PV Kishore

Bio: PV Kishore is an academic researcher from Manipal College of Medical Sciences. The author has contributed to research in topics: Tuberculosis & Pyrazinamide. The author has an hindex of 7, co-authored 15 publications receiving 133 citations.

Pattern of adverse drug reactions experienced by tuberculosis patients in a tertiary care teaching hospital in Western Nepal.

Abstract: Tuberculosis is a common problem in developing countries including Nepal. Data regarding the safety profile of anti tubercular drugs is lacking in Nepal. The present study analyzed the pattern of ADRs caused by the antitubercular drugs. Inpatient files of all the TB patients who received treatment at the Manipal Teaching Hospital, Pokhara, Nepal during the period from 1st January 2001 till 31st December 2006 were taken. Altogether 326 patients were identified among which 40 (females 24, males 16) experienced at least one ADR (incidence 12.27%). The mean+/-SD age of the patients was 42.12+/-20.41 years. The most common ADR was elevated liver enzymes [24 (57.14%)] and hepatobiliary system was the most common system affected [24 (58.5%)]. More than half the ADRs [21 (52.55%)] developed with in 20 days of initiation of therapy. Isoniazid and pyrazinamide were the suspected drugs responsible for 32.32% each of the total ADRs. The mean+/-SD of the total number of drugs used in the patients were 4.77+/-1.46. The most common laboratory abnormality observed was elevated SGOT level [21 patients (52.5%)]. Seven (17.5%) patients needed specific drug treatment for managing the ADRs and 10 (25%) needed symptomatic management. Thirty five (87.5%) patients recovered following the ADR. Multiple drug therapy was the reason behind the development of 30 (75%) ADRs. It was found that 29 (72.5%) ADRs were 'probably' due to the suspected drugs. Majority [19 (47.5%)] of the ADRs were mild [level (1)]. This study shows that ADRs to anti tubercular drugs are common. Since TB is a common problem in Nepal, special efforts are needed to tackle the drug related complications associated with ATT drugs.

A clinicoepidemiological study of 50 cases of cutaneous tuberculosis in a tertiary care teaching hospital in pokhara, Nepal.

Abstract: Background: Cutaneous tuberculosis (TB) is essentially an invasion of the skin by Mycobacterium tuberculosis, the same bacteria that causes pulmonary tuberculosis. Aim: This study was conducted to study the common types of cutaneous TB and to find the management pattern in a tertiary teaching hospital in Pokhara, Nepal. Materials and Methods: All the cases of cutaneous TB were biopsied and furthermore investigated by performing Mantoux test, sputum examination, fine needle aspiration cytology, chest X-ray and ELISA. Results: In this study, we found that tuberculosis verrucous cutis (48%) had a higher incidence than other types of cutaneous TB. More males were affected than were females (1.2:1). Commonly affected sites were the limb and the buttock (48%). The most commonly affected age group was 16-25 years (40%). All cases (except two) were more than 15 mm in size in the Mantoux test. The histopathological picture was typical in all except three cases. All patients were treated with antitubercular treatment as per the national guidelines. Conclusion: The most common type of cutaneous TB was tuberculosis verrucous cutis and the most commonly affected sites were the limb and the buttock. As cutaneous TB sometimes reflects the presence of pulmonary tuberculosis, its incidence should not be ignored.

Drug induced hepatitis with anti-tubercular chemotherapy: challenges and difficulties in treatment.

Abstract: Tuberculosis is a major health burden worldwide. In Nepal, it is a significant cause of morbidity and mortality. Although better drugs are available for managing tuberculosis, treatment failure is one of the common problems encountered. Among the various causes which can cause treatment interruption, drug induced hepatotoxicity is a common cause. Isoniazid and Pyrazinamide are the common drugs causing hepatotoxicity. Upon occurrence of hepatotoxicity, the hepatotoxic drugs should be stopped and reintroduced as per the available guidelines. The healthcare professional should also counsel the patients for recognizing the early symptoms due to hepatotoxicity which could prevent morbidity.

