Factors affecting treatment outcome among Pulmonary Tuberculosis patients under RNTCP in urban Pondicherry, India

Background: Many factors associated with unsuccessful TB treatment outcome. Objective: To find out the factors affecting treatment outcome among Pulmonary Tuberculosis patients under RNTCP in urban Pondicherry, Methods: A cross-sectional study was conducted among 265 PTB patients from 6 randomly selected urban PHCs of Pondicherry from Jan 2013 to March 2014. A Pre-tested questionnaire was used. Data were entered in Epi-data v3.1 and was analysed by SPSS v20. Chi-square test and multiple logistic regressions were used. Results: Out of 265 patients registered 235 (88.7%) patients were included. The Majority were males (79.6%), and Mean (SD) age was 44±14 years. The Majority (83.4%) were formally educated, 74% were employed, and 77% received Cat I treatment. Prevalence of alcohol drinkers, current smokers and smokeless users was 31.5%, 23.5%, 9.4% respectively. A total of 14.5% had bad treatment Outcome Univariate analysis showed that Current smoker and Category II PTB treatment had significantly associated with bad outcome (p value-<0.05). In Multivariate analysis, Category II PTB treatment [AOR = 3.5 (1.6-7.8)] had significantly associated with bad outcome (p value-<0.05) after adjusted with age group, gender, Smoking and alcohol status Conclusion: Current Smoking and Category II PTB Treatment were the major factors affecting the TB treatment outcom

Unilateral tremor induced by risperidone in a patient with acute mania: Vitamin B12 deficiency as possible mediating factor

Identification and management of drug-induced movement disorders is a clinical challenge, more so when the clinical presentation is atypical. A young male with acute mania was under treatment with sodium valproate and risperidone. He developed tremors of right hand and neck. These were present at rest and exacerbated by mental activity, when under observation and during voluntarily initiated activity. There were no associated extra pyramidal symptoms or cerebellar signs. Investigations for other common causes of tremors did not reveal any evidence except for low value of serum vitamin B12 levels. The tremors persisted after the withdrawal of valproate, but resolved following the withdrawal of risperidone. It is a common dictum that drug-induced tremors are bilateral. This may not be true always as we found out in our case. These movements were probably induced by risperidone. This atypical presentation could be due to concurrent use of valproate and low serum vitamin B12 levels

Profile of substance use and health risk due to substance use in subjects attending outpatient departments of a tertiary care hospital, South India

Background: The pattern and prevalence of substance use change from region to region and differ from country to country. Most of the people who abuse the drugs do not know the ill effects of their habit. Objective: This study aimed to assess the profile and health risk involved in each subject who used substances. Materials and Methods: The study was conducted in the outpatient departments of Medicine and Pulmonary Medicine of a tertiary care hospital using cross-sectional descriptive design. A screening questionnaire, “Alcohol, Smoking, and Substance Involvement Screening Test” (ASSIST) was administered to assess the type of substances that had been used and the level of health risk associated with them based on the ASSIST score. Statistical Analysis: Sociodemographic variables and the level of risk were presented as frequency and percentage. Chi-square test and Fisher's exact test were used to assess the relationship between categorical variables and ASSIST scores. Results: Most of the participants participated in the present study came under moderate health-risk category. Majority of the participants 114 (53.53%) had a family history of substance use. There was a strong association for gender with alcohol and tobacco use. Conclusion: The most widely abused substances in the present setup were alcohol and tobacco

Benzodiazepine maintenance for alcohol dependence: A case series

Alcohol addiction is a chronic relapsing syndrome. Benzodiazepines remain as the mainstay for detoxification, taking care of the acute withdrawal syndrome. There is fear of dependence and abuse of benzodiazepines on prolonged use. Here, we selectively interviewed ten cases who were on longer duration of benzodiazepines to elicit their potential perceived benefits, attitudes, and any adverse effect. Three patients experienced adverse effects. None of them had features of benzodiazepine dependence. We opine that in select cases, benzodiazepine use should persist beyond detox period, and its benefits continue beyond the acute withdrawal phase while monitoring their safety/adverse effects

Substance use disorder and the family: An Indian perspective

The substance use disorder not only impacts the patient himself/herself, but also affects family members. This is more relevant in a country like India where the familial ties are stronger with family members playing a significant role in the treatment process. This narrative review takes an overview of the inter-relationship between substance use disorder and the family. The domestic violence and adverse familial circumstances, both often arise as a consequence of substance use. Although the spouses of substance users experience greater rates of psychopathology and distress, children of patients with substance user disorders demonstrate higher levels of behavioral disturbances. Codependence often develops in the familial relationship, which perpetuates the substance use disorder. Substance use places quite a burden on the family, both psychologically as well as in terms of resources. Nonetheless, family members provide motivation, emotional support, and practical help during the treatment of substance use disorders and hence need to be engaged in the therapeutic process. Finally, the changing family structure and family dynamics in India might influence the in the future both the effect of substance use disorder on the family, and the familial resource available for treatment