Efficacy and Safety of Different Drug Regimens for Tuberculosis Preventive Treatment: A Systematic Review and Meta-Analysis.

Tuberculosis prevention treatment (TPT) is crucial to the eradication of tuberculosis (TB). Through a comprehensive review and meta-analysis, we compared the efficacy and safety of different TPT regimens. We searched PubMed, Google Scholar, and medrxiv.org with search terms Tuberculosis Preventive Treatment, TPT, efficacy, safety, and drug regimens for TPT and all RCT, irrespective of age, setting, or co-morbidities, comparing at least one TPT regimen to placebo, no therapy, or other TPT regimens were screened and those reporting either efficacy or safety or both were included. The meta-analysis data were synthesized with Review Manager and the risk ratio (RR) was calculated. Out of 4465 search items, 15 RCTs (randomized-controlled trials) were included. The TB infection rate was 82/6308 patients in the rifamycin plus isoniazid group (HR) as compared to 90/6049 in the isoniazid monotherapy (H) group (RR: 0.89 (95% CI: 0.66, 1.19; p=0.43). A total of 965/6478 vs 1065/6219 adverse drug reactions (ADRs) occurred in HR and H groups respectively (RR: 0.86 (95%CI: 0.80 0.93); P<0.0001). Efficacy analysis of the rifampicin plus pyrazinamide (RZ) vs H showed that the risk ratio of infection rate was not considerably varied (RR: 0.97 (95% CI: 0.47, 2.03); P=0.94). Safety analysis showed in 229/572 patients developed ADRs in rifampicin plus pyrazinamide as compared to 129/600 ADRs in the isoniazid group. (RR: 1.87 (95% CI: 1.44, 2.43)). Safety analysis of only rifamycin (R) vs H group showed 23/718 ADRs in R vs 57/718 ADRs in H group (RR: 0.40 (95% CI: 0.25 0.65); P=0.0002). Rifamycin plus isoniazid (3HP/R) has no edge over other regimens in terms of efficacy but this regimen was found significantly safer as compared to any other regimens used for TPT. Rifampicin plus pyrazinamide (RZ) was found equally efficacious but less safe as compared to other regimens.

Three-way summaries as a teaching-learning tool: Student perspective and impact on retention of learning.

BACKGROUND: "Three-way summaries" (TWS) are a teaching-learning tool in which students respond to a question or topic inquiry by three different summaries (10-15 words, 30-50 words, and 75-100 words). The aim of this study was to introduce TWS, to establish its impact on learning retention, and to identify students' perception for TWS. MATERIALS AND METHODS: It was an educational interventional study. It was carried out in two randomly allocated groups, Group A having TWS as intervention and Group B without TWS, followed by crossover of the groups. Participants were assessed using two multiple choice question (MCQ) tests, ten marks each (one immediately and second after 1 week) during both phases. Students' perception regarding TWS was assessed by questionnaire using Likert scale. Statistical analysis was done by two-tailed independent t-test. RESULTS: Both groups' performance deteriorate after 1 week, but it was affected more in Group B without TWS (4.85 ± 1.89-4.70 ± 2.05, P = 0.05) as compared to Group A with TWS (5.30 ± 1.81-4.63 ± 1.90, P = 0.69). While in second phase, performance of the Group B with TWS improved more significantly (5.92 ± 2.24-6.83 ± 2.21, P = 0.04) in comparison with Group A without TWS (4.96 ± 1.89-5.66 ± 2.35, P = 0.09). Most of the students liked TWS as an educational tool using Likert scale (72%-86% agreeing and strongly agreeing). CONCLUSIONS: TWS is highly acceptable teaching-learning tool which improves learning retention.

Anticonvulsant hypersensitivity syndrome associated with carbamazepine administration: Case series.

Hypersensitivity reactions are common adverse drug reactions (ADRs) associated with antiepileptics. Carbamazepine is one of the routinely prescribed drugs for the treatment of epilepsy and neuropathic pain. ADRs due to carbamazepine range from mild maculopapular rash to severe anticonvulsant hypersensitivity syndrome (AHS). AHS is the triad of fever, rash, and internal organ involvement occurring 1-8 weeks after exposure to an anticonvulsant (1 in 1,000 to 10,000 exposures). Spontaneously reported three cases of AHS-drug hypersensitivity reactions induced by carbamazepine are discussed here. Seven to ten days after starting therapy, patients developed maculopapular skin rashes, fever and liver or kidney involvement. The causal relationship between drug and ADR was found to be 'certain' in one case and 'probable' in other two cases with both WHO-UMC and Naranjo causality assessment scale. All the three cases show category 4a according to Hartwig's severity scale as ADR was the cause for hospital admission. On assessing preventability of ADRs by modified Schumock and Thorntons' scale, one case was falling into category of 'definitely preventable' and other two were 'not preventable'. AHS is rare but serious reaction with carbamazepine which requires vigilant monitoring by physicians to avoid major consequences.