One size does not fit all: community views on choices for TB treatment and prevention

Treatment and prevention paradigms in TB have been dominated by a 'one-size-fits-all' approach, in which all persons are given the same treatment regimens. This stands in contrast to other health conditions, where differentiated models of care have been shown to be effective. In this Viewpoint, we make the case for considering multiple factors when deciding which regimens should be offered to people with TB infection and disease. Choice about which regimens to use should be made in conjunction with people who have TB and consider efficacy, safety, duration, pill burden, formulation, drug interactions, time spent in monitoring, drug susceptibility, compatibility with other areas of life, and availability of support services. Ideally, these choices should be considered within an equity framework with the most intensified services being offered to those considered most vulnerable.

Is ulcer recurrence after simple closure of perforated duodenal ulcer predictable?

OBJECTIVE

To study whether factors such as age, duration of pre-perforation symptoms, size of perforation and operative evidence of chronicity could predict recurrence of ulcer after simple closure of perforated duodenal ulcers, thus enabling patients at high risk of recurrence to be subjected to definitive surgery instead of simple closure of perforation.

DESIGN

Retrospective. One hundred and fifty-two patients who had undergone simple closure of duodenal ulcer perforation in the last 10 years were included in the study.

SETTING

A postgraduate research and teaching institution.

PATIENTS AND MEASUREMENTS

Patients were subjected to a personal interview and Visick grading of symptoms 1-10 years after simple closure of duodenal ulcer perforation. Ninety of them underwent esophagogastroduodenoscopic evaluation.

RESULTS

Symptomatic ulcer recurrence rate was 23.1% by Visick grading and 42.2% on endoscopy. Ulcer symptom recurrence rate had no correlation with patient's age, duration of pre-perforation symptoms, or size of perforation, but correlated significantly with operative evidence of chronicity (p < 0.001). However, 7 of 35 symptomatic recurrences would have been missed by the use of this criterion alone. Endoscopic evidence of recurrence also correlated only with operative evidence of chronicity. False positives and false negatives with Visick grading showed that this symptomatic evaluation was unsatisfactory even for selecting patients for further endoscopic workup.

CONCLUSION

Though not infallible, evidence of chronicity of ulcer at laparotomy may be a useful predictor of recurrence of ulcer after simple closure of perforated duodenal ulcer.

Seroepidemiological study of Japanese encephalitis in Dimapur, Nagaland

A seroepidemiological study of Japanese encephalitis (JE) in Dimapur, Nagaland was carried out following an outbreak of the disease between July, 1985 and February, 1986. Altogether 50 persons were affected with 30 (60 per cent) deaths. The attack and death rates per 1000 were more in Nagas viz. 0.55 and 0.34 than non-Nagas viz. 0.33 and 0.20 respectively. All ages and both sexes were affected. Of the nine mosquito species encountered Culex vishnui showed the highest density (44.5/MH). Culture of mosquito pool did not yield any viral agent. A total of 311 serum samples comprising 95 humans, 166 animals and 50 birds were tested for the presence of haemagglutination inhibition (HI) antibodies against Chikungunya and three flavirus antigens, viz. JE, WN and DEN-2. The overall flavivirus HI antibody in humans was positive in 26 (27.3 per cent) almost identical to JE antibody prevalence. The per cent positivity of HI antibodies to JE, WN and DEN-2 were 42.2 per cent, 22.2 per cent and 13.3 per cent in the affected and 14.2 per cent, 10 per cent and 6 per cent in the unaffected area. The activity of Alpha (Chikungunya) virus though very low was significantly higher (chi 2 = 5.57) in the affected area. The prevalence of JE antibody was 77.7 per cent in dogs, 52 per cent in cattle, 34 per cent in pigs and 21.1 per cent in goats. Of the five species of birds, flavivirus and JE antibodies were detected in 21.4 per cent pigeons and 22.2 per cent heron egrettes. Neutralisation test established the distinct role of JE virus over other related flavivirus antigens.