Does nutritional support under programmatic settings result in weight and body mass index changes among tuberculosis patients? Evidence on the impact of nutritional support through Pradhan Mantri Tuberculosis Mukt Bharat Abhiyan under national tuberculosis elimination programme from Ramgarh district of Jharkhand

Background: To increase community participation in tuberculosis (TB) elimination efforts, the government of India has launched ‘Pradhan Mantri TB Mukt Bharath Abhiyan’ (PMTBMBA) under the national TB elimination programme. The scheme allows interested parties (Ni-kshay mitras) to offer nutritional support to TB patients. This study aims to understand the impact of such a support in improving weight and body mass index (BMI) among TB patients as most available evidence comes from research settings. Methods: This is a retrospective cross-sectional study carried out in Ramgarh district of Jharkhand, India, for the period first quarter 2023. Relevant data was extracted from Ni-kshay web portal and TB treatment cards. The data is analyzed using excel 365. Results: Of the 114 participants, 69 received nutritional support during the entire duration of treatment and 45 received support partially. Single factor ANOVA on weight and BMI gain revealed statistically significant difference in mean weight/BMI between the two groups with F (1, 110)=35.4660, p=3.16×10-08 and F (1, 110)=22.9994, p=5.12×10-06. Correlation analysis showed a moderate correlation between the number of nutritional kits received and the weight/BMI gain with correlation coefficients r=0.5, p=1.07×10-07 and r=0.4, p=1.65×10-05 respectively. Conclusions: The study concludes that the impact of nutritional supplementation in programmatic setting is comparable with that of implementation research study settings.

Who found it easy to avail nutritional support through direct benefit transfer under national TB elimination programme in Eastern India: an early evidence from Jharkhand

Background: National TB Programme of India launched Nikshay Poshan Yojana (NPY) through Direct Benefit Transfer (DBT) in April 2018, to provide financial support for additional nutritional requirement during TB treatment. This study aims to understand the enabling attributes in availing Nikshay Poshan Yojana (NPY) through Direct Benefit Transfer (DBT) among notified TB patients from the Indian state of Jharkhand for the year 2019. Methods: This is a retrospective cross sectional descriptive study using secondary data obtained from Nikshay web portal for the Indian state of Jharkhand in the year 2019. State level data on TB Notification and NPY DBT scheme is downloaded from the Nikshay portal in excel format and analysed using Excel 2016 version. Odds Ratio and P value are calculated and analysed to prove any statistically significant associations. Results: The study found higher odds (1.08, 95% CI: 1.03, 1.14; P value 0.004) of having patients who belong to 15 to 65 years, female sex (odds ratio 1.05, 95% CI: 1.01, 1.09; P value 0.018), seeking care in public sector (odds ratio 4.05, 95% CI: 3.83, 4.27; P value <0.00001) and with drug sensitive TB (DS TB) (odds ratio 1.39, 95% CI: 1.1, 1.59; P value <0.00001), among those who received at least one instalment of DBT. Conclusions: TB patients belonging to productive age group, female sex, seeking care in public sector and with DS TB have higher odds of receiving NPY among the study population.

A retrospective observational study on incidence and clinico-epidemiological features of COVID-19 associated pulmonary aspergillosis among cancer patients hospitalized with COVID-19 in a tertiary care cancer centre of India

Background: COVID-19 associated pulmonary aspergillosis (CAPA) is an emerging complication among patients with COVID-19 but hasn’t been well studied in cancer patients. This study, we try to find out important aspects associated with CAPA among cancer patients with regards to clinico-epidemiological factors. Methods: In this retrospective observational study, we included 198 consecutive patients COVID-19 between April 2020 and February 2021. CAPA cases were classified according to CAPA-European Confederation of Medical Mycology criteria (2020 ECMM/ISHAM consensus criteria). Results: The overall incidence of CAPA was found to be 10.1% in our study population. The incidence among hematological malignancies was 11.25% and solid tumors was 10%. In-hospital mortality was significantly high among patients with CAPA as compared to that among without CAPA (40% versus 16.85%; p<0.012695). Significant number of patients with CAPA had received chemotherapy in last 3 months before diagnosis of COVID-19 (50% versus 28.09%, p=0.043222) and had evidence of culture positive bacterial infection (30% versus 5.62; p=0.000888). Significantly more patients having CAPA were on steroids, required oxygen and/or ventilator support as compared to those without CAPA. Conclusions: CAPA is a significant cause of mortality and length of hospital stay (16 versus 7 days; p=0.00001) among cancer patients with COVID-19. Cancer patients with COVID-19 were at increased risk of CAPA as compared to non-cancer patients.

Comparison of attitudes toward psychiatry among undergraduate and postgraduate medical students

Introduction: Attitudes toward psychiatry among medical students will have a great impact on future of expanding psychiatry and breaking barriers at multiple levels. Aims: To assess and compare the attitudes of undergraduate (UG) and postgraduate (PG) medical students toward psychiatry and assess association between sociodemographic variables and attitudes toward mental illness. Methods: A cross-sectional study conducted in a tertiary health care centre, total of 100 (50 UG and 50 PG) medical students were recruited in the study. A standardised questionnaire, Attitudes Toward Psychiatry-30 items (ATP-30) and semi-structured proforma for sociodemographic details were given to study subjects to fill up. Statistical analysis: Both quantitative and qualitative measures of data were calculated. Statistical significance was kept at p-value of <0.05, using Fisher’s exact test and Chi-square test. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 21. Results: The overall ATP-30 score responses were positive (>90) in both males (88%) and females (62%). More number of positive responses were seen in both UG (68%) and PG (84%) medical students compared to only some negative responses in UG (22%) and PG (16%). This difference is significant at p-value <0.05. There is a significant difference (p-value <0.05) in attitudes among UG and PG students in item number four revealing 32% PGs wish was to be psychiatrist. Majority of the UGs and PGs agreed that UG psychiatric training is valuable. Conclusion: We have found overall good attitudes toward psychiatry in the study population but conflicting interest in taking psychiatry as career choice.

Sero-prevalence of Rubella Antibodies in Pregnant Women with Bad Obstetric History Attending A Rural Tertiary Care Hospital in West Bengal, India

Background: Rubella infection in pregnant mothers is of great concern as it acts as a teratogen causing abortions, still births, intra-uterine foetal deaths and multiple birth defects. In India, rubella causes significant bad obstetric pregnancy outcome including congenital deformities due to lack of proper surveillance and immunization coverage with rubella vaccination. Aim: To determine Sero-prevalence of rubella IgM and IgG antibodies in Bad Obstetric History (BOH) pregnant women in Tertiary Rural Medical College in Eastern India. Materials and Methods: Cross sectional study was conducted from 1st January 2017 to 31st March 2017 on sera of 100 antenatal mothers with bad obstetric history aged between 20-40 years of age group with pregnancy of ≥18 wks. Rubella IgM and IgG antibodies were assessed by ELISA. Statistical Analysis: Percentage, proportions and ᵡ2 test were applied. Results: Eleven per cent (11%) sero-prevalence for IgM antibodies and 54% for IgG antibodies was observed with maximum sero-positivity among 20-25 years mothers. Repeated abortions were the commonest pregnancy outcome. Conclusion: All antenatal cases should be routinely screened for rubella, so that early diagnosis will help in proper management and foetal outcome and strong recommendation for universal coverage of MMR in early age group of children.

Orchitis: An unusual presentation of polyarteritis nodosa

Polyarteritis nodosa (PAN), a systemic necrotizing vasculitis with multiorgan development, is generally restricted to the medium-sized muscular arteries. The varied initial clinical presentations of PAN can lead to a delayed diagnosis. We present the case of a middle-aged male patient who presented with an acute onset right-sided testicular pain as the initial clinical symptom with ischemic changes on ultrasonogram, thereby requiring orchiectomy. This was reported to be a case of tubercular epididymo-orchitis. On review, the biopsy revealed features of necrotizing arteritis as seen in PAN with fibrinoid necrosis and giant cells, thus highlighting the fact that vasculitis due to PAN may have a localized presentation at the time of diagnosis. PAN should be distinguished from other causes of epididymo-orchitis and other vasculitis lesions, the most common being tubercular etiology in the Asian population.

