminary data on safety and effectiveness of six-month all-oral regimens in patients with rifampicin-resistant tuberculosis in Belarus“. In MSF Scientific Day International 2023. NYC: MSF-USA, 2023. http://dx.doi.org/10.57740/6r4t-kf45.
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INTRODUCTION The total duration of treatment for rifampicin-resistant tuberculosis (RR-TB) in Belarus prior to December 2022 was 18-20 months. The efficacy of treatment with such regimens is low, with the WHO’s Global TB Report suggesting that efficacy was around 73% in Belarus in 2018. The development of effective short regimens for RR-TB treatment is urgent. In Belarus, six-month long treatment with all-oral regimens is used in patients with RR-TB, under operational research conditions, following WHO recommendations. METHODS A preliminary assessment of the effectiveness of six-month all-oral regimens containing bedaquiline, pretomanid, linezolid, and moxifloxacin or clofazimine (BPaLM/BPaLC), was performed in a cohort of RR-TB patients. Treatment outcomes, time to culture conversion, and time to adverse event (AE) occurrence, AE types, frequency, and outcomes are described. ETHICS This study was approved by the MSF Ethics Review Board (ERB) and by the Belarus Ministry of Health ERB. RESULTS Of 177 patients who were enrolled from February 2022 to July 2022, one patient was excluded due to linezolid resistance; this patient continued treatment under an individualised regimen. Of the rest of the cohort (133 (76%) male, 43 female (24%); median age, 44 years (interquartile range, IQR, 25-29 years), 93.2% (164/176) had a favourable treatment outcome, 11 patients were lost to follow-up, and one died. 52 (30%) patients had a sputum smear positive result at treatment start, 59 (34%) a cavitary lesion on chest X-ray, and 42 (24%) patients had been previously treated. 12 patients (7%) were HIV-positive; 23 (13%) had had hepatitis C infection; 45 (26%) abused alcohol, and 6 (3%) of patients had diabetes mellitus. Median time to culture conversion was 27 days (IQR, 25-29). In 96.0% of patients, culture conversion was achieved within 2 months of treatment. 9% of patients had serious AE’s (SAE). Out of total 19 SAE’s, 12 resolved, two resolved with sequelae, three were resolving at the time of assessment, one did not resolve, and one was fatal. Median time from treatment start to the first SAE was 92.5 days (IQR, 12.5-143). The most frequent SAE’s were elevated liver function (6 (32%) cases), acute kidney injury (4 (21%) cases), and amylase increased/pancreatitis (3 (16%) cases). Two cases also revealed cancer or progression of cancer; one showed QTcF prolongation; one, anemia, one, thrombotic cerebral infarction, and one, Clostridium difficile infection. Two cases of cancer and thrombotic cerebral infarction (a patient with a long-standing history of multiple strokes) were assessed as unrelated to study drugs. The one death from cancer was assessed as not related to treatment. Permanent withdrawal of one study drug (linezolid or clofazimine) was done only in three instances (15.8%). CONCLUSION The effectiveness of six-month all-oral regimens in this cohort was very high (93.2%). BPaLM/BPaLC regimens were observed to be characterised by a good safety profile. Further data are necessary to evaluate longer-term treatment outcomes. CONFLICTS OF INTEREST None declared
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Castilho, Manoel Olavo Valentim Fernandes de, Karen Tamires Viau, Tulio Avelar Ferreira, Ana Luísa Bacile Katsui, Emilly Anne Teixeira Pereira und Lucas Fernando da Silva Moraes. „Enucleation of a large meroblastic fibroma: Case report“. In IV Seven International Congress of Health. Seven Congress, 2024. http://dx.doi.org/10.56238/homeivsevenhealth-034.
