Asunto(s)
Recursos en Salud , Nivel de Atención , Estreptoquinasa/uso terapéutico , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Medicina Basada en la Evidencia , Accesibilidad a los Servicios de Salud , Humanos , India , Masculino , Persona de Mediana Edad , Paresia/etiología , Servicios de Salud Rural , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: A secondary care hospital in rural India serving a highly tuberculosis (TB) and malnutrition endemic region. OBJECTIVE: In this study conducted on patients with chronic protein energy malnutrition (PEM) and TB, we sought to compare nurse-estimated vs. smartphone photograph analytic methods for assessing caloric intake and determine the incidence of refeeding hypophosphatemia (RH) and refeeding syndrome (RFS) in patients with TB. METHODS: Inpatients were prospectively enrolled. Baseline demographic, comorbidity and preadmission caloric data were collected. Nurse estimated caloric intake was compared with digital "before and after" meal images. Serum phosphorus was measured on days 1, 3 and 7 post admission. Patients with RH underwent further evaluation for RFS-associated findings. RESULTS: 27 patients were enrolled. 85% were at risk of RFS by National Institute for Health and Care Excellence (NICE) criteria. Significant discrepancy (>700 calories) was noted between nurse-estimated caloric intake compared to digital images. RH was found in 37% (10/27). None developed clinical RFS. CONCLUSIONS: Our study suggests more standardized methods of caloric intake are needed in resource-limited settings with high co-prevalence of PEM and TB. We noted that despite RH being common in inpatients with PEM+TB given high caloric diets, RFS was not detected.
Asunto(s)
Ingestión de Energía , Desnutrición Proteico-Calórica/dietoterapia , Síndrome de Realimentación/epidemiología , Tuberculosis/tratamiento farmacológico , Adulto , Anciano , Animales , Diabetes Mellitus/tratamiento farmacológico , Femenino , Humanos , Hipoalbuminemia/sangre , Hipoalbuminemia/complicaciones , Hipoglucemiantes/uso terapéutico , Hipofosfatemia/sangre , Hipofosfatemia/epidemiología , India/epidemiología , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Desnutrición Proteico-Calórica/complicaciones , Síndrome de Realimentación/sangre , Factores de Riesgo , Delgadez/epidemiología , Tuberculosis/complicaciones , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/tratamiento farmacológico , Desequilibrio Hidroelectrolítico/epidemiología , Adulto JovenRESUMEN
The Government of India has passed a notification making the non-reporting of tuberculosis (TB) by a clinical establishment a punishable offence. This article examines this move from an ethical standpoint. One of the main ethical concerns relates to the violation of patient confidentiality that may result from this. Also as regards improvement in patient care, there appears to be a poor cost-benefit ratio in terms of the actionable data obtained by this There may be possible adverse consequences by a limiting of access to care due to penalising of non-reporting. In terms of the bigger picture, the notification may lead to an increased tension between the private sector and Government. Moreover, it is the position of the authors that such a step distracts attention from the more important issues that plague TB care in India today.