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KV N.,District Tuberculosis Center | Duraisamy K.,WHO Country Office for India | Balakrishnan S.,WHO Country Office for India | M S.,State Training and Demonstration Center | And 5 more authors.
PLoS ONE | Year: 2013

Settings:Kerala State, India has reported the greatest dual burden of Tuberculosis (TB) and Diabetes Mellitus (DM). Malappuram district in Kerala has monitored and recorded DM status and its control from 2010 under Revised National Tuberculosis Control Program (RNTCP).Objectives:To assess, under programme conditions, comprehensiveness of recording DM status among TB cases and the TB treatment outcomes among DM patients (disaggregated by glycemic control) and compare with-non DM patients.Design:This retrospective record review included 3,116TB patients from April 2010 to September 2011.DM was defined as per international guidelines and TB treatment outcomes were categorized as favourable(cured and treatment completed) and unfavourable(death, default, failure and transfer out). Relative Risk (RR) and 95% confidence intervals(CI) were calculated to assess the risk of unfavourable outcomes.Results:DM status was recorded in 90% of TB cases and 667 (24%) had DM. 17% of DM patients and 23% of patients with unknown DM status had unfavourable outcomes but this difference was not statistically significant. Unadjusted RR for poor glycemic control or unknown control status for unfavourable outcome were (2.00; 95% CI 0.97-4.13) and (2.14; 95% CI 1.11-4.13).Conclusion:This study could not confirm an adverse association between DM or its control during treatment and the course of response to TB treatment.DM screening in TB cases and recording of DM care needs to be improved to enable more conclusive evidence. © 2013 KV et al.


Philip S.,Government TD Medical College | Isaakidis P.,Medecins Sans Frontieres | Sagili K.D.,International Union Against Tuberculosis and Lung Disease | Meharunnisa A.,Government TD Medical College | And 2 more authors.
PLoS ONE | Year: 2015

Background: Despite being a recognized standard of tuberculosis (TB) care internationally, mandatory TB case notification brings forth challenges from the private sector. Only three TB cases were notified in 2013 by private practitioners compared to 2000 TB cases notified yearly from the public sector in Alappuzha district. The study objective was to explore the knowledge, opinion and barriers regarding TB Notification among private practitioners offering TB services in Alappuzha, Kerala state, India. Methods & Findings: This was a mixed-methods study with quantitative (survey) and qualitative components conducted between December 2013 and July 2014. The survey, using a structured questionnaire, among 169 private practitioners revealed that 88% were aware of mandatory notification. All patient-related details requested in the notification form (except government-issued identification number) were perceived to be important and easy to provide by more than 80% of practitioners. While more than 95% felt that notification should be mandatory, punitive action in case of failure to notify was considered unnecessary by almost two third. General practitioners (98%) were more likely to be aware of notification than specialists (84%). (P<0.01). Qualitative purposive personal interviews (n=34) were carried out among private practitioners and public health providers. On thematic framework analysis of the responses, barriers to TB notification were grouped into three themes: 'private provider misconceptions about notification', 'patient confidentiality, and stigma and discrimination 'and 'lack of cohesion and coordination between public and private sector'. Private practitioners did not consider it necessary to notify TB cases treated with daily regimen. Conclusion: Communication strategies like training, timely dissemination of information of policy changes and one-to-one dialogue with private practitioners to dispel misconceptions may enhance TB notification. Trust building strategies like providing feedback about referred cases from private sector, health personnel visit or a liaison private doctor may ensure compliance to public health activities. © 2015 Philip et al.


Sarkar A.,Medical College | Mukherjee A.,State Training and Demonstration Center | Ghoshal A.,I.P.G.M.E. and R. | Kundu S.,I.P.G.M.E. and R. | Mitra S.,I.P.G.M.E. and R.
Lung India | Year: 2010