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Although ameloblastic fibroma is a benign neoplasm, it has considerable rates of recurrence and malignant transformation into an ameloblastic fibrosarcoma. In this context, we seek to provide important information on the clinical presentation, diagnosis and treatment of this rare and challenging tumor. To this end, we present a case report of a 24-year-old patient with an asymptomatic increase in volume in the left mandibular region together with a panoramic X-ray showing a multilocular radiolucent area involving the mandibular ramus, angle and body associated with an included element 47. The initial clinical approach was complementary examinations followed by incisional biopsy under AL with the anatomopathological result of ameloblastic fibroma. The treatment of choice was enucleation + peripheral osteotomy of the lesion under GA. The patient is currently being followed up for one year with no evidence of recurrence and healthy new bone formation at the site. Ameloblastic fibroma is a rare benign odontogenic lesion with a high recurrence rate and potential for malignant transformation. The treatment of choice is enucleation and curettage, and resection with a safety margin may be necessary in cases of larger lesions and recurrences. Long-term follow-up is essential to monitor possible recurrences. Treatment should therefore be individualized, taking into account factors such as age, location, recurrences and post-operative patient morbidity.
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LeBrun, Alexander, Ronghui Ma und Liang Zhu. „Tumor Shrinkage Study in Magnetic Nanoparticle Hyperthermia Based on Designed Heating Protocols“. In ASME 2016 5th International Conference on Micro/Nanoscale Heat and Mass Transfer. American Society of Mechanical Engineers, 2016. http://dx.doi.org/10.1115/mnhmt2016-6559.
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Magnetic nanoparticle hyperthermia has attracted growing attentions recently due to its ability of confining nanoparticle-induced heating in targeted tumor region. Our recent studies have identified an injection strategy to achieve repeatable and controllable nanoparticle deposition patterns in PC3 tumors using microCT scans. Based on the injection strategy, simulation of temperature elevations in tumors is conducted to design heating protocols to induce irreversible thermal damage to the entire tumors. In this study, in vivo heating experiments are performed on PC3 tumors implanted on mice following the designed heating protocols. The tumors in the control group without heating triple their sizes over a period of eight weeks. The tumors in the heating groups are heated for either 25 minutes or 12 minutes, representing that the Arrhenius integral is equal to or larger than 4 or 1 in the entire tumors, respectively. The tumors in the heating group of 25 minutes disappear completely after the 3rd days, and the site maintains the disappearance for over eight weeks. The sizes of the tumors in the heating group of 12 minutes decrease in the first ten days, however, the tumors re-grow afterwards, and by the end of the 8th week, they are approximately 60% larger than their initial size. This study demonstrates the importance of imaging-based design for individualized treatment planning. The success of the designed heating protocol in complete damaging PC3 tumors validates the theoretical models used in planning the heating treatment in magnetic nanoparticle hyperthermia.
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Neto, Eclésio Batista de Oliveira, Gabriela Leite Almeida Costa, Edson Santana Gois Filho, João Deon de Araújo Filho und Daniele Gonçalves Bezerra. „NEUROCISTICERCOSE SUBARACNOIDE: TRATAMENTO FARMACOLÓGICO“. In II Congresso Brasileiro de Parasitologia Humana On-line. Revista Multidisciplinar em Saúde, 2022. http://dx.doi.org/10.51161/conbrapah/6.
