Status of smear-positive TB patients at 2-3 years after initiation of treatment under a DOTS programme

Objective: To describe the status of cases 2-3 years after the initiation of treatment under DOTS. Setting: After DOTS implementation in Tiruvallur district, south India, we followed up a cohort of smear-positive TB patients registered during 2002-03 after initiation of treatment. Results: The overall mortality rate was 15.0% and among the remaining 18.6% had active disease. In multivariate analysis, a higher mortality rate was independently associated with age, sex, occupation, treatment outcome and initial body weight of patients. Conclusion: The mortality and morbidity rates are still high during follow-up and needs to be curtailed by addressing these issues effectively in TB control programm

Assessing Tuberculosis Case Fatality Ratio: A Meta-Analysis

Background: Recently, the tuberculosis (TB) Task Force Impact Measurement acknowledged the need to review the assumptions underlying the TB mortality estimates published annually by the World Health Organization (WHO). TB mortality is indirectly measured by multiplying estimated TB incidence with estimated case fatality ratio (CFR). We conducted a meta-analysis to estimate the TB case fatality ratio in TB patients having initiated TB treatment. Methods: We searched for eligible studies in the PubMed and Embase databases through March 4(th) 2011 and by reference listing of relevant review articles. Main analyses included the estimation of the pooled percentages of: a) TB patients dying due to TB after having initiated TB treatment and b) TB patients dying during TB treatment. Pooled percentages were estimated using random effects regression models on the combined patient population from all studies. Main Results: We identified 69 relevant studies of which 22 provided data on mortality due to TB and 59 provided data on mortality during TB treatment. Among HIV infected persons the pooled percentage of TB patients dying due to TB was 9.2% (95% Confidence Interval (CI): 3.7%-14.7%) and among HIV uninfected persons 3.0% (95% CI: 21.2%-7.4%) based on the results of eight and three studies respectively providing data for this analyses. The pooled percentage of TB patients dying during TB treatment was 18.8% (95% CI: 14.8%-22.8%) among HIV infected patients and 3.5% (95% CI: 2.0%-4.92%) among HIV uninfected patients based on the results of 27 and 19 studies respectively. Conclusion: The results of the literature review are useful in generating prior distributions of CFR in countries with vital registration systems and have contributed towards revised estimates of TB mortality This literature review did not provide us with all data needed for a valid estimation of TB CFR in TB patients initiating TB treatmen

A REVIEW ON ANTI -ULCER HERBS IN SIDDHA MEDICINE

Abstract: Peptic ulcer disease (PUD) is the most common and serious gastrointestinal disorder on clinical practice. Peptic ulcer is a sore in the lining of stomach or duodenum or anywhere in the gut. If peptic ulcers are found in the stomach, they are called gastric ulcers. If they are found in the duodenum, they are called duodenal ulcers. The symptoms related with PUD are dyspepsia, burning pain in the gut, heartburns, vomiting after or before meal, constipation, not feeling of well. The drugs like Antacids, H2 Receptor antagonist and Proton pump inhibitors are used for PUD all around world widely .The use of medicinal plants becoming more popular due to the adverse effects of such allopathic drugs .Now a day's world population evolution towards herbal remedies for complete healing of such tragic ailments. Many herbs are used for their anti-ulcerogenic, anti-secretory & Gastro-protective property .Siddha medical system is one of the most famous Indian systems of medicine. It is helpful in treating the diseases using herbs, inorganic substances and animal products. Many of the Siddha medicinal plants possess the anti-ulcerogenic property and they are commonly used in southern regions of India as home remedies. Siddha system has better remedies for the treatment and management of Peptic ulcer. This article reviews the gastro-protective and/or anti-ulcer properties of the most commonly employed herbs in Siddha medicine. This review may be supportive for the researchers, academician and clinician about the promising Siddha herbs having anti-ulcer property. This review has offered the recent advancement of herbs in Siddha medicine as an antiulcer agent, with the vision to support the further research and also to give permanent resolution for the society

Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India

OBJECTIVE: To identify risk factors associated with relapse among cured tuberculosis (TB) patients in a DOTS programme in South India. DESIGN: Sputum samples collected from a cohort of TB patients registered between April 2000 and December 2001 were examined by fluorescence microscopy for acidfast bacilli and by culture for Mycobacterium tuberculosis at 6, 12 and 18 months after treatment completion. RESULTS: Of the 534 cured patients, 503 (94%) were followed up for 18 months after treatment completion. Of these, 62 (12%) relapsed during the 18-month period; 48 (77%) of the 62 relapses occurred during the first 6 months of follow-up. Patients who took treatment irregularly were twice more likely to have a relapse than adherent patients (20% vs. 9%; adjusted odds ratio [aOR] 2.5; 95%CI 1.4–4.6). Other independent predictors of relapse were initial drug resistance to isoniazid and/or rifampicin (aOR 4.8; 95%CI 2.0–11.6) and smoking (aOR 3.1; 95%CI 1.6–6.0). The relapse rate among nonsmoking, treatment adherent patients with drug-sensitive organisms was 4.8%. CONCLUSIONS: The relapse rate under the DOTS programme may be reduced by ensuring that patients take their treatment regularly and are counselled effectively about quitting smoking

