Status of smear positive pulmonary tuberculosis patients after chemotherapy under the ndistrict tuberculosis programme

In North Arcot district, where Short Course Chemotherapy (SCC) had been introduced in 1983, a cross sectional survey was carried out in respect of smear positive patients put on SCC or traditional regimens between April 1986 and March 1988. It was found that 19% of the treatment cards from the D . T . C . w e r e i n r e s p e c t o f d u p l i c a t e registrations. The address given was inadequate in 13% of the cards. Only 69% of the smear positive patients had accepted short course chemotherapy and the rest were given traditional regimens. The cross sectional survey covered the period 6 to 36 months after the start of treatment. Overall mortality in patients with tuberculosis was 28% during 36 months. It was 3-5 times as high in those who had taken less than 50% of chemotherapy, irrespective of age. Thirty one percent of the patients were smear positive at the time of the home visit. However, among those who had taken 80% or more of chemotherapy, 20% on SCC and 26% placed on conventional treatment were sputum positive. Nonetheless, even among those who had taken less than 50% of chemotherapy about 58% were sputum negative

Anticonvulsant drugs and women with seizures

The incidence of congenital anomalies in children born to mothers under anticonvulsant therapy has been studied, in 2536 women who gave birth to 3348 children. The follow up period varied between 3 to 20 years. The mothers had received barbiturates, hydantoinates and carbamezapine in various combinations. The incidence of congenital anomalies noted was only 41, a figure not greater than the incidence ofanomalies in the general population. A plea is made that anticonvulsant therapy should not be discontinued during pregnancy in women with seizures

Computerized Tomography Detects Pulmonary Lesions in Children with Normal Radiographs Diagnosed to have Tuberculosis

This report is based on observations during the conduct of a larger study to develop diagnostic criteria for childhood tuberculosis (TB). Of 20l children confirmed to have pulmonary or lymph node TB, 84 had normal chest radiographs. Computerized tomography (CT) of the chest was performed in nine of them, seven of whom had normal chest radiographs while two had visible calcification. Eight of the nine children had definitive lesions detected by computerized tomography of the chest. While five children had primarily hilar lymph node enlargement, three had pulmonary parenchymal lesions. The use of more sensitive diagnostic tests like computed tomography helps to detect tuberculosis lesions not otherwise visualized on chest radiographs. This report highlights the difficulty in excluding active tuberculosis in children. More studies are required on the role of CT scans in the diagnosis of tuberculosis in children

Community empowerment - a successful model for prevention of non-communicable diseases in India - the Chennai Urban population study (CUPS - 17)

Background and objective: Randomized clinical trials have documented that lifestyle changes through physical activity can prevent diabetes. However there is no data whether such strategies are applicable at community level, that is, in a real life setting. This study demonstrates the first attempt in India, to our knowledge, of increasing physical activity through community empowerment in an attempt at primary prevention of non communicable diseases. Methods: The Chennai Urban Population Study [CUPS] was conducted in the year 1996 in two residential areas: a middle income group the Asiad colony at Tirumangalam, and a low income group at Bharathi Nagar in T. Nagar. The Asiad colony was selected for this study. Of the 524 eligible individuals available at baseline in 1998 [age ≥ 20 years], 479 individuals consented for the study (response rate:91.4%). After seven years, in 2004, the number of eligible individuals increased to 712 of whom 705 consented for the study (response rate:99%). Education regarding the benefits of physical activity was provided by mass awareness programmes like public lectures and video clippings. Both at baseline and during follow-up, details about the physical activity were collected using a validated questionnaire, which included job related and leisure time activities, and specific questions on exercise. Study individuals were then graded as having light, moderate and heavy physical activity using a scoring system. Results: In response to the awareness programmes given by our research team, the colony residents constructed a unique public park with their own funds. Though the occupation grades did not change, there was a significant change in the pattern of physical activity. At baseline, only 14.2% of the residents did some form of exercise more than three times a week, which presently increased to 58.7%[p<0.001]. The number of subjects who walked more than three times a week increased from 13.8% at baseline to 52.1% during follow-up [p<0.001]. Conclusion: This study is a demonstration of how community empowerment with increased physical activity could possibly lead to prevention of diabetes and other non communicable diseases at the community level. This study also highlights the importance of sharing the results of research studies with the community

Bacteriology of Acute Respiratory Infections in Children

Bacteriological investigations were carried out on 151 children (80 males and 71 females) suffering from acute respiratory infections (ARI) to And out bacteria associated with ARI. Fifty one children presenting with upper respiratory infections (URI) and 100 with lower respiratory infections (LRI) seen at the outpatient department of the Institute of Child Health and Hospital for Children, Madras, were included in this study. In all, 56% of the children yielded any one or a mixture of bacteria that could be potential or probable pathogens of ARI. Nonfermenting gram negative bacilli (NFGNB) were the predominant organisms isolated (27%) followed by non-typable ampicillin resistant Haemophilus influenzae (13%) and b. haemolytic streptococci groups C and G (11%). The other bacteria isolated in this study were Klebsiella pneumoniae (7%), Streptococcus pneumoniae (3%), Neisseria sps. pure (3%) and Staphylococcus aureus (1%). The isolation rate of NFGNB was maximum (47%) when the duration of illness exceeded 7 days. Mixed infections of potential or probable pathogens were observed in 11 patients which included NFGNB + K. pneumoniae (2); H. influenzae + NFGNB (2); b- haemolytic streptococci + H. influenzae (2); b- haemolytic streptococci + K. pneumoniae (1) ; S. aureus + K. pneumoniae (1) ; Neisseria sp. + K. pneumoniae (2) and NFGNB + b- haemolytic streptococci + H. influenzae (1)

