Knowledge of Rights of Persons with Disability (RPwD) Act and caregiver burden in depressed parents of children with intellectual disability

Background: Caregiver burden and depression are related in parents of children with intellectual disability (ID), however, few Indian studies have addressed this. The Rights of Persons with Disabilities (RPwD) Act, 2016 outlines several benefits for persons with disability, but no study has looked into the knowledge parents of children with ID have about it. The present study assessed caregiver burden and the knowledge regarding RPwD Act in depressed parents of children with ID.. Methodology: The present cross – sectional, observational study recruited 50 parents of children with ID, diagnosed with Major Depressive Disorder as per DSM – 5. They were administered the Hamilton’s Depression Scale (HAM – D) and Pai and Kapur’s Family Burden Interview Schedule (FBIS) to assess for severity of depression and caregiver burden respectively. A semi-structured questionnaire was developed to assess knowledge of RPwD Act. Results: 26% of depressed parents had severe caregiver burden. Severity of depression correlated positively with caregiver’s and child’s age. Caregiver burden did not correlate with any factor. 88% of the parents were aware about the RPwD Act and certification procedure but more than 50% did not know regarding the specific provisions. Lowest knowledge was seen regarding tax rebates (4%), followed by reservations (6%). Conclusion: Caregiver burden is present in approximately one – fourth of caregivers with depression. Older children and older caregivers have more severe depression. Knowledge regarding tax rebates, educational and financial benefits in the RPwD Act appears to be poor in caregivers with depression.

Clinical response of newly diagnosed HIV seropositive & seronegative pulmonary tuberculosis patients with the RNTCP Short Course regimen in Pune, India.

Background & objectives In the Revised National Tuberculosis Control Programme (RNTCP) in India prior to 2005, TB patients were offered standard DOTS regimens without knowledge of HIV status. Consequently such patients did not receive anti-retroviral therapy (ART) and the influence of concomitant HIV infection on the outcome of anti-tuberculosis treatment remained undetermined. This study was conducted to determine the results of treatment of HIV seropositive pulmonary tuberculosis patients with the RNTCP (DOTS) regimens under the programme in comparison with HIV negative patients prior to the availability of free ART in India. Methods Between September 2000 and July 2006, 283 newly diagnosed pulmonary TB patients were enrolled in the study at the TB Outpatient Department at the Talera Hospital in the Pimpri Chinchwad Municipal Corporation area at Pune (Maharashtra): they included 121 HIV seropositive and 162 HIV seronegative patients. They were treated for tuberculosis as per the RNTCP in India. This study was predominantly conducted in the period before the free ART become available in Pune. Results At the end of 6 months of anti-TB treatment, 62 per cent of the HIV seropositive and 92 per cent of the HIV negative smear negative patients completed treatment and were asymptomatic; among smear positive patients, 70 per cent of the HIV-seropositive and 81 per cent of HIV seronegative pulmonary TB patients were cured. Considering the results in the smear positive and smear negative cases together, treatment success rates were substantially lower in HIV positive patients than in HIV negative patients, (66% vs 85%). Further, 29 per cent of HIV seropositive and 1 per cent of the HIV seronegative patients expired during treatment. During the entire period of 30 months, including 6 months of treatment and 24 months of follow up, 61 (51%) of 121 HIV positive patients died; correspondingly there were 6 (4%) deaths among HIV negative patients. Interpretation & conclusions The HIV seropositive TB patients responded poorly to the RNTCP regimens as evidenced by lower success rates with chemotherapy and high mortality rates during treatment and follow up. There is a need to streamline the identification and management of HIV associated TB patients in the programme with provision of ART to achieve high cure rates for TB, reducing mortality rates and ensuring a better quality of life.

Opportunistic parasitic infections in HIV/AIDS patients presenting with diarrhoea by the level of immunesuppression.

Background & objectives: Enteric parasites are major cause of diarrhoea in HIV infected individuals. The present study was undertaken to detect enteric parasites in HIV infected patients with diarrhoea at different levels of immunity. Methods: The study was carried out at National AIDS Research Institute, Pune, India, between March 2002 and March 2007 among consecutively enrolled 137 HIV infected patients presenting with diarrhoea. Stool samples were collected and examined for enteric parasites by microscopy and special staining methods. CD4 cell counts were estimated using the FACS count system. Results: Intestinal parasitic pathogens were detected in 35 per cent patients, and the major pathogens included Cryptosporidium parvum (12%) the most common followed by Isospora belli (8%), Entamoeba histolytica/Enatmoeba dispar (7%), Microsporidia (1%) and Cyclospora (0.7%). In HIV infected patients with CD4 count < 200 cells/μl, C. parvum was the most commonly observed (54%) pathogen. Proportion of opportunistic pathogens in patients with CD4 count <200 cells/μl was significantly higher as compared with other two groups of patients with CD4 count >200-499 and ≥ 500 cells/μl (P=0.001, P=0.016) respectively. Interpretation & conclusions: Parasitic infections were detected in 35 per cent HIV infected patients and low CD4 count was significantly associated with opportunistic infection. Detection of aetiologic pathogens might help clinicians decide appropriate management strategies.

