scholarly journals Spinal Tuberculosis – Directly Observed Treatment and Short Course or Daily Anti Tubercular Therapy -Are We Over Treating?

2018 ◽  
Vol 12 (1) ◽  
pp. 380-388 ◽  
Author(s):  
Ravinder Kumar Banga ◽  
Jagdeep Singh ◽  
Anshul Dahuja ◽  
Radhe Shyam Garg
Keyword(s):  
Pain Score ◽  
Neurological Deficit ◽  
Spinal Tuberculosis ◽  
Treatment Modalities ◽  
Randomised Control Trial ◽  
P Value ◽  
Short Course ◽  
Directly Observed Treatment ◽  
Anti Tubercular Therapy

Study Design: Prospective randomised control trial. Purpose: To compare the effectiveness of Directly Observed Treatment and Short Course (DOTS) and Daily Anti Tubercular Therapy (ATT) in spinal tuberculosis with no neurological deficit. Overview of Literature: Spinal tuberculosis is rampant in India with a major cause of morbidity and mortality. There is a lot of conflict regarding management with anti tubercular drugs, the regimen to be followed and the duration the drugs needed for complete cure. Material and Methods: This prospective study was conducted during the period of 2006 to 2009. Thirty cases of spinal tuberculosis were randomly divided equally into two groups of fifteen each and treated with DOTS and Daily ATT and compared at the end of follow up on clinical, radiological and Erythrocyte Sedimentation Rate values (ESR). Results: Pain score on Visual Analogue Scale (VAS) exhibits that mean pain score was 5.93+_1.54 at start and 0.64+_1.01 at the end of follow up with 89.39% change with DOTS therapy whereas mean pain score was 7.08 +_1.61at start of therapy and 0.69+_0.95 at end of follow up with 91.73% change in patients treated with Daily ATT with p value >0.05 (not significant). The radiological recovery in patients with DOTS and Daily ATT have similar results after 1.5 years with p value > 0.05 showing that the radiological recovery by both treatment modalities are comparable. Mean change in ESR scores in DOTS therapy patients and patients on daily ATT were 74.57+_9.34% and 75.69+_9.38% change with p value >0.05 which was not significant. Conclusion: DOTS therapy is an effective means of management of spinal tuberculosis cases with no neurological involvement, however its efficacy in patients with neurological deficit is further to be evaluated.

ROLE OF COMPUTED TOMOGRAPHY SCAN IN POST-COVID SINO-NASAL MUCORMYCOSIS WITH CLINICO-EPIDEMIOLOGICAL CORELATION

2021 ◽  
pp. 49-52
Author(s):  
Srijit Saha ◽  
Aarti Anand ◽  
Debraj Saha
Keyword(s):  
Broad Spectrum ◽  
Health Care Professionals ◽  
Epidemiological Data ◽  
Treatment Modalities ◽  
Intracranial Extension ◽  
P Value ◽  
Comorbid Condition ◽  
Invasive Ventilation ◽  
Broad Spectrum Antibiotics

Ÿ OBJECTIVE: Ÿ To evaluate the spectrum of radiological ndings in post-COVID sinonasal mucormycosis cases Ÿ To evaluate the demography, comorbidities and treatment modalities used in these patients which may be attributable to development of sinonasal mucormycosis after recovery from COVID-19 disease. Ÿ MATERIALS AND METHODS: In this retrospective study, 80 out of 793 patients who came for follow-up after recovering from COVID pneumonia, had symptoms related to paranasal sinus and orbit. CECT PNS and orbit was performed in them and 69 patients had positive CT ndings. Clinico-epidemiological data was recorded. The correlation between CT ndings and clinical history was performed by Chi2 test. P value <0.05 was considered as statistically signicant. Ÿ RESULTS: Majority - 48 (69.5%) belonged to age group between 40-60 years. Diabetes mellitus was the most common comorbid condition seen in 58 (84%) patients. The treatment history during COVID-19 disease revealed administration of intravenous or oral steroids in 54 (78.2%) patients, Injection Remdesivir in 48 (69.5%), broad-spectrum antibiotics in 36 (52.2%). 15 (21.7%) were given non-invasive ventilation and 7 (10.1%) needed invasive ventilation. Ethmoidal sinus- 68 cases (98.5%) and maxillary sinus- 65 cases (94.2%) were most frequently affected sinus. Intraorbital extension of the soft tissue was seen in 37 (53.6%) and intracranial extension was seen in 11 (15.9%) cases. On follow-up, fungal hyphae were detected in 39 (56.5%) cases via KOH mount or biopsy. Ÿ CONCLUSION: The widespread use of steroids/monoclonal antibodies/broad-spectrum antibiotics/oxygen therapy for treating COVID-19 may lead to the development/exacerbation of pre-existing fungal diseases. Health care professionals should act promptly when there is a suspicion of mucormycosis

