Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 150
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 150
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 151
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::index() - APP/Controller/ArtileDetailController.php, line 151
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 97
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Warning (512): Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853 [CORE/src/Http/ResponseEmitter.php, line 48]
Code Context
            if (Configure::read('debug')) {

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        LATEST NEWS UPDATES | Totally drug resistant TB: government in denial mode by Sonal Matharu    </title>
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Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB





The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented..."/>
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Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB





The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented..." />
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                            <div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented the presence of this strain of TB in India for the first time in the December 21, 2011 edition of the journal, Clinical Infectious Diseases. Patients suffering from it are resistant to all available drugs to cure the deadly disease.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Since October 2011, Mumbai has reported 14 instances of patients carrying the TDR-TB strain; of them, four patients have died, including a 13-year-old boy. Twelve cases are from the Hinduja hospital in Mahim and the remaining two are from Jamshedji Jijibhoy Hospital in Byculla.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">But the health ministry in its press release on January 17 said that the term TDR-TB is &ldquo;non-standardized&rdquo; and &ldquo;misleading&rdquo;. It added that the term is neither recognised by the World Health Organisation (WHO) nor by the government-run national programme for TB control&mdash;Revised National TB Control Programme (RNTCP).</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>TDR TB does exist, say experts</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">However, doctors and public health experts say the term used to classify the 14 Mumbai patients is not new and has been used earlier in other countries.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">&ldquo;Cases of TDR-TB do exist. There is nothing extra-ordinary that these cases have come up. Many patients do not complete the treatment under RNTCP or the drugs they may be taking are not appropriate. Resistance to drugs develops in such cases. TDR-TB cases in India are expected. But the government is always in a denial mode,&rdquo; says Sarman Singh, head of &nbsp;clinical microbiology department in the All India Institute of Medical Sciences (AIIMS).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">TDR-TB cases are similar to extensively drug-resistant TB (XDR-TB), in which resistance develops to the second-line drugs for TB as well, says Soumya Swaminathan, scientist with the department of clinical research at the Tuberculosis Research Centre in Chennai, Tamil Nadu. &ldquo;TDR-TB is very similar to the XDR-TB. It is very difficult to treat these cases,&rdquo; she says.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Mortality in cases resistant to second-line drugs is more than 80 per cent and the only options left to treat these patients are either surgery or by giving patients drugs that have not been tried before.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The first-line drugs for TB are isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin. Once patients develop resistance to these drugs, they are given second-line of drugs&mdash;ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicylic acid and ethionamide.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Lab tests contested</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">The ministry has also contested the laboratory tests carried out by the doctors at Hinduja Hospital.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">&ldquo;The Hinduja Hospital Laboratory is not accredited by the RNTCP for culture and sensitivity for second line drugs to diagnose XDR-TB or TDR-TB cases, and is only accredited for conducting Drug Susceptibility Testing (DST) by liquid culture and sensitivity for first line drugs,&rdquo; the release says.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The authors of the study, Zarir Udwadia, Camilla Rodrigues, Rohit Amale and Kanchan Ajbani, performed DST through bacteria culture at different concentrations of the antibiotic and found that the patients were resistant to all the WHO prescribed first and second line of drugs for treating TB. In addition, three of the patients underwent genotypic DST analysis using more advanced tests. They added in the study that the laboratory at the hospital is a referral laboratory and a RNTCP-accredited laboratory for Mumbai.</div><div style="text-align: justify">&nbsp;</div><div style="text-align: justify">Besides DST, they also audited the prescriptions of the patients that revealed that three patients had received &ldquo;erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners (average of four physicians during a 18-month period) in an attempt to cure their multi-drug resistant TB (MDR-TB).&rdquo;</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The Maharashtra health department joint director for TB control, P Y Gaikwad, said the state government is planning to conduct field visits to assess how widespread the problem is in the state. &ldquo;The state health department will be sending teams to the field and identifying more such cases, including cases in TB hospital in Sewri, Mumbai. Samples collected may even be sent to National TB Institute at Bengaluru. Samples collected will be those that are resistant to second-line TB drugs,&rdquo; he said.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Most docs can't prescribe correctly</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">India has become the third country in the world to identify patients with TDR-TB. Earlier, TDR-TB cases were first identified in 15 patients in Iran in 2006 and then in Iraq in 2007.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The authors write, &ldquo;Only 5 of 106 private practitioners practising in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis. We would urge that patients with MDR tuberculosis only be treated within the confines of government sanctioned DOTS-Plus programmes to prevent the emergence and spread of this untreatable form of tuberculosis.&rdquo;</div><div style="text-align: justify"><br /></div><div style="text-align: justify">As per the 2007 WHO global resistance report, only one per cent of patients in India with multi-drug resistance tuberculosis have to the Directly Observed Treatment, Short-course (DOTS)&ndash;Plus initiatives, treatment regime prescribed under RNTCP. India accounts for 20 per cent of the world&rsquo;s MDR tuberculosis load.</div>                                                           
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    <br><a href="http://www.downtoearth.org.in/content/totally-drug-resistant-tb-government-denial-mode" class="re" target="_blank">Down to Earth, 17 January, 2012, http://www.downtoearth.org.in/content/totally-drug-resistant-tb-government-denial-mode</a><div class="clear"></div>
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Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB





The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented..."/>
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Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB





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    <h1 class="cat-box-title">Totally drug resistant TB: government in denial mode by Sonal Matharu</h1>
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		 Published on</span><span class="text-date"> Jan 27, 2012</span>
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                            <div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented the presence of this strain of TB in India for the first time in the December 21, 2011 edition of the journal, Clinical Infectious Diseases. Patients suffering from it are resistant to all available drugs to cure the deadly disease.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Since October 2011, Mumbai has reported 14 instances of patients carrying the TDR-TB strain; of them, four patients have died, including a 13-year-old boy. Twelve cases are from the Hinduja hospital in Mahim and the remaining two are from Jamshedji Jijibhoy Hospital in Byculla.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">But the health ministry in its press release on January 17 said that the term TDR-TB is &ldquo;non-standardized&rdquo; and &ldquo;misleading&rdquo;. It added that the term is neither recognised by the World Health Organisation (WHO) nor by the government-run national programme for TB control&mdash;Revised National TB Control Programme (RNTCP).</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>TDR TB does exist, say experts</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">However, doctors and public health experts say the term used to classify the 14 Mumbai patients is not new and has been used earlier in other countries.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">&ldquo;Cases of TDR-TB do exist. There is nothing extra-ordinary that these cases have come up. Many patients do not complete the treatment under RNTCP or the drugs they may be taking are not appropriate. Resistance to drugs develops in such cases. TDR-TB cases in India are expected. But the government is always in a denial mode,&rdquo; says Sarman Singh, head of &nbsp;clinical microbiology department in the All India Institute of Medical Sciences (AIIMS).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">TDR-TB cases are similar to extensively drug-resistant TB (XDR-TB), in which resistance develops to the second-line drugs for TB as well, says Soumya Swaminathan, scientist with the department of clinical research at the Tuberculosis Research Centre in Chennai, Tamil Nadu. &ldquo;TDR-TB is very similar to the XDR-TB. It is very difficult to treat these cases,&rdquo; she says.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Mortality in cases resistant to second-line drugs is more than 80 per cent and the only options left to treat these patients are either surgery or by giving patients drugs that have not been tried before.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The first-line drugs for TB are isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin. Once patients develop resistance to these drugs, they are given second-line of drugs&mdash;ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicylic acid and ethionamide.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Lab tests contested</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">The ministry has also contested the laboratory tests carried out by the doctors at Hinduja Hospital.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">&ldquo;The Hinduja Hospital Laboratory is not accredited by the RNTCP for culture and sensitivity for second line drugs to diagnose XDR-TB or TDR-TB cases, and is only accredited for conducting Drug Susceptibility Testing (DST) by liquid culture and sensitivity for first line drugs,&rdquo; the release says.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The authors of the study, Zarir Udwadia, Camilla Rodrigues, Rohit Amale and Kanchan Ajbani, performed DST through bacteria culture at different concentrations of the antibiotic and found that the patients were resistant to all the WHO prescribed first and second line of drugs for treating TB. In addition, three of the patients underwent genotypic DST analysis using more advanced tests. They added in the study that the laboratory at the hospital is a referral laboratory and a RNTCP-accredited laboratory for Mumbai.</div><div style="text-align: justify">&nbsp;</div><div style="text-align: justify">Besides DST, they also audited the prescriptions of the patients that revealed that three patients had received &ldquo;erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners (average of four physicians during a 18-month period) in an attempt to cure their multi-drug resistant TB (MDR-TB).&rdquo;</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The Maharashtra health department joint director for TB control, P Y Gaikwad, said the state government is planning to conduct field visits to assess how widespread the problem is in the state. &ldquo;The state health department will be sending teams to the field and identifying more such cases, including cases in TB hospital in Sewri, Mumbai. Samples collected may even be sent to National TB Institute at Bengaluru. Samples collected will be those that are resistant to second-line TB drugs,&rdquo; he said.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Most docs can't prescribe correctly</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">India has become the third country in the world to identify patients with TDR-TB. Earlier, TDR-TB cases were first identified in 15 patients in Iran in 2006 and then in Iraq in 2007.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The authors write, &ldquo;Only 5 of 106 private practitioners practising in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis. We would urge that patients with MDR tuberculosis only be treated within the confines of government sanctioned DOTS-Plus programmes to prevent the emergence and spread of this untreatable form of tuberculosis.&rdquo;</div><div style="text-align: justify"><br /></div><div style="text-align: justify">As per the 2007 WHO global resistance report, only one per cent of patients in India with multi-drug resistance tuberculosis have to the Directly Observed Treatment, Short-course (DOTS)&ndash;Plus initiatives, treatment regime prescribed under RNTCP. India accounts for 20 per cent of the world&rsquo;s MDR tuberculosis load.</div>                                                           
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    <br><a href="http://www.downtoearth.org.in/content/totally-drug-resistant-tb-government-denial-mode" class="re" target="_blank">Down to Earth, 17 January, 2012, http://www.downtoearth.org.in/content/totally-drug-resistant-tb-government-denial-mode</a><div class="clear"></div>
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        LATEST NEWS UPDATES | Totally drug resistant TB: government in denial mode by Sonal Matharu    </title>
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Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB





The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented..."/>
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Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB





The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented..." />
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    <h1 class="cat-box-title">Totally drug resistant TB: government in denial mode by Sonal Matharu</h1>
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		 Published on</span><span class="text-date"> Jan 27, 2012</span>
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                            <div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented the presence of this strain of TB in India for the first time in the December 21, 2011 edition of the journal, Clinical Infectious Diseases. Patients suffering from it are resistant to all available drugs to cure the deadly disease.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Since October 2011, Mumbai has reported 14 instances of patients carrying the TDR-TB strain; of them, four patients have died, including a 13-year-old boy. Twelve cases are from the Hinduja hospital in Mahim and the remaining two are from Jamshedji Jijibhoy Hospital in Byculla.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">But the health ministry in its press release on January 17 said that the term TDR-TB is &ldquo;non-standardized&rdquo; and &ldquo;misleading&rdquo;. It added that the term is neither recognised by the World Health Organisation (WHO) nor by the government-run national programme for TB control&mdash;Revised National TB Control Programme (RNTCP).</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>TDR TB does exist, say experts</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">However, doctors and public health experts say the term used to classify the 14 Mumbai patients is not new and has been used earlier in other countries.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">&ldquo;Cases of TDR-TB do exist. There is nothing extra-ordinary that these cases have come up. Many patients do not complete the treatment under RNTCP or the drugs they may be taking are not appropriate. Resistance to drugs develops in such cases. TDR-TB cases in India are expected. But the government is always in a denial mode,&rdquo; says Sarman Singh, head of &nbsp;clinical microbiology department in the All India Institute of Medical Sciences (AIIMS).</div><div style="text-align: justify"><br /></div><div style="text-align: justify">TDR-TB cases are similar to extensively drug-resistant TB (XDR-TB), in which resistance develops to the second-line drugs for TB as well, says Soumya Swaminathan, scientist with the department of clinical research at the Tuberculosis Research Centre in Chennai, Tamil Nadu. &ldquo;TDR-TB is very similar to the XDR-TB. It is very difficult to treat these cases,&rdquo; she says.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">Mortality in cases resistant to second-line drugs is more than 80 per cent and the only options left to treat these patients are either surgery or by giving patients drugs that have not been tried before.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The first-line drugs for TB are isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin. Once patients develop resistance to these drugs, they are given second-line of drugs&mdash;ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicylic acid and ethionamide.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Lab tests contested</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">The ministry has also contested the laboratory tests carried out by the doctors at Hinduja Hospital.