Is a differentiated care model needed for patients with TB? A cohort analysis of risk factors contributing to unfavourable outcomes among TB patients in two states in South India.

BACKGROUND: TB is a preventable and treatable disease. Yet, successful treatment outcomes at desired levels are elusive in many national TB programs, including India. We aim to identify risk factors for unfavourable outcomes to TB treatment, in order to subsequently design a care model that would improve treatment outcomes among these at-risk patients. METHODS: We conducted a cohort analysis among TB patients who had been recently initiated on treatment. The study was part of the internal program evaluation of a USAID-THALI project, implemented in select towns/cities of Karnataka and Telangana, south India. Community Health Workers (CHWs) under the project, used a pre-designed tool to assess TB patients for potential risks of an unfavourable outcome. CHWs followed up this cohort of patients until treatment outcomes were declared. We extracted treatment outcomes from patient's follow-up data and from the Nikshay portal. The specific cohort of patients included in our study were those whose risk was assessed during July and September, 2018, subsequent to conceptualisation, tool finalisation and CHW training. We used bivariate and multivariate logistic regression to assess each of the individual and combined risks against unfavourable outcomes; death alone, or death, lost to follow up and treatment failure, combined as 'unfavourable outcome'. RESULTS: A significantly higher likelihood of death and experiencing unfavourable outcome was observed for individuals having more than one risk (AOR: 4.19; 95% CI: 2.47-7.11 for death; AOR 2.21; 95% CI: 1.56-3.12 for unfavourable outcome) or only one risk (AOR: 3.28; 95% CI: 2.11-5.10 for death; AOR 1.71; 95% CI: 1.29-2.26 for unfavourable outcome) as compared to TB patients with no identified risk. Male, a lower education status, an initial weight below the national median weight, co-existing HIV, previous history of treatment, drug-resistant TB, and regular alcohol use had significantly higher odds of death and unfavourable outcome, while age > 60 was only associated with higher odds of death. CONCLUSION: A rapid risk assessment at treatment initiation can identify factors that are associated with unfavourable outcomes. TB programs could intensify care and support to these patients, in order to optimise treatment outcomes among TB patients.

Rehabilitation of long-span Kennedy class IV partially edentulous patient with a custom attachment-retained prosthesis.

The rehabilitation of a patient in the Kennedy class IV situation demands biomechanical balance and aesthetic improvement. The long-span condition complicates the problem because of the unavailability of sufficient number of abutments to support the prosthesis. Conventional removable prosthesis and fixed partial denture are not advised for the same reason. This report describes a novel technique for the fabrication of a custom attachment to retain prosthesis. An acrylic resin removable partial denture (RPD) is retained by a custom attachment. The patrix part of the custom attachment is fabricated using molar bands, prefabricated circumferential clasp, and straight die pins. The matrix part of the attachment is constituted by the plastic sleeves of the straight die pins, which are embedded inside the tissue-fitting surface of the prosthesis. This article describes an inexpensive custom attachment for rehabilitating the long-span Kennedy class IV situation. The entire technique is reversible, inexpensive, and demands less skill compared to semi-precision and precision attachments.

Efficacy of diffusion tensor imaging in identification of degenerative cervical spondylotic myelopathy.

AIM AND OBJECTIVES: To study the diagnostic accuracy of Diffusion tensor imaging technique in detection of cervical spondylotic myelopathy changes. MATERIAL AND METHOD: Study population included 50 patients with symptoms of cervical myelopathy. The patients were evaluated based on symptoms using the European myelopathy scoring system and were divided into: Grade 1, including patients with mild symptoms; Grade 2, referring to patients with moderate symptoms and Grade 3, which included patients revealing severe symptoms. All the patients were investigated with a 1.5 T MRI unit acquiring DWI and DTI sequences. FA and ADC values from each spinal segment were analyzed in terms of Frequency, Percentage, Mean, Standard Deviation and Confidence Intervals. The comparison of values was done by ANOVA and post hoc analysis by bonferroni test. Comparison of accuracy of FA, ADC and T2WI in recognizing myelopathic changes was done by t-test. Receiver Operating Characteristics (ROC) analysis was performed to obtain a cut off value of FA and ADC for each spinal level to identify myelopathic change in the spinal cord. RESULTS: The study revealed a significant difference in the mean FA and ADC value of stenotic and Non-stenotic segments. T2WI was highly significant (p = 0.000) in recognizing myelopathy changes in patients falling under Grade 2(moderate) and Grade 3(severe) according to European Myelopathy scoring system. Regarding patients under Grade 1 (mild) FA and ADC values showed significant difference compared to T2WI. The collective sensitivity in the identification of myelopathic changes was highest with FA (79%) as compared to ADC (71%) and T2WI (50%). ROC analysis was done to determine the cut off values of FA and ADC at each cervical spine segments. The proposed cut off, for FA and ADC at the level of C1-C2 is 0.68 and 0.92, C2-C3 is 0.65 and 1.03, C3-C4 is 0.63 and 1.01, C4-C5 0.61 and 0.98, At C5-C6 0.57 and 1.04, At C6-C7 0.56 and 0.96 respectively. CONCLUSION: FA and ADC values enhance the efficacy and accuracy of MRI in the diagnosis of cervical spondylotic myelopathy. Hence diffusion tensor imaging can be used as a non-invasive modality to recognize spondylotic myelopathy changes even in the early stages, which can be helpful in deciding on appropriate timing of decompression surgery before the irreversible chronic changes set in.

Evaluation of the Erosive Potential of Various Pediatric Liquid Medicaments: An in-vitro Study.

BACKGROUND: The present in-vitro study was a scanning electron microscope (SEM) study conducted in primary teeth in order to evaluate the erosive potential of ten commonly used pediatric liquid medications (PLMs). MATERIALS & METHODS: 10 commonly used PLMs and 33 exfoliated or extracted primary teeth were collected. The 33 teeth were divided into two groups, the control group (n=3) and the study group (n=30). The endogenous pH of all the teeth was measured using a pH electrode meter. The control group teeth were immersed in artificial saliva for three different time intervals- 1 minute, 10 minutes and 8 hours. The study group teeth were also maintained for 1 minute, 10 minutes and 8 hours in various selected PLMs. The primary enamel surface (PES) changes were then observed under the SEM for all the teeth of both groups. RESULTS: All the PLMs used in the study showed an erosive effect on the PES when viewed under SEM. Majority of the medications caused etched prism pattern followed by crater formation and sporadic rod ends in that order on PES. CONCLUSION: There is a need to educate parents and professionals about the association between dental erosion and PLMs which predisposes to dental caries. How to cite the article: Tupalli AR, Satish B, Shetty BR, Battu S, Kumar JP, Nagaraju B. Evaluation of the Erosive Potential of Various Pediatric Liquid Medicaments: An In-vitro Study. J Int Oral Health 2014;6(1):59-65.