Gauri Suhas Kulkarni ¹

Affiliations
1 Vasatrao Pawar Medical College, Adgoan, Nashik, Maharashtra-422003, IN

Abstract

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.

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Gauri Suhas Kulkarni ¹, Maya Madhav Mortale ¹, Juhi R. Kadukar ¹, Abhijit J. Telkhade ¹

Affiliations
1 Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

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.

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Gauri Suhas Kulkarni ¹, Abhijit Janardhan Telkhade ¹, Sushama Dugad ¹

Affiliations
1 Department of Respiratory Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

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 TB

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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

Abstract

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 Pollution

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