Neonatal Sepsis-Culture Positive Sepsis Vs Clinical Sepsis

The incidence of sepsis is increasing globally, with high morbidity and mortality. Diagnosis of neonatal sepsis is still a clinical and laboratory challenge. Though blood culture is gold standard, it sometimes gives false negative result. So, judgement of clinical condition along with various investigations is important

Comparative study of the effectiveness between balancing exercises and strengthening exercises with common use of TENS to improve functional ability in Osteoarthritis involving knee joint.

Background and purpose: People with knee Osteoarthritis (OA) sometimes report episodes of knee instability that limit their activities of daily living. Proprioception and balance are important aspects of osteoarthritis treatment because of their strong correlation with function in the knee. The purpose of this study is to evaluate the effects of balancing exercises and strengthening exercises to improve functional ability in knee osteoarthritis patients and also it may be helpful to identify the use of best treatment protocol for OA knee. Material and methods: Thirty OA knee patients randomly allocated into two groups and received either balancing exercises (Group A) or strengthening exercises (Group B). Both the groups received TENS and taken treatment for 4 days a week for 4 weeks. The outcome measures were VAS and WOMAC. VAS was used to measure intensity of knee pain and WOMAC was used for assessment of perceived pain, stiffness and functional ability. Results: After 4 weeks of treatment, significant reduction in the WOMAC score and VAS was found in both the Groups. The result showing statistical improvement is more in Group A than Group B. Conclusion: The results of the study shows that balancing exercise is more effective than strengthening exercise to improve the functional ability of OA involving knee joint. The improvement in Group A is more than Group B and having statistically highly significant.

Visual inspection of cervix with Lugol's iodine for early detection of premalignant & malignant lesions of cervix.

Background & objectives: Majority of cases of cervical cancer are diagnosed at an advanced stage as cytology based screening programmes are ineffective in developing countries. The present study was done to look for carcinoma cervix and its precursors by visual inspection with Lugol's iodine (VILI), visual inspection with acetic acid (VIA) and Papanicolaou smear, and to analyse their sensitivity, specificity and predictive values using colposcopic directed biopsy as reference. Methods: In this cross-sectional study, 350 women were subjected to Pap smear, VIA, VILI and colposcopy. Cervical biopsy and endocervical curettage was taken from patients positive on any of these tests and in 10 per cent of negative cases. Results: The Pap smear was abnormal in 3.71 per cent, including (2.85%), low grade (LSIL) and (0.85%) high grade squamous intraepithelial lesions (HSIL). Thirteen per cent of the patients were found to be positive by VIA and 11.71 per cent were positive on VILI. Sensitivity for VIA, VILI and Pap smear was 89.5, 100 and 52.6 per cent, respectively, while the specificity for VIA, VILI and Pap smear was 91.2, 93.3 and 99.1 per cent, respectively. Interpretation & conclusions: In low resource settings, cervical cancer screening by Pap smear can be replaced by visual methods like VILI, which has the highest sensitivity (100%) to detect any grade of dysplasia, and a good specificity (93.3%).

Reducing Use of Injections Through Interactional Group Discussions: A Randomized Controlled Trial.

Objective: To determine whether “interactional group discussions” could reduce prescriptions of injections by physicians. Study design: Randomized controlled trial. Setting: Rural public health care facilities, North 24 Parganas district, West Bengal, India. Subjects: 72 medical officers, 36 each in intervention and control groups. Intervention: Interactional group discussions. Outcome measure: Proportion of prescriptions including at least one injection. Results: In the intervention group, 249 of 1,080 prescriptions (23%) included at least one injection compared with 79 of 1,080 prescriptions (7%) before and after the intervention, respectively. (RR: 0.32, 95% CI: 0.25-0.40). In the control group, 231 of 1,080 prescriptions (21%) included at least one injection before the intervention vs 178 of 1,080 prescriptions (16%) after the intervention (RR 0.77, 95% CI: 0.65-0.92). Conclusion: Interactional group discussions reduce prescription of injections.

Nitrilase-catalysed conversion of acrylonitrile by free and immobilized cells of Streptomyces sp.