Diagnosing Abdominal Tuberculosis: A Retrospective Study From Nepal

Abstract: Introduction: Tuberculosis (TB) is a common problem in developing countries including Nepal. Abdominal TB accounts for nearly 2% of TB cases world-wide. Data regarding this disease is lacking in Nepal. Objectives: To evaluate the clinical presentation, diagnostic and effectiveness of treatment methods of abdominal TB in Nepal. Methods: 32 cases of abdominal TB (10.59% of the total extra pulmonary TB) were identified among the total 302 extra pulmonary TB patients at Manipal Teaching Hospital during April 2003 to December 2006. All the cases diagnosed as abdominal TB were selected for this study. The details of demographic information, clinical presentation, and co morbid conditions were recorded from the medical case files. The laboratory and imageological reports and other necessary information were also obtained and the information was recorded on a proforma designed for the purpose. Results: From the 32 cases of abdominal TB, 17 (53.13%) were females. The Mean ± SD age of the patients was 39.62 ± 21.18 years. The common symptoms exhibited by the patients were weight loss [100% (n=32)], loss of appetite [100% (n=32)], fever [71.88% (n=23)]. The personal history revealed smoking in case of 40.63% (n=13) of the patients and alcohol intake in case of 37.5% (n=12) of the. The treatment was given as per the WHO guidelines with category I [46.88% (n=15)] and category III 53.13% (n=17)] drugs. Five cases were later diagnosed to be of unrelated aetiology and were removed from the study. One patient (3.13%) died due to drug toxicity. Conclusion: The clinical presentations of abdominal TB appear not specific for the condition. Thus, careful approach and supportive results are required in order to issue the final diagnosis. Measures are to be taken not to misdiagnose other morbid conditions as abdominal TB. If diagnosed early, it can be treated successfully with the conventional anti-TB drugs.

Health literacy interventions and outcomes: an updated systematic review.

Abstract: Objectives To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined. Data sources We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010. Review methods We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence. Results We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient. Conclusions The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.

The Merck Manual of Diagnosis and Therapy

Abstract: The world's most widely used comprehensive reference book of medicine has been updated 16 times since 1899. It took 5 years of work to bring out this 16th edition. The 12 physicians on the editorial board enlisted the aid of 29 distinguished consultants with outstanding qualifications to complete the volume. The manual has been expanded by 120 pages and includes 154 figures and 382 tables. New subjects include sports medicine, hospice medicine, human immunodeficiency virus infection in children, cardiopulmonary resuscitation in infants and children, genetic evaluation and counseling, anabolic steroid abuse, cultural issues in medicine, and cocaine withdrawal in newborns. A table of generic drugs with their trade names has been included and will be useful for the ophthalmologist as a reference. As in past editions, the contents are arranged by organ system on the basis of the origins of each disease. The pathologicand physiologic features of each disease are

Ellenhorn's medical toxicology : diagnosis and treatment of human poisoning/ Matthew J. Ellenhorn ; consulting editors, Donald G. Barceloux, Seth Schonwald, Jonathan Wasserberger ; technical associate, Sylvia Syma Ellenhorn

Abstract: Part 1 Principles of poison management: the clinical approach diagnostic procedures gut decontamination elimination enhancement antidotes supportive care toxicokinetics the pregnant patient. Part 3 Drugs: analgesics - newer analgesics, nonsteroidal anti-inflammatory drugs, phenazopyridrine salicylate update anti-infectivedrugs - AIDS drugs, antifungal drugs, antiparasitic drugs, antiviral drugs drugs of abuse - amphetamines and designer drugs, cocaine, hallucinogenic drugs, marijuana and other cannabinoids, phencyclidine, opiates systems toxicology - bone drug toxicology, blood and blood forming products, anticoagulants, antifibrinolytics, thrombolytics, blood transfusions and citrate intoxication, cytokines, plasma volume expanders, ticlopidine, cardiovascular toxicology, antiarrhthmic drugs, antihypersensitive agents, vasodilators, lipid lowering drugs, central nervous system drugs, anticonvulsants, the psychotropic agents, antidepressant agents, cyclic antidepressants, monoamine oxidase inhibitors, the neuroleptics, sedative hypnotics, endocrine drugs, gastrointestinal tract drugs, immunotoxicology, respiratory tract drugs receptor toxicology - antimuscarines, dopamine receptor drugs, H1 receptor drugs, serotonin receptor agents, muscle relaxants unclassified drugs. Part 3 The home: over-the-counter products, food poisonings, household poisonings. Part 4 Chemicals: the alcohols, anaesthetics, antiseptics and disinfectants, chemical disasters, chemical warfare, contrast media, cancer chemotherapeutic agents (cytoxic drugs), disulfiram, explosives, hobbies, arts and crafts, the hydrocarbon products, respiratory toxicology, metals and related compounds, pesticides, plastics and plasticizers and epoxy resins, radiation poisoning, veterinary product poisonings in man. Part 5 Natural toxins: envenomations - bites and stings, indigenous toxicology, folk medicine, plants - mycotoxins - mushrooms.

Cutaneous tuberculosis: diagnosis, histopathology and treatment - Part II

Abstract: The evolution in the knowledge of tuberculosis' physiopathology allowed not only a better understanding of the immunological factors involved in the disease process, but also the development of new laboratory tests, as well as the establishment of a histological classification that reflects the host's ability to contain the infectious agent At the same time, the increasing bacilli resistance led to alterations in the basic tuberculosis treatment scheme in 2009 This article critically examines laboratory and histological investigations, treatment regimens for tuberculosis and possible adverse reactions to the most frequently used drugs