BackgroundGlobally treatment outcomes for multidrug-resistant Mycobacterium tuberculosis (MDR-TB) remain poor and this is compounded by high drug toxicity. Little is known about the influence of adverse drug reactions (ADRs) on treatment outcomes in South Africa.MethodsWe evaluated the impact of severe ADRs among a prospective cohort of MDR-TB patients in South Africa (2000–2004). The HIV-infected study participants were anti-retroviral naïve.ResultsOf 2,079 patients enrolled, 1,390 (66.8%) were included in this analysis based on known HIV test results (39.1% HIV-infected). At least one severe ADR was reported in 83 (6.9%) patients with ototoxicity being the most frequent ADR experienced (38.9%).ConclusionsWe found that being HIV-infected but antiretroviral naïve did not increase occurrence of SADRs in patients on second-line anti-tuberculosis drugs. Early screening and proactive management of ADRs in this patient population is essential, especially given the rollout of decentralized care and the potential for overlapping toxicity of concomitant MDR-TB and HIV treatment.

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Baseline ETH molecular resistance before second-line treatment is a concern. Unfavorable treatment outcomes of patients with ethA, ethR, and inhA mutations highlight the importance of genotypic testing before initiation of treatment containing ETH. The clinical significance of whole genome analysis for early detection of mutations predictive of treatment failure needs further investigation.

The practice of Lesson study in the field of mathematics education is often restricted due to the assumptions of education theory and its impact on the teaching and learning practice. The paper discusses possible constructs and design principles that arise from such preconceptions of Lesson study. By incorporating these principles into the facilitation of Lesson study, a stronger community of practice can be established. As part of an undergraduate mathematics education methodology course's content, two volunteer groups of students specialising in Grades 4 to 7 mathematics participated in the design and study of a research lesson. The aim was to determine how these students depict Lesson study in theory and practice through a-priori design principles, and how these principles led to the identifying of constructs that produced new principles that can inform the development of a (new) Local theory. The results indicate that the design principles produced constructs of metacognitive skills, metacognitive language and metacognitive networking that can be theorised. Recommendations follow on how Lesson study practice can be theorised about and facilitated through these design principles.

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