Role for Linezolid in drug sensitive tuberculosis.

Tuberculosis (TB) continues to be a global challenge. Reducing the duration of TB treatment for drug-sensitive TB (DSTB) has direct and distinct advantages. We ventured into the aspect of utilizing linezolid as a pivotal drug in shortening therapy in DSTB. Linezolid has gained prominence as it is faring well in resistant TB management. Only a few studies use the strategy of Linezolid in DS-TB but it seems a lucrative approach, the bactericidal effects have been reported favourably in the studies. There have been concerns about the potential adverse drug effects of Linezolid reported but clinical trials have demonstrated safety and tolerability when administered for shorter periods. If the safety and efficacy of giving Linezolid for a shorter period along with standard drugs for DSTB is established it could lead to newer avenues using Linezolid for shortening the duration of treatment for DSTB as an alternative to treat DSTB.

Dyslipidemia among HIV-infected Patients with tuberculosis taking once-daily nonnucleoside reverse-transcriptase inhibitor-based antiretroviral therapy in India.

BACKGROUND: Our aim was to study the incidence and pattern of dyslipidemia among human immunodeficiency virus (HIV)-infected patients with tuberculosis (TB) who received once-daily antiretroviral therapy (ART). METHODS: Antiretroviral-naive HIV-infected patients with TB were recruited to a trial of once-daily nonnucleoside reverse-transcriptase inhibitor (NNRTI)-based ART and treated with rifampicin-based thrice-weekly antituberculosis treatment (ATT); participants were randomized to receive didanosine (250/400 mg) and lamivudine (300 mg) with either efavirenz (600 mg) or nevirapine (400 mg) once-daily after an intensive phase of ATT. Fasting triglyceride (TG) level, total cholesterol (TC) level, low-density cholesterol (LDL-c) level and high-density cholesterol (HDL-c) level were measured at baseline and at 6 and 12 months. Lipid levels at 6 and 12 months were compared with baseline values with use of repeated measures analyses. McNemar test was used to compare the proportion of patients with lipid abnormality at baseline versus at 12 months, and χ² test was used to compare between the 2 groups. RESULTS: Of 168 patients (79% men; mean age, 36 years; mean weight, 42 kg; median CD4+ cell count, 93 cells/mm³), 104 received efavirenz-based ART, and 64 received nevirapine-based ART. After 6 months, TC levels increased by 49 mg/dL, LDL-c levels by 30 mg/dL, and HDL-c levels increased by 18 mg/dL (P < .001 for all). At baseline and at 12 months, TC was >200 mg/dL for 1% and 26% of patients, respectively; LDL-c level was >130 mg/dL for 3% and 23%, respectively; HDL-c level was <40 mg/dL for 91% and 23%, respectively; and blood glucose level was >110 mg/dL for 14% and 13%, respectively. TC level >200 mg/dL was more common among patients who received efavirenz than among those who received nevirapine (32% vs 16%; P = .04). CONCLUSIONS: HIV-infected patients with TB who initiate NNRTI-based ART undergo complex changes in lipid profile, highlighting the importance of screening and treating other cardiovascular disease risk factors in this population.

Strategies for smoking cessation (pharmacologic intervention versus enhanced motivation vs. standard motivation) in TB patients under treatment in the RNTCP, India - A cluster - Randomized trial.

BACKGROUND: Tuberculosis burden is still high and smoking prevalence among males has increased in India. It is found that increased morbidity, mortality and relapse among TB smokers. METHOD: Setting: Patients from two Revised National Tuberculosis Control Program Centres of Tamilnadu form the study population. OBJECTIVE: To compare the effectiveness of Bupropion therapy along with standard counselling versus enhanced counseling versus standard counseling for smoking cessation among TB patients. STUDY DESIGN: Cluster randomized effectiveness trial. PROCEDURE: Patients from each of the thirty-six Designated Microscopic Centres were randomly allocated to receive one of the three interventions using cluster randomization. Smoking cessation was assessed by self-reporting and confirmed by Carbon monoxide(CO) monitors, done at three-time points and TB treatment outcome at the end of ATT. RESULTS: Out of 517 male patients enrolled to the study, the smoking status is available only to 381 subjects. The proportion of patients who have quit smoking in drug, enhanced and standard arms at the end of treatment was 67%, 83% and 52% (P= < 0.001). There was no statistical significance in response to TB treatment between those who quit and those who did not (Favourable response 99.2% vs 97.6%). CONCLUSION: Both enhanced counselling arm and drug arm are effective strategies for smoking cessation among TB patients and their implementation in the TB programs are recommended.

Permanent Anterior Teeth Fractures and its Impact on Oral Health-Related Quality of Life among 8-15-Year-Old Schoolchildren of Chennai City - A Cross-Sectional Survey.

