<p class="abstract"><strong><span lang="EN-US">Background: </span></strong>As per WHO’s “Global Tuberculosis Report, 2012”, India accounts for an estimated 64000 patients out of 310000 cases of drug resistant TB estimated to have occurred amongst the notified cases of TB across the globe in a year. <strong> </strong><span lang="EN-US">MDR-TB is a man-made phenomenon– poor treatment; poor drugs, poor adherence lead to the development of MDR-TB. </span><span lang="EN-US"> </span><span lang="EN-US">Treatment of MDR-TB is difficult, much costlier, challenging and needs experience and skills. Reserve drugs are frequently associated with high rates of unacceptable adverse drug reactions, needing change of regimen. Therefore, it is imperative to monitor and treat adverse drug reactions. <strong></strong></span></p><p class="abstract"><strong><span lang="EN-US">Methods: </span></strong>The present prospective observational study was carried out at Drug Resistant Tuberculosis Centre at Govt. Medical College, Aurangabad, Maharashtra, to monitor patients for early detection of adverse events after starting treatment till the patients were admitted and later followed up personally or telephonically at regular intervals.</p><p class="abstract"><strong><span lang="EN-US">Results:</span></strong><span lang="EN-US"> We observed adverse drug reactions among </span>90/265 (33.96 %) patients of whom 90/265 (33.96 %) had gastro intestinal ADRs, followed by ototoxicity 15/265 (5.66%), psychiatric manifestations 14/265 (5.28%), injection site pain swelling 13/265 (4.90%), arthralgia 11/265 (4.15%), dermatological ADRs 7/265 (2.64%), peripheral neuropathy 5/265 (1.88%), renal dysfunction 3/265 (1.13%), <span lang="EN-US">change of therapy was only required in 13 psychiatric and 12 ototoxic ADRs.</span></p><p class="abstract"><strong><span lang="EN-US">Conclusions:</span></strong><span lang="EN-US"> ADRs are more common in MDR TB patients on second line anti tubercular treatment. Good counseling, spacing drugs, high protein diet helps patients to tolerate therapy better and default rate to drop.</span></p>
Background: Community acquired pneumonia (CAP) is an infection affecting a significant proportion of population from all age groups across the globe with considerable morbidity and mortality. There is a need for data from various parts of India to better understand the epidemiology of CAP. Present study is an attempt to present the relevant data from a tertiary care hospital in Rajkot, Gujarat during the study period.Methods: This observational prospective descriptive study was done during November 2014 to April 2016 at Department of TB and chest diseases, PDU Hospital at Rajkot in Gujarat. 50 patients with clinical features suggestive of CAP were enrolled. Male and female patients (above age of 12 years) admitted to TB and Chest ward or patients on OPD basis were selected for the study. The diagnosis of CAP was mainly clinical with some assistance from radiological picture. All patients were thoroughly examined particularly with regards to detailed history, clinical examination, predisposing factors and associated co-morbid conditions. Sputum examination-gram stain and culture sensitivity was done in all patients, where sputum was available. Sputum examination for acid fast bacilli (AFB) by Ziehl Nelson staining technique was done. Age and sex distribution of patients, microorganisms isolated and the clinical features were described and analyzed.Results: The mean age was 38.38±17.41 (SD) years. Male patients were 34 (68%) and female patients were 16 (32%). Male to female ratio was 2.1:1. In this study, 47 (94%) patients were admitted in the hospital for the management and 3 (6%) patients were treated on the OPD basis. Fever and cough were most common symptoms whereas dull note on affected side and crepitations were the commonest signs elicited. In this study, the most common predisposing factor was smoking which accounted for 20 (40%) patients. The most common lobe involved was Left Lower lobe accounting for 20 (40%) patients and least common lobe involved was left upper lobe accounting for 2 (4%) patients. Streptococcus pneumoniae was the most common organism isolated in 8 (16%) patients and second common organism was Klebsiella isolated in 7 (14%) patients.Conclusions: Males, especially smokers were more commonly affected and Streptococcus pneumoniae was the most common organism isolated. The study gives the hospital based data from the region regarding epidemiology and clinical features of community acquired pneumonia.
Background: The emergence of drug resistant mycobacteria has become a significant public health problem world over creating an obstacle to effective TB control. ADRs are common in patients of MDR-TB on DOTs-Plus drug regimen. Present study was carried out in tertiary care hospital. Identification of types and frequency of adverse drug reactions in Intensive and continuation phase of MDR-TB Patients.Methods: It was a prospective observational study conducted in Department of TB- Chest and Medicine, Govt. Medical College, Aurangabad, Maharashtra, India. All the MDR-TB patients admitted at the directly observed treatment, short course plus (DOTS plus) Center at Medical College Hospital were enrolled and were monitored for ADRs. The causality and severity of the reactions were determined using Naranjo algorithm and Hartwig questionnaire, respectively.Results: A total of 121 tuberculosis patients of MDR-TB on DOTS therapy were enrolled for the study. Out of 121 patients, 13 were dropouts, 6 died, 7 defaulted so 108 patients assessed for ADRs, 48 patients developed 61 (56.48%) adverse drug reactions. The higher numbers of ADRs were observed in age group 31-40yrs followed by 21-30yrs which were more common in men. Majority of adverse drug reactions were Gastrointestinal (GI) problems 32 (52.45%), followed by Ototoxicity 7 (11.48%) and Psychiatric Manifestations 6 (9.84%) and skin problems 3 (4.92%). On evaluation of the causality of ADRs, majority were found to be Possible (59.02%). The severity assessment showed that most of the patients ADRs were of moderate level (50.82%).Some patients required treatment withdrawal and replacement with other drug and most of the patients were managed with supportive medication without removing anti-tubercular drug from their treatment regimen.Conclusions: ADRs are major factor limiting completion of drug therapy under RNTCP and occurrence of drug resistance which requires attention of all health care professionals.
Background: Tuberculosis (TB) is currently one of the greatest health hazards in the world, more so in India. So this study was conducted to study the clinical profile and treatment outcome of TB patients in a tuberculosis unit attached to a tertiary care centre.Methods: A retrospective study was conducted among the tuberculosis patients attending the tuberculosis unit attached to Government Medical College, Aurangabad, Maharashtra. In which patient’s clinico-demographic profile and treatment outcome was recorded.Results: A total of 2414 patients were included in this study of which 1377 (57.04%) were males and 1037 (42.96%) were females. The average age of patients was 33.4 years. 1811 (75.02%) patients had pulmonary, while 603 (24.98 %) patients had extra pulmonary involvement. Maximum patients were newly diagnosed type (77.51%) , while rest included defaulters, ATT (anti-tuberculous therapy) failure cases and relapse cases. 1795 patients (74.36%) belonged to category I ATT, 543 (22.49%) belonged to cat II ATT, and 76 (3.15%) belonged to category III ATT. Out of 2414 patients, 1088 (45.07%) were cured, while 834 (34.55%)successfully completed treatment. There were 232 defaulters (9.61%), 45 failures (1.86%) and 134 deaths (5.55%).Conclusions: Though this study showed a greater predominance of pulmonary TB. It also observe high percentage extra pulmonary TB. A high positive treatment outcome noted may be attributed to the availability of specialist doctors and diagnostic facilities in the tertiary care centre.
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