Renal replacement therapy (RRT) options and practice varies in countries worldwide and is influenced by patients' choice, nephrologists' practice patterns, health system, payer practice, public policy, and socioeconomic factors. In India, hemodialysis (HD) remains the dominant RRT modality, and the practice is largely influenced by socioeconomics of the region of practice since third party payer is limited. Resource stretch to maximize outcome benefit is essential and HD session twice weekly is an improvized and cost-effective clinical practice. However, within the country, the patient characteristics, practice patterns, and outcomes of twice-weekly HD compared against patients dialyzed thrice weekly remain unclear. We did a retrospective analysis of patients who underwent twice- and thrice-weekly HD in a single center under similar settings. The patients on thrice a week dialysis were older and with a higher proportion of diabetics and were insured by private payers. Weight gain, ultrafiltration rates, blood pressures, and hemoglobin remained more favorable in the thrice-weekly patients. There was no significant difference in the hospitalization rates or mortality rates in the two groups. Patients who undergo twice-weekly HD have poorer intermediate measures of the outcome; although, morbidity and survival were not different in a small study population with short follow-up. The small sample size and the short duration of follow-up may limit the scope of findings of our study.

BackgroundWorldwide highest number of new pulmonary tuberculosis (PTB) cases, was reported from India in 2012. Adverse treatment outcomes and emergence of drug resistance further complicated the prevailing scenario owing to increased duration, cost and toxicity associated with the treatment of drug-resistant cases. Hence to reinforce India’s fight against TB, identification of the correlates of adverse treatment outcomes and drug resistance, seemed critical.MethodsTo estimate the associations between diagnostic findings, patient types (based on treatment outcomes), drug resistance and socio-demographic characteristics of PTB patients, a cross-sectional study was conducted in two tertiary-care hospitals in Kolkata between April 2010 and March 2013. Altogether, 350 consenting Mycobacterium tuberculosis sputum-culture positive PTB patients were interviewed about their socio-demographic background, evaluated regarding their X-ray findings (minimal/moderately advanced/far advanced/cavities), sputum-smear positivity, and treatment history/outcomes (new/defaulter/relapse/treatment-failure cases). Multiple-allele-specific polymerase chain reaction (MAS-PCR) was conducted to diagnose drug resistance.ResultsAmong all participants, 31.43% were newly diagnosed, while 44%, 15.43% and 9.14% patients fell into the categories of relapsed, defaulters and treatment-failures, respectively. 12.29% were multi-drug-resistant (MDR: resistant to at least isoniazid and rifampicin), 57.71% had non-MDR two-drug resistance and 12% had single-drug resistance. Subjects with higher BMI had lower odds of being a relapse/defaulter/treatment failure case while females were more likely to be defaulters and older age-groups had more relapse. Elderly, females, unmarried, those with low BMI and higher grade of sputum-smear positivity were more likely to have advanced X-ray features. Higher grade of sputum-smear positivity and advanced chest X-ray findings were associated with relapse/treatment-failures. Elderly, unmarried, relapse/defaulter/treatment-failure cases had higher odds and those with higher BMI and moderately/far advanced X-ray findings had lower odds of having MDR/non-MDR two-drug resistant PTB.ConclusionTargeted intervention and appropriate counseling are needed urgently to prevent adverse treatment outcomes and development of drug resistance among PTB patients in Kolkata.

Distinct TNF-α and NO levels appear to be associated with different clinical forms of TB and might help to assess prognosis and contribute to a better understanding of underlying immunopathological mechanisms.

No abstract

BACKGROUND Low occurrence of mutant strains of Mycobacterium tuberculosis with multi-drug resistant genes in cavitary pulmonary tuberculosis and dramatic reduction of metabolic activity of tubercle bacilli in chronically infected animals reveal that apart from drug resistant genes, long generation time could be an additional explanation of drug resistance. We wanted to analyze the drug resistance pattern of Mycobacterium tuberculosis isolates from new sputum smear positive patients and previously treated patients on failing regimen in the light of generation time. METHODS 20 new sputum smear positive pulmonary tuberculosis patients and 20 previously treated patients on failing regimen were placed in the study. Mycobacterium tuberculosis isolates were obtained in pure culture by decontaminating, liquefying & concentrating sputum sample & anti-tubercular susceptibility tests were performed. From these, 10 all-drug (Rifampicin and Isoniazid) sensitive isolates, 10 resistant to at least one drug (Rifampicin/Isoniazid) were chosen. Single mycobacterial cell suspension was prepared from each. After proper standardization, they were inoculated in Middlebrook 7H9 broth and incubated at 37 0 C in 10% CO2. Subculture was done at intervals of 0, 18, 36, 54, 72 hours, using 10μl of each culture suspension in Middlebrook 7H11 agar plate to measure CFU/ml. Generation time was evaluated from steep portion of the growth curve using standard formula. RESULTS It was found that, mean generation time of MDR isolates of previously treated patients on failing regimen (35.27+2.44 hrs.) were significantly greater (p= 0.04, i.e. <0.05) in comparison to the drug sensitive isolates (21.42+1.6 hrs.). CONCLUSIONS Thus, mutant strains of tubercle bacilli, which are slow multipliers, as suggested by their long generation time could hardly be killed by the regimens containing drugs targeting bacterial multiplication. Hence, apart from genes, long generation time is a potential, additional explanation for drug resistance.