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Kulkarni, Gauri Suhas
- Resistance to Isoniazid and Rifampicin and Factors Associated with Resistance Among MDR TB Patients Visiting DOTS PLUS Site
Abstract Views :244 |
PDF Views:83
Authors
Affiliations
1 Vasatrao Pawar Medical College, Adgoan, Nashik, Maharashtra-422003, IN
1 Vasatrao Pawar Medical College, Adgoan, Nashik, Maharashtra-422003, IN
Source
MVP Journal of Medical Sciences, Vol 4, No 1 (2017), Pagination: 14-18Abstract
Introduction: Multidrug-Resistant (MDR-TB) is defined as M tuberculosis resistant to isoniazid and rifampicin with or without resistant to other drugs. Drug resistant TB is known to occur from time of introduction of antituberculosis drugs. MDR TB has become a significant health problem and an obstacle to effective TB control1. Resistance of M. tuberculosis to anti- TB drugs is caused by chromosomal mutations in genes encoding drug targets. Multidrug-resistant strains of M. tuberculosis (MDR-TB) evolve due to sequential accumulation of mutations in target genes. The WHO cites TB as the single most important fatal infection, with around 8.8 million new cases and 1.4 millions deaths per year, 95% in developing countries. According to Global TB report 2015 data of MDR TB as follows2. 50% successfully completed treatment (cure or treatment completed), 16% died, 16% defaulters, 10% treatment failure, 8% without outcome. The MDR-TB is also threatening World Health Organization’s target of tuberculosis elimination by 2050. Study conducted by NIRT and NTI suggest MDR level of 1% to 3% in new cases and around 12% in retreatment cases and revealed an overall emergence to rifampicin in only 2% of patients, despite a high level (18%) of initial resistance to isoniazid, either alone in or in combination with other anti tuberculosis drugs+. Aims and Objectives: 1. To Study the drug resistance to isoniazid and rifampicin among the MDR TB patients visiting DOTS PLUS CENTRE. 2. To Study the various factors associated with resistance to Isoniazid and rifampicin among MDR TB patients. Material and Methods: Present study was conducted at DOTS PLUS Centre in tertiary health care centre. Total 140 of newly diagnosed cases of MDR-TB were included in the present study after satisfying the inclusion and exclusion criteria. Written informed consent was taken from the study participants. Patients’demographic details were noted such as name, age, sex, occupation, socioeconomic status, education. Patients were asked detailed history about smoking, alcohol, tobacco chewing, diabetes mellitus, hypertension, COPD (chronic obstructive pulmonary disease), HIV Status. Details about past history of tuberculosis, treatment history were noted, If the patient was found to have defaulted previous antituberculous treatment, detailed evaluation was done to find out reasons for defaulting the treatment, History of MDR TB contact was noted. The drug resistance pattern of isoniazid and rifampicin was noted. Results: Of the 140 drug resistance tuberculosis patients, MDR Pulmonary tuberculosis was more common in economically productive age group of 21-40 years, distribution of male (60%) and female (40%), 35% patients were found to have defaulted previous antituberculous treatment. Main reasons for defaulting were, becoming asymptomatic, feeling better 40.8% followed by medication side effects 32.65% Conclusion: Isoniazid and rifampicin resistance (74.28%)is more than rifampicin monoresistance (25.72%), there is significant association between addiction of patient and defaulting the previous antituberculous treatment, analysis of patients various factors for drug resistance showed that MDR-TB is more commonly seen in males, age between 21 to 40 years, low socioeconomic status, past history of ATT, Alcoholic and tobacco user.Keywords
Co Morbidities, Defaulter, MDR TB, Resistance.References
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- Saputkal S, et al. Increasing burden of tuberculosis and high rate of drug resistance in HIV epidemic in Northern Thailand, 1989-1997. Int Conf AIDS; 1998. p. 288.
- Paramasivan CN, et al. Surveillance of drug resistance in tuberculosis in two districts of south India. Int J Tuibercle and Lung Dis. 2002; 6:479–84. PMid:12068979.
- Mahadev GB, Kumar P, Agarwal SP, Chauhan LS, Srikantaramu N. Surveillance of drug resistance to anti-tuberculosis drugs in district of Hoogli in West Bengal and Mayurbhanj in Orrisa. India J Tuberc. 2005; 52:5–101.
