[Cultural diversity in mental health care]

Background  Of the total Dutch population, 25.7% has a migration background. The countries of origin, migration motives and time in the Netherlands are very diverse. Aim  To provide an overview of the cultural diversity within the psychiatry of different groups of people with a migration background, and to address the challenges and mental health care to these groups and the position of transcultural psychiatry in the Netherlands. Method  Based on integration of a narrative literature review (without a systematic search), own experiences and a fictitious case, we discuss the most important groups. This concerns the so-called guest workers as a specific group of first-generation migrants, second-generation migrants with their specific problems, and finally refugees and undocumented migrants with an accumulation of risk-increasing factors. Results  In addition to predisposition and migration factors, insufficient understanding of cultural context contributes to the psychiatric problems of first- and second-generation migrants. Refugees and undocumented migrants also have limited access to care. There is a reimbursement system in the Netherlands for undocumented migrants, through which they can also rely on care. By understanding cultural backgrounds, professionals can further improve their skills and communication in the field of intercultural psychiatry. Conclusion  Cultural diversity of patient groups demands additional attention to diagnosis and therapy.

Squill oil for decreasing dyspareunia and increasing sexual satisfaction in menopausal women: A triple-blind randomized controlled trial

OBJECTIVE

The present study aimed to investigate the effect of squill oil on dyspareunia and sexual satisfaction in menopausal women.

MATERIALS AND METHODS

The present triple-blind randomized two-group controlled trial was conducted on 60 menopausal women (n=30 in placebo group and n=30 in squill oil group) in Mashhad in northeast of Iran in 2019. The Sabbatsberg Sexual Self-Rating Scale and Marinoff dyspareunia scale were the main tools used in this study. The participants were randomly assigned to two groups namely, squill oil group and placebo group and they received the treatments for 4 weeks. Questionnaires were completed before and 4 weeks after the intervention in both groups. Data analysis was performed using SPSS 24 by Mann-Whitney, t-test, and repeated measures ANOVA with a significance level of less than 0.05.

RESULTS

The average age in the squill oil group and placebo group were 53.5±2.2 and 51.7±4.5 years, respectively. There was a significant difference (p<0.001) between the two groups in terms of dyspareunia score before (1±3.6 vs 1±3.5) and after intervention (0.7±0.1 vs 1.2±1.2) in two groups.Results of independent t-test indicated that there was a significant difference (p<0.001) between the two groups in terms of sexual satisfaction before (23.4±5.7 vs 23.1±2.8) and after intervention (36.5±5.6 vs 24.8±2.5) in two groups.

CONCLUSION

Using squill oil can cause a reduction in painful sexual intercourse and an increase in sexual satisfaction in postmenopausal women.

Comparing the Effectiveness of Sexual Counseling Based on PLISSITand BETTER Models on Sexual Selfdisclosure in Women with Sexual Problems after Childbirth: A Randomized Trial

Background:

Sexual self-disclosure is one of the factors that affect sexual satisfaction. The aim of this study was to assess the efficacy of individual therapy using the Bring up, Explain, Tell, Timing, Educate, and Record (BETTER model) in comparison to individual therapy using the Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT model) in terms of increasing sexual self-disclosure in women with sexual problems after childbirth.

Materials and Methods:

This randomized trial was conducted in 2017 in Mashhad, Iran. 80 women with sexual problems within 4 weeks to 6 months after childbirth were randomized into two equal groups and received the interventions in 2 sessions of 60–90 minutes. The research instruments included a demographic questionnaire, the Female Sexual Function Index (FSFI) and Hulbert sexual self-disclosure index. Changes in mean (SD) scores of sexual self-disclosures between groups were assessed before and 4 weeks after the intervention and the results (mean changes) were compared between groups. The data analysis was conducted using independent t-test, paired t-test, Chi-square, analysis of covariance (ANOVA), and Mann-Whitney U test in SPSS (p < 0.05).

Results:

In the PLISSIT group, the mean (SD) sexual self-disclosure score at baseline was 43.80 (9.50) and after 4 weeks was 51.60 (8.30). In the BETTER group, at baseline and after 4 weeks the mean (SD) sexual self-disclosure score was, respectively, 44.10 (10.30) and 55.60 (8.20) (Z = -2.5, p = 0.013).