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Introdução: A Neurocisticercose (NC) é causada pela infecção do cérebro por metacestódeos da Taenia solium. Os sintomas encontrados geralmente são: dor de cabeça, convulsões, confusão mental e coma. Entretanto, os sinais e sintomas variam de acordo com o tamanho do cisto, localização, número e grau de inflamação. A Neurocisticercose subaracnoide (NCS) é causada por uma forma proliferativa anatomicamente anormal de cisto da T. solium. Em comparação com cistos estruturados normais, que têm a estrutura anatômica típica de metacestódeos com o escólex invaginado em sua bexiga. Os cistos relacionados à NCS têm elementos estruturais desorganizados, geralmente sem um escólex, e com frequência com múltiplas vesículas contendo fluido, dando o aspecto característico de cistos racemosos. Estes se degeneramno espaço subaracnóideo e progridem para uma aracnoidite, podendo enfim evoluir paracomplicações graves e frequentemente fatais como a compressão de nervos, lesão cerebral focal e infartos. Objetivo: Revisar os tratamentos disponíveis para a neurocisticercose subaracnoide. Material e métodos: Foi realizada uma revisão bibliográfica na base de dados BVS (Biblioteca Virtual em Saúde) e PUBMED com os descritores "Subarachnoid Neurocysticercosis" e "Treatment”, com e sem o operador AND. Os critérios de inclusão foram (1) textos completos condizentes com o tema e objetivos do trabalho; (2) em inglês, espanhol e português; (3) publicados nos últimos 5 anos. Foram encontrados 12 estudos, após a aplicação dos critérios de inclusão e exclusão, foram mantidos e analisados 8 estudos. Resultados: Os artigos revisados enfatizam que o tratamento deve ser individualizado, e ter como base o número, localização dos cisticercos e resposta inflamatória do hospedeiro. São utilizadas drogas antiparasitárias como o albendazol e praziquantel, que fornecem um benefício clínico significativo na doença parenquimatosa. A doença subaracnoide parece requerer terapia mais prolongada e intensiva. Alguns investigadores usam um curso curto de 8-10 dias de alta dose de albendazol e dexametasona ou 15 dias de praziquantel. No entanto, esse regime falha com frequência, exigindo retratamento. Conclusão: As abordagens terapêuticas para NCS variam porque a fisiopatologia da doença ainda não foi compreendida totalmente e não existem ensaios randomizados rigorosos para orientar a terapia. Sendo necessários mais estudos para um tratamento mais eficiente.
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Owosela, Kingsley. „Reversal of Type 2 Diabetes Using Nutrition and Lifestyle Interventions“. In SPE International Health, Safety, Environment and Sustainability Conference and Exhibition. SPE, 2024. http://dx.doi.org/10.2118/220250-ms.
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Abstract Background The worldwide prevalence and burden of Type 2 diabetes mellitus (T2DM) keeps growing at a frightening rate and uncontrolled diabetes has become one of the most common reasons for restricted fitness to work in the oil and gas industry. Based on the 2021 International Diabetes Federation's statistics, MENA Region has the highest regional prevalence of 16.2% and is expected to reach 31% by 2045 (IDF, 2021). Type 2 diabetes has long been classified as an irredeemable chronic metabolic disease based on the standards of care treatment approach. The best outcome expected has been the improvement of symptoms or slowing the predictable consequences of diabetes. Although traditional view has been that diabetes is irredeemable and unstoppable, the paradigm is changing. Evidence from numerous studies show that type 2 diabetes remission and reversal is possible through health education, low-carb Mediterranean diet and other lifestyle interventions. Aim The purpose of this retrospective study was to assess the effectiveness of our company's diabetes program on glycated hemoglobin (HbA1c), body weight, and fasting blood sugar (FBS) for the remission or reversal of Type 2 Diabetes. Methods The study involved 106 employees with T2DM within the age range of 21 to 60 years and HbA1c value between 7.0% to 14.0%. The participants were assigned holistic diabetes expert doctors that provided tailored holistic nutrition, sustainable fitness, and counseling/behavioral modification/education to reverse T2DM. Lab values of FBS, HbA1c, and body weight of the patients were recorded at the start and the end of the study. The determine the efficacy of the program, we compared the results in the program to that of a control group with 73 individuals diagnosed with T2DM and treated with diabetes pharmaceuticals but not part of the company's diabetes program. Results After analysis (mean ± SD), a substantial reduction in FBS, HbA1c, and body weight was observed in the program participants in comparison to the control. Based on the results HbA1c decreased from 10.5 ± 1.3% to 5.7 ± 1.0% with a mean drop of 4.8±1.2%; FBS reduced from 195.1 ± 53.4 mg/dL to 93.2 ± 18.8 mg/dL with an average FBS reduction of 101.9 ± 45.3 mg/dL, and body weight dropped from 89.8 ± 11.2 kg to 74.6 ± 11.8 kg with a mean loss of 15.2 kg. Conclusion These results demonstrate that a holistic diabetes care program involving individualized holistic nutrition, sustainable exercise training, counseling, lifestyle behavioral modification, and education similar to our diabetes program, can help to improve and sustain a healthy blood sugar status and body weight in individuals with T2DM. In comparison to the aforementioned MENA region prevalence of 16.2% and the company's prevalence of 13.4% in 2019, the prevalence now stands at 3.2%.
