RESUMO
BACKGROUND: Drug resistance has emerged as a major problem in management of pulmonary tuberculosis (PT) with increase in its incidence. METHODS: Sixty patients who presented to a tertiary referral chest centre with drug resistant PT were included in the study out of 835 clinically diagnosed cases of PT treated between January 2000 and May 2002. They were studied to see the incidence, pattern of drug resistance and response to treatment. RESULTS: 7.2% of the clinically diagnosed cases of PT had drug resistance and 14.8% of the 403 strains of mycobacterium tuberculosis (MTB) tested were resistant to one or more antitubercular drugs (ATD). 40 cases (66.7%) had initial resistance and acquired resistance was seen in 20(33.3%) out of the 60 cases of drug resistant PT. Single drug resistance was observed in 21 cases (35%), two drug resistance in 19 (31.7%) and 20(33.3%) cases showed resistance to three or more drugs. Individual drug resistance breakup was: INH(H) - 36(8.9%), Rifampicin (R)-38(9.4%), Ethambutol (E) - 14(3.5%), Streptomycin (S) - 34(8.4%), Pyrazinamide (Z) - 2(0.5%), Ciprofloxacin (C) - 2(0.5%), Ethionamide (N) - 2(0.5%), Cycloserine - 1(0.3%) and Kanamycin - 1(0.3%). 98.3% showed sputum conversion after starting reserve drugs. Average period of sputum conversion was 10 weeks. 3.3% were HIV positive. CONCLUSION: Incidence of drug resistance was not as high as reported by some other workers and majority of the cases showed satisfactory outcome.
RESUMO
Homologous blood transfusion, despite numerous and serious transfusion associated hazards, is an important treatment modality. Transmission of infectious agents like HIV, hepatitis viruses, malaria, etc is a distinct possibility notwithstanding careful screening of the blood. Predeposit autologous blood transfusion (PABT) and per operative acute normovolemic haemodilution (ANH) are two comparatively safer, simpler and practical alternatives. Unfortunately, their potential remains unexploited. Earnest motivation efforts at PABT and ANH have paid handsome dividends in our hospital. These have now become very popular amongst surgeons as well as the patients. These techniques can be easily adapted at all hospitals to reduce the demand for homologous blood transfusion. ANH can be safely practised even in hospitals without a blood bank.
