Implementation of the new integrated algorithm for diagnosis of drug-resistant tuberculosis in Karnataka State, India: How well are we doing?

BACKGROUND: As per national policy, all diagnosed tuberculosis patients in India are to be tested using Xpert® MTB/RIF assay at the district level to diagnose rifampicin resistance. Regardless of the result, samples are transported to the reference laboratories for further testing: first-line Line Probe Assay (FL-LPA) for rifampicin-sensitive samples and second-line LPA(SL-LPA) for rifampicin-resistant samples. Based on the results, samples undergo culture and phenotypic drug susceptibility testing. We assessed among patients diagnosed with tuberculosis at 13 selected Xpert laboratories of Karnataka state, India, i) the proportion whose samples reached the reference laboratories and among them, proportion who completed the diagnostic algorithm ii) factors associated with non-reaching and non-completion and iii) the delays involved. METHODS: This was a cohort study involving review of programme records. For each TB patient diagnosed between 1st July and 31st August 2018 at the Xpert laboratory, we tracked the laboratory register at the linked reference laboratory until 30th September (censor date) using Nikshay ID (a unique patient identifier), phone number, name, age and sex. RESULTS: Of 1660 TB patients, 1208(73%) samples reached the reference laboratories and among those reached, 1124(93%) completed the algorithm. Of 1590 rifampicin-sensitive samples, 1170(74%) reached and 1104(94%) completed the algorithm. Of 64 rifampicin-resistant samples, only 35(55%) reached and 17(49%) completed the algorithm. Samples from rifampicin-resistant TB, extra-pulmonary TB and two districts were less likely to reach the reference laboratory. Non-completion was more likely among rifampicin-resistant TB and sputum-negative samples. The median time for conducting and reporting results of Xpert® MTB/RIF was one day, of FL-LPA 5 days and of SL-LPA16 days. CONCLUSION: These findings are encouraging given the complexity of the algorithm. High non-reaching and non-completion rates in rifampicin-resistant patients is a major concern. Future research should focus on understanding the reasons for the gaps identified using qualitative research methods.

Effect of cobalt-60 gamma radiation on reproductive disturbance in freshwater prawn Macrobrachium rosenbergii (De Man, 1879).

The present study was designed to evaluate the effect of acute level of 60Co gamma radiation on fecundity of freshwater prawn Macrobrachium rosenbergii. Prawns were exposed to four different dose levels (3, 30, 300 and 3000 mGy) and their reproductive disturbances i.e Gonadosomatic Index (GSI), Egg Clutch somatic Index (ESI), Egg Counts and Egg hatching rates were calculated. The experimental group showed significant reduction in GSI (0.47 ± 0.01) & ESI (1.22 ± 0.08) after exposure to 60Co gamma radiation. Egg Count (3713 ± 21) and Egg hatching rates (3798 ± 11) were significantly reduced in all irradiated groups. The number of dead larva increased with the increasing level of doses. With the increase in dosage level, the gonad and egg clutch weight were decreased which likely lead to reduced number of eggs. Our results proved that even low level of ionizing radiation (60Co) affects the fecundities of freshwater crustacean M. rosenbergii.