The Characteristics and Patterns of Drug-Resistant Pulmonary Tuberculosis in Eastern India.

BACKGROUND: Drug-resistant tuberculosis is a major public health problem throughout the world and accounts for substantial morbidity and mortality rates in India, too. Early diagnosis is the corner stone of tuberculosis treatment. State-level and cluster-wise variations in drug resistance is a possibility and should be regularly checked in from time to time. MATERIALS AND METHODS: The present prospective cohort study (January 2019 to May 2022) was conducted in Darbhanga Medical College and Hospital on drug-resistant pulmonary tuberculosis patients. Sputum specimens were collected from designated centers. Rapid molecular drug-resistance testing (genotypic tests) and growth-based drug-susceptibility testing (DST) (phenotypic tests) were performed in the National Tuberculosis Elimination Program certified Laboratory. RESULTS: A total of 268 patients with drug-resistant pulmonary tuberculosis were included in the study group. The treatment outcomes revealed as cured in 100 (37.31%); treatment completed in 43 (16.04%); died in 56 (20.89%); treatment failed in 22 (8.21%); loss of follow up in 34 (12.69%); and transferred out in 13 (4.85%) drug-resistant pulmonary tuberculosis patients. Adverse events were recorded in 199 (74.25%) of the drug-resistant pulmonary tuberculosis patients. CONCLUSIONS: Drug-resistant pulmonary tuberculosis patients are a matter of concern and need to be addressed.

Socio-demographic Profile of MDR-TB and XDR-TB Patients Admitted in DR-TB Centre, North India.

BACKGROUND: As per WHO Global TB report (2018), 10.0 million people developed TB in 2017. India accounted for 20 % of world cases. Globally, 3.5 % of new cases and 18% of previously treated cases had MDR-TB. Corresponding figures for India are 2.8 % and 12 %. Among cases of MDR-TB in 2017, 8.5% were estimated to have XDR-TB. Drug resistant TB cases are on rise and needs planning and research for its treatment and control. MATERIALS AND METHODS: A retrospective study was conducted on MDR-TB and XDR-TB patients to evaluate social and demographic profile of these patients in Bihar. RESULTS: A total of 700 (530 males and 170 females) MDR-TB and 51 (40 males and 11 females) XDR-TB patients were analyzed, which revealed 293 (41.86 %) patients of MDR-TB and 23 (45.10 %) patients of XDR-TB in the age group of 15 to 25 years. Mean age of MDR-TB patients in this age group was 20.52 years and for XDR-TB 21.17 years. CONCLUSION: Drug Resistant Tuberculosis Control Programme should focus adequately on youth in state of Bihar, India.

Assessment of anxiety, depression, and serum cortisol level in oral submucous fibrosis patients: A controlled clinical trial.

OBJECTIVE: The aim of this study was to assess the anxiety, depression, and serum cortisol level in OSMF patients. MATERIALS AND METHODS: This cross-sectional study was conducted in the Outpatient Department of Oral Medicine and Radiology, Teerthanker Mahaveer Dental College and Research Centre, Moradabad, Uttar Pradesh, India. Age- and gender-matched 105 patients were divided into three equal groups as follows: Group 1 - those with areca nut chewing habits and OSMF, Group 2 - those with areca nut chewing habits but no OSMF, and Group 3- those without areca nut chewing habits and without OSMF. Anxiety and depression were assessed by the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale, respectively. Serum cortisol level was also measured simultaneously. STATISTICAL ANALYSIS: Paired t-test, Chi-square test, and analysis of variance were used. RESULTS: Fifty (47.62%) patients were observed to be in the age group of 25-32 years. Ninety-six (91.4%) patients were males and 9 (8.6%) were females. The mean serum cortisol level was observed to be higher among patients with OSMF-C followed by those with OSMF-D. CONCLUSION: We conclude that there is a significant association between OSMF, depression, and serum cortisol level.

Valproic Acid versus Lamotrigine as First-line Monotherapy in Newly Diagnosed Idiopathic Generalized Tonic -Clonic Seizures in Adults - A Randomized Controlled Trial.

INTRODUCTION: Idiopathic Generalized Tonic-Clonic Seizures (GTCS) are frequently encountered in adults. Their successful control is necessary to improve the quality of life of these patients. Valproic acid is a simple branched-chain carboxylic acid and lamotrigine is a phenyltriazine derivative. Opinions differ in regards to their effectiveness in idiopathic GTCS. AIM: To compare the effectiveness of valproic acid and lamotrigine in newly diagnosed adults with idiopathic generalized tonic-clonic seizures. MATERIALS AND METHODS: The present prospective randomized study was conducted on 60 patients suffering from idiopathic GTCS. Thirty patients received valproic acid and rest 30 patients received lamotrigine. All patients were followed regularly monthly for one year for treatment response and adverse effects. RESULTS: After 12 months follow-up, 76.67% patients taking valproic acid and 56.67% patients taking lamotrigine were seizure-free. Common adverse effects recorded were nausea, dyspepsia, headache and skin rash. CONCLUSION: Valproic acid is more effective than lamotrigine as first-line drug in the treatment of adults with newly diagnosed idiopathic generalized tonic-clonic seizures.