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">&ldquo;The Hinduja Hospital Laboratory is not accredited by the RNTCP for culture and sensitivity for second line drugs to diagnose XDR-TB or TDR-TB cases, and is only accredited for conducting Drug Susceptibility Testing (DST) by liquid culture and sensitivity for first line drugs,&rdquo; the release says.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The authors of the study, Zarir Udwadia, Camilla Rodrigues, Rohit Amale and Kanchan Ajbani, performed DST through bacteria culture at different concentrations of the antibiotic and found that the patients were resistant to all the WHO prescribed first and second line of drugs for treating TB. In addition, three of the patients underwent genotypic DST analysis using more advanced tests. They added in the study that the laboratory at the hospital is a referral laboratory and a RNTCP-accredited laboratory for Mumbai.</div><div style="text-align: justify">&nbsp;</div><div style="text-align: justify">Besides DST, they also audited the prescriptions of the patients that revealed that three patients had received &ldquo;erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners (average of four physicians during a 18-month period) in an attempt to cure their multi-drug resistant TB (MDR-TB).&rdquo;</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The Maharashtra health department joint director for TB control, P Y Gaikwad, said the state government is planning to conduct field visits to assess how widespread the problem is in the state. &ldquo;The state health department will be sending teams to the field and identifying more such cases, including cases in TB hospital in Sewri, Mumbai. Samples collected may even be sent to National TB Institute at Bengaluru. Samples collected will be those that are resistant to second-line TB drugs,&rdquo; he said.</div><div style="text-align: justify"><br /></div><div style="text-align: justify"><em>Most docs can't prescribe correctly</em></div><div style="text-align: justify"><br /></div><div style="text-align: justify">India has become the third country in the world to identify patients with TDR-TB. Earlier, TDR-TB cases were first identified in 15 patients in Iran in 2006 and then in Iraq in 2007.</div><div style="text-align: justify"><br /></div><div style="text-align: justify">The authors write, &ldquo;Only 5 of 106 private practitioners practising in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis. We would urge that patients with MDR tuberculosis only be treated within the confines of government sanctioned DOTS-Plus programmes to prevent the emergence and spread of this untreatable form of tuberculosis.&rdquo;</div><div style="text-align: justify"><br /></div><div style="text-align: justify">As per the 2007 WHO global resistance report, only one per cent of patients in India with multi-drug resistance tuberculosis have to the Directly Observed Treatment, Short-course (DOTS)&ndash;Plus initiatives, treatment regime prescribed under RNTCP. India accounts for 20 per cent of the world&rsquo;s MDR tuberculosis load.</div>                                                           
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    <br><a href="http://www.downtoearth.org.in/content/totally-drug-resistant-tb-government-denial-mode" class="re" target="_blank">Down to Earth, 17 January, 2012, http://www.downtoearth.org.in/content/totally-drug-resistant-tb-government-denial-mode</a><div class="clear"></div>
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Home हिन्दी

