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.

Objective Assessment of Superiority of Enteral Feeding by Traditional Home Kitchen-Based Feed V/S Commercial Formula Feed in Patients of Esophagogastric Corrosive Injury

Background: Corrosive ingestion can cause severe chemical injury to upper gastrointestinal tract which leads to dysphagia, malnutrition and weight loss. Early nutritional assessment and support through feeding jejunostomy is important and it should be nutritionally optimum and economically balanced. The aim is to compare cost and nutritional status after nutritional support with traditional home kitchen made and commercial formula feed through feeding jejunostomy.Methods:A prospective study included patients on enteral nutrition based on traditional home kitchen feed (cohort-1) and on commercial formula feed (cohort-2). Patient抯 body weight, BMI, haemoglobin, serum albumin, nutritional risk index, controlling nutritional status score were checked at the admission, 3rd and 6th month follow up.Results: In cohort 1 mean albumin and haemoglobin raised by 33.13% & 14.60% at 3rd month and 47.23% & 22.3% at 6th month respectively; In cohort 2 it was 9.12% & 2.69% at 3rd month and 17.62% & 6.53% at 6th month respectively. At 6th month in cohort 1 and 2 mean weight gain was 7.56% & 4.0%; mean increase in NRI was 34.78% & 11.5% respectively. Mean CONUT score at six months was better improved in cohort 1 which is 6 to 1 as compared to cohort 2 which was 6 to 3. Mean monthly cost of home-based feeds was significantly lower as compared to commercial feeds (62.14 Rs v/s 682-2354 Rs/day).Conclusions:In corrosive GI tract injury patient enteral nutrition with traditional home kitchen-based feeds is safe, cost effective and associated with better improvement in nutritional status objective parameters.

Relation between serum uric acid and Non Insulin Dependent Diabetes Mellitus(NIDDM).

Background & Objectives: NIDDM is an independent risk factor for cardiovascular disease. NIDDM increases the risk for all manifestations of atherosclerotic vascular disease, coronary heart disease, cerebro-vascular disease and peripheral vascular disease. Coronary heart disease mortality and morbidity rates are two to four times higher in diabetic patients than in non-diabetic subjects. NIDDM is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency. The aim of the study was to assess the relation between serum uric acid and NIDDM. Methods: The study group included 30 NIDDM cases and 30 control of both sex. Fasting blood samples were collected from both cases and controls in Dhiraj General Hospital, Pipariya, vadodara. Fasting blood sugar, and serum levels of uric acid, creatinine, lipid profile assayed by standard IFCC protocol. Results: There was a significant increase in fasting blood sugar, serum creatinine, uric acid, and lipid profile with exception to high density lipoprotein in NIDDM cases as compared to control. However the correlation bet ween uric acid and other parameter was not very relevant. Conclusion: The study showed significant increase in serum uric acid with the increase in blood sugar value in NIDDM. Elevated uric acid levels are associated with increased risk of cardiovascular mortality in NIDDM.

Study of lipid profile in cirrhotic patients.

Background &Objective: liver cirrhosis is a chronic inflammatory condition associated with lipid abnormalities. The aim is to study lipid profile in liver disease and to determine the lipid profile in patients with cirrhosis and to asses if it relates to the severity of the cirrhosis. Materials and Methods: In an analytical cross-sectional study, 40 patients with cirrhosis (case) and 40 age- and sex-matched healthy normolipidemic patients (control) were studied in Dhiraj General Hospital, Pipariya, and Vadodara. Details including personal characteristics, etiology of cirrhosis, and lipid profile (total, LDL, and HDL cholesterol and triglyceride) was taken for each patient (both case and control). Statistical analysis was done and results were documented. Results: In patients with cirrhosis, there was a significant decrease in serum total cholesterol, triglyceride, LDL and HDL cholesterol levels compared to the control group (mean of 132 vs. 186, 78 vs. 182, 76 vs. 137, and 41 vs. 47 mg/dL, respectively; all p<0.05). Interpretation & Conclusion: Serum total, LDL and HDL cholesterol level in patients with cirrhosis is inversely correlate with severity of cirrhosis.

A study of first episode of acute myocardial infarction in type 2 diabetes mellitus patients.