- Gupta D, Singh N, Kumar R, Jindal SK. Manisfestations of pulmonary tuberculosis in the elderly: a prospective observational study from North India. Indian J Chest Dis Allied Sci. 2008; 50:263-7. PMid:18630791.
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- Jaggarajamma K, Sudha G, Chandrasekaran V, Nirupa C, Thomas A, Santha T, Muniyandi M, Narayana PR. Reasons for non-compliance among patients treated under Revised National Tuberculosis Control Programme (RNTCP), Tiruvallur district, South India. Indian J Tuberc. 2007; 54(3):130–5.
- Castelnuovo B. A review of compliance to anti tuberculosis treatment and risk factors for defaulting treatment in Sub Saharan Africa.The African Health Sciences. 2010 Dec; 10(4):320–4. PMid:21416032 PMCid:PMC3052808.
- Study of Respiratory Symptoms in Farmers Admitted in Tertiary Health Care Institute
Abstract Views :338 |
PDF Views:125
Authors
Affiliations
1 Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
1 Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
Source
MVP Journal of Medical Sciences, Vol 6, No 1 (2019), Pagination: 84-87Abstract
Background: Farmers have a high prevalence of respiratory symptoms and airway obstruction. Respiratory problems occurs on exposure to various types of farming which are both immunologic and non-immunologic in nature. Aims and Objectives: To study the respiratory symptoms and their association with type of farming in farmers admitted to respiratory medicine ward in a tertiary health care institute. Results: Breathlessness (89.1 %) was the most common clinical feature amongst population. Exposure to organic and inorganic dust, hays, biomass fuel and pesticide were the most common risk factors associated with farming. Nonsmoker farmers also had a more respiratory symptom. Conclusion: Respiratory symptoms are the most common among farmers though smoking is a confounding factor, but it was observed that nonsmoker farmers also developed symptoms.Keywords
Farming, Non-Smoker Farmer, Respiratory Symptoms.References
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- Drug Resistance Patterns among XDR-TB Patients visiting a TB Centre at a Tertiary Health Care Facility
Abstract Views :206 |
PDF Views:78
Authors
Affiliations
1 Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
1 Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
Source
MVP Journal of Medical Sciences, Vol 7, No 1 (2020), Pagination: 53-59Abstract
Background: Resistance to MDR TB has additional resistance to fluoroquinolones and second line injectables it is defined as XDR-TB. The present study is designed to evaluate drug resistance patterns in such XDR patients. Aims and Objectives: To study drug resistance patterns in XDR-TB patients. Material and Methods: Researcher carried out a cross-sectional study over a period of two years. In this study, 43 patients were studied. The criteria used to observe was that – Newly diagnosed cases of XDR-TB patients by using the second line Drug Sensitivity Testing (DST). This method was used at an accredited RNTCP lab regardless of age and gender of the patients. Further, demographic, clinical and treatment data were analyzed in terms of drug sensitivity of the patients. Results: 48.83% of patients showed resistance with fluoroquinolone, 20.93% showed resistance with XDR with Second line injectables, 30.23% with flouroquinolones + second line injectibles. Maximum resistance was seen in Ofloxacin (81.4%) followed by kanamycin (44.2%). 41.86% patients were diabetics showing that drug resistance was more prevalent in these population. Maximum defaulters (80%) were from the lower class. Conclusion: Flouroquinolones and second-line drugs must be administered rationally and considerately to prevent the widespread drug resistance. The role played by diabetes and lower socio economic status in the emergence of drug resistance must not be undermined.Keywords
Diabetes, Drug Sensitivity, Fluoroquinolones, XDR TB, MDR TBReferences
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- Ahmad N, Javaid A, Sulaiman SA, Ming LC, Ahmad I, Khan AH. Resistance patterns, prevalence and predictors of fluoroquinolones resistance in multidrug resistant tuberculosis patients. Brazilian Journal of Infectious Diseases. 2016 Feb; 20(1):41–7. PMid: 26626164. https:// doi.org/10.1016/j.bjid.2015.09.011.
- Sharma SK, Chaubey J, Singh BK, Sharma R, Mittal A, Sharma A. Drug resistance patterns among extrapulmonary tuberculosis cases in a tertiary care Centre in North India. The International Journal of Tuberculosis and Lung Disease. 2017 Oct 1; 21(10):1112–7. PMid: 28911354.
