Rupak Singla

Natonal Institute of Tuberculosis and Respiratory Diseases,New Delhi-110030, India · Department of Tuberculosis and Respiratory Disease

COVID-19 affected millions of people worldwide, and tuberculosis (TB) continues to affect millions of people each year. The combined pandemic of COVID-19 and TB had a catastrophic effect on healthcare policies and healthcare setups around the globe. The clinical profile and factors affecting the outcome of COVID-19 disease in TB patients on treatme...

This study was carried out to assess the role of therapeutic drug monitoring of crucial first-line anti-tubercular drugs: rifampicin (R) and isoniazid (H) among 75 non-responding proven drug-sensitive tuberculosis patients on treatment followed by intervention in field conditions. The intervention was done in the form of either an increase in the d...

Background Indicators of extensive disease—acid fast bacilli (AFB) smear positivity and lung cavitation—have been inconsistently associated with clinical rifampin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) outcomes. We evaluated the association of these indicators with end-of-treatment outcomes. Methods We did an individual participant...

Background Longitudinal cohort data of patients with tuberculosis (TB) and COVID-19 are lacking. In our global study, we describe long-term outcomes of patients affected by TB and COVID-19. Methods We collected data from 174 centres in 31 countries on all patients affected by COVID-19 and TB between 1 March 2020 and 30 September 2022. Patients wer...

Objective Studying treatment duration for rifampicin-resistant and multidrug-resistant tuberculosis (MDR/RR-TB) using observational data is methodologically challenging. We aim to present a hypothesis generating approach to identify factors associated with shorter duration of treatment. Study design and setting We conducted an individual patient d...

BACKGROUND Adverse effects (AE) to TB treatment cause morbidity, mortality and treatment interruption. The aim of these clinical standards is to encourage best practise for the diagnosis and management of AE. METHODS 65/81 invited experts participated in a Delphi process using a 5-point Likert scale to score draft standards. RESULTS We identified...

Urine based biomarker discovery employing proteomics platform has been successfully attempted for multiple diseases. Urine is an excellent source of biomarker discovery but its potential is not fully tapped in tuberculosis (TB) diagnostics. In the present study, proteomic profiling of urine samples from thirty five subjects (Mean age=41 years (15-7...

The disease chronic pulmonary aspergillosis (CPA), which has 3 million cases globally, has a substantial impact on global health. The morbidity and mortality it cause are also rather severe. Patients with modest immune suppression or those with underlying structural and chronic lung illnesses are more likely to develop this condition. CPA pose a di...

At the 77th National Conference on Tuberculosis and Chest Diseases, which took place on February 27, 2023, a pre-conference workshop on Basic Spirometry and Advanced Pulmonary Function Tests was held under the auspices of NATCON-2022. With the assistance of highly experienced faculty who are national and international level experts in their fields,...

Background The immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sput...

Rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) is a significant burden on global tuberculosis (TB) prevention and eradication efforts. MDR-TB can be treated, but it is expensive, takes a long time (typically two years), and contains potentially toxic drugs. Under certain conditions, the WHO recommends standard regimens lasting 9...

Tuberculosis has maximum burden among young population in developing countries like India. However, children and elderly form a special group where TB may have atypical presentation. This presents with epidemiological, diagnostic and treatment challenges in these groups which may need special attention in the national programmes for TB. Due to atyp...

Introduction Drug-resistant tuberculosis (DR-TB) is a global public health problem. Patients suffer for months if undiagnosed or treated inadequately, transmitting DR-TB in the community before succumbing to the disease. Early diagnosis, prompt treatment initiation and completion play a significant role in treatment success. However, extended regim...

BACKGROUND The aim of these clinical standards is to provide guidance on ‘best practice’ for diagnosis, treatment and management of drug-susceptible pulmonary TB (PTB). METHODS A panel of 54 global experts in the field of TB care, public health, microbiology, and pharmacology were identified; 46 participated in a Delphi process. A 5-point Likert s...

Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for chil...

