Months Of Intensive Phase Research Articles

Awareness, perception, and utilization of the benefits of recently introduced health schemes among the general population of India: A narrative review

Several health schemes have been introduced by the Government of India in recent years. It becomes essential to know the usefulness of these schemes. This narrative review was done to discuss the awareness, perception, and utilisation of the benefits of recent health schemes. Four schemes either introduced or revised between January 2016 and December 2021 namely AB PM-JAY, PMBJP, NPY, and PMSMA were discussed. Thirteen original articles related to these schemes fulfilling inclusion/exclusion criteria were identified using Web of Science, Scopus, Google Scholar, Embase, and PubMed databases.
 
 Awareness about AB PM-JAY was absent among 22.7% to 77% participants. The prerequisites for beneficiaries like non-payment of professional tax and non-ownership of certain household equipment were responsible for missing the benefits among some poor participants. About one-fourth of the participants reported poor awareness and attitude towards PMBJP. To support PMBJP, people wanted doctors to take the initiative by endorsing and prescribing generic medicines available under this scheme. Awareness about NPY was absent among 8.5% participants. As many as 21.5% to 71.5% of tuberculosis patients did not receive its benefits. Only 7.3% to 52.6% of the tuberculosis patients received the first incentive within two months of intensive phase. Common problems reported were unavailability of savings bank account or Aadhaar number, particularly among those from rural areas. About one-fourth of patients utilised the money to meet their family expenses. Hardly 5% were aware of PMSMA and among them just 32% had utilised antenatal care services. Counselling services were not offered to some beneficiaries. Few shortcomings in these health schemes were identified which need to be addressed by the stakeholders.

Description of Uric Acid Levels and Blood Pressure In Pulmonary Tuberculosis Patients Consuming Anti Tuberculosis Drug (ATD) in the Working Area of Sakra Public Health Center

Background: Anti-tuberculosis (ATD) used is the standard blend of INH, PAS and streptomycin for one to two years. The amino salylic (pas) acids are then replaced with pirazinacids. Pirazinbacteria is a drug that can cause increased levels of uric acid in the body (hyacinth). Hiperurisemia is the state of concentration of the veins in the plasma or the serum has exceeded the limit of the monosodium ligament of 7.0 milligrams /dl. Hyperuricemia is also cited as an important risk factor for hypertension and other cardiovascular diseases. Research purposes: For details of uric acid and blood pressure on lung tuberculosis patients who use antituberculosis (oats) in the region of the sakra hospital. Research methods: The kind of research used I s a descriptive observation study with a sectional design, a study in which dependent and independent variables are done and measured simultaneously. The sample retrieval technique on this study USES a total sample using the criteria the researchers have chosen in selecting a sample. Research: Average uric acid and blood pressure in lung tuberculosis patients who consume single-month intensive drugs (ATD) are 7,8 mg/dl and 121/75 mmHg. Average levels of uric acid and blood pressure in lung tuberculosis patients who use 2 months of intensive phase (ATD) are 9,1 mg/dl and 129/78 mmHg. Conclusion: There are high levels of uric acid and blood pressure in those with lung TB who take anti-tuberculosis drugs (ATD).

Adverse Drug Reactions to a Daily Fixed-dose Combination Based Antituberculosis Treatment Regime in India’s National Tuberculosis Elimination Programme: A Prospective Cohort Study

