Rashmi B. M

Abstract

Background: The prevalence of multi-drug resistant tuberculosis (MDR-TB) is increasing worldwide. The treatment of MDR-TB is challenging due to its delayed diagnosis, prolonged duration of therapy with larger number of drugs, coupled with their great potential for adverse drug reactions (ADRs), which severely impair treatment adherence.  Early identification and effective management of ADRs form the cornerstone to ensure treatment adherence, which is an essential aspect in better treatment outcome. Materials and Methods: A prospective observational study was conducted for a period of 3 years, at Basaveshwara Medical College and Hospital, Chitradurga. All MDR-TB patients who fulfilled study criteria were included in study. After pre-treatment clinical evaluation, necessary radiological, serological and bacteriological investigations, patients were treated by Cat IV regimen for MDR TB and monitored for development of ADRs and treated appropriately. Results: Mean age of patients was 38 ± 3.6 years. A 70.9% of patients had low body mass index (BMI). A 74.5% of patients got successfully cured. ADRs were reported among 52.6% of patients. GI intolerance (49.1% in intensive phase) and psychiatric symptoms (41.8% in continuation phase) were most common ADRs reported. Low BMI was found to be significantly associated with ADRs. Conclusion: Meticulous and regular follow-ups with emphasis on early detection of ADRs during the course of ATT, dosage adjustments to effectively manage ADRs, addressing problem of malnutrition, a compulsory psychiatrist opinion as part of pre-treatment evaluation and also during continuation phase of ATT to detect the emergence of psychiatric symptoms, will go a long way in achieving high rates of favourable outcomes among MDR-TB patients. Keywords: Adverse drug reactions; Depression; Suicidal tendencies; Malnutrition; Gastro-intestinal intolerance.

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Abstract

Municipal street sweepers are exposed to large amount of dusts, microorganisms, toxins and automobile exhaust pollution. Chronic inhalation of such particulate matter has the potential to impair their pulmonary functions. The strict adherence to the standards and norms for the management of municipal solid wastes to reduce occupational health hazards in developing countries India is still a matter of concern. This study conducted among the municipal sweepers of Chitradurga district, compared the effects of chronic exposure to dust on the pulmonary function using spirometry test. This study also assessed the effects of smoking and irregular usage of protection masks, and compared the results with the healthy controls. Respiratory symptoms of cough (30%), chest pain (17.5%), catarrah and sneezing (21.5%) were found to be in higher percentage among the municipal street sweepers than the controls. Only 20% of participants municipal street sweepers used personal protective measures, wearing protective masks, regularly in the past 1 year, during sweeping streets. It was found that FEV1, FEV1/FVC, PEFR and FEF 25%-75% were significantly lesser among non-smoker street sweepers, when compared with that of non-smoking controls. Similarly these PFT values were significantly reduced among the smoker street sweepers and among the sweepers who didn’t use protective masks while sweeping. This study highlights the occupational hazard faced by municipal sweepers and attempts to emphasize on importance of usage of protective masks. Keywords: Street sweepers; Personal Protective Measures; Dust; Spirometry.

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