Treatment success rates among tuberculosis patients notified from the private sector in West Bengal, India.

In India, an estimated 50% of tuberculosis (TB) patients are diagnosed and managed by private providers (PPs). However, there is limited information on treatment outcomes among those treated by PPs largely because of a lack of systems for patient follow-up and documentation of the outcomes. Tuberculosis Health Action Learning Initiative (THALI) project implemented in six districts of West Bengal, supported PPs in managing TB patients and systematically documented the TB treatment outcomes of such patients. This provided us an opportunity to describe the treatment outcomes and assess factors associated with 'unsuccessful outcomes' among TB patients notified by PPs from January to April 2018. This was a retrospective cohort study using routinely collected data. During the study reference period, 2347 patients were notified from 389 PPs. The patient's mean (SD) age was 39.9 (17.2) years and 61% were males. Of the total, about 86% had pulmonary TB, 95% were new cases, and 23% were microbiologically confirmed (either on sputum smear microscopy or Xpert assay). Among 2347 patients, 19% received free drugs from the National Tuberculosis Program (NTP) under the supervision of PPs while the rest purchased anti-TB drugs from the private pharmacies. The 'successful outcomes' (cured and treatment completed) were seen in 86.1% (95% confidence interval (CI), 84.6%-87.4%) patients and 8.6% were 'not evaluated'. The patients who received free NTP drugs (adjusted relative risk-4.0 (95% CI: 3.1-5.0)) had a higher risk of 'unsuccessful outcomes' than those who availed of drugs from private pharmacies. The high 'successful outcomes' among TB patients treated by PPs are promising. However, higher 'unsuccessful outcomes' among patients on free NTP drugs need to be explored, and suitable corrective actions have to be taken.

Phacoemulsification with toric IOL implantation in Alport syndrome with anterior lenticonus having spontaneously ruptured anterior capsule.

PURPOSE: To report the outcome of phacoemulsification with toric intraocular lens (IOL) implantation in Alport syndrome with spontaneously ruptured capsule. METHODS: Case report and literature review. RESULTS: A 2.2-mm clear corneal phacoemulsification with toric lens implantation was done in anterior lenticonus with spontaneously ruptured anterior capsule. The toric IOL was well-centered with good visual outcome. CONCLUSIONS: Safe phacoemulsification with toric IOL implantation is possible in cases with spontaneous rupture of anterior lens capsule. Ability to achieve compact and complete capsulorhexis is one of the key steps to achieve favorable results.

Epiretinal deposits post cataract extraction.

PURPOSE: To report two unusual cases of epiretinal deposit post cataract surgery. METHODS: Retrospective identification of an unusual complication in patients who had cataract extraction recently with intraoperative complications. RESULTS: Two patients were identified with epiretinal deposits after cataract extraction where the posterior capsule barrier was breached. Inflammation was limited to the posterior segment, and investigative workup for infective causes was negative. No intraocular antibiotics had been used. In both the cases, hydroxypropyl methylcellulose was used as the viscoelastic substance. CONCLUSION: The authors report rare posterior segment toxicity in cataract surgeries complicated with intraoperative breach of posterior capsule barrier and hydroxypropyl methylcellulose use.