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Barddhamān, India

Achanta S.,World Health Organization | Kumar A.M.V.,World Health Organization | Nagaraja S.B.,World Health Organization | Jaju J.,World Health Organization | And 7 more authors.
PLoS ONE | Year: 2012

Background: Though internationally recommended, provider initiated HIV testing and counseling (PITC) of persons suspected of tuberculosis (TB) is not a policy in India; HIV seroprevalence among TB suspects has never been reported. The current policy of PITC for diagnosed TB cases may limit opportunities of early HIV diagnosis and treatment. We determined HIV seroprevalence among persons suspected of TB and assessed feasibility and effectiveness of PITC implementation at this earlier stage in the TB diagnostic pathway. Methods: All adults examined for diagnostic sputum microscopy (TB suspects) in Vizianagaram district (population 2.5 million), in November-December 2010, were offered voluntary HIV counseling and testing (VCT) and assessed for TB diagnosis. Results: Of 2918 eligible TB suspects, 2465(85%) consented to VCT. Among these, 246(10%) were HIV-positive. Of the 246, 84(34%) were newly diagnosed as HIV (HIV status not known previously). To detect a new case of HIV infection, the number needed to screen (NNS) was 26 among 'TB suspects', comparable to that among 'TB patients'. Among suspects aged 25-54 years, not diagnosed as TB, the NNS was 17. Conclusion: The seroprevalence of HIV among 'TB suspects' was as high as that among 'TB patients'. Implementation of PITC among TB suspects was feasible and effective, detecting a large number of new HIV cases with minimal additional workload on staff of HIV testing centre. HIV testing of TB suspects aged 25-54 years demonstrated higher yield for a given effort, and should be considered by policy makers at least in settings with high HIV prevalence. © 2012 Achanta et al. Source

Saharia G.K.,Post Graduate Institute of Medical Education and Research | Ruram A.A.,North Eastern Indira gandhi Regional Institute of health and Medical science NEIgRIhMS | Lyngwa J.,District Center
Indian Journal of Tuberculosis | Year: 2015

Background Meghalaya has high tuberculosis burden with increasing multidrug-resistant tuberculosis (MDR-TB) cases. Drug-induced hypothyroidism is one of the well-documented adverse effects in treatment of MDR-TB, the data of which are unavailable in the population residing in this part of the Indian subcontinent. Aim This study was undertaken to assess the thyroid profile status of patients under DOTS Plus treatment and to evaluate the effects of anti-tubercular drugs on thyroid functions with respect to the pre-treatment thyroid status. Methods A prospective study of 114 patients who initiated treatment for MDR-TB between June 2012 and August 2013 was performed. Thyroid hormones, viz., TSH, Total T3, Total T4, Free T3 and Free T4 were estimated. Results Out of our study group of 114 MDR-TB patients, 15 dead patients and defaulters were excluded. So, out of 99 patients, till now, 76 patients have completed 6 months of DOTS Plus treatment and were re-evaluated for thyroid status. 52(68%) patients showed TSH levels more than the reference limit of 5.60 μIU/mL and 5(7%) patients had TSH >10 μIU/mL suggesting presence of sub-clinical hypothyroidism. Conclusion We suggest the need for Mandatory TSH screening at baseline and then six months interval for all patients taking DOTS Plus so that no adverse effect goes under-reported and early intervention if required should be done to maintain proper adherence. © 2015 Tuberculosis Association of India Source

Achanta S.,World Health Organization | Jaju J.,World Health Organization | Kumar A.M.V.,Directorate General of Health Services | Nagaraja S.B.,World Health Organization | And 7 more authors.
PLoS ONE | Year: 2013

Setting:Private medical practitioners in Visakhapatnam district, Andhra Pradesh, India.Objectives:To evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC.Design:Cross- sectional survey using semi-structured interviews.Results:Of 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine.Conclusion:Few private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance. © 2013 Achanta et al. Source

Jose M.J.,Medical College | Varkey V.,District Center | Zubaida P.A.,Medical College | Maliekkal J.,Medical College
Journal of Association of Physicians of India | Year: 2016

Objectives:To study the relation of smoking and abnormal renal function in type 2 diabetes mellitus by estimating urine protein- creatinine ratio, blood urea, serum creatinine, glomerular filtration rate and serum lipid profile in selected subjects. Methods:Diabetic patients who attended the Diabetic Clinic, Medical College, Kozhikode were enrolled in the study. The study duration was 6 months, from July 2008 to December 2008. It was conducted in four groups of 40 subjects: diabetic smokers, diabetic non-smokers, non-diabetic smokers and non-diabetic non-smokers. The parameters assayed were: Blood urea, Serum creatinine, Fasting Blood Glucose and Serum Lipid Profile. The parameters assayed in the different groups were compared. Logistic regression analysis was done to study the effect of smoking on renal function. Results: The mean difference of Urine protein- creatinine ratio between diabetic smokers and non-diabetic smokers is statistically significant (0.46±0.21 vs 0.24±0.14, p < 0.001). The mean differences of Blood Urea between all the groups are statistically significant. The mean difference of Serum Creatinine of diabetic smokers with non-diabetic smokers is statistically significant (1.2±0.5 vs 0.96±0.2, p < 0.05). The mean differences of Total Cholesterol, Triglycerides, HDL, LDL and VLDL between all the study groups is statistically significant. In the regression analysis, it was found that 12.9% of the alteration of renal function can be explained by smoking alone. (R2 = 0.129) Conclusion: Smoking is an independent risk factor for progression of diabetic nephropathy. 24.8% of deterioration of renal function can be explained by smoking, obesity, hypertension and dyslipidemia and 12.9% of the alteration of renal function by smoking alone. © 2016, Journal of Association of Physicians of India. All rights reserved. Source

Paul D.,World Health Organization | Busireddy A.,District TB Office | Nagaraja S.B.,World Health Organization | Satyanarayana S.,International Union Against Tuberculosis and Lung Disease | And 9 more authors.
PLoS ONE | Year: 2012

Background: Excessive time between diagnosis and initiation of tuberculosis (TB) treatment contributes to ongoing TB transmission and should be minimized. In India, Revised National TB Control Programme (RNTCP) focuses on indicator start of treatment within 7 days of diagnosis for patients with sputum smear-positive PTB for monitoring DOTS implementation. Objectives: To determine length of time between diagnosis and initiation of treatment and factors associated with delays of more than 7 days in smear-positive pulmonary TB. Methods: Using existing programme records such as the TB Register, treatment cards, and the laboratory register, we conducted a retrospective cohort study of all patients with smear-positive pulmonary TB registered from July-September 2010 in two districts in India. A random sample of patients with pulmonary TB who experienced treatment delay of more than 7 days was interviewed using structured questionnaire. Results: 2027 of 3411 patients registered with pulmonary TB were smear-positive. 711(35%) patients had >7 days between diagnosis and treatment and 262(13%) had delays >15 days. Mean duration between TB diagnosis and treatment initiation was 8 days (range = 0-128 days). Odds of treatment delay >7 days was 1.8 times more likely among those who had been previously treated (95% confidence interval [CI] 1.5-2.3) and 1.6 (95% CI 1.3-1.8) times more likely among those diagnosed in health facilities without microscopy centers. The main factors associated with a delay >7 days were: patient reluctance to start a re-treatment regimen, patients seeking second opinions, delay in transportation of drugs to the DOT centers and delay in initial home visits. To conclude, treatment delay >7 days was associated with a number of factors that included history of previous treatment and absence of TB diagnostic services in the local health facility. Decentralized diagnostic facilities and improved referral procedures may reduce such treatment delays. © 2012 Paul et al. Source

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