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Case Conferences

   

September 25, 2013

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Total Posts: 16

Joined 2014-04-02

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Issues raised in this session included the usage of flouroquinolone based regimens and management of TB in patients with underlying liver disease and the diagnosis and management of TB relapse.

     
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Total Posts: 21

Joined 2014-05-04

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Case 1 - At the start the neck swelling was hard swelling - hence excision biopsy would have been the choice rather then repeated FNAC. The diagnosis could have been established much earlier. Secondly we do not start steroids without ruling out malignancy, hence before starting steroids an excision biopsy was needed.

     
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Total Posts: 21

Joined 2014-05-04

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Case 2 - Highlights the importance of adherence to treatment and how much to rely on patient history of good adherence. Once she was put on NGT drugs she became smear negative highlighting probably she had not taken the drugs at all hence the weight loss. She might be having Anorexia nervosa?

     
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Total Posts: 8

Joined 2014-05-05

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Very distinctive and interesting cases indeed.

Case 1: Drug induced hepatitis and TB treatment categorically generate challenging cases to be treated. Fluoroquinolones as additional or substitute components to anti-tuberculous drug regimens for drug-sensitive and drug resistant tuberculosis have shown variable results.

There are research data suggesting added efficacy of fluoroquinolones in managing MDR-TB when combined with well-established regimens (Huang 2000; WHO 2006), and there is evidence that levofloxacin, moxifloxacin and ofloxacin have a pivotal role in MDR-TB regimens (Yew 2000; Yew 2003). However, conflicting data have accumulated suggesting a lack of increased efficacy when fluoroquinolones are included in anti-tuberculous regimens (Kohno 1992; Kennedy 1996; ElSadr1998; Burman2006).

But I think, in the present scenario, this was the best appropriate option to treat TB with hepatitis and also reducing the duration of treatment schedule.

I essentially appreciate the efforts of US health department in caring so much for each TB patient, stringently keeping a watch over his drug compliance and home isolation and I totally agree that default of a TB patient is truly the default of our health system.

Case 2:  Relapse in TB could either be because of reactivation of the person’s previously latent TB or because they have been reinfected. The patient might not have taken drugs regularly as an actual or presumed side effects, lack of commitment to a long course of drugs, malabsorption, social barriers. But then I have a doubt, if the DOTs system is working so effectively how could the patient miss her drugs and if she was missing her drugs than how was she able to clear her TB effusion. I do feel that she should have visited a psychologist.

Sangita Shelke

     
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Total Posts: 24

Joined 2014-05-05

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case 1-  was serially LFT was done to monitor the hepatitis ? if so what was the changing scenario of biochemical tests ?

     
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Total Posts: 14

Joined 2014-05-07

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Legal action to ensure compliance is something new and not done in India.