Tuberculosis

To meet global healthcare demands, a tertiary care teaching hospital studies pulmonary TB patients' drug use. Respiratory TB is a major problem in poor nations. The study optimizes anti-tuberculosis medicine use to improve patient outcomes and prevent transmission. Due to dosage and duration, optimization influences drug effectiveness, side effects, and resistance. The study emphasizes medication adherence and patient compliance to prevent treatment failure and drug-resistant strains. Pulmonary TB is infectious yet hard to identify due to its mild symptoms. Diagnostics and treatment include clinical and laboratory tests and long-term antibiotics. Immunization and latent TB therapy prevent TB. Healthcare professionals, governments, and international organizations must collaborate to eliminate pulmonary TB. During the 8-month study period, a group of 600 patients with PTB was examined. The group of 30-50 years revealed more males than females with PTB among them. The drug isoniazid was by far the most heavily recommended first-line treatment. In contrast to Isoniazid, it couldn’t adhere to Levofloxacin efficiently. In one of the tests, it was observed that there were undernourished persons that are protein and micronutrient deficient also. The study showed most mental comorbidities as depression. Multidrug resistance preceded non-resistance. From this study, we determined the high rate of PTB relapse and partial healing. The study suggested approaches to improving protein-energy deficit and mental depression as well as to multi-drug resistance and for treating patients. The study suggested collaboration and research to reduce PBA mortality rates and produce tablets, medications, and treatments to help doctors treat, change diets, and counsel PTB patients.

Tuberculosis is a ubiquitous, highly contagious chronic granulamatous communicable bacterial infectious disease caused by Mycobacterium tuberculosis and other species of same genera. “Rifabutin” which is useful in the management of tuberculosis. Formulated Rifabutin in the form of solid lipid nanoparticle evaluated for their efficacy ex-vivo by checking for various interactions. Thus, physiological parameters like cellular uptake, MTT cytotoxicity assay and hemolytic toxicity of rifabutin  loaded mannosylated solid lipid nanoparticles are determined and compared. The present work establishes the suitability of rifabutin loaded mannosylated solid lipid nanoparticles as a delivery system.

Tuberculosis is a bacterial infection, which is the dominant cause of death all over the world. It is the chronic infectious disease caused by the tubercle bacillus. It is regarded as oldest disease. Tuberculosis is the infection occurs by inhaling the droplet nuclei containing Mycobacterium tuberculosis organisms by susceptible person. New methods have been evolved in diagnosing, treatment and prevention. The disease remains as an important public health problem in developing countries. Extra pulmonary TB became more common with the advent of infection with human immunodeficiency virus and by the increase in the number of organ transplantation, which also leads to immunosuppression of thousand of persons. Urogenital TB represents 27% of extrapulmonary cases. Renal involvement in TB can be part of a disseminated infection or a localized genitourinary disease. Renal involvement by TB infection is underdiagnosed in most health care centers. Most patients with renal TB have sterile pyuria, which can be accompanied by microscopic hematuria. The diagnosis of urinary tract TB is based on the finding of pyuria in the absence of common bacterial infection. The first choice drugs include isoniazide, rifampicin, pirazinamide, ethambutol, and streptomycin. Awareness of renal TB is urgently needed by physicians for suspecting this disease in patients with unexplained urinary tract abnormalities, mainly in those with any immunosuppression and those coming from TB-endemic areas.

Mycobacterial enoyl acyl carrier protein reductase (InhA) is a clinically validated target for the treatment of tuberculosis infection, a disease that still causes the death of at least a million people annually. The current study aims to design and explore the possible mechanism of action of various furfuraldehyde formazans as direct inhibitors of InhA through molecular docking studies. A series of furfuraldehyde formazans were computationally designed and energy minimized. These compounds were docked into the active site of InhA (PDB code, 2NSD) using software Glide from the suite of Schrödinger. These compounds were identified as potential inhibitors of InhA on the basis of Glide Score (G-Score), hydrogen bonding (H-bond) and van der Waals (vdw) interaction between ligand and the receptor. Ten furfuraldehyde formazans displayed G-Scores (-7.351 to -9.148) higher than that of isoniazid (-7.250). These compounds have good hydrogen bonding and hence good affinity for the enzyme, when compared with isoniazid. Further, we plan to synthesize these compounds and screen them for antimycobacterial and enzyme inhibitory activity.

Bioanalytical methods of Reverse Phase-High performance liquid chromatography (HPLC) was developed and validated for simultaneous estimation of Isoniazid (INH) and Ciprofloxacin Hydrochloride (CIP HCl) encapsulated in lipid polymeric hybrid nanoparticles (LPNs) in plasma and in organ homogenates of lung, liver, spleen and kidney of mice. Chromatographic separation was done using Agilent® C18 bonded silica column of dimensions 150 × 4.6 mm, 5μmwith flow rate 1.0 ml/min, injection volume 20 µland column temperature 40°C. The mobile phase consists of a mixture of 70 volumes of 0.1 percent v/v of trifluoroacetic acid(TFA) and 30 volumes of acetonitrile (ACN). The results indicated that the developed method was linear and selective for all matrices studied. Analysis of accuracy and precision showed adequate values, with relative standard deviation values lower than 5, which are in accordance with USFDA guidelines for bioanalytical method validation. Isoniazid (INH) and Ciprofloxacin Hydrochloride (CIP HCl) were stable in plasma and tissue homogenates under different storage and processing conditions. This method was applied to study the pharmacokinetic and biodistribution profile of both drugs in free form and in bound state with lipid nanoparticles. The results showed that polymeric nanoparticles showed higher drug accumulation in the target site i.e. lung as compared to non-target organs fulfilling our aim of developing a HPLC method for the simultaneous estimation of both drugs and their application in determination of pharmacokinetic and pharmacodynamic potential of the lipid nanoparticles.

Tuberculosis remains a significant public health issue worldwide especially in developing countries. India leads the world in its burden of tuberculosis (TB) due to its neglect as a public health problem, and mismanagement of TB patients in both public and private sectors. The original National Tuberculosis Programme (NTP), launched in 1962, failed because of several reasons. To overcome its shortcomings, the DOTS strategy was introduced in 1992 as an initiative under the Revised National Tuberculosis Control Program (RNTCP). Though the latter has been better funded and better managed, it is yet to address several key issues like lack of adequate and updated infrastructure, unregulation of the private practice sector and the emergence and increase in number of drug-resistant tuberculosis in India.

Tuberculosis is a major infective disease affecting Indian population with high socio-economic impact. For eradication of tuberculosis and successful implementation of Revised National Tuberculosis Control Program – Directly Observed Treatment Short Course RNTCP- DOTS program regular assessment of the condition is imperative.The aim was to determine  the sputum carried out in District Tubercular Centre (DTC), Mangalore. The data of all patients registered from January 2011 to December 2011 were examined.The study was conducted on sample population of 297 patients. Of these, 183 (61.6%) patients were NSP cases and 114 (38.4%) patients were retreatment cases. The mean age of patients in category 1 and category 2 was 40.86± 18.20 and 42.49 ± 13.32 respectively. Males constituted 71.2 % and females were 28.8% of population. No significant difference in distribution with respect to gender (x2 = 1.327, p = 0.249) and residential area (x2 = 1.290, p = 0.256) in each categories. There is significant difference in distribution in category 1 and category 2 with mean age in years in different age category(x2 = 21.521, p = 0.001). Of 183 patients in NSP, 137 patients converted to negative at the end of the 2 month intensive phase with conversion rate of 86.33% and 21 patients converted to negative at the end of extended intensive phase with conversion rate of 67.54 %.The sputum conversion rate was comparable to other study but was less than national average. Conversion rate is less in category 2 compared to category 1 showing the importance of treatment completion in patients with TB. Majority of patients belong to a productive age group between 21-60 years indicating the impact of the disease on socio-economy of patient as well as on the country.

Tuberculosis is a contagious infection caused by air borne bacteria Mycobacterium tuberculosis. Tuberculosis is a growing health problem in the developing world. India accounts for one-fifth of the global TB incident cases, each year nearly two million people in India develop TB1. This was a retrospective record based survey carried at AH & RC (Adichunchanagiri Hospital & Research Centre) Tertiary care teaching hospital, B.G Nagara. Twelve month data of all TB patients i.e. from Sep-09 to Aug-10 that were diagnosed in the Directly Observed Treatment Short Course Centre was taken, which included 120 diagnosed patients. Out of 120 patients diagnosed, the male to female ratio was 2.5:1, and 29 were from age group of 40 to 49 years. Pulmonary TB cases were more i.e. 85 (75.83%) when compared to extra pulmonary i.e. 35 (29.17%), new smear positive cases were 62 (51.67%) and new smear negative cases were 58 (48.33%). Total 67 (55.83%) patients were categorized in CAT-I, 25 (20.83%) patients in CAT-II and 28 (23.33%) in CAT-III.The Treatment Completion Rate (TCR) and rate of cure was not known since all patients were transferred to their nearest peripheral RNTCP/DOTS Centers, and those centers failed to provide proper feedback. So, for transferred TB cases a better system of follow up should be done in order to know about the TCR and rate of cure. Key Words: RNTCP/DOTS centre, Category, Tuberculosis, TCR (Treatment Completion Rate).  

The present study was carried out to monitor, estimate the prevalence and consequences of ADRs on treatment of TB and to assess causality, predictability, preventability and severity of the ADRs. A prospective observational and active surveillance study was conducted over a period of 9 months. Each reported ADR was assessed for its causality, severity, predictability and preventability as per standard algorithms. The management and outcome of ADRs were determined. A total of 128 ADRs (in 53 patients) were identified out of which the prevalence of ADRs in female was found to be 31.58% and 29.66% in male patients. The causality assessment by Naranjo’s scale showed that out of 128 ADR’s, 128 (100%) ADR’s were probable and based on WHO probability assessment scale 119(92.97%) were possible where as 9(7.03%) were probable. Preventability assessment showed that 125 (97.66%) were not preventable and 03 (2.34%) were definitely preventable. Severity Assessment by Modified Hartwig and Siegel Scale showed that 82 (64.06%) ADRs were mild and 46(35.94%) ADRs were moderate. 128(100%) were found to be predictable. Majority of the ADRs were recovered without giving symptomatic treatment. The study concluded that there is a need of a system for proper monitoring of ADRs caused by anti-TB drugs in RNTCP centre.  The counselling of patients for timely prevention, detection and management of ADRs will helps in further ADR occurrence minimisation.

  Colloidal Drug Delivery system is an advancing technology expected to bring revolutionary changes in the field of pharma and health sciences including drug delivery, diagnostics and treatment. The advancement in colloidal drug delivery systems helps in preparing newer formulations which become useful for treatment of tuberculosis. Development of Metered dose inhaler (MDT) and Directly Observed Therapy (DOTS) also proves to helpful in treatment of tuberculosis. Various colloidal drug delivery systems liposomes, niosomes, nanoparticles and microparticles proves to be a successful tool for tuberculosis treatment. One of the preparations like microemulsions results in theimprovement of bioavailability of the drugs. Similarly corticosteroids also found to be an interesting tool here because corticosteroids reduced the risk of pleural thickening in tuberculosis patients. These various colloidal drug delivery systems minimize the problems of conventional therapy like poor penetration, drug resistance, systemic toxicity and also main the improved drug delivery. This article describes the applications of various formulations along with their future aspects in treatment of tuberculosis.