BACKGROUND: Tooth fracture is not only a distressing experience on the physical level of a child, but it may also have an effect on emotional and psychological levels. This study aims to assess the permanent anterior teeth fractures and their impact on Oral Health-Related Quality of Life (OHRQoL) among 8-15-year-old schoolchildren of Chennai city. MATERIALS AND METHODS: Thirty schools were randomly selected by stratified random sampling. All school-going children aged 8-15 years were invited to participate. A total of 7247 children were screened and 628 children with permanent anterior teeth fractures were included. Data were collected using Child Oral Health Impact Profile questionnaire. In addition, questionnaire addressing sociodemographic data and factors influencing permanent anterior teeth fractures were recorded. Descriptive statistics was performed to characterize the sample. One-way analysis of variance and Tukey's honestly significant difference post hoc tests was applied for multiple pair-wise comparisons. RESULTS: The prevalence of permanent anterior teeth fracture was found to be 8.7%. The type of school had highly significant (P < 0.001) influence on the impact of permanent anterior teeth fracture on OHRQoL with negative OHRQoL among the corporation schools. The study participants of corporation schools had negative OHRQoL with significant difference in oral health well-being (P < 0.001) and self-image (P = 0.014). CONCLUSION: All the children reporting with tooth fractures had negative OHRQoL. The study stresses the importance of promoting good oral health-care practices to prevent oral disease in children and to meet children's unmet oral health-care needs.

Association of COL1A2 (PvuII) gene polymorphism with risk and severity of dental fluorosis - A case control study.

INTRODUCTION: Dental fluorosis is a foremost public health problem in many countries, including India. Very few studies investigated gene polymorphism and risk of dental fluorosis. Genetic polymorphisms in Collagen Type I, alpha 2 (COL1A2) gene, found to be linked with bone pathogenesis, may affect the tooth formation resulting in the vulnerability to dental fluorosis. AIM: To assess the association between COL1A2 (PvuII) gene polymorphism and risk as well as severity of dental fluorosis. METHODS: The present case control study was conducted among participants with (n = 60) and without (n = 60) dental fluorosis. Dental fluorosis was assessed using Modified Dean's fluorosis index (1942). The PvuII polymorphisms (in exon 25) inside the COL1A2 gene were genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) procedure. Statistical analysis were carried out with Chi-square test and Odds Ratio (OR) was determined with multivariate logistic regression analysis. RESULTS: The genetic polymorphism in COL1A2 PvuII was found to be associated with the risk of dental fluorosis which was highly significant (p < 0.001). The odds ratio was 31.4 times [OR = 31.9, 95% CI: 3.9-48.7] higher for the homozygous PP genotype group and 4.0 times [OR = 4.0, 95% CI: 1.0-10.7] higher for the heterozygous Pp genotype. CONCLUSION: Genetic polymorphism of COL1A2 was found to be associated with dental fluorosis. The present study provides an insight for identification of the population who may subsist at risk of developing dental fluorosis in their later life.

Comparative evaluation of salt water rinse with chlorhexidine against oral microbes: A school-based randomized controlled trial.

BACKGROUND: Mouth rinse that is natural, safe, cost-effective, readily available and culturally acceptable is required as an adjunct to routine tooth brushing to combat dental diseases. The aim of present study was to compare the effectiveness of salt water rinse with chlorhexidine mouth rinse in reducing dental plaque and oral microbial count. MATERIALS AND METHODS: The Minimum Inhibitory Concentration (MIC) of salt water against S. mutans, L.acidophilus, A. actinomycetemcomitans and P. gingivalis was determined by Macrobroth Dilution method. Thirty participants were randomly allocated into study group (salt water rinse) and control group (chlorhexidine rinse). Baseline DMFS, defs and plaque scores were recorded. Baseline unstimulated saliva samples were collected by spitting method. Oral prophylaxis was done after baseline sample collection. The participants were advised to rinse the allocated mouthrinse for 5 days under the supervision of co- investigator. Pre- rinse (after oral prophylaxis) and Post -rinse (5th day of mouthrinsing) plaque examination and salivary microbial analysis was done. The collected salivary samples were immediately transported and streaked on the respective media for microbial count. RESULT: MIC of salt water was 0.7 M for S. mutans, A. actinomycetemcomitans and P. gingivalis and 0.8M for L. acidophilus. There was statistically significant reduction in the plaque scores, salivary S. mutans, L. acidophilus, A. actinomycetemcomitans and P. gingivalis count from baseline, pre-rinse to post-rinse in the study group (p=0.001) and control group (p=0.001). Salt water was as effective as chlorhexidine in reducing dental plaque (p = 0.19) and A. actinomycetemcomitans (p = 0.35) count and while chlorhexidine was superior against S. mutans (p = 0.001), L. acidophilus (p = 0.001) and P. gingivalis (p =0.001). CONCLUSION: Salt water rinse can be used as adjunct to routine mechanical plaque control for prevention of oral diseases.

