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Title: An investigation into the characteristics of a large North West London cohort of patients with Mycobacterium tuberculosis with a particular focus on tuberculosis in the elderly and treatment related toxicity
Author: Abbara, Aula
ISNI:       0000 0004 9356 6352
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2017
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London has some of the highest rates of tuberculosis (TB) in Western Europe but there have been few detailed studies of the clinical characteristics of the UK cohort. The North West London cohort in which I undertake my study represents a high prevalence area for TB in a developed country with otherwise low TB prevalence. This unique setting allows for optimal diagnostic and management strategies compared to low resource settings. Using clinical data extracted from the electronic databases at Northwick Park Hospital, I have studied 3 aspects of this cohort: 1: Clinical presentation of TB in the elderly: Factors which influence time to starting treatment in older versus younger patients with TB. 2: TB treatment in the elderly: A comparison of TB treatment regimens, toxicity of anti-tuberculosis therapy (ATT) and outcomes between older versus younger patients with TB. 3: Drug-induced liver injury (DILI): Evaluating DILI secondary to anti-tuberculous therapy (ATT). Key findings are that among older patients with TB, the clinical presentation and radiological findings have fewer of the 'classical features' of TB, time to starting treatment from first contact with secondary care is longer, there is an increased incidence of side effects on TB treatment and mortality is higher than in younger patients with TB. The study on ATT associated DILI has demonstrated that risk factor based monitoring of ATT associated DILI is of poor sensitivity in identifying DILI with only a quarter of DILI patients having a risk factor.
Supervisor: Kon, Onn Min ; Hansel, Trevor Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral