Assuntos
COVID-19 , Controle de Doenças Transmissíveis , Transmissão de Doença Infecciosa , Pandemias , Tuberculose , COVID-19/epidemiologia , COVID-19/terapia , COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Índia/epidemiologia , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , SARS-CoV-2 , Tuberculose/epidemiologia , Tuberculose/terapia , Tuberculose/transmissão , Organização Mundial da SaúdeRESUMO
BACKGROUND: The delay in the diagnosis and treatment initiation of patients with MDR-TB worsens individual prognosis and increases the risk of disease transmission in the community. These delays have been attributed to delay in treatment-seeking by the patient and shifting to multiple healthcare facilities before being tested and diagnosed through India's National Tuberculosis Elimination Program (NTEP). OBJECTIVE: to identify treatment pathways in patients with MDR-TB from the time of onset of symptoms and treatment seeking until diagnosis at a PMDT site and subsequent treatment initiation. We also compared these characteristics with those of patients with DS-TB. METHODS: We recruited a total of 168 patients with MDR-TB and DS-TB each, in Delhi. Data were analyzed using IBM SPSS Version 25. RESULTS: The mean (SD) patient delay for initial treatment-seeking was 20.9 (15.9) days in patients with MDR-TB, and 16.1 (17.1) days in patients with DS-TB (p < 0.001). The median time from visit to the first healthcare facility (HCF) until confirmation of MDR-TB diagnosis was 78.5 days, and until treatment initiation was 102.5 days. Among patients with DS-TB, the time interval from a visit to the first HCF until the initiation of ATT-DOTS was 61.5 days.. Patients diagnosed with DS-TB, whose first source of treatment was a private facility (n = 49), reported a significant delay in the initiation of ATT-DOTS (p < 0.001). CONCLUSIONS: Despite the introduction of universal drug sensitivity testing in individuals having presumptive MDR-TB, a significant delay in the diagnosis and initiation of effective MDR-TB treatment persists as a major public health challenge in India.
Assuntos
Antituberculosos/uso terapêutico , Procedimentos Clínicos , Diagnóstico Tardio , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis , Tempo para o Tratamento , Tuberculose Resistente a Múltiplos Medicamentos , Adulto , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Índia/epidemiologia , Masculino , Testes de Sensibilidade Microbiana/métodos , Testes de Sensibilidade Microbiana/tendências , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Aceitação pelo Paciente de Cuidados de Saúde , Prognóstico , Tempo para o Tratamento/organização & administração , Tempo para o Tratamento/normas , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/terapia , Tuberculose Resistente a Múltiplos Medicamentos/transmissãoRESUMO
Amongst different institutions, "Parija Library" of Utkal University, Bhubaneswar has about 101 palm-leaf manuscripts (mss.) on Ayurveda to its credit. Most of these mss. have not been reported earlier. Herewith a brief description of these mss. has been made with the intention of bringing it out for the Ayurvedic fraternity and to enrich the literary stock of Ayurveda.