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Mansoor, H., N. Hirani, VV Chavan, A. Joshi, V. Oswal, J. Sharma, A. Iyer et al. „Clinical utility of target-based next-generation sequencing for drug-resistant tuberculosis: a pilot from Mumbai, India“. In MSF Scientific Days International 2022. NYC: MSF-USA, 2022. http://dx.doi.org/10.57740/atfq-6s03.
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INTRODUCTION In countries with a high tuberculosis (TB) burden, poor access to drug susceptibility testing is a major bottleneck in diagnosing drug-resistant (DR) TB. India is estimated to account for a quarter of multidrug-resistant (MDR)-TB patients globally, with around 124,000 cases in 2020. Mumbai, a densely populated city in Maharashtra State, is a DR-TB hotspot with 24% of treatment- naïve cases, and 41% of previously-treated cases, having MDR-TB, and a high frequency of fluoroquinolone resistance occurring among these MDR-TB cases. Targeted next- generation sequencing (tNGS) is a promising technology for rapid detection of resistance. We assessed the role of tNGS for diagnosis of DR-TB. METHODS We performed a laboratory-based study involving Mycobacterium tuberculosis (MTB)-positive samples from patients with presumptive TB or DR-TB identified by GeneXpert in Shatabdi Hospital, Mumbai. A total of 161 sputum samples from bacteriologically-confirmed TB cases were included in the study. The study was conducted at Sir JJ Hospital’s TB lab, with sample collection occurring from patients living in M-East Ward (MEW), Mumbai. Two sputum samples were collected from each presumptive TB patient at MEW. Spot samples with a positive result on Xpert MTB/Rif were sent for tNGS and conventional testing (phenotypic drug sensitivity testing (pDST), line probe assays (LPA), and mycobacteria growth indicator tubes (MGIT)) at Sir JJ Hospital’s TB lab. tNGS samples were processed using Deeplex MycTB-kit (GenoScreen, France) and sequenced on a MiSeq platform (Illumina, USA). These samples were also processed for pDST using 16 drugs on MGIT (Becton Dickinson, USA) and LPA (MTBDRplus and MTBDRsl, Hain Lifesciences, Germany). To ensure sequence quality, Xpert results with cycle threshold values <20 or direct smear results >2+ were prepared for tNGS using direct sputum sediments. Primary cultures were prepared for samples with lower bacterial loads. ETHICS This study was approved by the ethics committee of the Grant Medical College & Sir J J Group of Hospitals, Mumbai, India. Permission was granted by the Medical Director of MSF, Operational Centre Brussels. RESULTS The median age of patients with samples included was 24 years (interquartile range, 20-40), and 57% were female. Approximately 70% of cases had no previous history of TB. Of 161 samples evaluated, 15 (9.3%) were rifampicin-sensitive and 146 (90.7%) were rifampicin-resistant (RR). 161 samples with completed pDST, tNGS and LPA were analysed. Of these, 88.2% had RR/MDR-TB resistance per WHO definitions, 58.5% had additional fluoroquinolone-resistance (pre-XDR) and 9.2% had fluoroquinolone resistance plus resistance to either linezolid or bedaquiline (extensively drug-resistant (XDR). Thirteen of 161 samples (8%) were culture-negative, yet resistance to one or more drugs was demonstrated in 8/13 samples with tNGS. Resistance frequency was similar across methods, with discordance in drugs less reliable in pDST or limited mutational representation within databases. Sensitivities aligned with the WHO catalogue for most drugs. 10% of the sample showed hetero-resistance and 75% of strains were of lineages 2 and 3. CONCLUSION In countries with a high burden of DR-TB, and high transmission rates, tNGS can provide information to rapidly design individualised regimens for early initiation and effective case management. It also gives information regarding lineages, uncharacterized mutations, hetero-resistance and mixed infection status of TB cases. Potentially tNGS could provide a diagnostic tool for rapid initiation of treatment in high DR-TB settings. CONFLICTS OF INTEREST None declared.