Evaluation study of treatment outcome in Tuberculosis patients receiving DOTS under RNTCP

<p><strong>Background</strong><strong>:</strong><strong> </strong>Tuberculosis is a global emergency and its control in community wholly depends on outcome of treatment taken by patient. India has 2^nd position in total number of cases in World. <strong>Objective: </strong>To evaluate the factors which affect treatment outcome? <strong>Material &amp; Methods:</strong> The study was a follow up study, for treatment outcome of tuberculosis patients receiving DOTS under RNTCP. Data were collected into SPSS version 16 and analyzed using appropriate statistical tests. <strong>Results:</strong><strong> </strong>241 patients were included in the study. Overall treatment success rate was 87.1%, default rate was 4.6%, failure rate was 2.1% and death rate was 6.2 %. Treatment success rate was 91.2% in category I and 70.2% in category II. Failure rate was 0.5% and 8.5%, default rate was 3.6% and 8.5%, death rate was 4.6% and 12 % for category I and category II respectively. In univariate analysis, variable education, occupation, socio-economic status, overcrowding, habit of tobacco consumption, presence of pre–existing illness and category of tuberculosis significantly affect the treatment outcome but on multiple logistic regression analysis education, occupation, habit of tobacco consumption and category of TB had significant effect on treatment outcome. <strong>Conclusion:</strong> Treatment success was 87.1% in present study conclude that DOTs is an effective form of tuberculosis treatment. Education, occupation, socio economic status and overcrowding have significant effect on treatment outcome.<strong></strong></p

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p&lt;0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons