End Of 2nd Month Research Articles

Impact of isoniazid monoresistance on overall and vulnerable patient populations in Taiwan

ABSTRACT Isoniazid is an early bactericidal anti-tuberculosis (TB) agent and isoniazid mono-resistance TB is the most prevalent drug-resistant TB worldwide. Concerns exist regarding whether resistance to isoniazid would lead to delayed culture conversion and worst outcomes. From January 2008 to November 2017, adult culture-positive pulmonary TB patients receiving isoniazid, rifampicin, pyrazinamide, and ethambutol were identified through Taiwan Center for Disease Control database and were followed until the end of 2017. Primary outcomes included time to sputum culture conversion (SCC) within two months. Secondary outcomes included death and unfavourable outcomes at the end of 2nd month. A total of 37,193 drug-susceptible and 2,832 isoniazid monoresistant pulmonary TB patients were identified. Compared with no resistance, isoniazid monoresistance was not associated with a delayed SCC (HR: 0.99, 95% CI: 0.94─1.05, p = 0.8145), a higher risk of 2-month mortality (HR: 1.19, 95% CI: 0.92─1.53, p = 0.1884), and unfavourable outcomes at 2nd month (OR: 1.05, 95% CI: 0.97─1.14, p = 0.2427). Isoniazid monoresistance was associated with delayed SCC (HR: 0.90, 95% CI: 0.83─0.98, p = 0.0099) and a higher risk of unfavourable outcomes (OR:1.18, 95% CI: 1.05─1.32, p = 0.0053) in patients aged between 20 and 65, and delayed SCC in patients without underlying comorbidities (HR: 0.90, 95% CI: 0.81─0.98, p = 0.0237). Isoniazid mono-resistant TB had a comparable outcome with drug-susceptible TB at the end of the intensive phase. Healthy, and non-elderly patients were more likely to had culture persistence, raising concerns about disease transmission in these subgroups and warranting early molecular testing for isoniazid resistance.

Newly synthesized chitosan-stevioside-TPGS nanoparticles (CSdNPs) attenuate the effects of high doses of free stevioside in male rats via inhibition of PRAP-α gene expression

This study investigated newly synthesized of chitosan-St-TPGS-NPs and chitosan-Sd-TPGS-NPs (CStNPs and CSdNPs) produced by a combination of sonication and emulsification/solvent evaporation method and in combination with the ionic gelation method with slight modifications. The newly synthesized CStNPs and CSdNPs were characterized by several technical methods such as SEM, TEM and FT-IR. In this study, 60 male Wistar rats were divided randomly into six groups. Each group included 10 animals with control group, stevia group (St), stevioside group (Sd), CNPs group, chitosan-stevia-TPGS nanoparticles (CStNPs) group, chitosan-stevioside-TPGS nanoparticles (CSdNPs) group. All the groups received their daily dosages orally for two months. After the end of the experiment, a blood sample was collected for estimation of the liver enzyme concentration (ALT, AST, ALP, and TSB), lipids profile (TC, TG, LDL-C, VLDL-C, and HDL-C), hematological parameters (RBCs, WBCs, Hb, and PCV, also FAS, FBG, and TyG index). Analysis was performed to assess the average change (AFC) in PPAR-α gene expression in all study groups. The results suggested that there is a significant difference in FAS (pg/mL) levels between the control group (494.2 ± 15.8) and the St or free Sd groups at the end of 2nd month (511.6 ± 16.2, and 561.7 ± 17.2), respectively. In addition the highly significant differences were registered between the Sd group in comparison with CNPs, CStNPs, and CSdNPs groups at the end of the experiment. On the other hand, the results of this study suggested that there is a significant difference in AFC between the control group (5.86 ± 0.58) and St or free Sd groups at the end of the 2nd month (3.00 ± 0.22, and 1.86 ± 0.12), respectively. In addition, highly significant differences were found between the Sd group (1.86 ± 0.12) and the CNPs, CStNPs, and CSdNPs groups at the end of the experiment (4.98 ± 0.25, 3.91 ± 0.24, and 4.02 ± 0.45). This study concluded that St and in large form Sd have harmful effects on the male liver of male rats. The newly synthesized (CStNPs and CSdNPs) should attenuate the risk of St and Sd via the activation of PPAR-α gene expression and inhibition of FAS.

The Therapy Based on Traditional Chinese Medicine for Otolithiasis

Background: Otolithiasis (also named benign paroxysmal positional vertigo, BPPV) is one of the most common illness for hospital visits. Residual dizziness and recurrence after reduction are problems for the treating BPPV with Western medicine. Traditional Chinese medicine (TCM) has shown obvious superiority in the treating BPPV. Here, we explore the curative effect of the theory of dizziness of TCM in treating BPPV. Methods: 183 BPPV patients were randomly divided into 3 groups: Reset group (RG) 61 cases, Traditional Chinese Medicine group (TG) 61 cases, and Reset plus Traditional Chinese medicine group (R+TG) 61 cases. RG received machine reset. TG was given the therapy based on the theory of dizziness of TCM. R+TG received machine reset plus the therapy of TCM. All patients, before and on 1th day, 7th day, and 14th day of treatment, were evaluated with the dizziness handicap inventory (DHI) for the physical (P), functional (F) and emotional (E) state. The efficacy of the different therapy in the treatment of mild, moderate, and severe BPPV has been observed. Follow up for 6 months, we record and compare the ratio of patients with residual dizziness and the recurrence of BPPV for the three groups. Serum levels of vitamin D, estrogen, and calcium and phosphorus ions were detected and compared between the groups of BPPV patients, dizziness non-BPPV patients, and non-dizziness patients. Results: The DHI score of the three groups, compared with which before treatment, RG (p < 0.05), TG (p < 0.01), and R+TG (p < 0.01), decreased significantly on the 7th day of treatment; R+TG decreased more significantly than RG (p < 0.05). The DHI scores of the three groups, on the 14th day of treatment, were significantly lower than those before treatment (p < 0.01). On the 7th day of treatment, compared with the same period of RG, the score of item E of TG and R+TG, decreased significantly (p < 0.05). Patients of mild BPPV responded well to the three kinds of the therapy; For the patients of moderate BPPV, on the 7th day of treatment, assessed by DHI, the effect showed significant improve for RG (p < 0.05), TG (p < 0.01) and R+TG (p < 0.01). For the patients of severe BPPV, on the 7th day of treatment, the effect of RG, assessed with DHI, showed no improvement (p > 0.05), while TG (p < 0.05) and RG+TG (p < 0.01) showed effective. The incidence of residual dizziness between the three groups show significantly different on the 2nd week (x2 = 7.635, p = 0.022) and the 1th month (x2 = 7.502, p = 0.023) of treatment; The incidence of RG was higher than those of TG and R+TG. The recurrence rates of BPPV of the three groups were significantly different on the end of 2nd month (x2 = 8.528, p = 0.014), 4th month (x2 = 13.287, p = 0.001), and 6th month (x2 = 12.587, p = 0.002) of treatment. The recurrence rates of TG and R+TG were lower than that of RG. There was no significant difference in recurrence rate and residual dizziness occurrence rate between TG and R+TG. There were differences in serum vitamin D and estrogen levels between the group of BPPV patients, dizziness non-BPPV patients, and non-dizziness patients; There was no difference in calcium and phosphorus ion levels between the three groups. Conclusions: Compared with therapy of RG, TG and R+TG showed more effective in treating BPPV; They can significantly improve patient's bad mood, reduce the proportion of residual dizziness, and reduce the recurrence rate. TCM and TCM plus reset have better efficacy in treating moderate and severe BPPV. The specificity of abnormal changes in serum vitamin D and estrogen for BPPV patients needs be further study.

Assessment of the Antibacterial Effect of Vitamin D3 against Red Complex Periodontal Pathogens: A Microbiological Assay.

The study aims is to evaluate the antibacterial effect of vitamin D3 against the red complex bacteria, Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia in chronic periodontitis patients. The study comprised 98 participants with chronic periodontitis. All clinical parameters including plaque index (PI), gingival bleeding index (GBI), probing pocket depth (PPD), clinical attachment level (CAL), and a microbiological assay of P. gingivalis, T. denticola, T. forsythia were assessed at the baseline. All study participants who underwent scaling and root planning were divided into two groups, A and B, each with 49 patients and only group B patients were advised to take vitamin D supplementation of 60,000 IU granules, once daily for 2 months. All the patients of both the groups were recalled at the end of 2nd month and all the clinical and microbiological parameters were reassessed. After two months, there was a reduction in all the clinical markers in both groups, but the group B patients showed more improvement following non-surgical treatment vitamin D intake. There was also a statistical reduction in P. gingivalis, T. denticola, and T. forsythia following administration of vitamin D in group B patients compared to group A. These discoveries proposed that vitamin D has a superb antimicrobial impact against red complex periodontal microbes and might be considered a promising compound in the counteraction of periodontal disease. Vitamin D is considered to possess anti-inflammatory and antimicrobial activity, which may help to delay the progression of periodontitis. So, vitamin D3 can be used as a potential supplement that could be employed to stop the advancement of periodontal disease. How to cite this article: Govindharajulu R, Syed NK, Sukumaran B, et al. Assessment of the Antibacterial Effect of Vitamin D3 against Red Complex Periodontal Pathogens: A Microbiological Assay. J Contemp Dent Pract 2024;25(2):114-117.

Prostatic Abscess Due to Idiopathic Granulomatous Disease: A Rare Complication of a Chameleon Disorder <br/>—Prostatic Abscess Due to Idiopathic Granulomatous Disease

Background: Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis (GP). Four cases of idiopathic xanthogranulomatous GP have been described previously and the present case report is the first of typical idiopathic variety. The case: A 60-year-old man presented with urine retention that was associated with pyuria and massively enlarged prostate. Cystoscopy revealed prostatic abscess (PA) that was opened. Urine and prostatic culture were negative for bacteria. Prostatic biopsy revealed multiple non-caseating granulomata surrounded by lymphocytes, plasma cells yet without foamy histiocytes, parasites and vasculitis. Special stains were negative for vasculitis, fungiand acid-fast organisms. The patient was treated with Solumedrol 1 g intravenously daily for 3 days followed by Prednisone 1 mg/kg/day for 1 month followed by gradual tapering till discontinuation by 3rd month. Moreover, he had received Mycophenolate mofetil (MMF) 1 g twice/daily. By the end of 2nd month; he was asymptomatic and without pyuria. Repeat cystourethroscopy and MRI scan of the prostate showed near normal prostate. In Conclusion: Idiopathic GP can present with PA that requires proper drainage and since it is a locally hyperimmune disease with genetic predisposition; MMF therapy will be maintained for a total of 2 years to prevent future disease-relapse.

A comparative study to evaluate the postoperative results between tympanoplasty alone and tympanoplasty with cortical mastoidectomy in chronic suppurative otitis media

<div class="WordSection1"><div class="WordSection1"><p class="keywords"><strong>Background:</strong> Chronic suppurative otitis media (CSOM) is a common ear disease presenting to the ENT OPD. It’s the most common cause of hearing dysfunction in our country. Most of these cases requires surgery but still controversial. In the surgical management of CSOM even well experienced otologist have the dilemma whether to combine mastoidectomy with tympanoplasty or not. Objectives of the study was to study and evaluate whether the additional mastoidectomy procedure helps in the outcome in the surgical treatment of CSOM in terms of graft uptake, perforation closure, improvement in hearing, disease eradication and recurrence.</p><p class="keywords"><strong>Methods:</strong> The 40 patients of age group 12 to 65 years diagnosed with CSOM of tubotympanic type in inactive or quiescent stage was taken as study group. Tympanoplasty alone was done in 20 cases and tympanoplasty with cortical mastoidectomy was done in 20 cases. Hearing gain following surgery and factors influencing the outcome were measured. Study done was prospective comparative study.</p><p class="keywords"><strong>Results:</strong> Graft uptake was seen in 17 cases (85%) in tympanoplasty alone group and 15 cases (75%) in Tymapanomastoidectomy group at the end of 2nd month. Graft uptake was found to be same in terms of significance in both groups. Post-operative hearing gain was observed in 75% of patients in each group</p><p class="keywords"><strong>Conclusions:</strong> Hearing improvement, graft uptake were statistically incomparable in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain, graft uptake and disease eradication if the middle ear mucosa is healthy.</p></div></div>

Is Posterior Nasal Nerve Neurectomy Really a Ray of Hope for the Patients of Allergic Rhinitis.

Allergic rhinitis significantly affects the quality of life, it contributes to missed or unproductive time at school or work, disturbed sleep pattern and day time somnolence. Rhinitis is defined clinically as having two or more symptoms of anterior or posterior rhinorrhoea, sneezing, nasal blockage and/or itching of the nose during two or more consecutive days for more than 1 h on most days (International rhinitis management working group, 1994). Allergic rhinitis is diagnosed when these symptoms are caused by allergen exposure leading to an IgE mediated reaction. Nerve irritation causes sneezing and itching, the loss of mucosal integrity causes causes rhinorrhoea and the vascular engrogment leads to nasal blockage. Medical modalities are symptomatically effective in mild cases, with temporary relief and addressable adverse effects. Prolonged treatment with allergy immunotherapy causes a sustainable financial burden while remaining inaccessible at smaller towns. Posterior nasal nerve neurectomy is short, easy and effective alternative. The basic procedure is to selectively cut nerve bundles at the level of the sphenopalatine foramen (SPF) with a trans nasal approach. By denervating the nasal mucosa one renders it unresponsive to any sorts of allergen or allergic reaction. The aim of the study was to evaluate the outcome of posterior nasal nerve neurectomy in cases of severe allergic rhinitis by assessing its impact on the total nasal symptom score. The study is a hospital based prospective study, conducted on 15 patients who presented to the ENT department of Mahatma Gandhi Hospital from march 2021 to October 2021 (6months) suffering from allergic rhinitis and did not show any satisfactory improvement even after 1year of medical treatment. Adult patients in the age group of 20-45 yrs. diagnosed with allergic rhinitis were enrolled into the study after obtaining a due written consent. These included patients having 2 or more symptoms of allergic rhinitis and refractoriness to medical therapy for > 1year along with significantly affected quality of life and elevated IgE level. Patients with drug induced & hormonal causes of rhinitis, chronic rhinosinusitis and any anatomical feature which precipitates to rhinitis such as deviated nasal septum, hypertrophied turbinates, blocked osteomeatal unit, polypoidal nasal mucosa and sinonasal polyposis were excluded from the study. During our study period from march 2021-September 2021, 15 patients were enrolled in the study. All the patients were followed up at 2nd and 6th month postoperatively. Amongst these patients, there were 11 females (73.34%) and 4 were male (26.67%)The mean age of patients was 35.2years. Subjective nasal symptoms of all 15 patients improved over the period of 6months. The mean TNSS improved from 12.067 preoperatively to 8.66 at the end of 2nd month, i.e., 23.1% improvement. By the end of the 6th postoperative month there was a consistent reduction in the tnss, which further reduced to a mean of 3.4 (70.2% reduction) indicating a further improvement in symptoms with time. With the advancement & popularity of endoscopic sinus surgery in the past decade, endoscopic resection of the posterior nasal nerve is emerging as a safe and less invasive technique with long standing results. Medical treatment usually provides mild and symptomatic relief with long duration of treatment period. Thus, PNN is safer, economical & easier alternative to current trend of treatment of allergic rhinitis, proving to be highly efficient in cases of intractable allergic rhinitis.

English

BACKGROUND Sputum smear conversion is the negative conversion of the sputum smear at the end of the second month of treatment regimen under the National Tuberculosis Elimination Program (NTEP). When the acid-fast bacillus (AFB) smear comes negative at the end of an intensive phase, the treatment regimen can shift to the continuation phase that indicates bacillary load is a minimum. Although some authors consider the conversion of cultures when the AFB smear is negative, two potent drugs in the continuation phase are sufficient to kill the remaining bacilli. The drug that can kill bacteria in the first 2 days of treatment is called early bactericidal activity (EBA). This can be assessed by the percentage of negative conversion of cultures at the end of the intensive phase of the treatment regimen. EBA is very essential because it reduces the transmission in the community and chances of patient death. When the purpose is to kill as many bacilli as possible in the first few days and weeks of treatment, it is very important to include bactericidal drugs in the treatment regimen so that it reduces the chances of patient death and infectiousness and the negative conversion of the cultures after 2-month treatment regimen is an indication of the bactericidal capacity of the drug. The purpose of this study was to compare sputum smear conversion in daily versus intermittent treatment regimens in diagnosed cases of new sputum smear-positive pulmonary tuberculosis patients. METHODS This retrospective observational study was carried out in the Department of Respiratory medicine and nodal drug resistance tuberculosis centre (DR-TB) at the Government medical college and hospital, Akola. In this study, a total of 120 new patients were taken. 60 patients were given daily and intermittent regimens respectively under NTEP. RESULTS Out of 120 patients, 56 (93.33 %) patients in intermittent and 53 (88.33 %) patients in daily regimen were sputum smear-negative at the end of 2nd month (intensive phase) and at the end of 6th month (continuation phase). 1 patient (1.6 %) remained sputum smear-positive after the intensive phase. That patient was given 1 month of extension of anti-tuberculosis treatment (AKT) in the intensive phase and the patient became sputum negative after 1 month of extension. CONCLUSIONS It was concluded in this study, daily regimens and intermittent regimens were equally effective in negative conversion of the sputum smear at the end of the intensive phase and the end of the continuation phase. Negative conversion of the sputum smear is quite important because the bacillary load will be so low at the end of 2nd month that reduces the chances of patient death and transmission in the community. KEY WORDS Pulmonary Tuberculosis (PTB), Drug-Resistant TB (DR-TB), National Tuberculosis Programme (NTP), Revised National TB Control Program (RNTCP), Intensive Phase (IP), continuation Phase (CP), National Tuberculosis Elimination Program (NTEP).

Balloon dilatation of cicatricial bladder neck contracture: evaluation of the efficacy after transurethral prostate interventions (preliminary results)

Introduction. Cicatricial bladder neck contracture (CBNC) is one of the most common complications after endoscopic prostate procedures. There is no consensus among urologists about which method is advisable to use in the treatment of postoperative CBNC — transurethral resection (TUR) or incision. In this regard, the study of balloon dilation is a promising alternative. Purpose of the study . To improve the results of balloon dilation in patients with CBNC after endoscopic surgery for BPH. Materials and methods. The study involved 34 patients with recurrent CBNC after TUR and laser enucleation. The patients were divided into 2 groups: group A (n = 16) included men who, after bladder neck's TUR, additionally underwent transurethral balloon dilatation, while control group B (n = 18) included men who were prescribed conservative therapy only using alpha-blockers. Results. 2 months after the bladder neck's TURP and 1 month after balloon dilatation in group A, the mean IPSS score was 14.2 ± 2.1, QoL was 2.9 ± 0.9, while in group B it was at the end of 2nd month after the bladder neck's TURP, these indicators were 16.2 ± 3.1 and 3.9 ± 0.8 points, respectively (p <0.05). The average maximum urine flow rate in group A was 15.8 ± 2.8 ml/sec, in group B was 11.6 ± 2.8 ml/sec (p <0.05). Also, a significant decrease in the residual urine volume was revealed from 43.4 ± 34.4 to 27.8 ± 12.5 ml in group A, while in group B this indicator decreased from 49.1 ± 30.2 to 30.2 ± 11.7 ml. Conclusions. The method of transurethral balloon dilatation in case of CBNC under TRUS control using local anaesthesia only avoids gross trauma to the urethra and bladder neck with a cystoscope or mechanical dilatator. It helps to reduce the likelihood and severity of complications of this treatment method.

