Pre-treatment delay and out of pocket expenses by notified new tuberculosis patients in an Indian mega city.

BACKGROUND: Study was carried out to find out delay from onset of symptoms and out of pocket expenditure (OOPE) until initiation of anti-TB treatment (ATT) by new Tuberculosis (TB) patients registered in public health facilities in Bengaluru. METHODS: Notified patients (N = 228) selected purposively were interviewed at initiation of ATT regarding number and type of facilities visited and delay in initiating ATT. OOPE was elicited separately for in- and out-patient visits, towards consultation, purchase of medicines, diagnostic tests, transportation, hospitalization and food. Dissaving or money borrowed was ascertained. RESULTS: Two-thirds of participants were 15-44 years of age and 56% were males, mean annual household income was $4357. About 75% first visited a private health facility; 68% and 87% respectively were diagnosed and started on ATT in public sector after visiting an average of three facilities and after a mean delay of 68 days; the median delay was 44 days. Of mean OOPE of $402, 54% was direct medical expenditure, 5% non-medical direct and 41% indirect. OOPE was higher for Extra-pulmonary TB compared to PTB and when number of health facilities visited before initiating treatment was >3 compared to those who visited ≤3 and when the time interval between onset of symptoms and treatment initiation (total delay) was >28 days compared to when this interval was ≤28 days. About 20% suffered catastrophic expenditure; 34% borrowed money and 37% sold assets. CONCLUSION: Concerted efforts are needed to reduce delay and OOPE in pre-treatment period and social protection to account for indirect expenditure.

The Epidemiology of IRIS in Southern India: An Observational Cohort Study.

Immune reconstitution inflammatory syndrome (IRIS) is an uncommon but dynamic phenomenon seen among patients initiating antiretroviral therapy (ART). We aimed to describe incidence, risk factors, clinical spectrum, and outcomes among ART-naive patients experiencing IRIS in southern India. Among 599 eligible patients monitored prospectively between 2012 and 2014, there were 59.3% males, with mean age 36.6 ± 7.8 years. Immune reconstitution inflammatory syndrome incidence rate was 51.3 per 100 person-years (95% confidence interval: 44.5-59.2). One-third (31.4%) experienced at least 1 IRIS event, at a median of 27 days since ART initiation. Mucocutaneous infections and candidiasis were common IRIS events, followed by tuberculosis. Significant risk factors included age >40 years, body mass index <18.5 kg/m2, CD4 count <100 cells/mm3, viral load >10 000 copies/mL, hemoglobin <11 g/dL, and erythrocyte sedimentation rate >50 mm/h. Immune reconstitution inflammatory syndrome-related morality was 1.3% (8 of 599); 3 patients died of complicated diarrhea. These findings highlight the current spectrum of IRIS in South India and underscore the importance of heightened vigilance for anemia and treatment of diarrhea and candidiasis during ART initiation.

Health seeking and knowledge about tuberculosis among persons with pulmonary symptoms and tuberculosis cases in Bangalore slums.

SETTING: Bangalore city slums, India. OBJECTIVES: To ascertain 1) health-seeking behaviour patterns in persons with pulmonary symptoms; 2) pathways followed by pulmonary tuberculosis (PTB) cases until diagnosis and treatment; and 3) their knowledge about TB-symptoms, cause, mode of transmission, diagnosis and treatment. METHODS: In selected slums, persons with pulmonary symptoms identified during house visits and residents with PTB were interviewed using pre-tested, semi-structured questionnaires. Visits to relevant health centres were made to obtain information regarding their treatment. RESULTS: About 50% of the 124 persons with pulmonary symptoms interviewed had taken action for relief; of these, three quarters had first approached private health facilities. About 19% had undergone sputum microscopy and 27% chest X-ray. Of 47 PTB cases interviewed, 72% first approached private health facilities; about 50% visited two health facilities before diagnosis and 87% visited two or more facilities before initiating treatment; 42 initiated treatment at government health facilities and five who initiated treatment at private health facilities were later referred to government health facilities. The majority of persons with pulmonary symptoms and PTB cases had poor knowledge about TB, and most of those with pulmonary symptoms were not aware of the availability of free anti-tuberculosis services at government health facilities. CONCLUSION: Educational interventions targeted at slum dwellers and their health providers are needed.

Antimicrobial activity of root extracts of dalbergia spinosa roxb.

The different concentrations of benzene, alcoholic and aqueous root extracts of Dalbergia spinosa Roxb. (Fabaceae) have been studied for its anitmicrobial activity against certain gram positive (Staphylococcus aureus), gram negative (Pseudomonas aeruginosa, Klebsiellapneumoniae, Escherichia coli) bacteria and fungi (Candida albicans) using cup plate method. Benzene, alcoholic extracts(50, 75 and 100 µg/ml) and aqueous extract only at higher concentration (100 µg / ml) exhibited significant activity.

Regulation of hysterectomy induced derangements in ovarian carbohydrate metabolism in albino rats. II. Role of prostaglandin F2 alpha.

Wistar strain albino rats were subjected to bilateral hysterectomy surgically and the ovarian carbohydrate metabolism of these animals was compared with sham operated controls. The ovarian glycogen content of hysterectomized animals was elevated with inhibition of glycogenolysis, hexose mono and diphosphate pathways and oxidative metabolism. Administration of PGF2 alpha to hysterectomized animals led to activation of ovarian glycogenolysis and other pathways of carbohydrate metabolism of hysterectomized animals was restored towards normal level after PGF2 alpha substitution.

Pattern of lipid profiles in cardiovascular tissues of hysterectomized albino rats.

Heart, dorsal aorta and plasma significantly accumulated the lipid components such as triacylglycerol, cholesterol and glycerol in two months period of hysterectomy which may lead to the development of cardiovascular disorders. Administration of PGF2 alpha decreased the lipid fractions of cardiovascular tissues probably due to luteolysis and ovarian activation.