Conclusions:

The findings confirm the effectiveness of the BETTER counseling model in increasing sexual self-disclosure after childbirth.

Association between serum uric acid and bone health in adolescents

Previous studies are suggestive of the protective role of uric acid on bone in the middle-aged and elderly. Whether this association exists in younger individuals has not been examined. This investigation showed a significant positive association between serum uric acid and bone parameters among Iranian adolescents.

INTRODUCTION

Uric acid (UA) might be linked to bone health, but it is unclear whether its effects on bone are limited to certain population subgroups. This study is aimed at investigating the correlation between serum uric acid levels and bone mineral density (BMD) in Iranian adolescents.

METHODS

This cross-sectional study was conducted on 413 (221 girls and 192 boys) Iranian adolescents aged 9-19 years. An analysis of anthropometric, biochemical parameters and bone density was performed on the participants. Measurements included serum uric acid, calcium, phosphorus, alkaline phosphatase, albumin, and vitamin D. They were divided according to their serum UA into the low UA group who had UA ≤ 6 mg/dL and the high UA group with UA > 6 mg/dL. BMD and bone mineral content (BMC) were measured in the total body, lumbar spine, and left femoral neck, using dual energy X-ray absorptiometry (DXA), and bone mineral apparent density (BMAD) was calculated.

RESULTS

A Pearson correlation analysis revealed a significant correlation between UA and bone parameters. In multiple regression analyses adjusted for potential confounders, serum UA was proven to be associated with BMD and BMC at all sites. There was no association between UA, serum calcium, and vitamin D concentrations.

CONCLUSION

Our study, as the first research on adolescents, demonstrated a higher bone density in those who had higher UA levels.

The influence of interferon-γ on cardiac and renal histopathological changes induced by carbamazepine

BACKGROUND

Carbamazepine (CBZ) is used for the treatment of epileptic seizures. This study was designed to evaluate the effect of Interferon-gamma on the fetal heart and kidney histopathological changes of CBZ-treated pregnant mice.

METHODS

Twenty pregnant mice were divided into four groups. The control group received distilled water. The second group received 240 mg/kg of CBZ by gastric gavage. The third group received intraperitoneal injection (IP) of IFN-γ. The fourth group received IP injection of IFN-γ with 240 mg/kg CBZ by gavage. The fetuses were delivered by hysterectomy on the 18th day of gestation.

RESULTS

The mean weight, crown-rump length, the total volume of the heart and kidney of the fetuses in the CBZ-treated group were significantly reduced when compared with the control, INF-γ and CBZ + INF-γ groups (p < 0.05). INF-γ prevented histopathological changes when used with CBZ (p < 0.05).

CONCLUSION

CBZ induced structural changes in the fetal tissues of the pregnant mice. However, IFN-γ could reduce these changes (Tab. 1, Fig. 4, Ref. 26).

Effects of selenium and vitamin C on the serum level of antithyroid peroxidase antibody in patients with autoimmune thyroiditis

PURPOSE

Selenium (Se), an essential trace element, has been implicated in pathogenesis of autoimmune thyroiditis (AIT). Most studies attributed the immune modulating effects of Se to its antioxidant properties. However, there is insufficient evidence to support the use of selenium supplementation or other antioxidants in patients with AIT. This clinical trial was designed to investigate the impact of Se and vitamin C supplementation on antithyroid peroxidase antibody (TPO-Ab) level in patients with AIT.

METHODS

One hundred and two subjects aged 15-78 years were randomized into three groups. Group one (GI) (n = 38) was treated with 200 μg/day sodium selenite, group two (GII) (n = 36) received 500 mg vitamin C/day, and group three (GIII) (n = 28) received placebo over a 3-month period. Thyroid stimulating hormone (TSH), TPO-Ab, antithyroglobulin antibody (Tg-Ab) and Se concentrations were once measured before treatment and at the end of the study.

RESULTS

After 3 months, TPO-Ab concentrations decreased within Se and vitamin C-treated groups, but did not change in the placebo subjects. In this regard, there was no significant difference between the groups. We also did not find any statistically significant difference in TSH and Tg-Ab levels within and between the groups. At the end of the study, Se level was significantly higher in GI compared with GII and GIII.

CONCLUSION

Our findings supported the hypothesis of antioxidant beneficial effects of Se in AIT. However, it was not superior to vitamin C, regarding its effects on thyroid-specific antibodies.