Knowledge of Pulmonary Tuberculosis among the Patients under Anti- Tubercular Therapy

2018 ◽  
Vol 5 (1) ◽  
pp. 27-31
Author(s):  
Golam Sagir ◽  
Rafiqul Islam ◽  
Md Mamnur Rashid ◽  
Mohammad Akter Hossain ◽  
Mohammad Ashraful Haque
Keyword(s):  
Pulmonary Tuberculosis ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Short Course ◽  
Chest Disease ◽  
Directly Observed Treatment ◽  
The Mean ◽  
Disease Hospital ◽  
Anti Tubercular Therapy

Background: Knowledge on tuberculosis is very important among the patients under anti-tubercular therapy for proper management.Objective: The purpose of the present study was to assess the knowledge about tuberculosis among patients attending the DOTS (directly observed treatment, short course) corner.Methodology: This cross sectional study was conducted in the DOTs corner of Sylhet MAG Osmani Medical College, Sylhet, Bangladesh and Sylhet Chest Disease Hospital, Sylhet, Bangladesh during the period from June 2011 to November 2011 for a period of six (6) months. All the patients who were diagnosed as case of pulmonary tuberculosis and were treated with anti-tubercular drugs at DOTs corner who attended in the both Hospitals, Sylhet were selected as study population.Result: The age of the patients ranged from 18 to 70 years with the mean age of 41.2 (SD+ 12.4) years. The age of the male patients were ranging from 18 to 70 years with the mean age of 42.1 (SD: 12.8) years. Among the 194 patients, 90(46.4%) patients had good knowledge and 104(53.6%) patients had poor knowledge about tuberculosis.Conclusion: In conclusion, greater efforts therefore need to be undertaken to improve TB control among TB patients through appropriate and sustainable health education.Bangladesh Journal of Infectious Diseases 2018;5(1):27-31

scholarly journals Efficacy of directly observed treatment short-course intermittent regimen in spinal tuberculosis

2012 ◽  
Vol 46 (2) ◽  
pp. 138 ◽  
Author(s):  
Rejith Valsalan ◽  
MK Raveendran ◽  
Sibin Surendran ◽  
Rajesh Purushothaman ◽  
Balaji Zacharia
Keyword(s):  
Spinal Tuberculosis ◽  
Short Course ◽  
Directly Observed Treatment ◽  
Intermittent Regimen

scholarly journals Outcome of Unstable Thoracolumbar Fracture Following Long Segment Posterior Fixation

2021 ◽  
Vol 39 (2) ◽  
pp. 114-122
Author(s):  
Abdullah Al Mamun Choudhury ◽  
Md Shah Alam ◽  
Abul Kalam Azad ◽  
Kohinoor Akhter
Keyword(s):  
Functional Outcome ◽  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Fusion Rate ◽  
Spine Injury ◽  
P Value ◽  
Posterior Fixation ◽  
Thoracolumbar Region

Introduction: Fractures of the thoracolumbar region are the most common injuries of the vertebral column and burst fractures are the most frequent. The purpose of this study was to see the radiological and functional outcome after long segment posterior fixation in unstable thoracolumbar spine injury with incomplete neurological deficit. Methods: A total of 146 cases were included in this prospective case series from January 2014 to December 2018 through non randomized purposive sampling. All the patients were operated with long segment posterior fixation and postero-lateral fusion by Autogenous cancellous bone graft. Postoperative functional outcome was assessed both clinically by ODI, VAS, ASIA and radiologically by Bridwell criteria. Postoperative follow up was conducted at 2nd, 6th,12th and finally 6 monthly. Results: The mean Cobb angle at pre-operative was 21.5 ±8.9 and at final follow-up was 11±4.57 in this study (p-value<0.05). At final follow up 1 grade improvement occurred in 116(79.5%) patients and 2 grade improvement in 36 (20.5%). Regarding ODI and VAS, moderate disability (25%) with mild pain (16%) was found at final follow up with a Bridwell fusion grade II (48%). Conclusion: Long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit is an effective method of treatment. This method enhances neurological and functional recovery with an acceptable fusion rate J Bangladesh Coll Phys Surg 2021; 39(2): 114-122

