Clinical Profile, Adverse Drug Reaction, and Outcome of Category V Patients at a Drug-resistant Tuberculosis Center, Mumbai

Background: Drug regimens for the treatment of drug-resistant tuberculosis (DR-TB) are composed of salvage drugs to which a patient has never been exposed to previously. Methods: A retrospective observational study was conducted in a DR-TB Center attached to a medical college in a metropolitan city using the database of category V patients (n = 100) who were prediagnosed and referred. The clinical records of the patients were reviewed for demographic data, history, sputum examinations, co-morbidities, and adverse drug reactions (ADRs). The therapy outcomes were assessed as per Revised National Tuberculosis Control Programme (RNTCP) guidelines. Results: Their mean age was 29.1 years; there were 57 males. Mean body weight was 41.8 kg. Pediatric patients (age 12�) constituted 13%. All the patients had pulmonary TB. Of the 100 cases, 80 were Category IV failure; 5% were defaulters of Category IV; and 15% were treated with second-line drugs adequately in private. Durg-susceptibility test (DST) showed extensively drug-resistant TB (XDR-TB) in 63 and pre-XDR-TB in 37 patients. The outcomes of Category V treatment were cure (7%), died (33%), failed on therapy (4%), transferred out (16%), lost to follow-up (2%), and still on the therapy (35%). Various comorbidities were present in 25% patients. ADRs were seen in 44%, and peripheral neuropathy (18%) was the most commonly observed ADR. Conclusions: DR-TB patients were younger and males were more affected. Mortality of Category V regimen was high (33%). Most common comorbidities were anemia and hypothyroidism. Adverse reactions were common (44%); ADR peripheral neuropathy being the most common.

Avaliação Ambiental Estratégica e as Áreas de Proteção Ambiental / Strategic Environmental Assessment and the Environmental Protection Areas

O estabelecimento e manejo de áreas protegidas constituem importantes estratégias para a proteção da biodiversidade. Para as Áreas de Proteção Ambiental (APA), os planos de manejo são essenciais para a consecução dos objetivos. Para melhorar os resultados, alguns países utilizam a Avaliação Ambiental Estratégica (AAE) para elaborar planos de manejo. Essa estratégia tem apresentado bons resultados, com a melhora na gestão da área protegida. No Brasil, há um Roteiro Metodológico para Gestão de APAs (RMG-APAs) que orienta a elaboração dos planos de manejo desta categoria. Neste contexto, o artigo analisa as contribuições da AAE para os planos de manejo e discute se estas contribuições podem ser encontradas no RMG-APAs utilizado no Brasil. O método utilizado neste artigo foi qualitativo e, a partir de um levantamento conceitual obtido na literatura internacional e a definição de cinco unidades de análise, foi realizada uma análise documental de três estudos de caso relacionados às áreas protegidas. Dois destes trabalhos obversavam planos de manejo com influência da AAE (internacionais) e o terceiro, sem influência da AAE, o RMG-APAs. Os resultados mostram importantes contribuições da AAE para os planos manejo, a saber: melhor integração das etapas de planejamento, notadamente com outros planos de uso do solo e também de outros setores; avaliação dos objetivos dos planos de manejo; melhor integração e avaliação de estratégias envolvendo o social, o ambiental e o econômico; fortalecimento da gestão participativa e outros. Com relação ao RMG-APAs, a conclusão é que os planos de manejo poderão apresentar melhores resultados quando associados à AAE.

The plans establishment and management for protected areas are key strategies for biodiversity protection. The management plans are essential to achieving the goals for Environmental Protected Areas (EPA), one of the conservation areas types in Brazil. Some countries use Strategic Environmental Assessment to make management plans and they are getting good results. On the other hand, in Brazil, the management plans preparation applied in EPAs follows a specific Methodological Guide. In this context, the present paper analyzed the SEA contribution to management plans and discussed how these contributions can improve Methodological Guide of EPA in Brazil. The method used was qualitative and the conceptual framework obtained from international literature. Thus, the paper analyzed three case studies: two were related to protected areas with SEA influence and the third without influence of SEA. The results show SEA important contributions for plans management, namely: planning stages better integration, especially with land use plans; consider other management plans objectives; better integration and evaluation of strategies involving social, environmental and economic issues; participatory management strengthening. Also, considering Methodological Guide of EPA, the conclusion is that management plans can provide better results when associated with SEA.