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.

Hepatic toxicological responses of SiO2 nanoparticle on Oreochromis mossambicus.

The present study was carried out to investigate the impact of various concentrations of SiO2 nanoparticles (SiO2 NP) on the commonly available freshwater fish Oreochromis mossambicus. The 96 h median lethal concentration (LC50) of SiO2 NP was found to be between 270-280 ppm. This novel study has demonstrated histological alterations in the hepatic tissues and a dose-dependent depletion of tissue protein content and an elevated transaminases activity in the treated fish, which has facilitated understanding of the impact of SiO2 NP in O. mossambicus.

Effect of cobalt-60 gamma radiation on total hemocyte content and biochemical parameters in Macrobrachium rosenbergii (De Man, 1879).

Purpose: The effect of low level cobalt-60 (60Co) gamma radiation on the freshwater prawn Macrobrachium rosenbergii was evaluated by observing their hemocyte counts and biochemical parameters. Materials and methods: Prawns were exposed to 3, 30, 300 and 3000 milligray (mGy) dose levels and their tissues of gills, hepatopancreas and muscle were analyzed. Results: The results showed that the number of hemocytes in the hemolymph and concentrations of protein and carbohydrate were significantly reduced in irradiated groups than compared to the control prawn. Increased aspartate transaminase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP), Acetyl choline esterase (AChE) in the irradiated groups reflects tissue damage. Conclusions: Hence, this study concludes that even low level of ionizing radiation (60Co gamma) can cause acute damages in gills, hepatopancreas and muscles in irradiated groups. Highlights 60Co exposures effect the THC and biochemical of prawn M. rosenbergii. Different dose levels such as 3, 30, 300 and 3000 mGy. Biochemical parameters serve as reliable indicators of physical status of organism. Self-regulating mechanisms might be the reason for preventing from the lethality. Suggested that nuclear industries should manage below 3 mGy.

Haemato-immunological studies in ZnO and TiO2 nanoparticles exposed euryhaline fish, Oreochromis mossambicus.

The present study was aimed to analyze the effect of ZnO and TiO2 nanoparticles (NPs) on Haemato-immunological parameters in adult Tilapia, Oreochromis mossambicus. The nanoparticles size found as 47 nm and 30 nm for ZnO and TiO2 respectively. The acute toxicity (96 h) of ZnO (LC50: 100-110 ppm) and TiO2 (LC50: 80-90 ppm) NPs were identified by using probit analysis. RBC, Hb and HCT levels decreased in nanoparticles exposed groups resulted in decreased oxygen carrying capacity of RBC and other erythrocyte indices (MCH, MCV, MCHC). Increased WBC, neutrophils & monocytes and decreased lymphocyte levels were observed as increased concentration of the nanoparticles. The results were found as statistically significant (p < 0.05). In conclusion, the present study depicts that ZnO NPs exhibits more toxicity than TiO2 NPs. Nanoparticles presence even in low concentration (ppm) cause damage to the connective tissues of fish, so the existing permissible levels of these nanoparticles in water are need to be revised.

Toxicological effect of Al2O3 nanoparticles on histoarchitecture of the freshwater fish Oreochromis mossambicus.

In the present study, freshwater fish Oreochromis mossambicus were exposed to sub lethal concentrations (120, 150 and 180 ppm) of Aluminium oxide nanoparticles (Al2O3 NPs) for 96 h. Histological abnormalities were not observed in the organs of control fishes whereas severe damages and extensive architectural loss was found in the brain, gill, intestine, kidney and muscle tissues of treated fishes with more pronounced effects in 180 ppm. The results showed that the acute exposure to Al2O3NPs altered the histoarchitecture in various fish tissues.

Histological alterations in the hepatic tissues of Al2O3 nanoparticles exposed freshwater fish Oreochromis mossambicus.

Adverse effects of nanoparticles on aquatic environment and organisms have drawn much special attention to many researches. Aluminium oxide nanoparticles (Al2O3-NPs) have potential uses in varied fields and are seen entering into the ecosystem. Their potential toxicity to the freshwater fish is not much studied. Hence this study was framed to investigate the effect Al2O3 NPs on freshwater fish Oreochromis mossambicus in terms of sub lethal toxicity, histological changes and hepato somatic index (HSI) under laboratory conditions. Fishes were exposed to varying concentrations of Al2O3 NPs for 96hr. LC50 value was found to be in between 235 and 245ppm. The findings of the present work showed that the NPs were accumulated in the fish liver and caused major histological anomalies such as structural alterations in the portal vein, necrotic hepatocytes, vacuolation, aggregation of blood cells and melanomacrophages. Significant histological alterations were observed in the highest concentration. Our results evidenced that the Al2O3 NPs in the aquatic environment affects the health condition of the fishes.