scholarly journals Paediatric Tuberculosis at the Directly Observed Treatment Short-Course Clinic of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

2020 ◽  
pp. 32-38
Author(s):  
B. I. Garba ◽  
T. Yusuf ◽  
L. K. Coker ◽  
K. O. Isezuo ◽  
M. O. Ugege ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Relevant Information ◽  
University Teaching ◽  
First Line ◽  
Successful Treatment Outcome ◽  
Short Course ◽  
Directly Observed Treatment ◽  
Lost To Follow Up ◽  
Paediatric Tuberculosis

Introduction: Tuberculosis (TB) is the leading infectious disease killer worldwide, despite significant progress against the disease in recent years. Most cases of TB in children occur in the TB endemic countries but the actual burden of paediatric TB is unknown. With early diagnosis and treatment using the first-line anti-tuberculous drugs, most people who develop the disease can be cured and onward transmission of infection curtailed. Objective: To determine the pattern and outcome of paediatric tuberculosis managed at a tertiary facility in Sokoto, Nigeria. Materials and Methods: Records of children managed for TB at the Directly observed treatment short-course (DOTS) clinic over a three-and-a-half-year period were reviewed retrospectively. All children (≤ 15 years) treated for TB over the study period was included. Relevant information was retrieved from the register and analysed accordingly. Results: 74 children were treated with 33(44.6%) being males, giving a M: F ratio of 1:1.2. Mean (±SD) age was 85.78 (±55.40) months and 34 (45.9%) belonged to the 0.0-5.0-year age group. Seventy-one (95.9%) were new cases and three (4.1%) were relapse. Pulmonary TB (PTB) was seen in 50 (67.6%), more females had PTB than males, which was not significant (χ2=0.4, p=0.52). Acid fast bacilli (AFB) were positive in only 8 (10.8%) while GeneXpert MTB/RIF sensitivity was detected in 7 (9.2%). Majority 36 (48.6%) were lost to follow up, 30 (40.5%) completed treatment, only 4(5.4%) were cured with no recorded mortality. Successful treatment outcome was low (45.9%). Conclusion: Treatment outcome using DOTS strategy was poor, far below the WHO benchmark. There is need to improve adherence to DOTs therapy to prevent development of multi drug resistant TB. 

scholarly journals The study of adverse drug reactions in indoor patients of tuberculosis taking standardized antitubercular therapy (directly observed treatment short-course and programmatic management of drug resistant tuberculosis) in a tertiary care hospital at Surat

2021 ◽  
Vol 10 (5) ◽  
pp. 507
Author(s):  
Payal P. Naik ◽  
Arvindsingh Panwar ◽  
Swati Patel
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Drug Resistant ◽  
Drug Reactions ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Short Course ◽  
Directly Observed Treatment

Background: Tuberculosis is a serious public health issue in India. The treatment regimen followed is Directly observed treatment short-course (DOTS) and Programmatic Management of Drug resistant Tuberculosis (PMDT) approach. In a long period of treatment adverse drug reactions (ADRs) can be an important programmatic issue. Thus, study was undertaken to assess the ADRs caused by antitubercular therapy in indoor patients in a tertiary care hospital at Surat.Methods: The Observational, prospective study was carried out for one year period. The causality was determined by WHO UMC scale and severity was determined by Modified Hartwig and Siegel scale. Chi square test was applied for statistical analysis.Results: Among 255 tuberculosis patients, 85 (33.3%) patients developed ADRs. Occurrence of ADRs was more among females (46.6%). The commonly involved systems are gastrointestinal (40.6%) followed by haematological (17.9%). The most common ADRs observed were nausea and vomiting (21.7%). High percentage of ADRs causing drugs were isoniazid (30.6%) followed by rifampicin (26.1%). Causality assessment showed 60.4% ADRs were possible, 37.7% ADRs were probable and 1.9% ADRs was certain. Severity assessment scale showed 81.1% of moderate, 12.3% of mild and 6.6% of severe grading. Occurrence of ADRs was more among PMDT (60%) in comparison to DOTS therapy (31.06%) [p value = 0.0084 (significant p value < 0.05)].Conclusions: Antitubercular treatment is safer but early detection, management and reporting of ADRs is required to prevent it at initial stage and helps to decrease default rate.

