ABSTRACT
Background & objectives: The National Tuberculosis (TB) Control Programme has transitioned from thrice-weekly to daily drug treatment regimens in India. This preliminary study was conceived to compare the pharmacokinetics of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) in TB patients being treated with daily and thrice weekly anti-TB treatment (ATT). Methods: This prospective observational study was undertaken in 49 newly diagnosed adult TB patients receiving either daily ATT (n=22) or thrice-weekly ATT (n=27). Plasma RMP, INH and PZA were estimated by high-performance liquid chromatography. Results: The peak concentration (Cmax) of RMP was significantly higher (RMP: 8.5 ?g/ml vs. 5.5 ?g/ml; P=0.003) and Cmax of INH was significantly lower (INH: 4.8 ?g/ml vs. 10.9 ?g/ml; P<0.001) in case of daily dosing compared to thrice-weekly ATT. Cmax of drugs and doses was significantly correlated. A higher proportion of patients had subtherapeutic RMP Cmax (8.0 ?g/ml) during thrice-weekly compared to daily ATT (78% vs. 36%; P=0.004). Multiple linear regression analysis showed that Cmax of RMP was significantly influenced by the dosing rhythm, pulmonary TB and Cmax of INH and PZA by the mg/kg doses. Interpretation & conclusions: RMP concentrations were higher and INH concentrations were lower during daily ATT, suggesting that INH doses may need to be increased in case of a daily regimen. Larger studies are, however, required using higher INH doses when monitoring for adverse drug reactions and treatment outcomes.
ABSTRACT
Tuberculosis (TB) is a major public health problem in India with high morbidity and mortality. As per the World Health Organization guidelines, the Revised National Tuberculosis Control Program introduced daily directly observed treatment, short-course (DOTS) regimen with a fixed-dose combination with weight bands. This study was undertaken to compare the effectiveness of daily DOTS regimen with intermittent regimen and to assess the proportion of adverse drug reactions in both groups. Materials and Methods: A descriptive study was conducted at a peripheral health institute under one of the TB Units in South Bengaluru. Participants registered for treatment during the third and fourth quarter of 2017 were selected using continuous sampling. Data were collected by case record analysis, structured interviews, and telephonic follow-up. Results: The study included 81 participants, with the mean age of 40 ± 16.1 years. Majority of the study participants 55 (67.9%) were male, and majority (38 [46.9%]) belonged to the upper-lower class. Forty-two (51.8%) of the study participants were on intermittent regimen, and 39 (48.1%) were on daily DOTS regimen. There was 100% sputum conversion at the end of treatment under both treatment regimens. A total of 36 (85.7%) participants under intermittent regimen and nine (23%) under daily regimen developed one or the other adverse drug reactions. The treatment success for participants under intermittent regimen was 38 (90.47%) and that for daily regimen was 35 (89.74%). However, there was no statistically significant difference between the two groups. Conclusion: Both daily and intermittent DOTS regimens are equally effective in TB treatment, but adverse drug reactions were more common with the intermittent regimen.
ABSTRACT
Prevention is a wise step to avoid incidence of diseases. Promotion is a positive effort to achieve excellence of health status. Ayurveda, an ancient medical science deals with the study of preservation of health and life along with treatment if disease occurs. Guidelines of prevention and promotion of health are descried in details at every stage of life from fetal life up to old age i.e. garbhavastha to jarawastha. All such guidelines described in Ayurveda are collectively called as Swasthavritta. Moreover, the life style supportive to cure diseased condition is also mentioned as aaturvritta. Swastha is a well-being of all components of an individual as body, mind, sense organs etc. Excellent capacities of those factors can be achieved by specific life style and rasyana dravyas by which longevity of life can be achieved. Methods to achieve it are described in details in Ayurveda Daily regimen, seasonal regimen, sadvritta dietary guidelines, rasayana, rules for sleep and Brahmacharya. Triskandha Ayurveda Hetu (aeitiological or causative factors of diseases or health), Linga i.e. sign and symptoms of health and diseases or dravyas for prevention and promotion of health and for treatment of diseases. These are fundamental concepts of Ayurveda. Another important concept is a Pradnyapardha is a route cause at all dosha vitiation and it is advised to avoid it. Sushrut and Vagbhat have descend preventive measures in details by following wholesome life style.
ABSTRACT
Purpose: The Revised National Tuberculosis Control Programme (RNTCP) is now introducing daily fixed-dose regimen instead of Directly Observed Treatment, Short Course (DOTS) regimen for treatment of drug-sensitive tuberculosis (TB) in India. It would be beneficial to understand the drawbacks, barriers and advantages of the existing system for better implementation of new policy. Our study was aimed to evaluate the current microbiological status of new microbiologically confirmed pulmonary TB patients who have successfully completed intermittent DOTS regimen within last 2 years and also to find the economic barriers faced by beneficiaries to avail DOTS treatment. Materials and Methods: We included patients who had completed CAT 1 DOTS regimen within the last 2 years. The patients were interviewed. Sputum sample was collected for microscopy and cartridge-based nucleic acid amplification test. Results: All patients were adhered to intermittent DOTS therapy, and sputum conversion rate was 83%. Minor gastrointestinal side effects were experienced by 60% of cases and 87% consumed drugs under supervision. On microbiological examination, 10% of the study population was found to be positive for TB and they all were rifampicin sensitive. Those who had completed treatment within 1 year with no clinical symptoms re-appeared after treatment. Conclusion: Till date, RNTCP does not follow up the patients for any period of time after successful completion of treatment. Through the present study, we could find relapse cases in 10% of the previously treated non-symptomatic patients. These unnoticed relapse cases have potential to spread TB and increase disease burden of country. Thus, we can conclude that RNTCP has to follow up the patients after successful treatment to determine whether they relapse. It is needed for the success of programme and control of the disease in the country.
ABSTRACT
Fifty patients with mild essential hypertension were studied to evaluate the efficacy of once-daily regimen of nitrendipine, 10~20mg daily for 12 weeks. 1) Thirty-Seven patients completed the study and showed -9% change in mean arterial headache etc. 2) Eight patients were dropped out because of side reaction, namely flushing, palpitation, headache etc. 3) Ambulatory blood pressure monitoring before and after treatment in 3 patients confirmed the drug efficacy revealing 9% decrement in mean blood pressure and 46% decrease in % elevated BP. 4) Twenty patients who were controlled with other hypotensive drugs were well controlled & maintained the blood pressure in normal range after switching to nitrendpine 10~20mg daily. In conclusion, citrendipine is a safe and good antihypertensive calcium antagonist in the treatment of mild hypertensives with 10~20mg of once-daily dosage.