The prevalence of tuberculosis in different economic strata: a community survey from South India

A cross-sectional socio-economic survey to assess the standard of living index (SLI) of a rural population in South India was undertaken along with a tuberculosis (TB) prevalence survey during 2004–2006. Of 32 780 households, the SLI was low, medium and high in 22%, 36% and 42%, and TB prevalence was 343, 169 and 92 per 100 000 population, respectively, a significant decrease in trend (P � 0.001); 57% of the TB patients had a low SLI and the prevalence of TB was higher amongst the landless (P � 0.001), those living below the poverty line (P � 0.01) and in katcha houses (P � 0.001), suggesting that TB disproportionately affects those with a low SLI

Coincident filarial, intestinal helminth, and mycobacterial infection: helminths fail to influence tuberculin reactivity, but BCG influences hookworm prevalence

The prevalence of helminth and tuberculosis infections is high in South India, whereas Bacille-Calmette- Guerin (BCG) vaccine efficacy is low. Our aim was to determine whether concurrent helminth infection alters the ability to mount a delayed-type hypersensitivity response to tuberculin. In a cross-sectional study in southern India, individuals 6–65 years of age were screened for intestinal helminths, circulating filarial antigenemia, tuberculin reactivity, active tuberculosis, and history of BCG vaccination; 54% were purified protein derivative (PPD) positive, 32% had intestinal helminth infection, 9% were circulating filarial antigen positive, and 0.5% had culture-confirmed active tuberculosis. Only age and BCG vaccination were significantly associated with PPD reactivity; however, BCG vaccination was associated with a lower prevalence of hookworm infection relative to those without prior BCG vaccination. Neither intestinal helminth infection nor filarial infection was associated with diminished frequencies of PPD positivity. Our findings suggest that preceding helminth infection does not influence significantly the delayed-type hypersensitivity response to tuberculin

Tuberculous infection in Saharia, a primitive tribal community of Central India

A cross-sectional tuberculin survey was carried out to estimate the prevalence of tuberculous infection and the annual risk of tuberculosis infection (ARTI) among children of Saharia, a primitive ethnic group in Madhya Pradesh, Central India. A total of 1341 children aged 1—9 years were subjected to tuberculin testing with 1 TU of PPD RT 23 and the reaction sizes were read after 72 h. The proportion of BCG scar-positive children was 34.6%. The frequency distribution of children by reaction sizes indicated a clear-cut anti-mode at 11mm and a mode at 18mm at the right-hand side of the distribution. The prevalence of infection among children irrespective of BCG scar was estimated as 20.4% (95% CI 18.2—22.5%) and the ARTI was 3.9% (95% CI 3.5—4.3%). The corresponding figures were 21.1% (95% CI 18.3—23.8%) and 3.9% (95% CI 3.4—4.5%) among BCG scar-negative children and 19.0% (95% CI 15.4—22.5%) and 4.0% (95% CI 3.2—4.8%) among BCG scar-positive children. The findings of the present study show a high prevalence of tuberculous infection and high ARTI in this primitive ethnic group. There is an urgent need to further intensify tuberculosis control measures on a sustained and long-term basis in this area

Annual risk of tuberculosis infection among tribal population of central India

objective To estimate the annual risk of tuberculosis infection (ARTI) among tribal children of Madhya Pradesh, central India. methods Community-based, cross-sectional tuberculin survey among children aged 1–9 years in the tribal population of Madhya Pradesh. Multistage stratified cluster sampling was used to select a representative random sample of villages predominated by tribal population from selected districts. A total of 4802 children were tuberculin-tested with 1TU of PPD RT 23 and the reaction sizes read after 72 h. results A total of 3062 (64%) children had no BCG scar. The frequency distribution of children by reaction sizes indicated a fair mode at 18 mm in the right hand side of the distribution. By mirror-image technique, the prevalence of infection among children with no recognizable BCG scar was estimated as 6.8% (95% CI: 4.8–8.9%). The ARTI was computed as 1.3% (0.9–1.7%). The corresponding figures for children irrespective of scar status were 7.1% (95% CI: 5.5–8.8%) and 1.3% (1.0–1.7%) respectively. conclusions The risk of tuberculosis infection in tribal population of Madhya Pradesh, central India is not different from other areas of the country. There is, however, a need to further intensify tuberculosis control measures on a sustained and long-term basis