A prospective, interventional clinical study to evaluate the safety and efficacy of Liv.52 DS in the management of non-alcoholic fatty liver disease

Introduction. Non-alcoholic fatty liver disease (NAFLD) is excessive fat build-up in the liver due to causes other than alcohol use. Aim. To evaluate the clinical efficacy and safety of Liv.52 DS tablets in the management of NAFLD. Material and methods. Prospective, interventional clinical study conducted on 60 patients of both sex, aged between 18-65 years, confirmed with NAFLD from clinical examination, laboratory test, ultrasound findings and those willing to give informed consent. All patients received Liv.52 DS at a dose of 2 tablets twice daily for 2 months. All patients were evaluated at baseline, end of 1st month, and end of 2nd month for liver function tests, hepatomegaly by ultrasound, NAFLD Fibrosis Score, lipid profile, hematology and biochemical investigations. Results. Study data was analyzed with GraphPad Prism Software Version 6.07. Data of those patients who completed the study was considered for analysis. Significant improvement in hepatomegaly, liver enzymes was observed. NAFLD fibrosis score revealed no progression of liver fibrosis due to NAFLD during the study period. No abnormal lab values were recorded and there were no adverse events reported during the study. Conclusion. Study concludes that Liv.52 DS is safe and beneficial in individuals suffering from NAFLD.

The importance of early and late ventricular arrhythmias detection and prediction in acute myocardial infarction

Abstract Background Malignant arrhythmias, ventricular tachycardia or ventricular fibrillation (VT/VF) in acute myocardial infarction (AIM) carry ominous prognosis including sudden cardiac death (SCD). It is not clear whether the timing of VT/VF occurrence always affects the poor prognosis of patients with AMI. Aim To investigate the prognosis of patients who undergoing primary percutaneous coronary intervention (PCI) in accordance with timing of VT/VF and to find the power predictors of their occurrence. Methods 307 consecutive patients in PREDICT-VT study (NCT03263949), 57.9±10.6 year old, 72.3% males were analysed. Of these patients, 27.7% had VT/VF from the symptoms onset, within 48 hours of AIM (early VT/VF group). 8.1% of patients had VT/VF after 48h, during one year follow up (late VT/VF group). Results The frequency of VT/VF occurrence was high between symptoms onset and the end of 2nd month and during 5th and 6th month of AIM. The parameters of conventional echocardiography were significantly impaired in late VT/VF group, as well as parameters of longitudinal strain (LS) (table). Moreover, the MACE (cardiovascular mortality, SCD, new infarction, emergency revascularisation, and hospitalized heart failure) was the highest in late VT/VF group (p=0.000). The most significant predictor of late VT/VF was systolic LS (cut off −12.72%, ROC 0.680, Sen 71%, Sp 64%, p=0.006). Conclusions Although late VT/VF occurrence after primary PCI were less frequent than early VT/VF occurrence, patients with late VT/VF had a very poor prognosis. The most power predictor of late VT/VF were systolic longitudinal strain. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Clinical Center of Serbia

Changes in the Quality of Black Mulberry and Blueberry Sherbets During Storage

This study was evaluated the quality properties of traditional drink sherbets that are prepared from black mulberry and blueberry fruits. After production sherbets were investigated to determine their pH, acidity, °brix and colour values, total sugar, phenolic, anthocyanin and antioxidant contents. Moreover the sherbets stored at 4°C during 2 months and the changes in these quality properties were examined per month. As a result statistically significant changes were observed in the quality properties of these sherbets of black mulberry and blueberry fruits which are known with their rich content of phytochemical compounds. The results show that in blueberry sherbet the degradation of phenolics was faster than black mulberry sherbet. Anthocyanins that are higher in black mulberry sherbets after production were preserved better in blueberry sherbets at the end of 2nd month. L*and a* values decreased for blackberry and blueberry sherbets during storage. b* value decreased from 5.59 to 4.92 for blackberry sherbet while it increased from 0.62 to 0.79 for blueberry sherbet at the end of the storage time.

