NATIONAL TUBERCULOSIS CONTROL STRATEGY IN THE POST HIV PERIOD

The tuberculosis situation in the country is a matter of great concern since the disease has not been contained. The problem has been further compounded by the emerging problem of HIV infection in the country together with development of multi-resistant tubercle bacilli. There is, therefore, a need to change our National Tuberculosis Control Strategy without disturbing the basic infrastructure of the National Tuberculosis Programme. Changes such as reinforcement of the District Tuberculosis Centre, HIV and drug sensitivity testing, giving up of long term chemotherapy, BCG vaccination policy, chemoprophylaxis policy and involvement of Non-Governmental Organisations and general practitioners are suggested.KEY WORDS: Human immunodeficiency virus, TuberculosisDespite existence of the National Tuberculosis Programme for over 3 decades, the situation of tuberculosis is grim in the country. Tuberculosis is responsible for 500,000 deaths annually in India [1]. According to an estimate, there were 10 million radiologically active cases of pulmonary tuberculosis in India in 1981 of which 2.5 million were infectious and as many as 50% people in India are infected by tubercle bacilli although they may appear healthy [2]. As per the estimates, there are more than 4 million people, mostly in developing countries, who have been infected with both HIV and tuberculosis [3]. HIV infection, by progressively impairing cell mediated immunity, appears to be the highest risk factor for reactivation of tuberculosis into an active disease [4]. It is a well known fact that HIV infection is spreading unabated throughout the length and breadth of the country and as per the estimates, by 2000 AD, 400,000 HIV infections will have occurred in the country. Thus tuberculosis can be considered as the most important candidate as an opportunistic infection in HIV infected individuals in the country. There is every possibility of the problem being compounded by infections or reinfections occurring with multi-drug resistant strains of tubercule bacilli [5]. As it is, the problem of drug resistant strains throughout the country remains unmapped and any emergence of such new strains may lead to their spread both among HIV infected persons as well as the general population. In such a complicated scenario it has become imperative to take a second look at our National Tuberculosis Programme and make changes consistent with the emerging problems. Suggested changes are as following:     

A European approach to categorizing medicines for fitness to drive: outcomes of the DRUID project

AIMS

To illustrate (i) the criteria and the development of the DRUID categorization system, (ii) the number of medicines that have currently been categorized, (iii) the added value of the DRUID categorization system and (iv) the next steps in the implementation of the DRUID system.

METHODS

The development of the DRUID categorization system was based on several criteria. The following steps were considered: (i) conditions of use of the medicine, (ii) pharmacodynamic and pharmacokinetic data, (iii) pharmacovigilance data, including prevalence of undesirable effects, (iv) experimental and epidemiological data, (v) additional data derived from the patient information leaflet, existing categorization systems and (vi) final categorization. DRUID proposed four tiered categories for medicines and driving.

RESULTS

In total, 3054 medicines were reviewed and over 1541 medicines were categorized (the rest were no longer on the EU market). Nearly half of the 1541 medicines were categorized 0 (no or negligible influence on fitness to drive), about 26% were placed in category I (minor influence on fitness to drive) and 17% were categorized as II or III (moderate or severe influence on fitness to drive).

CONCLUSIONS

The current DRUID categorization system established and defined standardized and harmonized criteria to categorize commonly used medications, based on their influence on fitness to drive. Further efforts are needed to implement the DRUID categorization system at a European level and further activities should be undertaken in order to reinforce the awareness of health care professionals and patients on the effects of medicines on fitness to drive.     

Clinical, brain electric earth map, endothelin and transcranial ultrasonic Doppler findings after hyperbaric oxygen treatment for severe brain injury

Objective　To analyze the effect and mechanism of hyperbaric oxygen (HBO) treatment for severe brain injury (SBI). Methods　Fifty-five patients were divided into a treatment group of 35 patients and a control group of 20 patients. We observed the alterations of clinical, brain electric earth map (BEAM), endothelin (ET) and transcranial ultrasonic Doppler (TCD) findings before and after HBO treatment as well as outcome. Results　In the treatment group, Glasgow coma scale, BEAM and outcome improved after HBO treatment; compared with that of the control group, it showed a significant difference. After one course of treatment, treatment group ET was reduced from 91.24±12.18?ng/L to 68.88±14.37?ng/L (P<0.01); in control group, ET was reduced from 90.78±15.71?ng/L to 83.12±12.22?ng/L, with a statistically significant difference (P<0.05). TCD records of MCA mean velocity (Vm) was reduced from 64.2±4.8?cm/s to 51.6±4.2?cm/s (P<0.01), and a decrease in MCA systolic velocity (Vs) and pulse index (PI) values was statistically significant (P<0.01). Conclusion　HBO treatment can improve the clinical, BEAM and outcome of severely brain injured patients, by decreasing acute stage ET and improving the blood velocity of MCA and decreasing cerebral vascular resistance. HBO treatment can reduce cerebral vascular spasms, cerebral ischemia and hypoxia. One of the important mechanisms of HBO treatment for severe brain injury is the lowering of intracranial pressure.     

Insulin-dependent diabetes mellitus (IDDM) is associated with CTLA4 polymorphisms in multiple ethnic groups

Linkage disequilibrium (association) analysis was used to evaluate a candidate region near the CTLA4/CD28 genes using a multi-ethnic collection of families with one or more children affected by IDDM. In the data set unique to this study (Spanish, French, Mexican-American, Chinese and Korean), the transmission/disequilibrium test (TDT) revealed a highly significant deviation for transmission of alleles at the (AT)n microsatellite marker in the 3' untranslated region (P = 0.002) and the A/G polymorphism in the first exon (P = 0.00002) of the CTLA4 gene. The overall evidence for transmission deviation of the CTLA4 A/G alleles is also highly significant (P = 0.00005) in the combined data set (669 multiplex and 357 simplex families) from this study and a previous report on families from USA, Italy, UK, Spain and Sardinia. Significant heterogeneity was observed in these data sets. The British, Sardinian and Chinese data sets did not show any deviation for the A/G polymorphism, while the Caucasian-American data set showed a weak transmission deviation. Strong deviation for transmission was seen in the three Mediterranean-European populations (Italian, Spanish and French) (P = 10(-5)), the Mexican-American population (P = 0.002) and the Korean population (P = 0.03). These results suggest that a true IDDM susceptibility locus (designated IDDM12) is located near CTLA4.