Changing the dehydrogenation pathway of LiBH4–MgH2via nanosized lithiated TiO2

Nanosized lithiated titanium oxide (Li_xTiO₂) noticeably improves the kinetic behaviour of 2LiBH₄ + MgH₂.

Ca(BH4)2-Mg2NiH4: on the pathway to a Ca(BH4)2 system with a reversible hydrogen cycle

The Ca(BH4)2-Mg2NiH4 system presented here is, to the best of our knowledge, the first described Ca(BH4)2-based hydride composite that reversibly transfers boron from the Ca-based compound(s) to the reaction partner. The ternary boride MgNi2.5B2 is formed upon dehydrogenation and the formation of Ca(BH4)2 upon rehydrogenation is confirmed.

Evaluation of verapamil efficacy in Peyronie's disease comparing with pentoxifylline

INTRODUCTION

Peyronie's disease described as penile curvature, fibromathosis and pain that occur most often in men aged 40 to 60 years. The main complaint that caused the patient to visit the clinic is nodules on the upper surface of the penis, causing curvature and distortion particularly during erection, but they don't have any urinary problem. In this study, we evaluated the effect of verapamil compared to pentoxifylline in Peyronie's disease.

METHODS

In this study, 90 patients with signs and symptoms of Peyronie's disease which were diagnosed and were in the age range 40 to 70 years enrolled. The patients were randomly divided into 3 groups. First group received pentoxifylline orally at a dose of 400 mg three times a day, in the second group verapamil (10 mg every other week for up to 12 sessions) was injected into the lesion and the third group received both treatments in combination.

RESULTS

In patients, who received pentoxifylline, curvature reduction was 26.7%, plaque size reduction was 30%, the recovery rate of erectile dysfunction was 46.7% and pain reduced was 73.3%. Each of these cases in patients, who used beta-blockers, was 36.7%, 33.3%, 66.7% and 76.6%. In combination therapy, curvature reduction was 36.7%, plaque size reduction was 33.3%, the recovery rate of erectile dysfunction was 86.7% and pain reduced was 80%.

CONCLUSION

In our study there was no significant difference between two groups using verapamil or pentoxifylline, but there was a significant improvement in combination therapy group. Due to our results we propose that combination therapy can improve results and should be considered as a choice in treatment of Peyronie's disease. 

Mathematical Modelling of Some Null-Context and Uniform Splicing Systems

The mathematical modelling of splicing system which involves recombination of DNA molecules was first introduced by Head in 1987. Splicing of DNA involves cutting of DNA molecules using the restriction enzymes and re-associating different fragments of DNA molecules using the ligase under some specific chemical conditions. A splicing language, L is generated if there exists a splicing system S for which L = L(S). There are different types of splicing systems which have been discussed by various researchers. Among them are the persistent splicing system, null-context and uniform splicing system. In this paper, some molecular examples on null-context splicing system and uniform splicing systems with different initial strings and combination of restriction enzymes will be discussed. Applications of automata theory on some molecular examples of null-context and uniform splicing languages will also be presented in this paper.

Synthesis and application of FePt/CNTs nanocomposite as a sensor and novel amide ligand as a mediator for simultaneous determination of glutathione, nicotinamide adenine dinucleotide and tryptophan

In this study, we report the synthesis and application of a FePt/CNTs nanocomposite as a highly sensitive sensor and novel amide ligand (9,10-dihydro-9,10-ethanoanthracene-11,12-dicarboximido)-4-ethylbenzene-1,2-diol as a mediator for the determination of glutathione (GSH), nicotinamide adenine dinucleotide (NADH) and tryptophan (Trp). The synthesized materials were characterized with different methods such as NMR, IR spectroscopy, TEM, XRD, FESEM, cyclic voltammetry, electrochemical impedance spectroscopy and square wave voltammetry (SWV). The modified electrode exhibited a potent and persistent electron mediating behavior followed by well-separated oxidation peaks of GSH, NADH and Trp. The peak currents were linearly dependent on GSH, NADH and Trp concentrations in the range of 0.08-220, 1.0-400 and 5.0-500 μmol L(-1), with detection limits of 0.05, 0.8 and 1.0 μmol L(-1), respectively. The modified electrode was used for the determination of these compounds in real samples.

