Guidelines versus ground lines: Tuberculosis of the central nervous system.

{"article_title":"Guidelines versus ground lines: Tuberculosis of the central nervous system.","author":"Khadilkar SV, Kadam ND, Kulkarni RV, Meshram CM, Meshram AR, Patel BA, Chheda AH","journal_title":"Neurology India","issn":"1998-4022","isbn":"","publication_date":"2019 May-Jun","volume":"67","issue":"3","first_page":"787","page_count":"","accession_number":"31347556","doi":"10.4103\/0028-3886.263198","publisher":"Medknow Publications","doctype":"Journal Article","subjects":"India; Practice Patterns, Physicians'; Tuberculosis, Central Nervous System diagnosis; Tuberculosis, Central Nervous System therapy; Humans; India; Neurologists; Neurology; Practice Guidelines as Topic; Surveys and Questionnaires","interest_area":["Infectious Disease & Vaccines"," Neurology"," Internal\/Family Medicine"],"abstract":"Aim: This questionnaire-based national survey is aimed at understanding the patterns of practice of various aspects of central nervous system (CNS) tuberculosis (TB) among neurologists. Settings and Design: Neurology department of a tertiary medical college. Materials and Methods: A questionnaire was sent through email to all practicing neurologists in India. The responses were analyzed. Statistical Analysis: Inferential statistics. Results: In all, 144 responses were received (out of the 853 questionnaires sent). The major discrepancies were in the primary antitubercular drug regimen (HRZE + HR), duration for tubercular meningitis (TBM) [12 months] and tuberculoma (12-18 months) to develop, follow-up (varied), linezolid use (varied), proportion of drug-resistant cases (<25%), and not taking histological aids (91%). The cerebrospinal fluid (CSF) TB polymerase chain reaction (PCR) utility (75%), not using CSF adenosine deaminase [ADA] (58%), the strategy to stop antitubercular drugs, and the use of steroids (77%) were according to guidelines. Conclusion: The present survey, for the first time, provides ground-level evidence of various aspects of CNS TB as practiced by neurologists in India. The major diversity was observed in therapeutics such as the choice of antitubercular drugs, its duration, linezolid use beyond the recommended duration, and knowledge of drug resistance. The monitoring aspects of CNS TB also showed variations. The investigational aspects of CNS TB such as using TB PCR, not using CSF ADA, and regular neuroimaging revealed a good clinical practice. Other CSF parameters require uniformity. This survey thus helps to identify areas of future work in CNS TB in India. Competing Interests: There are no conflicts of interest","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=31347556&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Khadilkar SV, Kadam ND, Kulkarni RV, Meshram CM, Meshram AR, Patel BA, Chheda AH","Journal_Info":"Publisher: Medknow Publications Country of Publication: India NLM ID: 0042005 Publication Model: Print Cited Medium: Internet ISSN: 1998-4022 (Electronic) Linking ISSN: 00283886 NLM ISO Abbreviation: Neurol India Subsets: MEDLINE","Publication_Type":"Journal Article","Published_Date":"2019-05-01","Source":"Neurology India [Neurol India] 2019 May-Jun; Vol. 67 (3), pp. 787-791.","Languages":"English","Electronic_ISSN":"1998-4022","MeSH_Terms":"Practice Patterns, Physicians'*, Tuberculosis, Central Nervous System\/*diagnosis , Tuberculosis, Central Nervous System\/*therapy, Humans ; India ; Neurologists ; Neurology ; Practice Guidelines as Topic ; Surveys and Questionnaires","Subjects":"Humans, India, Neurologists, Neurology, Practice Guidelines as Topic, Surveys and Questionnaires, Practice Patterns, Physicians', Tuberculosis, Central Nervous System diagnosis, Tuberculosis, Central Nervous System therapy","Title_Abbreviations":"Neurology India","Volume":"67"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"31347556","RelevancyScore":"836","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"836.083435058594"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=31347556&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=31347556&authtype=shib&custid=ns346513&group=main&profile=eds"}