The biotransformation of acrylonitrile was investigated using thermophilic nitrilase produced from a new isolate Streptomyces sp. MTCC 7546 in both the free and immobilized state. Under optimal conditions, the enzyme converts nitriles to acids without the formation of amides. The whole cells of the isolate were immobilized in agar-agar and the beads so formed were evaluated for 25 cycles at 50°C. The enzyme showed a little loss of activity during reuse. Seventy-one per cent of 0.5 M acrylonitrile was converted to acid at 6 h of incubation at a very low density of immobilized cells, while 100% conversion was observed at 3 h by free cells.

Antinuclear antibodies by indirect immunofluorescence : optimum screening dilution for diagnosis of systemic lupus erythematosus.

BACKGROUND & OBJECTIVES: Antinuclear antibodies (ANA) are serological hallmark of systemic lupus erythematosus (SLE). Conventionally, the test is carried out on human epithelial cells (HEp2) by indirect immunofluorescence (IIF) technique. Since culturing and maintaining HEp2 cells in the laboratory are labour intensive, in-house assays have given way to kits manufactured by commercial companies. The reference screening dilutions provided by the manufacturers are based on different ethnic population than ours. Therefore, it becomes mandatory for every laboratory to have its own screening dilutions for the local population that distinguishes best between healthy and diseased state. As, there is paucity of such data, we aimed to define the optimum screening dilution that distinguishes the patient with SLE from healthy individuals. METHODS: Sera of patients fulfilling ACR criteria for diagnosis of SLE, idiopathic inflammatory polymyositis/dermatomyositis (PM/DM) and rheumatoid arthritis (RA), and age and sex matched healthy individuals were tested for ANA by IIF using a commercial kit (Euroimmun, Germany) at 5 dilutions, namely 1:40, 1:80, 1:160, 1:320 and 1:640. Receiver operator characteristics (ROC) curve were constructed to define the optimum dilution that distinguished healthy sera from the diseased ones. RESULTS: Test was performed on 213 sera from 94 healthy individuals, and 43 SLE, 37 RA and 39 DM/PM patients. In healthy individuals, ANA at dilutions 1:40, 1:80, 1:160, 1:320 and 1:640 was positive in 13.8, 4.3, 2.1, 2.1 and 0 per cent respectively, whereas in SLE it was positive in 95.3, 95.3, 65.1, 53.5 and 23.3 per cent respectively. INTERPRETATION & CONCLUSION: ROC curves analysis showed that at 1:40 dilution, sera of 95.3 per cent of SLE and 13.8 per cent of normal individuals were (ANA) positive, whereas at 1:80 dilution it was 95.3 per cent for SLE and 4.3 per cent for healthy individuals. A fluorescent intensity of > or =2 was more specific for SLE. The best discrimination between healthy individuals and the SLE patients was found at screening dilution of 1:80 and fluorescent intensity of > or =2 in our laboratory.

Protection of adrenal and male gonadal functions by androgen in lead-treated rats.

The potential health hazard of the large amounts of Lead that occurs in canned baby food, domestic water from lead-lined tanks and, in printing and petroleum industries. Lead acetate administration at a does of 8 mg/kg body weight for 21 days resulted a significant increase in adrenal steroidogenic enzyme (Delta5-3beta- HSD) and serum levels of corticosterone, while serum levels of testosterone, FSH, LH and testicular spermatogenesis were decreased in albino rats. But lead-treated rats received exogenous testosterone for the last 14 days of lead treatment, showed prevention of adrenocortical hyperactivity by decreasing adrenal Delta5-3beta-HSD activity and serum level of corticosterone. Testosterone administration also increased serum level of testosterone, FSH and LH along with spermatogenesis. The results suggest that testosterone supplementation in lead-treated rats protects adrenocortical activity and testicular spermatogenesis.

Development of bioconcrete material using an enrichment culture of novel thermophilic anaerobic bacteria.

