Incidence of ethambutol-related visual impairment during treatment of active tuberculosis [Review article]
Why this work is in the frame
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Bibliographic record
Abstract
BACKGROUND: Recent World Health Organization guidelines recommend the addition of ethambutol (EMB) throughout standardised treatment of new cases of active tuberculosis (TB) in populations with increased prevalence of isoniazid resistance to reduce the risk of creating multidrug resistance. This could expose patients to the risk of blindness. METHODS: We searched Cochrane, Embase and PubMed electronic databases from 1965 to February 2011 for original studies that prospectively followed all patients treated with EMB for active TB, and routinely ascertained the occurrence of visual toxicity using standard methods. Pooled estimates, overall and stratified by major covariates, were calculated using random effects meta-analysis. RESULTS: Pooled cumulative incidence of any visual impairment in all patients was 22.5 per 1000 persons treated with EMB (95%CI 10.2-35), and permanent impairment was 4.3/1000 (95%CI 0.3-9.0). After restricting the analyses to arms in which the average dose was 27.5 mg/kg/day or less and treatment was for 2-9 months, the incidence of any visual impairment was 19.2/1000 (95%CI 5.8-33), and permanent impairment was 2.3/1000 persons (95%CI 0-6.1) treated, as the majority of episodes were reversible. In reversible cases, resolution of impairment occurred after an average of 3 months. CONCLUSIONS: In this review, any visual impairment occurred in 22.5/1000 persons receiving EMB at standard doses for up to 9 months, and permanent impairment in 2.3/1000-an important risk. However, these estimates are imprecise, and the studies were of variable quality and the results heterogeneous. Well-designed prospective studies with repeated measurements of multiple visual parameters that clearly describe the degree of permanent impairment are needed.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it