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- Lan Y, Li Y, Chen L, Zhang J, Zhang H. Drug resistance profiles and trends in drug-resistant tuberculosis at a major hospital in Guizhou Province of China. Infection and Drug Resistance. 2019; 12:211. PMid: 30666136 PMCid: PMC6330984. https://doi.org/10.2147/IDR.S188538.
- Sinha P, Srivastava GN, Gupta A, Anupurba S. Association of risk factors and drug resistance pattern in tuberculosis patients in North India. Journal of Global Infectious Diseases. 2017 Oct; 9(4):139. PMid: 29302148 PMCid: PMC5750437. https://doi.org/10.4103/jgid.jgid_167_16.
- Argita D. Salindri, Maia Kipiani, Russell R. Kempker,Neel R.Gandhi, Lasha Darchia, Nestani Tukvadze, Henry M.Blumberg, Matthew J. Magee. Diabetes Reduces the Rate of Sputum Culture Conversion in Patients With Newly Diagnosed Multidrug-Resistant Tuberculosis. Open forum of infectious diseases. 2016 Jun1 14; 1.
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- Mogashoa T, Melamu P, Derendinger B, Ley SD, Streicher EM, Iketleng T, Mupfumi L, Mokomane M, Kgwaadira B, Rankgoane-Pono G, Tsholofelo TT. Detection of second line drug resistance among drug resistant Mycobacterium Tuberculosis Isolates in Botswana. Pathogens. 2019 Dec; 8(4):208. PMid: 31661825 PMCid: PMC6963291. https://doi.org/10.3390/pathogens8040208
- Study of Some Risk Factors in Acute Exacerbation of COPD at Tertiary Care Centre
Abstract Views :201 |
PDF Views:86
Authors
Juhi R. Kadukar
1,
Ramesh Sundrani
2,
Sushma Dugad
3,
Gauri Suhas Kulkarni
4,
Jaspreet Singh Khandpur
5,
Maya Mortale
1
Affiliations
1 Former PG Resident, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
2 Professor and Head, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
3 Associate Professor, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
4 Professor, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
5 PG Resident, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
1 Former PG Resident, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
2 Professor and Head, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
3 Associate Professor, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
4 Professor, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
5 PG Resident, Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Nashik - 422203, Maharashtra, IN
Source
MVP Journal of Medical Sciences, Vol 7, No 1 (2020), Pagination: 98-103Abstract
Background: Respiratory symptoms of patients usually worsen, which may be beyond normal day to day variation this is nothing but an acute event of a disease leading to further change in medication. Acute exacerbation of Chronic obstructive pulmonary disease is defined as sudden worsening of symptoms like in breathlessness, chest pain, change in quantity and colour of sputum, fever, these symptoms usually last for several days. These symptoms are aggravated by environmental pollutants, bacterial and viral infections wherein infections usually lead to 75% or more of the exacerbations but improper inhaler technique is also one of the most important factors for causing exacerbation of Chronic Obstructive Pulmonary disease. Aims and Objectives: To study the risk factors for exacerbation of COPDs. Methods: Present sample consists of 51 diagnosed COPD patients who fulfilled eligibility criteria. Study was conducted in the department of Respiratory medicine from August 2016 to December2018. Detailed history along with general and respiratory system examination was done and findings were recorded. Results: Most of the study population was present between 51 to 60 years (41.2%) of age group and rest were in 41 to 50 years (29.4%) and more than 60 years (29.4%). There was male predominance (64.7%) amongst study population as compared to females (35.3%). 82.4% of study population were taking inhaler improperly. 64.7 % of study population were exposed to outdoor pollution. 43.1% of study population are exposed to indoor pollution. Conclusion: Environmental stress are also involved in acute exacerbation of chronic obstructive pulmonary disease apart from viral and bacterial infections. Improper technique of using inhaler was also the main risk. So patients are advised proper & regular use of inhaler technique. Indoor and outdoor pollution is also main risk factor for exacerbation so avoidance of exposure to biomass fuel and outdoor pollution should be considered.Keywords
Biomass Fuel, COPD, Improper Inhaler Technique, Indoor and Outdoor PollutionReferences
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