Comparative assessment of the prevalence of periodontal disease in subjects with and without systemic autoimmune diseases: A case-control study.

BACKGROUND: Immune mechanism shares a common pathway both for systemic autoimmune diseases and periodontal diseases. Scientific exploration of literature revealed limited studies on the association between systemic autoimmune diseases and periodontal diseases in India. AIM: The aim of the study is to find whether the presence of systemic autoimmune diseases in an individual is a risk factor for the development of periodontal disease. SETTINGS AND DESIGN: This was a hospital-based case-control study. MATERIALS AND METHODS: A sample of 253 patients with systemic autoimmune diseases, attending the Rheumatology Department of Government General Hospital, Chennai-3, and 262 patients without systemic autoimmune diseases, attending the outpatient department of the Tamil Nadu Government Dental College and Hospital, Chennai-3, constituted the case and control groups, respectively. Age, gender, and oral hygiene status matching was done. Oral hygiene status was assessed using oral hygiene index (OHI) and periodontal status was assessed using community periodontal index (CPI) and loss of attachment (LOA) index. STATISTICAL ANALYSIS: Statistical analysis was done using SPSS version 15 (SPSS Inc, 2006, Chicago). RESULTS: Results showed 99.2% and 73.9% prevalence of gingivitis and periodontitis, respectively, in the case group as compared to 85.5% and 14.9%, respectively, in the control group. There is no linear relationship between OHI scores and prevalence of periodontitis (CPI and LOA scores) in the case group. Patients suffering from systemic autoimmune diseases showed more prevalence of periodontal diseases irrespective of oral hygiene scores. CONCLUSION: It is postulated that the presence of systemic autoimmune diseases may pose a risk for the development of periodontal diseases.

Influence of calcination temperature on the luminescent properties of Eu³âº doped CaAl4O7 phosphor prepared by Pechini method.

Motivated by the need for new phosphor for white light emitting diode (WLED) applications, CaAl4O7 phosphors activated by Eu(3+) rare earth ion was synthesized using the Pechini method at different calcination temperatures. The crystal structure and luminescent properties were investigated by X-ray diffraction (XRD), scanning electron microscope (SEM), Fourier transform infrared spectroscopy (FTIR), UV-Vis diffuse reflectance spectroscopy (DRS), and photoluminescence spectroscopy (PL). The XRD and SEM patterns confirm the presence of a single grossite monoclinic phase (311) and the particles exhibit good crystallinity and the particle size varies with calcination temperature. Absorption peak of FT-IR shows the decomposition of citrate ethylene glycol complex and the formation of CaAl4O7:Eu(3+) phosphor. Diffuse reflectance spectra indicate an absorption in the UV-region. The photoluminescence excitation spectrum exhibited a broad band covering from 340 to 420 nm with a sharp band at 395 nm. CaAl4O7:Eu(3+) phosphor excited by near UV (395 nm) light showed a strong red emission at 611 nm. The emission band is due to f-f transitions within the 4f(6) configuration of Eu(3+) ions, respectively. The photoluminescence properties were found to be strongly dependent on the calcination temperature and the PL properties are superior for sample calcined at 950 °C.

Age, nutritional status and INH acetylator status affect pharmacokinetics of anti-tuberculosis drugs in children.

SETTING: The currently recommended dosages of rifampicin (RMP), isoniazid (INH), pyrazinamide (PZA) and ethambutol in children are extrapolated from adult pharmacokinetic studies, and have not been adequately evaluated in children. OBJECTIVE: To describe the pharmacokinetics of RMP, INH and PZA given thrice weekly in children with tuberculosis (TB), and to relate pharmacokinetics to treatment outcomes. METHODS: Eighty-four human immunodeficiency virus negative children with TB aged 1-12 years in Chennai and Madurai, India, were recruited. Phenotypic INH acetylator status was determined. Nutritional status was assessed using Z scores. During the intensive phase of anti-tuberculosis treatment, a complete pharmacokinetic study was performed after directly observed administration of drugs. At 2 and 6 months, drug levels were measured 2 h post-dose. Drug concentrations were measured using high performance liquid chromatography and pharmacokinetic variables were calculated. Multivariable regression analysis was performed to explore factors impacting drug levels and treatment outcomes. RESULTS AND CONCLUSIONS: Children aged <3 years had significantly lower RMP, INH and PZA concentrations than older children, and 90% of all children had sub-therapeutic RMP Cmax (<8 µg/ml). Age, nutritional status and INH acetylator status influenced drug levels. Peak RMP and INH concentrations were important determinants of treatment outcome. Recommendations for anti-tuberculosis treatment in children should take these factors into consideration.