Tuberculosis Case Notification by Registered Private Medical Practitioners in Kolkata: A Mixed-Methods Study

Background: Under?notification of tuberculosis(TB) cases remains a persistent problem that impedes accurate estimation of the disease burden. India’s private health sector contributes to only one?fourth of the total TB notifications. Objectives: The present study was conducted among registered private practitioners in Kolkata to assess their knowledge, attitude and practice on TB notification, to find the socio?demographic and work-related factors associated with it, to identify the barriers faced by them in notifying TB cases and to elicit suggested solutions in overcoming these barriers. Materials and Methods: It was an observational study, cross-sectional in design following explanatory sequential mixed?methods approach conducted among 426 private practitioners in Kolkata Municipal Corporation area over 2 years (July 2019–October 2021). Quantitative data were analyzed using SPSS 25.0 with suitable descriptive and inferential statistics. Qualitative data were analyzed using Atlas.ti 7.1 and data were represented in the form of themes, codes, and verbatims. Results: Out of 426, 295 (69.2%) of the study population had adequate knowledge, 385 (90.4%) had positive attitude and only 115 (27.0%) had satisfactory practice. Lack of awareness, inadequate communication, and breaching patient confidentiality were the main barriers identified. Suggested solutions to improve engagement of private sector were organizing more continuing medical educations, active case finding, and acknowledgement to private practitioners on notification. Conclusion: Private practitioners had adequate knowledge on TB notification, their attitude was very positive but practice was poor. Training and sensitization of private practitioners on notification are recommended with feedback from both ends.

Perforation Repair Using Biodentine:A Nobel Approach

Root perforations are one of the many consequences of compromised endodontic procedure. It not only poses a significant problem in treatment outcome but also greatly affects the prognosis if not repaired in time. If it occurs, it allows microbial invasion and inflammation in the non-invated area of operation. So, choice of restorative material should be such that it closes the pathway of communication between the root canal system and its associated tissues. It should possess all the good qualities of an ideal orthograde or retrograde filling material. The following note describes a case report of a young boy with failed root canal treatment performed earlier with its steps of management.

Perforation Repair Using Biodentine:A Nobel Approach

Root perforations are one of the many consequences of compromised endodontic procedure. It not only poses a significant problem in treatment outcome but also greatly affects the prognosis if not repaired in time. If it occurs, it allows microbial invasion and inflammation in the non-invated area of operation. So, choice of restorative material should be such that it closes the pathway of communication between the root canal system and its associated tissues. It should possess all the good qualities of an ideal orthograde or retrograde filling material. The following note describes a case report of a young boy with failed root canal treatment performed earlier with its steps of management.

Diameter of anterior cerebral artery - An anatomical study.

Background & objectives: The anterior cerebral artery is the smaller of the two terminal branches of the internal carotid. The cerebral arteries lie between their origins and their junctions with the corresponding communicating arteries. The haemodynamics of the circle of Willis is influenced by variations in the caliber of the segments of the anterior and posterior cerebral arteries and their communicating arteries. Arteries forming parts of circle of Willis frequently vary in size. Methods: In the present study the diameter of A1 segment of anterior cerebral artery, forming the anterior part of the circle of Willis, is measured in the brains of 50 embalmed cadavers. . The measurements of the diameters of the artery were taken using an electronic digital calliper with 300mm operating instructions (0.001mm accuracy). Results: The anterior cerebral artery at point ‘A ’has a diameter of 2.79mm and 2.39mm on left and right sides respectively and at point ‘B ’ it has a diameter of 2.73mm and 2.38mm on left and right sides respectively. Interpretation & conclusion: The findings suggest that the left anterior cerebral artery has a larger diameter than the right anterior cerebral artery. The information regarding size and co-relation of the considered arteries may be useful for better interpretation of angiographic images and for deeper understanding of cerebral pathology. A knowledge of the normal size of these vessels may also be of use to the surgeon in assessing the feasibility of shunt operations and in the choice of patients.

Sporadic Hemiplegic Migraine.

We report a 4-year old boy with probable sporadic hemiplegic migraine. The present case did not fulfill the International Classification of Headache Disorders diagnostic criteria for the disease completely, as it is unclear whether the child had any headache or not. The differential diagnoses are discussed. The case is reported for its rarity and to increase awareness.

Iron deficiency anaemia in sickle cell disorders in India.

BACKGROUND & OBJECTIVE: Iron deficiency anaemia (IDA) is uncommon in individuals with sickle cell disease (SCD) because of availability of an adequate iron source potentially from increased red cell turnover and from blood transfusions. Also, iron deficiency anaemia can often go unnoticed because the sickle cell disease patients are already anaemic. Iron deficiency in sickle cell patients may result in lowering the intracellular haemoglobin concentration and this may ameliorate sickling. The present study was undertaken to determine the prevalence of iron deficiency anaemia and the response of iron supplementation in sickle cell disorders in tribal population of the four States viz. Maharashtra, Gujarat, Orissa and Tamil Nadu. METHODS: A total of 8434 individuals (7105 AA, 1267 AS and 62 SS) were tested for zinc protoporphyrin/haem (ZPP/H) ratio and haemoglobin levels. Twenty two sickle cell anaemia (SS), 47 sickle cell trait (AS) and 150 normal control (AA) individuals who were iron deficient, were given iron therapy for a period of 12 wk and the laboratory investigations were repeated at the 13th wk. RESULTS: Sixty seven per cent of subjects with sickle cell anaemia and 26 per cent with sickle cell trait had elevated ZPP/H ratios (>80 micromol/mol) as against 22.8 per cent of normal individuals. The elevated ZPP/H ratios is an indicator of microcytic anaemia of iron deficiency. Following iron therapy, an improvement in the Hb levels and ZPP/H ratios was observed in both sickle cell disorders and normal individual cases. INTERPRETATION & CONCLUSION: This study suggests that iron deficiency anaemia is an important problem in Indian sickle cell anaemia patients and iron supplementation should be given only in proven cases of iron deficiency anaemia.

Limitation of glucose oxidase method of glucose estimation in jaundiced neonates.

The most widely used method for estimation of plasma glucose is that adopted by Trinder's using glucose oxidase-peroxidase (GOD-POD) system. This method gives much lower blood glucose values with blood samples of neonatal jaundice (plasma bilirubin level > 10 mg/dL) of age 10 +/- 5 daysthan with samples of neonates of the same age group without jaundice or older children suffering from other diseases like acute respiratory distress, septicemia.

Hemoglobin sickle D Punjab-a case report.

Compound heterozygosity for bS/bD results in a severe hemolytic anemia and a clinical syndrome similar to that of sickle cell disease. Here, we report a case of HbSD Punjab disease. A 10 year old female child residing at Nagpur, Maharashtra presented with severe hemolytic anemia, hepatosplenomegaly and occasional pains in bones and abdomen. Initially, she was thought to be a case of sickle cell anemia, however, with the help of HPLC and molecular analysis it was confirmed as HbSD Punjab disease.

Diagnostic evaluation of extrapulmonary tuberculosis by fine needle aspiraton (FNA) supplemented with AFB smear and culture.

One hundred forty-three patients, 72 males and 71 females, with extrapulmonary tuberculosis were aspirated and subjected to cytological (Ziehl-Neelsen stain) examination and culture in Lowenstein-Jensen media. Routine haematological examination and Mantoux test were done in all the cases, x-ray chest in 112, skeletal x-ray in 3 relevant cases and sputum was examined for AFB in 16 cases where pulmonary tuberculosis was associated/suspected with extrapulmonary tuberculosis. HIV status was evaluated in 51 cases and 9 (7.64%) were seropositive. FNA cytology in 102 cases (71.3%) had caseating epithelioid granulomas while smear for AFB was positive in 57 cases (39.8%). Both culture and smear were positive in 29 (20.2%) cases. Combining both smear and culture yielded positive results in 47.5% cases. It was observed that AFB positivity was higher in untreated patients and with HIV positive cases. Further more, the triad of FNAC, AFB smear and culture were cheaper, foolproof and confirmatory than costlier tests like TB IgG, IgM, RTPCR and BACTEC.

Re-evaluation of reading frame-shift hypothesis in Duchenne and Becker muscular dystrophy.

The reading frame hypothesis has been proposed to explain the molecular basis of two allelic forms of muscular dystrophies, Duchenne/Becker muscular dystrophy (D/BMD). To evaluate the hypothesis in Indian D/BMD patients, we analyzed deletion of dystrophin exons in 147 DMD and 19 BMD patients. Our studies showed deviation of more than 30% from the reading frame hypothesis in DMD patients (47/147). The present results implicate a need to reevaluate the reading frame hypothesis.

Clinical examination and hematological data in asymptomatic & apparently healthy school children in a boarding school in a tribal area.

In a boarding school of Maharashtra State of India 314 students (Bhil & Pawar) were examined clinically and blood was examined. Anemia was present in 16.2% male & 38.3% female. B (Beta). Thalasemia trait was present in 1.6% male & 2.4% female. Sickle cell trait was present in 21.3% male and 14.4% female and sickle cell disease in 0.6% student. G6PD deficiency was seen in 5.1% male & 4.8% female students.

Carrier detection in non-deletional Duchenne/Becker muscular dystrophy families using polymorphic dinucleotide (CA) repeat loci of dystrophin gene.

BACKGROUND & OBJECTIVES: Carrier detection and prenatal diagnosis is of great importance for families with one or more sons affected with Duchenne/Becker muscular dystrophy (D/BMD). In about 35-40 per cent of these patients, the causative mutation does not involve gross rearrangement in the structure of dystrophin gene. In these non-deletional families, genetic counselling can be provided only by linkage analysis. The aim of the present study was to determine the carrier status of female relatives in north Indian families with non-deletional D/BMD using highly polymorphic intragenic dinucleotide (CA) repeat markers. METHODS: Six short tandem repeats (STRs) spanning 5' (1), central (4) and 3' regions of the dystrophin gene were used to analyse 14 unrelated families comprising 68 individuals with 12 female siblings at risk of being carriers. RESULTS: Five female siblings inherited at risk STR haplotype, six inherited normal haplotype and one had meiotic recombination. The intragenic recombinations were observed in three families at the central region STR loci and in one family between the proximal and central regions of the gene. INTERPRETATION & CONCLUSIONS: Our study suggested that at least 6 STR markers spanning 5', central and 3' regions of the dystrophin gene are essential to ascertain one or more informative loci and to rule out recombinations in non-deletional D/BMD families for carrier analysis.

Role of dopamine in the modulation of adrenal gland responses in the osmotically stressed pigeons, Columba livia.

Salt loading on pigeons (C. livia) had stimulatory effects on brain amines (dopamine and 5-hydroxytryptamine), corticosterone, norepinephrine and epinephrine contents of adrenal gland. Conjoint administration of dopamine with hypertonic saline restored the brain amines and corticosterone of adrenal gland, but had no effect on catecholamine (CAM) contents of adrenal medulla. The excessive release of CAM in the plasma indicates sympathetic stimulation after both the treatments.

Trimodal distribution of HbS levels in sickle heterozygotes--an useful predictor of the alpha-genotype for population screening.

The trimodal distribution of HbS levels in sickle heterozygotes has been used as an indirect approach to determine the prevalence of alpha-thalassaemia in different population groups. We used this approach to predict the alpha-genotypes of 124 sickle cell heterozygotes where the HbS concentration varied from 20 to 46 per cent with antimodes at 28.0 and 33.0. The alpha-genotypes in these individuals were also determined by Southern blot hybridization. We predicted homozygous (-alpha/-alpha) or heterozygous (-alpha/alpha alpha) alpha-thalassaemia-2 in 78 subjects by the trimodal distribution of HbS. However, actual genotyping showed that 75 patients had alpha-thalassaemia. Forty six of the 47 subjects with a normal alpha-globin genotype (alpha alpha/alpha alpha) could be predicted indirectly. The overall sensitivity was 100 per cent and specificity was 94.2 per cent with a positive predictive value of 96.2 per cent and negative predictive value of 100 per cent. As alpha-genotyping is very expensive and not feasible in most laboratories in India, we conclude that the trimodal distribution of HbS levels is a suitable method for screening for alpha-thalassaemia in population studies.

The influence of alpha-thalassaemia on the haematological & clinical expression of sickle cell disease in western India.

We evaluated the clinical and haematological features of 29 sickle cell anaemia patients with associated alpha-thalassaemia and 22 sickle cell homozygotes with a normal alpha-globin genotype from western India. The presence of alpha-thalassaemia resulted in significantly higher haemoglobin (Hb), haematocrit (HCT), red blood cells counts (RBC) and haemoglobin A2 (HbA2) levels but lower mean cell haemoglobin (MCH) and mean cell volume (MCV). The clinical presentation in these patients was also milder with fewer episodes of painful crisis, chest syndromes, infections, requirement of hospitalization and blood transfusions. However, splenomegaly was more common as compared to the patients with a normal alpha-globin genotype. It is evident from the present study that alpha-thalassaemia could be an important genetic factor modulating the clinical expression and haematological severity of sickle cell anaemia in this region.

Influence of haloperidol on testicular functions in rat.

The study involved exploration of the role of dopamine antagonist haloperidol on the testicular functions of rat. Chronic administration of haloperidol (0.2 mg/kg/day/sc for 21 days) caused significant increase in brain DA and serum prolactin. At testicular level the treatment revealed atrophic degeneration of seminiferous epithelium indicating suppression of hypophyseal gonadotrophins and proves importance of dopaminergic control over prolactin release for normal functions of male gonad.