Genetic variation in macrophage migration inhibitory factor associated with gestational diabetes mellitus and metabolic syndrome

The aim of this study was to investigate the association of macrophage migration inhibitory factor (MIF) polymorphism rs1007888 with gestational diabetes mellitus (GDM), and its association with postpartum metabolic syndrome. In a case-control study, 147 GDM and 169 healthy pregnant patients were recruited. Blood sample was taken 2 times from all the participants; one at 24-28 weeks of gestation, second at 6-12 weeks of postpartum. Biochemical measurement and DNA extraction were performed. The PCR_SSP was performed for genotyping. The frequencies of AA, AG, and GG genotypes were 11.24% (19), 76.92% (130), and 11.83% (20) in healthy pregnancies and were 7.48% (11), 70.74% (104), and 21.76% (32) in GDM individuals. The distributions of MIF genotypes were significantly different in GDM and healthy subjects (p=0.04). Moreover, GG genotype had a significant association with pre-pregnancy obesity and family history of diabetes. In postpartum follow-up GG genotype was two-fold more frequent in women with metabolic syndrome (p=0.01, odds ratio=2.30, CI 95%; 1.23-4.30) and relative risk was equal 1.77 (CI 95%; 1.19-2.64). Our findings demonstrate an association between MIF polymorphism rs1007888 and susceptibility to GDM in pregnancy and metabolic syndrome development.

Fracture Resistance of Cuspal Coverage of Endodontically Treated Maxillary Premolars with Combined Composite-Amalgam Compared to Other Techniques

Combined composite-amalgam for cuspal coverage of endodontically treated premolars was similar to direct composite coverage in strengthening restored teeth; however, composite onlay had the highest fracture resistance.

MIF Expression in Induced Peripheral Blood Mononuclear Cells by Vitamin D3 and its Potential Correlation with Resting Metabolic Rate in Obesity

Macrophage migration inhibitory factor (MIF) plays a pivotal role in systemic and local inflammatory and immune responses. The aim of this study is to assess MIF gene expression in PBMCs harvested from obese individuals and to compare it with that of lean subjects to analyze any potential relationship between resting metabolic rate as well as several different parameters and MIF expression in PBMC. We also aim to assess anti-inflammatory characteristics of vitamin D3 on MIF expression in vitro. Participants were 30 obese and 18 non-obese subjects who were assessed following an overnight fasting for RMR by means of indirect calorimetry. Body composition was measured using a Bodystat device. The PBMCs were separated from whole blood by the Ficoll-hypaque technique. The mRNA was extracted and the cDNA was synthesized. This process was followed by real-time PCR using primer pairs specific for MIF mRNA and beta actin as internal control. Our findings clearly demonstrate that there were significant differences in terms of BMI, BMR predict, fat proportion, fat mass, free fat mass, TBW, visceral fat, fasting serum glucose, TG, HDL, Hs-CRP and RMR between the two groups. Moreover, the level of MIF expression in the obese group was approximately 2.5 times higher compared to the lean group. An increased level of MIF expression in the obese group and a decreased expression of that non-obese was observed after inducing PBMCs with vitamin D3. One of the intriguing results of this study was the observed reverse correlation between MIF expression and fat mass as well as fat proportion after PBMCs were cultured in the presence of vitamin D3. Therefore, it could be concluded that MIF expression, which is in turn influenced by vitamin D3, has a role in the hyperactive immune profile and the pro-inflammatory state observed in obese individuals which is suggested to have a causal relationship with obesity.

Tandem Repeats of the Catt Element of Macrophage Migration Inhibitory Factor Gene May Predict Gestational Diabetes Mellitus Severity

Previous investigations have demonstrated the association of the CATT repeated allele in the Macrophage migration inhibitory factor (MIF) with obesity and diabetes. Since there are common risk factors and molecular pathways in Type 2 Diabetes and Gestational Diabetes Mellitus (GDM), we focused on the associations of MIF variation with GDM. In a case-control study we enrolled 157 GDM and 217 healthy pregnant women, referred to the outpatient clinic of Shariati Hospital. The different repeats of CATT in MIF promoter were determined. MIF relative gene expression was evaluated in Peripheral blood mononuclear cells of all the participants. The GDM group had higher mean age and pre-gravid BMI. Also fasting serum glucose, insulin and MIF gene expression were significantly higher in the GDM patients. The statistically significant difference was observed between GDM and a healthy group in carrying 7-CATT allele and MIF gene expression. Regarding GDM risk factors, MIF 7-CATT allele showed significant relation with pre-pregnancy obesity, as well as the need for insulin therapy. Our results indicate that an association between MIF genotypes and its expression with GDM, obesity and the need of insulin for management of GDM patients exists.

