Study of side effect profile of bedaquiline containing regimen among patients with extensively drug-resistant tuberculosis at a nodal drug-resistant center

Background: Extensively drug-resistant tuberculosis (XDR TB) is a type of tuberculosis (TB) characterized by resistance to isoniazid and rifampicin, along with resistance to one of the fluoroquinolones and at least one of the second line injectable drugs. Bedaquiline is a diarylquinoline antimycobacterial agent approved for the treatment of adults with pulmonary multidrug-resistant TB (MDR-TB) and XDR-TB by the food and drug administration. Aim and Objective: The aim of this study was to study the side effect profile of bedaquiline containing regimen among XDR TB patients. Materials and Methods: This study was conducted at outpatient and wards of nodal drug-resistant TB Center, Department of Pulmonary Medicine, SVRRGGH, Tirupati, for a period of 1 year. Forty patients of more than 18 years age and diagnosed with XDR TB were included in the study. Bedaquiline was started and daily monitoring was done with ECG and all organ function tests were repeated every 15 days. Results: All 40 cases were retreatment cases; no new XDR TB case was reported in study period. Most common age group of presentation in our study was 46 to 55 years (32.5%). Gastrointestinal adverse drug reactions were found to be more common (37.5%), cardiovascular QTc changes were observed in 10% of patients, 5% of patients had neurological reactions (Headache), 2.5% of patients had peripheral neuropathy, and 2.5% of patients had arthralgia. Conclusions: Bedaquiline containing regimen is very effective for the treatment of XDR TB cases. The study shows that compliance with this regimen is very good. Bedaquiline has minimal adverse reactions and even these are easily manageable. Bedaquiline has good safety profile and patients have improved quality of life.

Imaging In Oral Cancers – A Practical Approach.

Imaging techniques have become an important element in the field of oral oncology. Continued research has led to technical progress in the existing modalities and addition of newer, exiting and highly accurate techniques. Although this is a boon, it has created differences of opinion regarding the ideal choice of imaging techniques. Inappropriate choice of imaging modality can result in delay in diagnosis and treatment thereby inducing more suffering for the patients. This problem is more so with imaging of oral cancers and responsible decisions of oral clinicians and radiologists is of paramount importance. In developing nations, problem is compounded by various other factors like affordability, availability and awareness. Thus, an imaging protocol needs to be devised that helps a clinician choose the best imaging modality for a particular clinical situation. This review illustrates the imaging protocol in the form of a decision tree, describes the various imaging techniques, their utility in evaluation of oral cancers and practical problems associated with these techniques.

Study of association of bacterial vaginosis in preterm labor and fetal outcome.

Background: Preterm labor has increasing evidence of infectious cause especially ascending infections from lower genital tract of late attention is being given to bacterial vaginosis. in many of the case control and prospective studies bacterial vaginosis has been associated with lat miscarriage, preterm labor, premature rupture of membranes, chorioamnionitis. Treating bacterial vaginosis can reduce the preventable cause of preterm birth. Aim: The association of bacterial vaginosis in preterm and its fetal outcome. Material and methods: A case control study of 120 pregnant women (study group-60 and controls 60 cases). Pregnant women with preterm labor, 28 weeks to 37 weeks were selected. vaginal discharge pH was measured. Sterile cotton swabs were used for vaginal smear preparation for gram staining and the organisms were scored based on Nugents scoring system. Clue cells were also noted on the smear. Diagnosis of bacterial vaginosis is done in women with pH above 4.5 and a score of 7 or more on gram staining of vaginal smear based on Nugents criteria. Outcome of delivery was observed. Results: 61.6% were < 34 weeks of gestation. High vaginal pH >4.5 is seen in 55%. Chi Square test and the P value 0.001 (99.9%) showed significance of the test. Gram staining revealed bacterial vaginosis infection 41.6% in study group and 16.6% in control group. This study was in aconcurrance with the study made by saifon Chawanpaiboon which showed an association between high vaginal pH, Amsels criteria and various stages of preterm labor. Neonatal complications were seen in women with preterm <34 weeks and positive for bacterial vaginosis. Conclusion: Association between bacterial vaginosis and preterm labor was established. Screening and treatment will reduce the incidence of preterm delivery.

Estimation of N‑terminal telopeptides of type I collagen in periodontal health, disease and after nonsurgical periodontaltherapy in gingival crevicular fluid: A clinico ‑ biochemical study.

Aim: This study explored gingival crevicular fluid (GCF) N‑terminal telopeptides of type I collagen (NTx) levels in periodontal health, disease and after nonsurgical periodontal therapy along with its association with the clinical parameters. Materials and Methods: Study comprised of three groups of 10 subjects each: Healthy (Group I), gingivitis (Group II), and periodontitis (Group III), while Group III patients after scaling and root planning (SRP) constituted Group IV. Gingival index (GI), probing pocket depth (PPD), clinical attachment loss (CAL), and radiological parameters were recorded. GCF samples were analyzed by competitive‑enzyme‑linked immunosorbent assay. Results: Samples in Group III and Group IV tested positive for NTx whereas in Group I and Group II, NTx was not detected. Mean NTx levels were higher in Group III (6.79 ± 0.94 nanomole bone collagen equivalents per liter [nm BCE/L]) compared to Group IV (5.73 ± 0.95 nm BCE/L) which was statistically significant. Positive correlation was seen between the clinical parameters and the NTx levels in Group III and IV. Conclusion: As NTx is specific bone turnover marker, it is detected only in periodontitis Group and the values decline after SRP. Failure to detect NTx in Group I and II, relates to the minimum or no resorption at the sample sites.

Mediators of Resolution in Inflammation: Exploring Avenues.

Timely resolution of an acute inflammatory response is essential for healthy tissues. Specialized chemical mediators derived from essential fatty acids are identified that actively promote resolution of inflammation via novel pro-resolving and anti-inflammatory cascades. In this review, we summarize potent role of the lipoxins ,resolvins along with other chemical mediators that are enzymatically generated and identified in the resolving inflammatory exudates.

Anaesthetic challenges in a super-morbidly obese patient undergoing laparoscopic sleeve gastrectomy

Laparoscopic sleeve gastrectomy [LSG] is an effective method of treating patients suffering from morbid obesity. The perioperative care of these patients can be complicated by physiological derangement, comorbidities, problems with the patient's airway and alterations in pharmacokinetics and pharmacodynamics of some drugs. We report a case of a 45-year-old man with body weight of 252 kg and body mass index [BMI] of 77 kg/m[2] who underwent LSG. This case investigates possibly the most overweight patient to undergo general anaesthesia in the United Arab Emirates [UAE]. Specific protocols in anaesthetic management and perioperative care should be implemented to allow effective and safer treatment in obese patients