Bacteriological study of meningococcal meningitis.

One hundred and thirty samples of cerebro spinal fluid were collected from patients admitted with suspected signs and symptoms of meningococcal meningitis (M. meningitis) during the period from January 1986 to April 1989 and were processed for gram's staining, cultivation and latex agglutination tests for detection of polysaccharide antigen in the CSF. Totally 41.5% of turbid and hazy spinal fluid were positive for N. meningitidis by smear examination. Only 24.6% were positive by culture but 61.5% of sample were positive by latex agglutination tests. All the strains were sensitive to all antibiotics except one strain which was resistant to penicillin but it was sensitive to rifampicin.

Comparative study of methods of detection of hepatitis 'B' surface antigen (HBsAg).

The serum samples were collected from 52 patients of acute viral hepatitis and 235 hospital staff from Kasturba Hospital for Infectious Diseases. HBsAg was detected in their sera by counter-immuno-electrophoresis (CIEP), reverse passive hemogglutination (RPHA) and by micro-enzyme-linked-immunosorbent assay (ELISA) technique. Among the patients, HBsAg was detected in 12 cases (23%) by CIEP, in 18 cases (34%) by RPHA and in 23 patients (45%) by ELISA. In the hospital staff, HBsAg was detected in 4 samples (1.7%) by CIEP, in 8 samples (3.5%) by RPHA and in 32 samples (13.5%) by ELISA. Thus ELISA was found to be the most sensitive technique in detecting HBsAg.

Chloramphenicol resistant Salmonella species isolated between 1978 and 1987.

During the ten year study i.e. 1978 to 1987, out of 53,251 cases of suspected enteric fever, S.typhi was isolated from 4005 cases (7%) and S.para typhi 'A' from 1108 cases (2.5%). A total of 52 strains of S. typhi and 4 strains of S.para typhi 'A' were found to be resistant to chloramphenicol. Minimal inhibitory concentration was greater than 256 micrograms/ml of all the strains of S.typhi and S.para typhi 'A'.

Comparison of biochemical characterisation of ICRC bacilli with M. leprae: effect of substrate alteration in the medium.

ICRC-bacilli strain C-44 when grown in Dubos medium of its equivalent, express M. avium taxonomic biochemical characters. Assuming that difference in characters of M. leprae and ICRC bacilli, could be due to 'in vivo' and 'in vitro' milieu, we altered the substrates in the medium. The bacilli grow well in the new medium containing selenium, ferric nitrate, magnesium chloride and deleting Tween 80. The ICRC strain C-44 grown in new medium expressed characters: 9/10 similarity with M. leprae. The 10 day tween hydrolysis reaction in weak but positive. It is probable that 'M. leprae culture isolate', may have acquired 'in vitro' growth potential by recombination with M. avium, an ubiquitous mycobacterium. The M. leprae culture isolate thus may express some characters of both M. leprae and M. avium.

Thalidomide in lepra reaction (ENL) in lepromatous leprosy patients.

Six male bacteriologically highly positive patients of lepromatous leprosy with ENL reaction not adequately controlled by conventional antireaction drugs were put on thalidomide 400 mg per day in four divided doses. Reaction was controlled between 13th to 18th day of therapy. There was no change in the bacteriological status. Liver functions, renal functions and hemogram were normal before therapy and remained unaltered at the end of treatment. Apart from fatigue, drowsiness and occassional constipation, thalidomide had no adverse effect. Control of ENL reaction by thalidomide in these patients is probably due to its immunosuppressive effect, more likely by its stablising action on lysosomes.

Antigeneic cross-reactivity between ICRC-bacilli and M. leprae--"in vitro" evaluation.

Leucocyte migration inhibition, in presence of specific particulate antigen, is a good correlate of CMI. It can detect small differences in related antigens. In the present study, LMI was used to study the cross-reactivity between ICRC bacilli and M. leprae and also to examine the antigenic relationship amongst different ICRC isolates. The study showed a close antigenic cross-reactivity in lepromin and ICRC-in. LMI has brought out strain differences in two ICRC culture isolates, C-44 and C-75. The data appear to elucidate the possible strain specific antigenic relationship of M. leprae with its culture isolate e.g. ICRC strains. This may have important bearing on the development effective antileprosy vaccine for human use.

Dopa-oxidase activity on ICRC bacilli.

Presence of O-phenoloxidase is regarded as M. leprae specific character. This enzyme activity was found to be present in ICRC bacilli, Strain C-44. Though this strain is cultivable 'in vitro', the expression of DOPA-Oxidase activity strongly suggests that it carries M. leprae genome. The ICRC bacilli, therefore, may thus from a group of M. leprae culture isolates, distinct from other known cultivable mycobacteria which do not possess this enzyme activity.