Double barrelled cross Abstract of articles from
Indian Journal of Tuberculosis
reproduced with kind permission
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Vol 53 No 3Jul 2006 ISSN 0019-5707

Editorial

Progress and prospects of RNTCP

Original articles

Case reports

Miscellaneous

  • Summaries of papers presented at the 60th National conference on TB & chest diseases in Lucknow February 23-26 2006
    • Performance of a DOTS programme:Administrative and technical challenges-A field report from a district in South India
    P.G.Gopi,R.Subramani,T.Santha,S.Radhakrishnan,V.Chandrasekaran,R.Rajeswari,R.Balasubramanian,A.Thomas,M.Muniandy and P.R.Narayana
    Background:: Performance of tuberculosis(TB)control programme depends on the functioning of health facilities(HFs).TB programmes have been evaluated based on the programme indicators of conversion and cure.We have attempted to correlate the programme performance based on the availability of staff and their performance at the HF level.
    Objective:To correlate the performance of HFs to programme indicators of conversion and cure of patients treated under DOTS,in a district of South India.
    Design:  Analysis of the data on new sputum smear-positive cases registered in 17 HFs during 1999-2003 was undertaken using TB register.The HFs with low conversion or cure rates were identified and the reasons for the same were analysed.A scoring system was designed for the functioning of the HFs based on staff availability,supervision and review meetings which was correlated with programme performance.Univariate and multivariate analyses were performed.
    ResultsOf 1893 new smear-positive patients registered during the study period,conversion was 1582(83.6%)with cure rate of 76.4%)1447 of 1893),254(13.4%)default,94(5.0%)failure and 85(4.5%)death.The conversion rates increased from 76% in 1999 to 87% in 2003;a statistically significant trend(chi square=15.9;P<0.001) Similarly a significant increase in trend ((chi square=4.0;P<0.05) was observed in cure rates also(71 to 80%)The HFs were broadly classified into four groups namely;poor,fair good and very good based on functioning scores.Correlation co-efficient was 0.77 between functioning and cure (P<0.01) Lack of regular review meetings was found to be independently associated with poor programme performance Conclusion:: Availability of staff such as Medical officer,Laboratory technician,and regular supervisory visits and review meetings are essential for a well functioning programme.There is significant impact on DOTS with good functioning of HFs.
    [Indian J Tuberc 2006;53:123-134]: 
    Role of low level nitrogen laser therapy in chronic drug resistant pulmonary tuberculosis
    Ashok BajPai,Salil Bhargava,Nageen Kumar Jain and P.K.Gupta