Risk of Acute Kidney Injury with Amikacin versus Gentamycin both in Combination with Metronidazole for Surgical Prophylaxis.

INTRODUCTION: Surgical site infection is one of the most important complication of surgery. It increases the mortality and morbidity. In order to decrease the incidence of surgical site infections perioperative antimicrobial prophylaxis has been recommended in certain types of clean and clean contaminated surgeries. Aminoglycosides are indicated as surgical prophylaxis for prevention of surgical site infection in patients with B-lactam allergy. AIM: The present study was carried out to study and compare the renal safety profile of single high dose gentamycin and amikacin as surgical prophylactic antibiotic. MATERIALS AND METHODS: Prospective and randomized study was carried out on 100 patients for over one year period in a tertiary care teaching hospital of western Uttar Pradesh, India. Patients in amikacin group received amikacin 15 mg/kg + metronidazole 500 mg intravenously single dose and those in the gentamycin group had gentamycin 5 mg/kg + metronidazole 500 mg intravenously single dose, one hour prior to incision. RESULT: A total of 16% patients of amikacin group and 24% patients of gentamycin group developed acute kidney injury within one week of drug administration. The rise in serum creatinine was temporary as all patients had normal serum creatinine level at one month follow up. CONCLUSION: Aminoglycoside intravenous single high dose is not safe as surgical prophylaxis.

Development of Screening Questionnaire for Detection of Alcohol Dependence.

INTRODUCTION: Alcohol dependence (AD) is a major reason for morbidity and visits to emergency medical settings. However, the detection of AD is often difficult or overlooked. This study aimed to develop a brief screening questionnaire in Hindi language for detection of AD in an emergency medical setting. MATERIALS AND METHODS: The authors in consultation devised a set of questions related to AD in the Hindi language requiring binary yes/no type of response. These questions were guided by clinical experience, nosological criteria and previously published screening questionnaires. After initial piloting, these questions were administered by the treating doctors to 100 consenting adult patients presenting with possible AD in the emergency medical services of a tertiary care hospital in North India. A diagnosis of AD was arrived at by administering Mini-International Neuropsychiatric Interview separately. Identification of the most discriminant combinations of items for the detection of AD were based on the chi-square test and binary logistic regression analyses. The final version of the questionnaire was then externally validated on another cohort of patients. RESULTS: Based on the analyses, we retained 5 items in the final version of the questionnaire. Sensitivity and specificity values for cut-off scores were calculated. Subsequent external validation revealed satisfactory psychometric properties of the questionnaire. CONCLUSION: The questionnaire represents a simple and brief clinician-administered instrument for screening of AD in an emergency medical setting.

Impact of drug awareness and treatment camps on attendance at a community outreach de-addiction clinic.

BACKGROUND: Substance misuse is an increasing problem in urban and rural India. The utility of community-based interventions and preventive strategies are increasingly emphasized in this context. The drug de-addiction and treatment center, Department of Psychiatry, Postgraduate Institute of Medical Education and Research, has been running a drug de-addiction and treatment clinic at Kharar Civil Hospital, Kharar, District Mohali, Punjab, since 1998. As part of an effort to enhance this community outreach program, community-based drug awareness and treatment camps have been organized since March 2004 in villages in and around Tehsil Kharar of Mohali. AIM: To study the impact of the drug awareness and treatment camps on the attendance of patients at the community outreach drug de-addiction and treatment clinic at Kharar Civil Hospital. METHODS: Sociodemographic and clinical variables, including treatment outcome-related variables, of patients attending the clinic at Kharar Civil Hospital, before and after the camps were compared. DISCUSSION AND CONCLUSION: The study showed a positive impact on drug awareness and treatment camps held in the community on outpatient attendance at a community outreach clinic, with attendance increasing more than 1.8 times.

Quality of life and health of opioid-dependent subjects in India.

BACKGROUND AND OBJECTIVES: The quality of life (QoL) of substance abusers is known to be severely impaired. This study was carried out to assess the impact of opioid dependence on the QoL of subjects and compared it with the normal subjects. MATERIALS AND METHODS: Based on specified inclusion criteria a total of 47 subjects were recruited from a tertiary care center from India. The WHOQoL-BREF scale domain scores obtained at baseline were compared to that of normal subjects. An assessment of dysfunction and reasons for continuing and other parameters were assessed. RESULTS: WHOQoL-BREF domains (Physical, Psychological, Social relationships and Environment) showed significantly lower scores and the difference was statistically significant. INTERPRETATION AND CONCLUSIONS: The results showed that QoL is an important parameter in assessment of substance abusers and can be used for long-term prognosis of these individuals.