scholarly journals Tubercular infection in children living with adults receiving Directly Observed Treatment Short Course (DOTS): a follow up study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Geetika Srivastava ◽  
M. M. A. Faridi ◽  
Shiv Sagar Gupta
Keyword(s):  
Tuberculin Skin Test ◽  
Contact Tracing ◽  
Sputum Smear ◽  
X Ray ◽  
Follow Up Study ◽  
Short Course ◽  
Directly Observed Treatment ◽  
Chest X Ray ◽  
Tubercular Infection

Abstract Background Children living with sputum smear-positive adult tuberculosis (TB) patients are vulnerable to acquire tubercular infection. Contact tracing is an important strategy to control tubercular infection in the community. This study was done to find out prevalence of tuberculosis and tubercular infection in children living with sputum smear-positive adult patients receiving DOTS at recruitment and to find out incidence of tubercular infection and disease in these children on follow up. Method Children (< 15 years) living in contact with adults on DOTS were grouped as < 6 years and 6–14 years. They were further sub grouped as being - uninfected, infected, diseased and on prophylaxis and were followed at 3, 6 and 9 months. Tuberculin skin test (TST) and chest X-ray were done. Results At recruitment 152 children were enrolled and 21.1% (n = 32) had TB. On follow up, 4.3% (n = 5), 5.8% (n = 6) and 11.6% (n = 11) children developed TB after 3, 6 and 9 months respectively.9 children did not come for the last follow up so the overall prevalence of TB disease at 9 months was 37.7% (n = 54). Out of the 128 children with TST reading 23.4% (n = 30) child contacts were found to be infected already at recruitment. The incidence of TST conversion was 20.7% (n = 18), 26.9% (n = 18) and 16.3% (n = 7) respectively. The overall prevalence of tubercular infection in the children, who were in contact with TB patients for 9 months was 74.5% (n = 73). Conclusion About half the children were either suffering from TB or tubercular infection on recruitment. During 9 months follow up 22 unaffected children developed disease and 43acquired infection.

scholarly journals Evaluation of Transpedicular Surgical Decompression withLong Segment Stabilization in Thoracic and Thoracolumbar SpinalTuberculosis

2018 ◽  
Vol 43 (3) ◽  
pp. 138-142
Author(s):  
Anowarul Islam ◽  
Fahad Goni ◽  
Naimur Rahman
Keyword(s):  
Pedicle Screw ◽  
Vertebral Body ◽  
Neurological Deficit ◽  
Screw Fixation ◽  
Spinal Tuberculosis ◽  
Pedicle Screw Fixation ◽  
Surgical Decompression ◽  
Posterior Decompression ◽  
Pott’S Disease

Pott’s disease is a common cause of neurological complications and kyphotic deformity.When deformity progressed that may lead to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality andlongevity oflife. The treatmentstrategy is to avoid neurological complication and achieve a near normal spine. In tuberculosis, spinal column may become unstable. Pathological fracture or dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression causefurther instability.The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old Pott’s disease is a most suitable device.This prospective interventionalstudywas conducted in BanglabandhuSheikh Mujib Medical University (BSMMU) for aperiod of 60 monthsfrom July 2011, with at leasttwo years follow-up period. Twentycases (13 males and 7 females) of thoracolumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 9–28 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage.The mean age of patients was 50.9 and kyphosis improved from 17.85±1.37 degrees to 10.85±2.66 degrees (p=0.0206).Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean visual analogue score (VAS) score improved from 5.5 to 0.75 (p=0.0031).So, posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the thoracic and thoracolumbar TB in patients with vertebral body destruction and <30degree kyphosis.

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