In the biosphere, bacteria can function as geo-chemical agents, promoting the dispersion, fractionation and/or concentration of materials. Microbial mineral precipitation is resulted from metabolic activities of microorganisms. Based on this biomineralogy concept, an attempt has been made to develop bioconcrete material incorporating of an enrichment culture of thermophilic and anaerobic bacteria within cement-sand mortar/concrete. The results showed a significant increase in compressive strength of both cement-sand mortar and concrete due to the development of filler material within the pores of cement sand matrix. Maximum strength was observed at concentration 10(5)cell/ml of water used in mortar/concrete. Addition of Escherichia coil or media composition on mortar showed no such improvement in strength.

Antioxidant potential of C-phycocyanin isolated from cyanobacterial species Lyngbya, Phormidium and Spirulina spp.

The antioxidant activity of C-Phycocyanin (C-PC) isolated from three cyanobacterial species Lyngbya (marine), Phormidium (marine) and Spirulina (fresh water) was studied in vitro. The results demonstrate that C-PCs from Lyngbya, Phormidium and Spirulina spp. are able to scavenge peroxyl radicals (determined by crocin bleaching assay) with relative rate constant ratio of 3.13, 1.89 and 1.8, respectively. C-PCs also scavenge hydroxyl radicals (determined by deoxyribose degradation assay) with second order rate constant values of 7.87 x 10(10), 9.58 x 10(10) and 6.42 x 10(10), respectively. Interestingly, Lyngbya C-PC is found to be an effective inhibitor of peroxyl radicals (IC50 6.63 microM), as compared to Spirulina (IC50 12.15 microM) and Phormidium C-PC (IC50 12.74 microM) and is close to uric acid (IC50 2.15 microM). Further, the studies suggest that the covalently-linked tetrapyrrole chromophore phycocyanobilin is involved in the radical scavenging activity of C-PC. The electron spin resonance (ESR) spectra of C-PCs indicate the presence of free radical active sites, which may play an important role in its radical scavenging property. This is the first report on the ESR activity of native C-PCs without perturbations that can cause radical formation.

Characterization of entamoeba histolytica antigens in circulating immune complexes in sera of patients with amoebiasis.

Isolated circulating immune complexes (CICs) from sera of patients with amoebiasis were characterized to determine Entamoeba histolytica antigens that participate in the disease process. In total, 116 serum samples were collected before starting anti-amoebic therapy, and their CICs were isolated by differential polyethylene glycol precipitation. The presence of amoeba-specific antigens in CICs was detected by antigen capture enzyme-linked immunosorbent assay (ELISA) and by immunoblot assay. Antigen capture ELISA showed significantly higher optical density (p < 0.001) in all patients with amoebiasis than in the normal healthy controls and patients of non-amoebic hepatic disorder. Immunoblot assay detected amoeba-specific CICs in all 18 patients (100%) with confirmed amoebic liver abscess, 28 (80%) of 35 patients with clinically-suspected amoebic liver abscess, and 18 (78.26%) of 23 patients with amoebic colitis. No patients with non-amoebic hepatic disorders and healthy control subjects had any detectable level of amoebic antigens in CICs. Immunoblot assay revealed E. histolytica antigens of relative molecular masses of 35, 56, 70, and 90 kDa present in CICs of 64 of 76 patients with amoebiasis. The 35-kDa polypeptide was observed in 52 patients (81.25%). The results of the study suggest that the 35-kDa polypeptide antigen can be a diagnostic marker in active amoebiasis.

Intestinal amoebiasis: delayed-type hypersensitivity response in mice.

Delayed-type hypersensitive (DTH) response was evaluated in C3H/HeJ mice intestinally infected with Entamoeba histolytica. Infected and non-infected control mice were challenged with amoebic antigen on day 5, 10, 15, 20, 25, 30, 40, 50, and 60 post-infection. Maximum footpad swelling was observed after 24 hours of the challenge. The E. histolytica-infected mice exhibited a DTH response on day 5, 15, 20, 25, 40 and 60 post-infection. However, on day 10, 30, and 50, such response was similar to that of the non-infected control mice. The mice developed an evident DTH response late in the course of infection (25 days post-infection). The infected mice did not show any alteration to their DTH response against heterologous unrelated antigen (sheep red blood cells), suggesting that cellular anergy was antigen-specific.