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Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status

BACKGROUND: Duration of treatment in tuberculosis of spine has always been debatable in the absence of marker of healing. The objective of the study was to evaluate the efficacy of extended DOTS regimen (2 months of intensive phase and 6 months of continuation phase) as recommended by WHO, by using...

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Autores principales: Jain, Anil K, Srivastava, Amit, Saini, Namita Singh, Dhammi, Ish K, Sreenivasan, Ravi, Kumar, Sudhir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543879/
https://www.ncbi.nlm.nih.gov/pubmed/23325964
http://dx.doi.org/10.4103/0019-5413.104191
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author Jain, Anil K
Srivastava, Amit
Saini, Namita Singh
Dhammi, Ish K
Sreenivasan, Ravi
Kumar, Sudhir
author_facet Jain, Anil K
Srivastava, Amit
Saini, Namita Singh
Dhammi, Ish K
Sreenivasan, Ravi
Kumar, Sudhir
author_sort Jain, Anil K
collection PubMed
description BACKGROUND: Duration of treatment in tuberculosis of spine has always been debatable in the absence of marker of healing. The objective of the study was to evaluate the efficacy of extended DOTS regimen (2 months of intensive phase and 6 months of continuation phase) as recommended by WHO, by using MRI observations as the healing marker. MATERIALS AND METHODS: 51 (Group A -28 prospective and Group B- 23 retrospective) patients of spine TB with mean age of 26.8 years (range 15-54 years) diagnosed clinico radiologically/imaging (n=36), histopathology or by PCR (n=15) were enrolled for the study. They were treated by extended DOTS regimen (2 months of HRZE and 6 months of HR) administered alternate day. The serial blood investigations and X-rays were done every 2 months. Contrast MRI was done at the end of 8 months and healing changes were recorded. Criteria of healing on the basis of MRI being: complete resolution of pre and paravertebral collections, resolution of marrow edema of vertebral body (VB), replacement of marrow edema by fat or by calcification suggested by iso- intense T1 and T2 weighted images in contrast enhanced MRI. Patients with non healed status, but, responding lesion on MRI after 8 months of treatment were continued on INH and rifampicin alternate day and contrast MRI was done subsequently at 12 months and 18 months till the healed status was achieved . RESULTS: 9 patients had paraplegia and required surgical intervention out of which 1 did not recover neurologically. All patients have completed 8 months of extended DOTS regimen, n=18 achieved healed status and duration of treatment was extended in rest (n=33) 5 were declared healed after 12 months, 8 after 18 months and one after 36 months of treatment, thus 32 were declared healed at varying periods. CONCLUSION: 35.2% patients demonstrate MRI based healed vertebral lesion at the end of 8 months of extended category 1 DOTS regimen. It is unscientific to stop the ATT by fixed time frame and MRI evaluation of the patients is required after 8 months of ATT and subsequently to decide for the continuation stoppage of treatment.
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spelling pubmed-35438792013-01-16 Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status Jain, Anil K Srivastava, Amit Saini, Namita Singh Dhammi, Ish K Sreenivasan, Ravi Kumar, Sudhir Indian J Orthop Original Article BACKGROUND: Duration of treatment in tuberculosis of spine has always been debatable in the absence of marker of healing. The objective of the study was to evaluate the efficacy of extended DOTS regimen (2 months of intensive phase and 6 months of continuation phase) as recommended by WHO, by using MRI observations as the healing marker. MATERIALS AND METHODS: 51 (Group A -28 prospective and Group B- 23 retrospective) patients of spine TB with mean age of 26.8 years (range 15-54 years) diagnosed clinico radiologically/imaging (n=36), histopathology or by PCR (n=15) were enrolled for the study. They were treated by extended DOTS regimen (2 months of HRZE and 6 months of HR) administered alternate day. The serial blood investigations and X-rays were done every 2 months. Contrast MRI was done at the end of 8 months and healing changes were recorded. Criteria of healing on the basis of MRI being: complete resolution of pre and paravertebral collections, resolution of marrow edema of vertebral body (VB), replacement of marrow edema by fat or by calcification suggested by iso- intense T1 and T2 weighted images in contrast enhanced MRI. Patients with non healed status, but, responding lesion on MRI after 8 months of treatment were continued on INH and rifampicin alternate day and contrast MRI was done subsequently at 12 months and 18 months till the healed status was achieved . RESULTS: 9 patients had paraplegia and required surgical intervention out of which 1 did not recover neurologically. All patients have completed 8 months of extended DOTS regimen, n=18 achieved healed status and duration of treatment was extended in rest (n=33) 5 were declared healed after 12 months, 8 after 18 months and one after 36 months of treatment, thus 32 were declared healed at varying periods. CONCLUSION: 35.2% patients demonstrate MRI based healed vertebral lesion at the end of 8 months of extended category 1 DOTS regimen. It is unscientific to stop the ATT by fixed time frame and MRI evaluation of the patients is required after 8 months of ATT and subsequently to decide for the continuation stoppage of treatment. Medknow Publications & Media Pvt Ltd 2012 /pmc/articles/PMC3543879/ /pubmed/23325964 http://dx.doi.org/10.4103/0019-5413.104191 Text en Copyright: © Indian Journal of Orthopaedics http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Jain, Anil K
Srivastava, Amit
Saini, Namita Singh
Dhammi, Ish K
Sreenivasan, Ravi
Kumar, Sudhir
Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status
title Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status
title_full Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status
title_fullStr Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status
title_full_unstemmed Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status
title_short Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status
title_sort efficacy of extended dots category i chemotherapy in spinal tuberculosis based on mri-based healed status
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543879/
https://www.ncbi.nlm.nih.gov/pubmed/23325964
http://dx.doi.org/10.4103/0019-5413.104191
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