A descriptive study of tuberculosis case finding in private health care facilities in a South Indian district.

SETTING: A South Indian district providing anti-tuberculosis services through the Revised National TB Control Programme (RNTCP) and private health care facilities. OBJECTIVE: To ascertain the profile of tuberculosis (TB) patients diagnosed and/or treated in private health care facilities. METHODS: Data on TB cases diagnosed and/or treated in all clinical departments of the medical college, 83 nursing homes and RNTCP health care facilities were collected prospectively. RESULTS: About 83% of new TB cases recorded in the private medical college, 47% in nursing homes and 24.5% in RNTCP TB registers were extra-pulmonary. The proportion of retreatment cases was respectively 5.5%, 9.6% and 19.8%. The proportion of males and those in the economically productive age group were similar in the three data sources. About 94% of cases diagnosed in the medical college and 55% in nursing homes were registered for treatment under the RNTCP. About 11% of the smear-positive patients diagnosed in RNTCP were initial defaulters. CONCLUSION: The proportion of extra-pulmonary cases was higher in the medical college and nursing homes and that of retreatment cases was lower than in the RNTCP.

Bioactive potential of seagrass bacteria against human bacterial pathogens.

Study of marine organisms for their bioactive potential, being an important part of marine ecosystem, has picked up the rhythm in recent years with the growing recognition of their importance in human life. Investigation was carried out to isolate 32 strains of endo and epiphytic bacteria in 2 seagrass species viz., Syringodium isoetifolium and Cymodocea serrulata. Morphologically different bacterial strains were tested against 5 antibiotic resistant human bacterial pathogens, of which 10 associated bacteria shown inhibitory activity against one or more bacterial pathogens. Minimum inhibitory concentration (MIC) and Minimum bacterial concentration (MBC) determination with extracellular bioactive compounds from the associated bacteria reveals that, the strain ENC 5 showed inhibitory activity against all the bacterial pathogens with the maximum sensitivity against Pseudomonas aeruginosa at the MIC value of 500 microg ml(-1).

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.

Change in the risk of tuberculous infection over an 8-year period among schoolchildren in Bangalore City.

SETTING: Bangalore City, South India. OBJECTIVE: To estimate the trends in transmission of tuberculous infection. METHODS: Two tuberculin surveys were carried out among children attending grades 1 and 2 of 60 selected schools at an interval of 8.3 years, corresponding to the period of DOTS expansion. Tuberculin testing was carried out using 1 tuberculin unit (TU) of purified protein derivative (PPD) RT 23 with Tween 80, and the maximum transverse diameter of induration was recorded about 72 h later. As the reactions due to infection with tubercle bacilli could not be clearly delineated from cross-reactions on the frequency distributions of tuberculin reaction sizes at either survey, the prevalence of tuberculin reactions > or = 10 mm, > or = 12 mm and > or = 14 mm in size were compared between the two surveys. The annual risk of tuberculous infection (ARTI) was computed from the estimated prevalence of reactions > or = 14 mm in size. RESULTS: Estimates of prevalence of reactions at all chosen cut-off points were lower at Survey II compared to Survey I. These differences were statistically significant. An average per annum decline in ARTI of about 4% was observed between the two surveys. CONCLUSION: Tuberculosis control measures should be further intensified to enhance the rate of decline in transmission of infection.

Annual risk of tuberculous infection in Andhra Pradesh, India.

BACKGROUND: There is paucity of information on epidemiological situation of Tuberculosis (TB) in Andhra Pradesh. The DOTS strategy under the Revised National Tuberculosis Control Programme (RNTCP) was introduced in the year 2000 to cover the entire State by 2005. OBJECTIVES: To estimate the prevalence of tuberculous infection among children 5-9 years of age and to compute the average Annual Risk of Tuberculosis Infection (ARTI) from the estimated prevalence. METHODS: A cluster-sample house-based tuberculin survey was carried out in a representative sample of children between 5-9 years of age. The clusters were selected by a two-stage sampling procedure. At first stage, five districts were selected by probability proportional to population size (PPS) method. Depending upon child population ratio, 32 clusters allocated to each district were further sub-divided into rural and urban clusters selected by simple random sampling. A total of 3636 children, irrespective of their BCG scar status, were tuberculin tested using one TU PPD RT23 with Tween 80 and the maximum transverse diameter of induration was measured about 72 hours later. RESULTS: The prevalence of infection estimated by mirror-image technique using observed mode of reactions attributable to infection with tubercle bacilli at 20mm was 9.6% (95% CI: 8.0-11.2). The ARTI was computed at 1.4% (95% CI: 1.1-1.6). CONCLUSION: Survey findings indicate a fairly high rate of transmission of tubercle bacilli.