Prevalence of Treatment Failure among Pulmonary Tuberculosis Patients in a Tertiary Care Teaching Hospital

1.1.Background:Failure of anti tuberculosis treatment can lead to some serious and unwanted consequences. This study aimed to determine the prevalence of treatment failure among patients diagnosed with pulmonary tuberculosis at Mufti Mahmood Memorial Teaching Hospital Dera Ismail Khan Pakistan. 1.2.Materials and methods:Consecutive patients of smear positive PTB, managed between February 2011 to October 2013 at the directly observed therapy (Tuberculosis) unit of Mufti Mahmood Memorial Teaching Hospital Dera Ismail Khan Pakistan were enrolled for the study. Each patient was required to have a sputum specimen collected and examined for the presence of acid fast bacilli (AFB). This was done at the time of enrolment into the study and at the end of 2nd (in category I cases only), 3rd (in category II cases only) and at the end 5th and 7th month of anti-tuberculosis treatment. 1.3.Results:144 patients were recruited and 20 were lost to follow up or had transferred out. 124 patients consisting of 53 (42.74%) males and 71 (57.26%) females aged 14-85 years completed the study. Ninety three (75%) of the patients were New (category I) at the time of enrolment while 31 (25%) were Retreatment cases (category II). Among 124 smear positive patients at baseline, 22 (17.74%) out of 93 were sputum smear positive at the end of 2nd month, 2 (2.15%) patients at were sputum smear positive at the end of 5th and 7th month respectively in category-1 patients, and 10 (32.26%) out of 31 patients from category 2 had been sputum positive at the end of3rd month of treatment and 4 (12.90%) patients remained positive at the end of 5th and 7th month of treatment respectively. 1.4.Conclusion:Prevalence of treatment failure was significant in our study (4.84%) and it demonstrated a requirement of vigilance on part of health personnel because drug resistant tuberculosis, if untreated, poses a threat to all contacts of patients with tuberculosis.

Isolated Bilateral Traumatic Patellar Fracture: A Case Report

Background: Patellar fracture accounts for approximately 1% of all skeletal fractures. Bilateral fracture of the patella is even rarer, comprising less than 3% of all patellar injuries. Case Description: A 28 year old man presented with bilateral patellar fracture after car accident and direct dashboard injury while driving, with superficial abrasion on both fracture sites. Mentioned fracture had transverse fracture pattern which was fixed with two Kirschner wire following tension band principle. Our patient was able to squat, sit in crossed leg position and perform his household activities by the end of 2nd month. He regained his full strength and ability to perform normal daily activities by the end of 6th months, without any post-operative complaints. Discussion: A case of bilateral patellar fracture as a consequence of dashboard injury is presented and pathomechanical and operative management and follow up of such injuries is discussed.

A study of sputum conversion in new smear positive pulmonary tuberculosis cases at the monthly intervals of 1 st , 2 nd &amp; 3 rd month under directly observed treatment, short course (dots) regimen

Aims and Objectives:To determine sputum conversion rate at monthly intervals of 1st, 2nd and 3rd month in new smear positive cases (cat-1) under treatment under RNTCP.Material and Methods:The study was conducted at DOTS Center, Gauhati Medical College and Hospital; Guwahati between July 2005 to June 2006.The study is a prospective study and consists of 100 cases of new smear positive pulmonary tuberculosis cases (category 1) irrespective of age and sex.Results and Observations:The age & sex distribution of 100 patients showed that majority of the patients (74%) belonged to 2nd, 3rd and 4th decades & 75% were males and 25% were female with male to female ratio 3:1 respectively. The chest x-ray of 100 Smear Positive patients shows that only 60 (60%) patients had x-ray evidence of pulmonary Koch. In the present study, sputum conversion i.e. from smear positive to smear negative at the end of the 1st month is 71%, at the end of 2nd month is 84% and at the end of 3rd month is 92%.Summary & Conclusion:In conclusion, the overall sputum conversion rate under Directly Observed Treatment, Short Course (DOTS) chemotherapy in 100 sputum smear positive Pulmonary Tuberculosis in DOTS centre, Gauhati Medical College & Hospital was 92%.The chest x-ray evidence of pulmonary Koch in 100 patients is 60%.The sputum conversion at the end of 1st month is 71%, at the end of 2nd month it is 84% and at the end of 3rd month the same is 92%. In the present study, the infectivity decreases from the baseline with significant P value for sputum conversion of 3+, 2+ and 1+ sputum positivity. Directly Observed Treatment is an effective intervention for improving adherence to tuberculosis treatment programme in a resource-poor country. A significant decrease in conversion rate was observed with the initial high grade smear positive cases.More Prospective studies on larger number of patients are necessary to sub-stantiate our findings in this study.