Curious Case of Alagille Syndrome: Case Report with NANDANIC-NOC Linkage in Care Plan

Alagille syndrome is a rare and complex multisystem disorder caused by an autosomal dominant genetic mutation of JAG1 (90% cases) and NOTCH2 (1-2% cases) genes located on the short arm of chromosome 20. This case is reported as per the CARE (for Case Reports, 2013) guidelines. A 14-year old male, known case of chronic cholestatic liver disease of neonatal onset, diagnosed with Alagille syndrome as evident from NOTCH 2 mutation in genetic analysis and paucity of intrahepatic bile ducts on biopsy presented with portal hypertension, growth failure and persistent hyperbilirubinemia.

Indirect costs in the treatment of Tuberculosis under DOTS.

Introduction: Tuberculosis (TB) causes enormous social and economic disruption and hampers nation’s development. DOTS strategy under RNTCP is one of the largest public health programes found to be beneficial against TB. The key component of DOTS is that each dose during continuous phase of treatment should be administered to patients under the supervision of a DOT provider, either from the community or the health system. This may sometime leads to loss of wages or incurs transportation charges for treatment in the program. Material and methods: A cross sectional study was conducted in 2 randomly selected DOTS centre of Jalandhar. Total number of patients registered during third quartile of 2014 was 107, out of which 102 patients can be contacted. Information regarding indirect costs i.e. wage loss, expenditure on transportation and extra nutrition was collected from all the patients. The data so collected was entered in analyzed using SPSS 16 software. Results: Overall mean expenditure of category 1 and 2 patients treated under DOTS was Rs 2072/- and 2319/- month. The major share of indirect costs (3/4 th) can be attributed to wage loss due to decreased capacity to work or work absenteeism. Majority of the patients (79%) preferred to take additional nutrients, which contributes to around one fourth of the total indirect costs. Travel costs as means of indirect expenditure were minimal (1.5%). Conclusion: Around half of the patients had undergone decrease in their monthly income. The major share of indirect costs (74%) can be attributed to wage loss due to decreased capacity to work. Recommendations: The patients registered under RNTCP should be covered under some food subsidy schemes with the help of Government sector/ NGOs. Patients unable to continue with their jobs should be assisted by social security schemes/ insurance coverage.