Combination of bleach and flourescent microscopy: a milestone in the diagnosis of smear negative tuberculosis

BACKGROUND

The reliability of direct smear microscopy for diagnosis of tuberculosis has frequently been questioned due to low sensitivity. Treatment of sputum with sodium hypochlorite (NaOCI) has been used to increase sensitivity in many settings. However, no study has established the effect of NaOCI on fluorescent microscopy.

OBJECTIVE

To establish whether NaOCI concentration method enhances positivity of fluorescent microscopy smear negative sputum for diagnosis of tuberculosis.

DESIGN

A prospective study.

SETTING

Mbagathi District Hospital and Centre for Respiratory Diseases Research, Kenya Medical Research Institute.

RESULTS

Forty five (22%) specimens were culture positive. Fluorescent microscopy sensitivity was 28.9% and 22.2% after centrifugation and sedimentation with 3.5% NaOCI, respectively (P > 0.05). Sensitivity was 24.4% and 17.8% after centrifugation and sedimentation with 5% NaOCI, respectively (P > 0.05). Although there was no statistical significance difference between the two NaOCI concentration methods, 3.5% NaOCI with centrifugation indicated a higher yield.

CONCLUSION

Use of NaOCI significantly enhances positivity of smear negative sputum for diagnosis of tuberculosis when used with fluorescent microscopy. This approach could be recommended for screening all tuberculosis suspects especially in settings with potential smear negative tuberculosis.

Clinical presentation among HIV-infected and non-infected adults with community acquired pneumonia in Nairobi

SETTING

Risk factors for mortality in hospitalized patients with community-acquired pneumonia (CAP) are well known. There are limited data on prognostic indicators among out-patients.

OBJECTIVE

To compare the clinical presentation, outcome and prognostic factors for clinical improvement in human immunodeficiency virus (HIV) infected and non-HIV-infected out-patients with CAP.

METHODOLOGY

Adults in Nairobi with CAP were treated with erythromycin as first-line therapy. Clinical symptoms were evaluated using a validated CAP-related symptom score (CSS). Clinical improvement was defined as reduction of baseline CSS by > or = 50%.

RESULTS

Of 531 adults enrolled with CAP, 422 (79.5%) completed follow-up. Participants had a mean age (+/- SD) of 33.7 +/- 11.4 years, 274 (51.6%) were male and 193 (37%) were HIV-seropositive with a higher baseline CSS (27 vs. 25, P < 0.006). Overall, 196 of 422 (46%) had clinical improvement by 28 days. Factors independently associated with a longer time to clinical improvement included not being married (adjusted hazard ratio [aHR] 0.66, 95% CI 0.48-0.92) and higher baseline CSS (aHR 1.05, 95% CI 1.03-1.06).

CONCLUSIONS

HIV-infected and non-infected patients with CAP responded similarly to out-patient treatment, but HIV-infected patients were more likely to present with severe symptoms. Baseline CSS and marital status were predictive of time to clinical improvement.

Planning for PPM-DOTS implementation in urban slums in Kenya: knowledge, attitude and practices of private health care providers in Kibera slum, Nairobi

SETTING

Kibera, the largest slum in Nairobi, Kenya.

OBJECTIVE

To determine the tuberculosis (TB) knowledge, attitude and practices (KAP) of private health care providers (PHCPs) to identify their training needs and willingness to participate in a National Leprosy and Tuberculosis Control Programme (NLTP) guided TB control effort in the slum.

DESIGN AND METHODOLOGY

A cross-sectional survey. The KAP of PHCPs was assessed using an interviewer administered questionnaire.

RESULTS

Of 75 PHCPs interviewed, the majority (96.0%) were paramedics; 51 (77.1%) did not consider sputum smear microscopy crucial in patients presenting with prolonged cough or when a chest X-ray was suggestive of TB; of 29 (38.7%) who indicated familiarity with the drugs used in TB treatment, 20 (58.5%) would have chosen the NLTP-recommended regimens for the treatment of the various types of TB; 16 (21.3%) PHCPs indicated that they treated TB, six (37.5%) of whom were not familiar with anti-tuberculosis drug regimens. All the PHCPs referred TB suspects to the public sector for diagnosis.