BACKGROUND Optimal drug dosing is important to ensure adequate response to treatment, prevent development of drug resistance and reduce drug toxicity. The aim of these clinical standards is to provide guidance on ‘best practice’ for dosing and management of TB drugs. METHODS A panel of 57 global experts in the fields of microbiology, pharmacology...

Background: The immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to spu...

Pulmonary tuberculosis (PTB) can lead to acute respiratory distress syndrome (ARDS), which can be at times fatal. Venovenous extracorporeal membrane oxygenation (VV-ECMO) ensures adequate oxygenation and carbon dioxide removal, avoiding ventilator-induced lung injury. We present a case where a young woman with refractory respiratory failure caused...

How to cite this article: Gupta A, Singla R. Evaluating Improved Success Rate of Newer 6–9-month Treatment Regimen under Conditional Access Program in Patients with Drug-resistant Tuberculosis. Indian J Chest Dis Allied Sci 2022;64(3):133–134.

Information on tuberculosis (TB) and COVID-19 is still limited. The aim of this study is to describe the features of the TB/COVID-19 co-infected individuals from a prospective, anonymised, multi-country register-based cohort with special focus on the determinants of mortality and other outcomes. We enrolled all patients of any age with either activ...

Tuberculosis (TB) does not respect borders, and migration confounds global TB control and elimination. Systematic screening of immigrants from TB high burden settings and—to a lesser degree TB infection (TBI)—is recommended in most countries with a low incidence of TB. The aim of the study was to evaluate the views of a diverse group of internation...

BACKGROUND: Increasing evidence suggests that post-TB lung disease (PTLD) causes significant morbidity and mortality. The aim of these clinical standards is to provide guidance on the assessment and management of PTLD and the implementation of pulmonary rehabilitation (PR). METHODS: A panel of global experts in the field of TB care and PR was ident...

Smoking, TB and Covid-19 are high prevalence entities with public health consequences. All three of them have a possible complex interaction at cellular level. Smoking behavior makes it difficult to maintain infection control measures. Smoking is known to increase TB infection and also adversely affect treatment outcomes in TB. There is also upcomi...

Rifampicin-resistant tuberculosis (RR-TB) and multidrug-resistant tuberculosis (MDR-TB) are characterised by higher rates of mortality, complexity and resource utilisation. There were an estimated half million cases of these drug-resistant forms of tuberculosis in 2018, with 186,772 cases being notified and only 156,701 started on treatment. Within...

Does bacteriological cure of MDR TB patients ensure good quality of llife and preserved lung function? Post MDR TB sequelae have poor quality of life and poorer lung functions.

Noonan syndrome is an autosomal dominant disease with low incidence. The incidence of Plastic bronchitis is not well defined. In Noonan syndrome, various lymphatic abnormalities have been described. Due to these abnormalities Plastic bronchitis may develop in the patients of Noonan syndrome. In the past, very few paediatric cases of Noonan syn...

Noonan syndrome is an autosomal dominant disease with low incidence. The incidence of Plastic bronchitis is not well defined. In Noonan syndrome, various lymphatic abnormalities have been described. Due to these abnormalities Plastic bronchitis may develop in the patients of Noonan syndrome.

A Study of the factors associated with the treatment outcome of patients put on Bedaquilline containing treatment regimen for Multi-drug Resistant (MDR) TB B edaquiline (BDQ) has emerged as new hope in the treatment of MDR TB especially in more complicated cases harboring additional drug resistance such as Fluroroquinolone (FQ) resistance. Wiht its...

Pre-conference workshop on Drug Resistant Tuberculosis was conducted under the banner of NATCON-2020 on 18th December 2020. The workshop covered various aspects of diagnosis including newer rapid genotypic methods, and gene sequencing. The workshop deliberated on the latest recommendations of the global and national guidelines about the management...

The current write-up is for Dr P.K.Sen TAI Gold Medal Oration Award for 2020 conferred to Dr Rupak Singla and delivered on 19 th December 2020. The title chosen for the oration was “Introduction and scale up of new anti-TB drugs in India: role of NITRD.ˮ However, in the oration the role this institute has played for overall scale up of Drug-resista...

Background: HIV (Human Immunodeficiency Virus) attacks the immune system and thereby weaken bodys natural defence mechanism against various diseases. Several pulmonary complications have been documented in HIV infected people among which Chronic Obstructive Pulmonary Disease (COPD) carries special importance. It has been postulated that COPD occurs...

As of 13 October 2020, 132 centres from 36 countries/regions joined the global study. Data covering 597 individual patients have already been provided by 27 countries/regions, and three countries have committed to provide data soon. To date, six countries have not reported any cases of TB and COVID-19 (Greece, Latvia, Lithuania, the Netherlands, Sl...

We read with interest the two articles by Tadolini et al. [1] and Stochino et al. [2] which described recent cohorts of either current or former TB patients with COVID-19 and studied their clinical course. India has the majority of global burden of tuberculosis (TB) along with highest rising number of daily COVID-19 cases in the world [3, 4]. Thoug...

Background The study aimed to analyze frequency and severity of adverse events (AEs) and other reasons for interruption of treatment and loss to follow up (LTFU) during first six months of treatment among tuberculosis patients on bedaquiline containing regimens. Methods This pilot exploratory observational study included 275 patients enrolled cons...

Both tuberculosis and COVID-19 being communicable and prevalent diseases in India, the co-existence can lead to worse outcomes, as seen in this study, where there was high mortality among active as well as treated TB patients with COVID-19 co-infection

The COVID‑19 pandemic is still raging, and it is not clear when the world would see its end. The coronavirus is highly infectious and spreads through droplets generated during coughing, sneezing, talking, and even breathing. Indirect contact via contaminated surfaces is another possible mode of infection. Transmission risks during pulmonary functio...

Multiple drugs taken for long duration in tuberculosis (TB) treatment, especially drug resistant TB (DR-TB), may produce adverse drug reactions (ADRs). Although any anti-TB drug can cause ADRs, but these are more common with drugs used for treatment of DR-TB. However, most of ADRs with these drugs are mild or moderate and can be managed if adequate...

BACKGROUND: Addressing TB in India is critical to meeting global targets. With the scale-up of diagnostic networks and the availability of new TB drugs, India had the opportunity to improve the detection and treatment outcomes in drug-resistant TB (DR-TB). OBJECTIVE: To document how the introduction of new drugs and regimens is helping India improv...

Background Treatment of multidrug-resistant tuberculosis requires long-term therapy with a combination of multiple second-line drugs. These drugs are associated with numerous adverse events that can cause severe morbidity, such as deafness, and in some instances can lead to death. Our aim was to estimate the absolute and relative frequency of adver...

Background and objectives Mortality of patients with pulmonary tuberculosis (TB) admitted to emergency departments is high. This study was aimed at analysing the risk factors associated with early mortality and designing a risk score based on simple parameters. Methods This prospective case-control study enrolled patients admitted to the emergency...

We sought to compare the effectiveness of two WHO-recommended regimens for the treatment of rifampin- or multidrug-resistant (RR/MDR) tuberculosis: a standardised regimen of 9–12 months (the “shorter regimen”), and individualised regimens of ≥20 months (“longer regimens”). We collected individual patient data from observational studies identified t...

Background: India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. Objective: Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. Methods: Between Jul...

Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national‐level expert group that formulated a comprehensive guideline document for FB...

Background: Identification of factors associated with early mortality among seriously ill pulmonary tuberculosis (PTB) patients may help in early interventions. Methods: 250 diagnosed/suspected PTB patients, presenting to respiratory emergency of a hospital were prospectively enrolled. Various demographic, clinical, radiological, microbiological an...

Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international...

indian j chest dis allied sci 2019;61:87-89] clinical summary Hydatidosis remain the endemic disease in some regions of the world. The liver and the lungs are the most common sites in adults. Mediastinal with cardiac hydatid cysts are very rare and true incidence has not been described in the literature. A 25-year-old male, non-smoker, came with co...