Introduction: In India, the daily weight-based, Fixed Dose Combination (FDC) Antituberculosis Treatment (ATT) regime under the National Tuberculosis Elimination Programme (NTEP) was introduced, replacing the previous intermittent regime with the aim of improving compliance, decreasing Adverse Drug Reactions (ADRs) and thus ultimately translating to improved treatment outcomes. The ADRs are an important factor that can adversely impact the treatment compliance and outcomes of an ATT regime. There is currently a paucity of studies reflecting the development of ADRs in the Indian population to the new ATT regime. Aim: To study the ADRs of daily FDC-based first-line ATT regime under NTEP. Materials and Methods: A prospective cohort analysis was conducted in the Department of Respiratory Medicine at Indira Gandhi Government Medical College (tertiary care centre), Nagpur, Maharashtra, India, from January 2019 to September 2020. Total 750 People With Tuberculosis (PWTB) were enrolled in the study. They were administered a standardised daily FDC first-line ATT regime under NTEP comprising of initial two months of intensive phase with Isoniazid (INH or H), Rifampicin (R), Ethambutol (E), and Pyrazinamide (Z) followed by a continuation phase of four months with INH, rifampicin, and ethambutol (2EHRZ/4HRE). Clinical evaluation and/or laboratory investigations were used at baseline and when clinically indicated during therapy to identify treatmentrelated adverse events. Results: Among the 750 PWTB, 402 (53.60%) were females, and 348 (46.40%) were males. The mean age of PWTB was 36.46±15.6 years. The ADR to ATT was present in 271 (36.13%) PWTB, 217 (80.07%) were managed on an Outpatient Department (OPD) basis and 54 (19.93%) patients required hospitalisation. Causality assessment revealed that most ADRs were probable (81.18%), followed by possible (18.82%). Regarding the severity of ADRs, 87.08% were mild, 11.44% were moderate, 1.48% were severe, and none of the ADRs was life-threatening. In 67.9% of PWTB, gastrointestinal ADRs were seen, followed by joint pain (37.64%) and cutaneous drug reactions (16.60%). Female PWTB, People Living with Human Immunodeficiency Virus & Tuberculosis (PLHIV-TB), and PWTB with systemic co-morbidities, especially diabetes and systemic hypertension, were at a higher risk of developing ADRs. The risk of ADRs was unaltered with age distribution, body mass index distribution, type of diet, the type of tuberculosis, or the pill burden. Addiction to alcohol and tobacco did not significantly alter the risk of ADRs. Conclusion: The ADRs caused by daily FDC-based ATT are common, but most are mild and can be managed on an OPD basis. Gastrointestinal ADRs, arthralgia, and cutaneous drug reactions are the most common ADRs of the daily FDC-based ATT regime. Female PWTB, PLHIV-TB, and PWTB with systemic co-morbidities, especially diabetes and systemic hypertension, being at a high risk of developing ADRs, need to be actively screened for ADRs during treatment.

Tuberculosis: Development of New Drugs and Treatment Regimens

Tuberculosis (TB) still becomes a public health crisis. Drug-resistant TB (DR-TB) becomes a concern as the increasing DR-TB cases in countries with high TB burden. The 2017 World Health Organization (WHO) guideline recommended a combination of TB treatment consisting of 2 months of intensive phase with isoniazid (H), rifampisin (R), pyrazinamid (Z), and ethambutol (E), followed by 4 months of continuation phase with HR daily. WHO has updated DR-TB treatment guidelines several times. In 2016, WHO recommended shorter regimen and individual regimen based on certain conditions. The most updated 2020 WHO guideline recommended the short regimen consisting of all oral drugs as well as changes in the grouping of medicines used in DR-TB regimens in longer/individual regimens. Bedaquiline, delamanid, pretomanid, and sutezolid are new drugs which have been studied for their uses as anti-TB drugs (ATD). Bedaquilin and delamanid, which have passed phase 3 trials, have been approved and recommended by WHO for DR-TB treatment. Repurposed drugs have been used for DR-TB treatment during the time of evaluation of drugs list and regimens for DR-TB treatment. Fluoroquinolones, clofazimine, linezolid, carbapenem, amoxicillin/clavulanic acid are repurposed drugs. TB and DR-TB management will be updated at any time, based on the latest findings in studies, to evaluate and improve the effectiveness of current treatments. Prevention of active TB disease by the treatment of latent TB infection (LTBI) is also a critical component of the end TB strategy by WHO. Therefore, the development of new drugs for the LTBI treatment is also needed.

Predictors of smear non-conversion among new-treatment pulmonary tuberculosis: a single center case-control study in Indonesia

BACKGROUND Previous studies concluded predictors of smear non-conversion pulmonary tuberculosis (TB) globally as well as in Indonesia. However, there is a limited data in hospital setting. This study aimed to explore predictors of smear non-conversion pulmonary TB in hospital setting.
 METHODS A case-control study was conducted to explore predictors of smear nonconversion among new-treatment pulmonary TB in Dr. Kariadi General Hospital from 2017 to 2019. Number of cases and controls have been determined consecutively. Data were collected from secondary data accessed in medical records and directly from subjects. Non-conversion status in the case group was defined as a persistent sputum smear-positive after 2 months of intensive phase of treatment. The subjects’ characteristics i.e., age, sex, BMI, education level, occupational status, and predictors of smear non-conversion, i.e., patient’s compliance, smoking status, alcohol consumption, presence of drugs side effects, health care access, first acid-fast bacilli (AFB) smear grading, diabetes mellitus (DM), housing condition, housing density, and household income were observed. Chi-square test and binary logistic regression were used.
 RESULTS 35 subjects were determined in the case group while 76 subjects were the control group and involved in the final analysis. Age, sex, first AFB smear grading, smoking status, housing condition, housing density, and DM were involved in the model of logistic regression. DM (OR = 3.4; 95% CI = 1.19–10.00) and first AFB smear grading (OR = 11.2; 95% CI = 3.86–33.00) were concluded as the predictors of smear nonconversion.
 CONCLUSIONS DM and first AFB smear grading were the predictors of smear nonconversion among new-treatment pulmonary TB subjects.