CONCLUSION

This study reveals a significant gap in TB knowledge among the PHCPs in Kibera slum. However, given appropriate training and supervision, there is potential for public-private mix for DOTS implementation in this setting.

Isolation of multidrug-resistant tuberculosis strains in patients from private and public health care facilities in Nairobi, Kenya

SETTING

Health care facilities in Nairobi, Kenya.

OBJECTIVE

To document the presence of multidrug-resistant tuberculosis (MDR-TB) strains in patients from Nairobi between September 1999 and October 2001.

DESIGN

Descriptive study.

RESULTS

Of the 983 referred patients who submitted sputum for culture and drug susceptibility testing (DST), 59% were males. Two hundred and nine (21.3%) patients had a positive culture, of whom 15.2% had a request for DST against isoniazid, rifampicin, streptomycin and ethambutol. Of these, 65 (43.6%) had an isolate resistant to one or more drugs, while 17 (11.4%) had MDR-TB. Ten (59.0%) cases were referred from public health care facilities while seven (41%) were from the private sector. Sixteen isolates were resistant to all four drugs. All MDR-TB cases but one were from Nairobi.

CONCLUSION

The emergence of MDR-TB in Nairobi is a cause for concern. An outbreak would be catastrophic, creating not only increased morbidity and mortality but also a tremendous strain on already limited health care resources. Lack of policies for the treatment and management of MDR-TB and the unavailability of appropriate diagnostic facilities may increase its spread. Efforts to prevent outbreaks of MDR-TB should be emphasised.

Urban-rural differences in questionnaire-derived markers of asthma in Kenyan school children

Grade 4 Kenyan children attending 10 randomly selected public primary schools in Nairobi (urban) and the Muranga District (rural) were surveyed to establish the prevalence of symptom markers of asthma and to assess the impact of urbanization. A respiratory health and home environment questionnaire was administered at school to parents or guardians. The questionnaire response rates were 94.2% (568/ 603) for Nairobi and 89.6% (604/674) for Muranga. The prevalence rates for asthma, defined as "attacks of shortness of breath with wheeze", were 9.5% for urban and 3.0% for rural children (odds ratio (OR) urban versus rural: 3.42; 95% confidence interval (CI): -1.96-5.91). This urban-rural gradient persisted after adjusting for urban-rural differences in host factors (including duration of breastfeeding and family history of asthma and/or allergy), but was largely explained by urban-rural differences in environmental factors, including indoor animals, sharing a bedroom with a smoker, parental education, house ventilation and exposure to motor vehicle fumes en route to school (adjusted OR: 1.59; 95% CI: 0.70-3.55). Similar results were obtained for all other symptoms. These findings confirm the clinical impression that asthma is an important illness in Kenya and underline the need for the further study of environmental factors amenable to intervention, particularly in urban areas.

Cohort study of HIV-positive and HIV-negative tuberculosis, Nairobi, Kenya: comparison of bacteriological results

We have set up a cohort of human immunodeficiency virus (HIV) positive and negative patients with tuberculosis in order to address the problems associated with HIV-related tuberculosis. We present here the results of sputum smear microscopy, culture, mycobacterial identification tests and drug susceptibility assays from specimens taken at presentation. In this selected population of largely pulmonary tuberculosis cases, HIV infection is not associated with significant differences in sputum smear positivity rate, culture positivity rate or initial drug resistance. No atypical mycobacteria were found. Direct sputum smear examination remains specific for the diagnosis of tuberculosis in Kenya in spite of the presence of HIV. HIV infection was not associated with an increase in the proportion of pulmonary cases still culture-positive at 6 months. However a significant increase in the proportion of cases still culture-positive at 6 months was seen in those with initially resistant strains and also in those treated with standard regimen (streptomycin, thiacetazone and isoniazid for 1 month followed by thiacetazone and isoniazid for 11 months, 1STH/11TH) rather than a short-course, rifampicin-containing regimen (rifampicin, pyrazinamide and isoniazid for 2 months, together with streptomycin for the first month and followed by 6 months of thiacetazone and isoniazid, SHRZ/6TH).