Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

A review of 196 suicides among medical students in India from year 2009 to 2018

Background: Study of medicine has always been challenging with immense pressure and high workload. This unjust pressure can sometimes transform into psychological illness and commitment of suicide. The objective of this study was to explore patterns and possible determinants of suicide among medical students in India. Methods: The present study is a record based retrospective study which included collection of data from news-articles published in various English, Hindi and regional dailies, news portal articles and publications in different streams of medical journals through web-based/electronic database search. More than 2000 such articles were reviewed from year 2009 to 2018 and data was extracted. Results: Among 196 medical students, who committed suicide over last 10 years, 42% were female, 42% belonged to the age group of 20-24 years and 68.37% were MBBS students. 31.12% of the victims were in their first year of medical education. Among 61 post-graduate students, most victims were from the department of Anaesthesia (10), General Surgery and Pediatrics (7 each). In 55% of the cases, method/mode of suicide was hanging. Academic & examination pressure was the most cited reason for commitment of suicide. Incidence density of suicide among medical students was calculated to be 6.82 per lakh students per year over the period of 2009-18; while it was 9.56 per lakh students per year in the year 2018. Conclusion: This study is first attempt to find incidence and possible reasons for suicide among medical students in India. It has comprehensively explored 196 suicides among medical students across the country over past 10 year