Comparative study of hematological parameters in newly diagnosed tuberculosis patient’s pre-att & after intensive phase of ATT

Introduction: Tuberculosis is a highly prevalent chronic infectious disease. TB exerts various hematologic effects & hematological abnormalities. Anti-Tuberculosis treatment has its own spectrum of effects on TB patients. This study aimed to study & compare various hematological parameters in newly diagnosed TB patients before ATT & to evaluate after the intensive phase ATT in same patient. Materials and Methods: A total of 40 newly diagnosed cases of TB were randomly selected. Under aseptic precautions, 2.5 ml of blood collected from patients in EDTA vacutainers & the following hematological parameters were analysed – HB%, TLC, DC, PC, MCV, MCHC, PCV and ESR. The same patients were put on 2 months of intensive phase of ATT. After completion of ATT, the hematological parameters of each patient were analysed. PreATT and after ATT the parameters were compared and analyzed with suitable statistics. Results: There was significant post treatment improvements in Hb%(Pre ATT-10g/dl & post ATT 11.8g/dl), RBC count (Pre ATT-4.8 millions/cumm & Post ATT-4.85 millions/cumm), PCV (Pre ATT-38% & Post ATT-40%), Total leucocyte count (Pre ATT-10,295cells/cumm & post ATT- 9,500 cells /cumm), Neutrophils (Pre-ATT-73% & post ATT-63%) and Lymphocytes (PRE-ATT - 20% & post ATT-30%) and ESR (PreATT 79mm/hr & post ATT 54mm/hr). The present study showed that, there was a significant statistical difference in HB%, TLC, DC, Platelets & ESR values. Conclusion: Hematological parameters can be a guide to assess the improvement of TB patients after ATT which indirectly speaks about the improvement in patients. Keywords: TB, ATT.

Changes of the pro-hormone levels of vitamin D 25(OH)D in patients with newly diagnosed pulmonary tuberculosis treatment failure

In Ukraine the number of patients with newly diagnosed tuberculosis (NDTB) who successfully complete the course of treatment reaches 60–65 % today. This is while the World Health Organization (WHO) criteria for successful treatment of this category of patients is 85 %. Scientists around the world are studying the possible pathogenetic factors of treatment failure of antimycobacterial therapy in patients with tuberculosis. Nowadays, the impact of vitamin D has been widely studied in this area. Studying of the dynamics of this indicator in patients with NDTB with widespread destructive tuberculosis in the lungs and bacterial excretion with the purpose of finding new markers of progression of a specific process and failure of treatment, as well as finding possible ways of additional pathogenetic therapy to accompany patients is actual. This approach will prevent treatment failure and, as a consequence, improve treatment efficiency.Purpose. To determine changes in the pro-hormone levels of vitamin D 25(OH)D in patients with NDTB treatment failure during the intensive phase of antimycobacterial therapy.Materials and methods. A prospective study involving 58 patients with NDTB lungs was performed. The patients were divided into 2 groups: 28 patients with pulmonary NDTB treatment failure were included in the 1st group (the main group), 30 patients, who subsequently successfully completed the course of treatment were included in the 2nd group (comparison group). The control group consisted of 29 healthy volunteer-donors. All the patients had been in inpatient treatment in Communal Institution “Zaporizhzhia Regional TB Clinical dispensary” during 2017–2019 years. Scientific medical-laboratory center of Zaporizhzhia State Medical University researched changes of the level of 25(OH)D in the blood serum by method of enzyme linked immunosorbent assay using immunoassay analyser Sirio S with “DIAsource ImmunoAssays S.A.” kit (Belgium) (ng/ml). Blood sampling was made after an overnight fast. Blood was collected uniformly throughout the year in all patients and volunteers to avoid the effect of seasonal variability in vitamin D in the blood.Results. While healthy volunteers have a reduction in the level of pro-hormone 25(OH)D only in 51.7 % of cases (deficiency in 13.8 % and insufficiency in 37.9 %), patients with NDTB with generalized specific process in the lungs, the presence of destruction of over 3 cm in diameter and bacterial excretion at the beginning of intensive phase of antimycobacterial therapy (0 doses), have its decrease in 96.5 % (81 % deficiency and 15.5 % insufficiency). 1/3 of patients (35.7 % at the 0th dose and 32.1 % at the 90th dose) with tuberculosis treatment failure have pro-hormone levels 25(OH)D less than 7 ng/ml, whereas in patients who successfully completed the course of treatment, this concentration of pro-hormone 25(OH)D was not even diagnosed. In the dynamics, after 3 months of intensive phase of antimycobacterial therapy (90 doses) in patients with NDTB treatment failure the levels of pro-hormone 25(OH)D continue to decrease significantly by 1.3 times relative to the initial values, which is 1.4 times lower than in patients who successfully completed the course of treatment.Conclusions. In the vast majority of patients with NDTB of lungs with a risk of ineffective treatment, a pronounced deficiency of vitamin D (1/3 patients with pro-hormone levels 25(OH)D less than 7 ng/ml) is determined at the beginning of treatment, and after 3 months of the intensive phase of antimycobacterial chemotherapy exacerbates vitamin D deficiency. Therefore, this indicator can be used as a prognostic for the tuberculosis treatment failure and reducing the level of pro-hormone 25(OH)D in the dynamics require consideration of the problem of methods of its correction by the addition of vitamin D.

Sputum smear conversion rate of adult pulmonary tuberculosis patients under directly observed treatment shortcourse in Rajarajeswari Medical College and Hospital, Bangalore

Background: Tuberculosis is among the most important causes of death from a single infectious agent and a major public health problem causing an enormous burden of disease and economic impact especially in the developing countries. Pulmonary tuberculosis is the most common form of tuberculosis causing >85% of all tuberculosis cases. The smear conversion rate is an operational indicator for the directly observed treatment short course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP) in India.Methods: A longitudinal study was conducted in DMC, RRMCH, in the first two quarters of the year 2013 i.e., from January 1st to June 31st of the year 2013. All 130 adult category I (new) sputum smear positive cases that attended DMC, and registered under RNTCP constituted the sample for the study. Data was collected by interview method by using pre-tested, semi-structured questionnaire. Data was analyzed using SPSS version 20.0.Results: Majority of the study subjects was >50 years, Hindus, illiterates, belonged to nuclear family from rural area belonged to upper lower socio-economic class. The overall sputum smear conversion rate is 92.4%. Lower sputum smear conversion rate was observed in the following risk factors like the male gender, smoking, diabetes, initial high pre-treatment smear grading and poor drug compliance.Conclusions: The overall sputum conversion rate at the end of two months of intensive phase under (DOTS) chemotherapy in 118 sputum smear positive (cat I) new pulmonary tuberculosis patients in Designated Microscopy and Treatment Centre (DMC) Rajarajeswari Medical College and Hospital was 92.4%.

Effect of Anti-tuberculosis Drugs on Patients with Multi-drug Resistance Tuberculosis in Mainland Hospital Yaba, Lagos, Nigeria

Introduction: The occurrence of multi-drug resistance tuberculosis among tuberculosis patients has raised global public health concern, especially in Nigeria. The increase in the number of cases of resistance tuberculosis despite the effort and need to curb the menace in Nigeria led to this study. 
 Aim of the Study: The aim was to investigate the effect of anti-Tuberculosis drugs on patients with multi-drug resistance Tuberculosis in Mainland Hospital Yaba, Lagos.
 Materials and Methods: This was a cross-sectional descriptive study of the already confirmed multi-drug resistance tuberculosis patients at the Mainland Hospital Yaba, Lagos .One hundred self-structured interview questionnaires were randomly administered among already confirmed mult-drug resistance tuberculosis patients at the hospital to collect bio-data information, and thereafter, received second- line anti-Tuberculosis drugs in phases for 22 months.
 Results and Discussion: The patients received the following regimen of treatments based on their weights and ages, the selected regimens administered for 22 months comprised of two phases; first, 8 months of intensive phase of Kanamycin, levofloxacin, cycloserine, prothionamide,and pyrazinamide and second, 12 months of Levofloxacin, cycloserine, prothionamide and pyrazinamide. Post laboratory analysis was used to monitor the effectiveness of the second-line anti-Tuberculosis drugs used. Out of the 92 patients that received the drugs, 89(96.7%) were confirmed negative to multi-drug resistance tuberculosis, while 3(3.3%) were still positive.
 Conclusion: The anti-Tuberculosis drugs in the order used is highly recommended for the reduction if not total eradication of multi-drug resistance tuberculosis in Nigeria. Effort should be geared towards making sure that the multi-drug resistance tuberculosis patients are confined, proper regimen administered and monitored in order to reduce the rate of spread.

809. Osteitis Caused by Bacillus Calmette-Guerin Tokyo 172 Strain in Immunocompetent Patients

BackgroundImmunization with BCG vaccine has been associated with local and systemic complications. Osteitis secondary to Mycobacterium bovis-BCG is a rare complication with frequency of 0.1/100,000 doses. Below we report a series of a third level pediatric hospital in Mexico City.MethodsThis is a retrospective, descriptive, and observational study of subjects diagnosed with TB at the National Institute of Pediatrics (INP) in Mexico City during the 2010–2018 period. Subjects under 18 years with skeletal TB and positive culture for M. bovis-BCG strain were included.ResultsFrom 2010 to 2018, 118 cases of TB were treated, from which 3 (2.5%) were osteitis secondary to M. bovis-BCG Tokyo 172 strain, two male and one female. All three cases had BCG immunization at birth. The age at diagnosis was 1, 2, and 3 years, respectively. The most common symptoms were pain, edema, and limp. Sites of injury were right proximal tibia, epiphysis of left distal femur, and left ileopubic eminence. Lytic lesions with periosteal reaction were reported in plain radiographs of all cases. The TST and COMBE studies were negative. Diagnosis was confirmed by biopsy with identification of M. bovis-BCG Tokyo 172 strain by Genotype. All strains were sensitive to rifampicin. The treatment given was INH, RIF, E, PZA, and Clarithromycin during 2 months of intensive phase followed by 7 months of maintenance phase with INH-RIF. A surgical approach was performed with curettage and graft placement in two cases. Tetrazoil nitro blue tests and immunoglobulin levels were normal. Outcome was favorable in all three cases.ConclusionIn Mexico the BCG vaccine is part of the national immunization program and is applied to 99% of newborns. This work is the first report in Mexico of osteitis secondary to M. bovis-BCG strain Tokyo 172. We suggest considering the diagnosis in patients with osteitis under 5 years of age with a history of BCG vaccination.Disclosures All authors: No reported disclosures.

Change in body weight and treatment outcome in sputum positive pulmonary tuberculosis patients treated under directly observed treatment short-course

Background: Patients with tuberculosis often suffer from severe weight loss and is used as useful marker to predict TB treatment outcome. Hence a study was planned with an objective to determine the change of patient’s body weight over time throughout treatment and to determine whether there was any association with treatment outcome.Methods: This was a retrospective cohort study, planned to be conducted among all smear positive pulmonary tuberculosis patients registered in a Tuberculosis Unit of Pune corporation, during the period of January to December 2015. Body weights of patients were recorded from TB treatment cards at the time of diagnosis, after 2 months of intensive phase of treatment and at the end of treatment. Total 344 cases were enrolled. Chi-Square test and Fisher’s exact test and repeated measure ANOVA test was used for analysis.Results: A bad outcome was more likely among the category II cases as compared to category I, among non-adherent to treatment cases in continuation phase and higher sputum grading at the time of diagnosis i. e. in 3+ sputum smear grading. The weights of the patients at the time of diagnosis, at end of intensive phase and at end of treatment showed statistical significant difference (p<0.0001). The weight gain, more so at end of treatment was significantly associated with good outcome.Conclusions: Weight gain has prognostic significance in patients with tuberculosis and should be considered as a surrogate marker to monitor response to TB treatment especially in developing countries where extensive laboratory tests are not feasible.

Role of Anaemia and Magnesium Levels at the Initiation of Tuberculosis Therapy with Sputum Conversion among Pulmonary Tuberculosis Patients.

Both pulmonary Tuberculosis (TB) and anaemia are prevalent in India. Magnesium levels also influence TB. There is limited and inconsistent literature on the association among anaemia, serum magnesium levels and sputum conversion during tuberculosis treatment. To study the effect of anaemia and serum magnesium levels on sputum conversion in pulmonary TB patients. One hundred each of newly diagnosed sputum smear positive Pulmonary Tuberculosis (PTB), sputum smear negative PTB patients initiated on Directly Observed Treatment Short Course chemotherapy (DOTS) and healthy age and sex matched controls were recruited in the study. Patients were followed up prospectively until completion of first two months of intensive phase. Patients were evaluated before initiation of TB treatment by performing the complete blood counts with peripheral blood smear, serum biochemistry, serum iron, serum magnesium, serum ferritin and microscopic examination of sputum. After giving two months of Antitubercular Therapy (ATT), sputum smears were re-examined for presence of acid fast bacilli. Haemoglobin values less than 13 g/dl in males or 12 g/dl in females was defined as anaemia. Mean and Standard deviations were calculated. Independent t-test was used to compare between the groups. Serum iron and serum ferritin was significantly lower in sputum positive PTB as compared to sputum negative PTB and controls. Anaemia was present in 162 (81%) patients of the study PTB cases. About 60% of anaemia in sputum positive cases was iron deficiency anaemia. Serum magnesium level was significantly lower in sputum positive PTB as compared to sputum negative PTB and controls though not in hypomagnesemic range. Delayed sputum smear conversion occurred in 12 (12%) sputum positive PTB patients. Of these, eight had severe iron deficiency anaemia, four with moderate anaemia. All 12 delayed sputum smear conversion had serum magnesium levels < 1.7 mg/dl (below normal reference range) (mean 1.42 ±0.22 mg/dl). Sputum was found to be positive even after two months of ATT course because of baseline anaemia and lower levels of serum magnesium. Further multicentric studies are warranted to study mechanisms for TB associated anaemia and possible role of intervention for anaemia in TB patients. One needs to find out the mechanisms behind the role of anaemia and lower magnesium levels in delaying the sputum smear conversion in order to lay the foundation of effective interventions. Randomized controlled trials are warranted to generate higher levels of evidences to support our findings.

Assessment of serum calcium and phosphorus in pulmonary tuberculosis patients before, during and after chemotherapy.

Our study was aimed to assess the levels of serum calcium and phosphorus in pulmonary tuberculosis patients. Blood samples were collected from 40 patients with pulmonary tuberculosis before treatment (PTB-0), at the end of 2months of intensive phase of treatment (PTB-2) and after 6months of treatment (PTB-6). Age and weight matched normal healthy volunteers (n=37) served as normal controls. Serum was analyzed for calcium and phosphorus. Serum calcium significantly decreased to hypocalcemic levels and serum phosphorus significantly decreased but was within normophosphatemic limits in pulmonary tuberculosis. Chemotherapy for tuberculosis managed to raise serum levels of both the ions, with hypocalcemia still persisting in majority of patients during treatment but getting resolved in a significant percentage of patients at the end of 6months of treatment. Results indicate the need for calcium and phosphorus supplements in tuberculosis patients during chemotherapy. This study also warrants the need for regular monitoring of serum calcium and phosphorus in patients undergoing anti-tuberculosis treatment.

Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status

Background:Duration of treatment in tuberculosis of spine has always been debatable in the absence of marker of healing. The objective of the study was to evaluate the efficacy of extended DOTS regimen (2 months of intensive phase and 6 months of continuation phase) as recommended by WHO, by using MRI observations as the healing marker.Materials and Methods:51 (Group A -28 prospective and Group B- 23 retrospective) patients of spine TB with mean age of 26.8 years (range 15-54 years) diagnosed clinico radiologically/imaging (n=36), histopathology or by PCR (n=15) were enrolled for the study. They were treated by extended DOTS regimen (2 months of HRZE and 6 months of HR) administered alternate day. The serial blood investigations and X-rays were done every 2 months. Contrast MRI was done at the end of 8 months and healing changes were recorded. Criteria of healing on the basis of MRI being: complete resolution of pre and paravertebral collections, resolution of marrow edema of vertebral body (VB), replacement of marrow edema by fat or by calcification suggested by iso- intense T1 and T2 weighted images in contrast enhanced MRI. Patients with non healed status, but, responding lesion on MRI after 8 months of treatment were continued on INH and rifampicin alternate day and contrast MRI was done subsequently at 12 months and 18 months till the healed status was achieved .Results:9 patients had paraplegia and required surgical intervention out of which 1 did not recover neurologically. All patients have completed 8 months of extended DOTS regimen, n=18 achieved healed status and duration of treatment was extended in rest (n=33) 5 were declared healed after 12 months, 8 after 18 months and one after 36 months of treatment, thus 32 were declared healed at varying periods.Conclusion:35.2% patients demonstrate MRI based healed vertebral lesion at the end of 8 months of extended category 1 DOTS regimen. It is unscientific to stop the ATT by fixed time frame and MRI evaluation of the patients is required after 8 months of ATT and subsequently to decide for the continuation stoppage of treatment.