Pharmacokinetics of isoniazid and rifampicin in patients with renal failure undergoing continuous ambulatory peritoneal dialysis (CAPD) Running Head : Pharmacokinetic of INH & RMP in renal failure (CAPD)

The pharmacokinetics of isoniazid (INH) and rifampicin (RMP) was determined in 22 renal failure patients, 11 each with low and high membrane permeabilities (LMP and HMP) undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD). Blood samples were collected at different time points following oral administration of INH and RMP. Estimations of INH and RMP in blood were carried out by standard procedures and certain pharmacokinetic variables were calculated based on their concentrations in blood. The INH inactivation status was determined based on salivary levels of INH. The pharmacokinetic variables of INH and RMP did not differ significantly between LMP and HMP groups. The study results suggest that renal failure patients on CAPD may not require reduction in the dosage of RMP or INH in rapid acetylators. Slow acetylators might require dose reduction of INH. Determination of INH inactivation status is important when patients with renal failure and tuberculosis are treated with INH-containing regimens

Timing of Mycobacterium tuberculosis exposure explains variation in BCG effectiveness: A systematic review and meta-analysis

Rationale The heterogeneity in efficacy observed in studies of BCG vaccination is not fully explained by currently accepted hypotheses, such as latitudinal gradient in non-tuberculous mycobacteria exposure. Methods We updated previous systematic reviews of the effectiveness of BCG vaccination to 31 December 2020. We employed an identical search strategy and inclusion/exclusion criteria to these earlier reviews, but reclassified several studies, developed an alternative classification system and considered study demography, diagnostic approach and tuberculosis (TB)-related epidemiological context. Main results Of 21 included trials, those recruiting neonates and children aged under 5 were consistent in demonstrating considerable protection against TB for several years. Trials in high-burden settings with shorter follow-up also showed considerable protection, as did most trials in settings of declining burden with longer follow-up. However, the few trials performed in high-burden settings with longer follow-up showed no protection, sometimes with higher case rates in the vaccinated than the controls in the later follow-up period. Conclusions The most plausible explanatory hypothesis for these results is that BCG protects against TB that results from exposure shortly after vaccination. However, we found no evidence of protection when exposure occurs later from vaccination, which would be of greater importance in trials in high-burden settings with longer follow-up. In settings of declining burden, most exposure occurs shortly following vaccination and the sustained protection observed for many years thereafter represents continued protection against this early exposure. By contrast, in settings of continued intense transmission, initial protection subsequently declines with repeated exposure to Mycobacterium tuberculosis or other pathogens

Tuberculosis in children in India-II: Chemotherapy for tuberculosis

Tubercle bacilli readily become resistant to the common drugs, and resistant bacilli are more likely to proliferate if they are present in the patient at the start of treatment. So always use more than one drug. The only possible exception is prophylaxis for an asymptomatic case with a normal X-ray. CAUTION! (1) Never give intermittent (twice or thrice weekly) treatment unless every dose can be supervised by a health worker. Daily treatment is usually mandatory. (2) When you give more than one drug, give them both at the same time, so that high blood levels coincide; do not give one drug daily and the other drug less often. THE DOSES of the commonly used drugs for daily and intermittent treatment in children and adults are: lsoniazid (H) 5 mg/kg/24 hours if he is moderately ill and 10 mg/kg/24 hours if he is severely ill. The dose for a twice weekly course is 15 mg/kg. CAUTION! Opinions on the dose of isoniazid vary. Some consider 10 mg/kg/24 hours too much for an Indian child and always give 5 mg. Rifampicin (R) 10 mg/kg/24 hours, or 10 mg/kg twice weekly. Pyrazinamide (Z) 35 mg/kg/24 hours, 75 mg/kg twice weekly or 50 mg/kg thrice weekly, is an important drug for short course treatment, so try to include it whenever it is mentioned in the regimes below. Streptomycin (S) 10-20 mg/kg/24 hours, or 40 mg/kg twice weekly, to a total of not more than 0.75 g. Streptomycin is painful, so avoid it if you can. If you give it, inject in different places each day, because repeated injections into the same site are painful. Ethambutol (E) 25 mg/kg/24 hours for 2 months, then 15 mg/kg/24 hours. Avoid ethambutol in younger children (under 12); they are unable to complain of the early symptoms of retrobulbar neuritis (blindness). Thiacetazone (T) 4 mg/kg/24 hours to a maximum Of 150 mg; unsuitable for intermittent treatment

A Profile of Bacteriologically Confirmed Pulmonary Tuberculosis in Children

Objective: To describe the clinical profile of children with bacteriologically confirmed tuberculosis. Study Design: A multicentric study was conducted in three hospitals in Chennai city between July 1995 and December 1997. Children aged 6 months to 12 years with signs and symptoms suggestive of tuberculosis were investigated further. Clinical examination, chest radiograph, tuberculin skin test with 1 TU PPD and, sputum or gastric lavage for mycobacterial smear and culture were done for all and, lymph node biopsy when necessary. Results: A total of 2652 children were registered and tuberculosis was bacteriologically confirmed in 201. Predominant symptoms were history of an insidious illness (49%), fever and cough (47%), loss of weight (41%) and a visible glandular swelling (49%). Respiratory signs were few and 62% were undernourished. Over half the patients with confirmed TB had normal chest X-ray. Abnormal X-ray findings included parenchymal opacities in 47% and hilar or mediastinal lymphadenopathy in 26%. The prevalence of isoniazid resistance was 12.6% and MDR TB 4%. Conclusions: Children with tuberculosis present with fever and cough of insidious onset. Lymphadenopathy is a common feature even in children with pulmonary TB. A significant proportion of children have normal chest X-rays despite positive gastric aspirate cultures. Drug resistance rates in children mirror the pattern seen in adults in this geographic area