    Aim::  In this longitudinal study,the role of low level laser therapy in chronic drug resistant pulmonary tuberculosis has been studied for a period of 10 years from 1995 to 2004 and follow up was done for a period of 3 years.
    Material and Methods 61 patients in Nitrogen Laser Therapy(LLLT group and 61 kept as control group. The aim of the study was to describe the efficacy and safety of low level nitrogen therapy in the management of chronic drug resistant pulmonary tuberculosis.All patients,included in this study,had already taken anti-tubercular drugs for more than one year and were still sputum smear and culture positive
    Results Among LLLT group,44(72.13%)patients became sputum smear and culture negative for MTB(Mycobacterium tuberculosis)as compared to 26(42.62%)in control group.Of the 44 patients,22(50%)converted within first month.
    Conclusion Low level Nitrogen Laser Therapy,may be used as an adjuvant to anti-tubercular drugs in cases of chronic drug resistant pulmonary tuberculosis. [Indian J Tuberc 2006;53:135-140]: 
    Influence of drug susceptibility on treatment outcome and susceptibility profile of failures to Category II regimen Pauline Joseph,V.Chandrasekaran,A.Thomas,P.G.Gopi,R.Rajeswari,R.Balasubramanian,R.Subramani,N.Selvakumar and T.Santa
    Objective: To assess the influence of drug resistance on treatment outcome among patients treated with Category-II regimen and document drug susceptibility pattern of "Failures" to this regimen.
    Design&Nbsp;A retrospective analysis of patients registered from May 1999 through December 2004. Results: Treatment success was 42% among 572 patients and was similar among patients with fully susceptible or resistant but non-MDR organisms(41% of 254 and 40%of 128 patients,respectively)Among 49 MDR-TB patients ,27% had successful treatment outcome.The failure rates among patients with fully susceptible,resistant but non-MDR and MDR bacilli,were 6%,12% and 27% respectively.Default was significantly higher among males(53% vs 34%;p<0.01) smokers (57% vs 36%;p<0.001) ,alcoholics(58% vs 39%;p<0.001) and patients with higher initial smear grading(2+ or 3+),56% vs scanty or 1+,44%;p<0.01)DST results were available for 60%(31 of 52) of failures and 10 had MDR-TB.
    Conclusion The low success rate to the re-treatment regimen was mainly due to non-compliance.Failure was observed among 9% of patients and MDR-TB was 32% among category II failures.The currently recommended Category II regimen appears to be adequate for majority of re-treatment cases..
    [Indian J Tuberc 2006;53:141-148]: 
    Private sector involvement in tuberculosis control in Chandigarh J.S.Thakur,Sitanshu Sekhar Kar,Alka Sehgal and Rajesh Kumar
    Background: Private practitioners in India treat a substantial proportion of the TB cases.The present study is an attempt to find out the extent of private sector involvement in the control of tuberculosis in the Union Territory of Chandigarh.
    Methodology : The study was conducted in Union Territory of Chandigarh during 2003-04.This study was cross-sectional study involving 20% of private practitioners practicing allopathic system of medicine in Chandigarh.A questionnaire was used for collection of data after pre testing.
    Results: Out of 114 doctors interviewed ,71 dealt with TB patients.In response to a question as to how many sputum samples were required for routine microscopy,72% stated 3 samples but only 6 per cent knew the correct timing of sputum collection.8.6 per cent of the practitioners followed the recommended guidelines of RNTCP treatment.Ass to reasons for not following standard guidelines.,46.6 per cent said that they were not aware of these guidelines.About 82 per cent were willing to be partners for implementation of RNTCP.A case history was given to practitioners to assess their knowledge regarding DOTS.It was observed that only 7.8 per cent knew the correct dosage and 21 per cent the correct duration of treatment.
    Conclusion: Knowledge of private practitioners regarding RNTCP and DOTS strategy was poor and they were not following recommended guidelines for control of tuberculosis,but they were willing to participate in the programme.
    [Indian J Tuberc 2006;53:149-153]: 
    Status report on RNTCP
    The case detection rate for the 1st quarter of 2006 was 63%with a total of 331525 patients placed on treatment.
    Over 15 lakh suspects were examined during the quarter and 1,9 lakh sputum positive cases were diagnosed.
    The success rate amongst the new smear positive PTB cases registered in the 1st quarter of 2005 was 86%The sputum conversion rate and cure rate among the new sputum positive cases was 89% and 83% respectively.
    External quality assessment (EQA)implementation<
    Training of different levels of workers are undertaken B April 2005 ,the DOTS services are available in 568 districts covering 1,013 million population of the country. [Indian J Tuberc 2006;53:168]: 
    Acute respiratory distress syndrome as a paradoxical response to anti-tuberculosis and anti-retroviral therapy
    H.S.Subhash,S.Supriya,B.Prakash and K.Thomas
    Paradoxical response or immune re constitution inflammatory syndrome(IRIS)during the course of anti-tuberculous therapy is being increasingly recognised among patients with and without HIV co-infection.A 40 year old HIV infected male on anti-retroviral therapy(ART)presented with persistent fever and weight loss.He was diagnosed to have miliary tuberculosis and HIV co-infection.Following initiation of anti-tuberculosis chemotherapy the clinical course was characterized by development of acute respiratory failure(ARDS) as a paradoxical response/IRIS to treatment.This uncommon manifestation of paradoxical response (ARDS in HIV and tuberculous co-infection following initiation of ART and anti-TB treatment is very scarcely reported in the past.With the increasing incidence of HIV/AIDS and TB co-infection along with a liberal access to ART in the developing world,it is likely that paradoxical reactions will be encountered more frequently.
    [Indian J Tuberc 2006;53:157-160]: 
    Sachin.S.Baldawa,Chirag S.Desai and Rajiv Satoskar<>BR> Pyogenic infection occurring in the pilonidal sinus is very common in young indiduals with sedentary occupation.Tuberculous infection of pilonidal sinus is extremely rare and restricted to a case report in the literature.We present a 68- year old male presenting with long standing pilonidal sinus with tuberculous infection [Indian J Tuberc 2006;53:161-162]: 

    Created on ... July 12, 2006

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