Background: Drug-Resistant Tuberculosis (DR-TB) patients for whom a WHO recommended regimen along with Bedaquiline (BDQ) cannot be prescribed, Delamanid (DLM) was added along with other drugs to provide a “Salvage Regimen”. The experience of the Institute in respect of early efficacy and safety of both drugs given together is presented. Objective:...

Background: Bedaquiline (BDQ) was approved for treatment of drug resistant TB (DR-TB) under Conditional Access Programme (CAP) of Revised National Tuberculosis Control Programme (RNTCP) and was also implemented in the National Institute of TB and Respiratory Diseases (NITRD). We present early efficacy and safety of BDQ containing regimens for DR-TB...

This report seeks to establish a potential non-invasive, relatively easy strategy using urine as the sample matrix for diagnosing chronic respiratory disorders like chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer (NSCLC). In this case-control study, early morning mid-stream urine samples were collected from 84 volunteers...

The End TB Strategy envisions a world free of tuberculosis—zero deaths, disease and suffering due to tuberculosis by 2035. This requires reducing the global tuberculosis incidence from >1250 cases per million people to <100 cases per million people within the next two decades. Expanding testing and treatment of tuberculosis infection is critical to...

Background Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis.

Background: Treatment outcomes for multidrug-resistant tuberculosis remain poor. We aimed to estimate the association of treatment success and death with the use of individual drugs, and the optimal number and duration of treatment with those drugs in patients with multidrug-resistant tuberculosis. Methods: In this individual patient data meta-a...

Introduction There is lack of information on the proportion of new smear—positive pulmonary tuberculosis (PTB) patients treated with a 6-month thrice-weekly regimen under Revised National Tuberculosis Control Programme (RNTCP) who develop recurrent TB after successful treatment outcome. Objective To estimate TB recurrence among newly diagnosed PTB...

Study definitions. (DOCX)

Background: Treatment of multidrug-resistant (MDR-TB) mainly focuses on bacteriological cure. However, only limited studies have evaluated the sequelae left after the completion of treatment among MDR-TB patients. Objective: To assess the persistent symptoms, radiological sequelae, pulmonary function impairment and quality of life at the complet...

Background: The audio signal in the conventionally accepted protocol of shuttle walk test (SWT) is not well-understood by the patients and modification of the audio signal may improve the performance of the test. Objectives: The aim of this study is to study the validity and reliability of an audio signal modified SWT, called the Singla-Richa mo...

One-third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism, whereas two-thirds manifest deep vein thrombosis (DVT). Overall, 25%–50% of patients with first-time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB) is a rare occurrence. Deep veno...

Background Different definitions used for chronic obstructive pulmonary disease (COPD) preclude getting reliable prevalence estimates. Study objective was to find the prevalence of COPD as per standard Global Initiative for Chronic Obstructive Lung Disease definition, risk factors associated, and treatment seeking in adults >30 years. Methodology...

Diaphragmatic hernias are commonly congenital and usually present in childhood. In adults presentation may differ from being asymptomatic to presenting with life-threatening complications, like obstruction or strangulation. Hernias with omentum as content may be misdiagnosed as mass lesions. Chest radiograph helps in establishing the diagnosis only...

Background: Treatment of pulmonary tuberculosis (PTB) focuses on microbiological cure and radiological improvement. However, many patients develop pulmonary impairment after the completion of anti-tubercular therapy (ATT), which affects their quality of life (QoL). Aim and objective: To study the occurrence and severity of pulmonary impairment a...

Allergic Rhinitis is rather erroneously viewed as a trivial disease. It is important in that it can significantly affect quality of life. There is paucity of community based prevalence studies on the disease in India. This study was planned to assess the prevalence of allergic rhinitis in adults, the proportion of asthmatics among them, risk factor...

Asthma is defined as a chronic inflammatory disorder of the airways which manifests itself as recurrent episodes of wheezing, breathlessness, chest tightness and cough. It is characterized by bronchial hyper-responsiveness and variable airflow obstruction, that is often reversible either spontaneously or with treatment. The prevalence of asthma in...