Background: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi notably Aspergillus spp. that colonize the airways of asthmatics. Early diagnosis and treatment with systemic corticosteroids is the key in preventing the progression of the disease to irreversible lung fibrosis. Aims: To study the occurrence of ABPM among asthma patients with fungal sensitization attending a chest clinic of a tertiary hospital of eastern India. The clinico-radiological and aetiological profiles are also described. Materials and Methods: All consecutive patients with asthma presenting to the chest clinic over a period of one year were screened for cutaneous hypersensitivity to 12 common fungal antigens. The skin test positive cases were further evaluated for ABPM using standard criteria. Results: One hundred and twenty-six asthma patients were screened using twelve common fungal antigens; forty patients (31.74%) were found to be skin test positive, and ABPM was diagnosed in ten patients (7.93%). Of the 10 cases of ABPM, nine cases were those of allergic bronchopulmonary aspergillosis (ABPA) and one case was identified as caused by sensitization to Penicillium spp. A majority of the cases of ABPM had advanced disease and had significantly lower FEV1 compared to non-ABPM skin test positive asthmatics. Central bronchiectasis on high resolution CT scan was the most sensitive and specific among the diagnostic parameters. Conclusion: There is a significant prevalence of ABPM in asthma patients attending our hospital and this reinforces the need to screen asthma patients for fungal sensitisation. This will help in early diagnosis and prevention of irreversible lung damage.


Chadha S.S.,International Union against Tuberculosis and Lung Disease The Union | BN S.,World Health Organization | Reddy K.,State Training and Demonstration Center | Jaju J.,World Health Organization | And 7 more authors.
PLoS ONE | Year: 2011

Background: Revised National TB Control Programme (RNTCP), Andhra Pradesh, India. There is limited information on whether MDR-TB suspects are identified, undergo diagnostic assessment and are initiated on treatment according to the programme guidelines. Objectives: To assess i) using the programme definition, the number and proportion of MDR-TB suspects in a large cohort of TB patients on first-line treatment under RNTCP ii) the proportion of these MDR-TB suspects who underwent diagnosis for MDR-TB and iii) the number and proportion of those diagnosed as MDR-TB who were successfully initiated on treatment. Methods: A retrospective cohort analysis, by reviewing RNTCP records and reports, was conducted in four districts of Andhra Pradesh, India, among patients registered for first line treatment during October 2008 to December 2009. Results: Among 23,999 TB patients registered for treatment there were 559 (2%) MDR-TB suspects (according to programme definition) of which 307 (55%) underwent diagnosis and amongst these 169 (55%) were found to be MDR-TB. Of the MDR-TB patients, 112 (66%) were successfully initiated on treatment. Amongst those eligible for MDR-TB services, significant proportions are lost during the diagnostic and treatment initiation pathway due to a variety of operational challenges. The programme needs to urgently address these challenges for effective delivery and utilisation of the MDR-TB services. © 2011 Chadha et al.


Praba V.L.,State Training and Demonstration Center | Kathirvel M.,State Training and Demonstration Center | Vallayyachari K.,State Training and Demonstration Center | Surendar K.,State Training and Demonstration Center | And 4 more authors.
Journal of Bionanoscience | Year: 2013

Nanoparticle-based systems have significant prospective for diagnosis, treatment and prevention of tuberculosis (TB). The properties of nanoparticles enable improvement of drug bioavailability and reduction of the dosing frequency, and may resolve the problem of nonadherence to prescribed therapy, which is one of the major obstacles in the control of TB epidemics. In this study, the stable Ag nanoparticles were chemically synthesized and their shape and size distribution were characterized by Field Emission Scanning Electron Microscope (FESEM). The free-radical generation effect of Ag nanoparticles on microbial growth inhibition was investigated by UV visible spectroscopy. The antimicrobial activity of Ag nanoparticles was investigated against the standard reference strains of Mycobacterium tuberculosis H37Rv (ATCC 27294), M. smegmatis mc2155 with chloroform assay and gram-negative bacterium Escherichia coli (ATCC 10536) and Bacillus cereus (ATCC 99815) on solid media. As results, E. coli (ATCC 10536) and B. ceres (ATCC 99815) was inhibited at the low concentration of Ag nanoparticles, whereas the complete growth-inhibitory effects of M. tuberculosis H37Rv (ATCC 27294) and M. smegmatis mc2155 were further acquired after the treatment of chloroform. These results suggest that Ag nanoparticles can be used as effective growth inhibitors against E. coli (ATCC 10536), and B. cereus (ATCC 99815), M. tuberculosis H37Rv (ATCC 27294) and M. smegmatis mc2155 making them applicable to diverse medical devices to prevent infection and targeted drug delivery as is a potential candidate against mycobacteria by conjugating with other chemical entities as a therapeutic index. Copyright © 2013 American Scientific Publishers. All rights reserved.

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