Totally drug resistant TB: government in denial mode by Sonal Matharu

Published on Jan 27, 2012   Modified on Jan 27, 2012

Health ministry deputes team to Mumbai; says neither WHO nor tuberculosis control programme recognise TDR-TB The Union ministry of health has denied the presence of totally drug resistant tuberculosis (TDR-TB) reported in Mumbai. Researchers at the Hinduja Hospital in Mumbai documented the presence of this strain of TB in India for the first time in the December 21, 2011 edition of the journal, Clinical Infectious Diseases. Patients suffering from it are resistant to all available drugs to cure the deadly disease. Since October 2011, Mumbai has reported 14 instances of patients carrying the TDR-TB strain; of them, four patients have died, including a 13-year-old boy. Twelve cases are from the Hinduja hospital in Mahim and the remaining two are from Jamshedji Jijibhoy Hospital in Byculla. But the health ministry in its press release on January 17 said that the term TDR-TB is “non-standardized” and “misleading”. It added that the term is neither recognised by the World Health Organisation (WHO) nor by the government-run national programme for TB control—Revised National TB Control Programme (RNTCP). TDR TB does exist, say experts However, doctors and public health experts say the term used to classify the 14 Mumbai patients is not new and has been used earlier in other countries. “Cases of TDR-TB do exist. There is nothing extra-ordinary that these cases have come up. Many patients do not complete the treatment under RNTCP or the drugs they may be taking are not appropriate. Resistance to drugs develops in such cases. TDR-TB cases in India are expected. But the government is always in a denial mode,” says Sarman Singh, head of  clinical microbiology department in the All India Institute of Medical Sciences (AIIMS). TDR-TB cases are similar to extensively drug-resistant TB (XDR-TB), in which resistance develops to the second-line drugs for TB as well, says Soumya Swaminathan, scientist with the department of clinical research at the Tuberculosis Research Centre in Chennai, Tamil Nadu. “TDR-TB is very similar to the XDR-TB. It is very difficult to treat these cases,” she says. Mortality in cases resistant to second-line drugs is more than 80 per cent and the only options left to treat these patients are either surgery or by giving patients drugs that have not been tried before. The first-line drugs for TB are isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin. Once patients develop resistance to these drugs, they are given second-line of drugs—ofloxacin, moxifloxacin, kanamycin, amikacin, capreomycin, para-aminosalicylic acid and ethionamide. Lab tests contested The ministry has also contested the laboratory tests carried out by the doctors at Hinduja Hospital. “The Hinduja Hospital Laboratory is not accredited by the RNTCP for culture and sensitivity for second line drugs to diagnose XDR-TB or TDR-TB cases, and is only accredited for conducting Drug Susceptibility Testing (DST) by liquid culture and sensitivity for first line drugs,” the release says. The authors of the study, Zarir Udwadia, Camilla Rodrigues, Rohit Amale and Kanchan Ajbani, performed DST through bacteria culture at different concentrations of the antibiotic and found that the patients were resistant to all the WHO prescribed first and second line of drugs for treating TB. In addition, three of the patients underwent genotypic DST analysis using more advanced tests. They added in the study that the laboratory at the hospital is a referral laboratory and a RNTCP-accredited laboratory for Mumbai.   Besides DST, they also audited the prescriptions of the patients that revealed that three patients had received “erratic, unsupervised second-line drugs, added individually and often in incorrect doses, from multiple private practitioners (average of four physicians during a 18-month period) in an attempt to cure their multi-drug resistant TB (MDR-TB).” The Maharashtra health department joint director for TB control, P Y Gaikwad, said the state government is planning to conduct field visits to assess how widespread the problem is in the state. “The state health department will be sending teams to the field and identifying more such cases, including cases in TB hospital in Sewri, Mumbai. Samples collected may even be sent to National TB Institute at Bengaluru. Samples collected will be those that are resistant to second-line TB drugs,” he said. Most docs can't prescribe correctly India has become the third country in the world to identify patients with TDR-TB. Earlier, TDR-TB cases were first identified in 15 patients in Iran in 2006 and then in Iraq in 2007. The authors write, “Only 5 of 106 private practitioners practising in a crowded area called Dharavi could prescribe a correct prescription for a hypothetical patient with MDR tuberculosis. The majority of prescriptions were inappropriate and would only have served to further amplify resistance, converting MDR tuberculosis to XDR tuberculosis and TDR tuberculosis. We would urge that patients with MDR tuberculosis only be treated within the confines of government sanctioned DOTS-Plus programmes to prevent the emergence and spread of this untreatable form of tuberculosis.” As per the 2007 WHO global resistance report, only one per cent of patients in India with multi-drug resistance tuberculosis have to the Directly Observed Treatment, Short-course (DOTS)–Plus initiatives, treatment regime prescribed under RNTCP. India accounts for 20 per cent of the world’s MDR tuberculosis load.

Down to Earth, 17 January, 2012, http://www.downtoearth.org.in/content/totally-drug-resistant-tb-government-denial-mode

Tagged with: Tuberculosis Health

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