ABSTRACT
The transportation of sputum samples may sometimes take more than one week which results in an increased contamination rate and loss of positive cultures. The current study was planned to analyze the recovery rate of mycobacteria from transported samples with and without Cetylpyridinium chloride (CPC). Addition of CPC is useful for isolation of M. tuberculosis from sputum subjected to long-term storage.
ABSTRACT
Setting: Department of Tuberculosis and Chest Diseases, Tertiary Level tuberculosis (TB) institute in Delhi, India. Objective: To study the reasons for interruption of Anti-Tubercular Treatment (ATT) as reported by tuberculosis patients admitted at LRSI. Design: Retrospective cohort-based analysis. Results: A total of 201 patients were enrolled (179 of pulmonary tuberculosis, eight of extra-pulmonary tuberculosis and fourteen of both pulmonary as well as extra-pulmonary tuberculosis); who had interrupted treatment 327 times. Maximum interruptions (72.17%) were found to occur by third month of ATT. More than one reason was often reported for discontinuation of treatment. In all, 366 responses were obtained from 201 patients, in response to reasons for treatment interruption. The rate of treatment interruption was higher in the private health sector (56.27%), as compared to DOTS (34.25%) and other sources of treatment (9.48%). Early improvement (30.05%) and high cost of treatment (16.39%) were found to be the two most common reasons, leading to treatment interruption. Conclusion: Early improvement and high cost of treatment were found to be the two most common reasons, leading to treatment interruption. Continuous health education should be provided to all tubercular patients emphasizing the need to continue treatment despite early improvement in symptoms.
ABSTRACT
Background: Sequelae of patients treated for multi-drug resistance tuberculosis (MDR-TB) remain unknown. Objective: To assess the clinical, bacteriological, radiological and functional status of MDR-TB patients after completion of treatment. Methodology: In a cross-sectional study, MDR-TB patients who had initiated standardized, community based therapy from January 2002 to December 2006 at Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases were investigated for their current clinical, bacteriological, radiological and functional status. Results: Between January 2002 to December 2006, 130 patients initiated treatment, of whom 24 died. Among rest 106 patients, 63 (59%) patients could be traced: 51 were currently alive while 12 had died. The 51 alive patients had completed a mean (+S.D.) post treatment period of 24+14.7 months ranging from 6 to 63 months before being enrolled in the study. Among currently alive patients who could be investigated, 78% had persistent respiratory symptoms; 98% had residual radiological sequelae with 40% having far advanced involvement. Abnormal Pulmonary Function Tests were observed in 45 (96%) patients with predominantly mixed type of ventilatory abnormality in 31 (66%) patients, while 9 (19%) had pure restriction and 5 (11%) had pure obstruction. None of the patients was found to be bacteriologically positive. Conclusion: Current study confirms the efficacy of the standardized regimen as none of the patients was bacteriologically positive on follow up. However, after completion of treatment significant number of cured MDR-TB patients are left with residual symptoms, abnormal X-ray chest and impairment of lung functions. These issues need to be addressed as a part of comprehensive management of MDR-TB patients under national programme.
ABSTRACT
BACKGROUND & OBJECTIVE: The applicability of Caucasian prediction equations in interpreting spirometry data in Indian patients has not been studied. The present study was undertaken to see if Caucasian and north Indian prediction equations can be used interchangeably while interpreting routine spirometric data. METHODS: Forced vital capacity (FVC), forced expiratory volume in first second (FEV(1)), and FEV(1)/FVC ratio were recorded from 14733 consecutive spirometry procedures in adults. Predicted values and lower limits of normality were calculated using regression equations previously derived at this centre, and four commonly used Caucasian equations described by Knudson, Crapo, European Community for Coal and Steel (ECCS) and the Third National Health and Nutrition Examination Survey (NHANES III). For men, 90 per cent of predicted values were also derived. Kappa estimates were used to study agreement, and Bland Altman analysis was performed to quantify differences, between interpretations from Indian and Caucasian equations. Receiver operating characteristic (ROC) curves were constructed to assess utility of using a fixed percentage of Caucasian predicted values in categorizing FVC or FEV(1) as abnormal. RESULTS: The use of Caucasian prediction equations (and 90% of predicted values in men) resulted in poor agreement with Indian equation in most height and age categories among both men and women. Bland Altman analysis revealed a large bias and wide confidence limits between Caucasian and Indian equations, indicating that the two cannot be used interchangeably. ROC analysis failed to yield good results with use of any single fixed percentage of Caucasian predicted value while categorizing FVC or FEV(1). INTERPRETATION & CONCLUSION: Our results showed that the use of Caucasian prediction equations, or a fixed percentage of their predicted values, resulted in misinterpretation of spirometry data in a significant proportion of patients. There is a need to assess performance of more than one regression equation before choosing any single prediction equation.