Background & objectives: Diabetes mellitus, both insulin and non insulin dependent, is an independent risk factor for coronary artery disease which have a larger infarct size, atypical ischemic symptoms and more post infarct complication than non diabetic patients.So the present study was undertaken with following objectives: (1) To study occurrences of various ischemic symptoms, complications and mortality between diabetics and non diabetics. (2) To find out the relation between duration of diabetes, glycemic control and mortality due to first episode of acute myocardial infarction. Methods: Total 100 cases of acute myocardial infarction included comprising 50 type 2 diabetic patients and 50 non diabetic patients. Patients having first episode of acute myocardial infarction and who is already known case of diabetes mellitus were included. Results: Highest incidence of first episode of acute myocardial infarction in diabetics was occurring at earlier age than non diabetics and more incidences in obese persons and diabetic females. There was less frequent occurrence of chest pain and perspiration in diabetics. Higher incidence of recurrent angina, bundle branch block, atrio-ventricular block and heart failure was noted in diabetics than non diabetics. 30 days mortality was higher in patients having Random blood sugar >198 gm% on admission and diabetes since more than 5 years. Interpretation & conclusion: In the present study, the overall conclusion has been made that in diabetic patients acute myocardial infarction occurs at earlier age, there are atypical ischemic symptoms and also higher incidence of complications and higher mortality rate. So in every patient of acute myocardial infarction glycaemia status should be assessed on admission and hyperglycaemia should be aggressively treated.

A comparative study of serum lipid profile between premenopausal and postmenopausal women.

Background & objectives: The effect of the hormonal changes associated with menopause on the serum lipid levels may play an important role in most cardiac related disorders associated with menopause. So the present study was undertaken with the following objectives. 1) To study the serum lipid profile in premenopausal and postmenopausal women. 2) To compare the differences of serum lipid profile between premenopausal and postmenopausal women. 3) To study the effect of duration of menopause on serum lipid profile. 4) To correlate the results of present study with that of other studies. Methods: 50 premenopausal and 50 postmenopausal women were recruited for the study. The subjects having risk factors that may affect the lipid profile were excluded. 5 ml of venous blood was collected after overnight fasting of 12 hrs in all the subjects for estimation of serum levels of total cholesterol, HDL, LDL, VLDL and triglycerides. Results: As compared to premenopausal women, mean level of serum total cholesterol and serum LDL were significantly higher in postmenopausal women and level significantly increased with increase in the duration of menopause. While level of serum HDL was significantly lower in postmenopausal women and level significantly decreased with increase in the duration of menopause. There was no statistically significant difference in serum triglycerides and serum VLDL between premenopausal and postmenopausal women up to 10 years duration of menopause. However they increased significantly after > 10 years duration of menopause. Interpretation & conclusion: According to the present study, menopause is associated with altered serum lipid profile and thus an independent risk factor for developing cardiovascular diseases. Therefore it is important to consider each and every postmenopausal woman to undergo screening for abnormal lipid profile. In them, specific health education strategies are needed in an order to prevent the emerging cardiovascular diseases.

Pharmacological control of cough.

Cough constitutes an important medical problem in all ages. Although treatment of underlying pathologies, e.g., bronchial asthma, upper respiratory tract infection, etc. is well justified to cure cough, non-specific therapy in the form of a number of antitussive agents like, codeine, dextromethorphan, etc. is widely practiced to suppress it. Most of these agents are efficacious and well-tolerated. Nevertheless, CNS toxicities may occur in new-borns, especially those with immature metabolic profile. Some recent reports about interactions (involving hepatic cytochrome P450 enzymes) between dextromethorphan and other drugs are also noteworthy.

Effect of flavone in a canine model of myocardial stunning.

Putative cardioprotective action of flavone (10, 20 and 30 mg/kg) was investigated in a canine model of regional ischemia (20 min) followed by 60 min of reperfusion. In animals pretreated with vehicle, myocardial stunning was evidenced by significant changes in hemodynamic parameters (depressed mean arterial pressure, LV peak (+) dP/dt, LV peak (-) dP/dt and elevated LV end-diastolic pressure) and biochemical parameters (decreased myocardial ATP and rise in plasma malondialdehyde or MDA; a marker of free radical-induced injury). A reduction in plasma MDA was noted with 20 and 30 mg/kg flavone, although attenuation of myocardial dysfunction was evident with all the three doses. The results suggest that besides a significant dose-dependent antioxidant effect, flavone may also have some cardioprotective actions per se, which needs to be further investigated.

Role of Lipistat in protection against isoproterenol induced myocardial necrosis in rats: a biochemical and histopathological study.

A test drug (Lipistat) comprising of equal-proportions of extracts of Terminalia arjuna, Inula racemosa Hook, latex of Commiphora mukul, in three different doses (225 mg/kg; 350 mg/kg; 450 mg/kg) were administered orally daily for 6 days a week for 60 days in rats. Thereafter, the rats were subjected to isoproterenol (ISO) induced (85 mg/kg, s.c. for 2 days) myocardial necrosis. Gross and microscopic examinations (histopathology) were done along with estimations of myocardial tissue high energy phosphates (HEP) stores and lactate content. Gross examination showed significant (P < 0.05) cardioprotection in Lipistat treated animals. On microscopic examination no statistically significant reduction in myocardial damage by 350 and 450 mg/kg of Lipistat were observed although loss of myocardial HEP stores and accumulation of lactate were significantly prevented. The results of the present study suggest the potential usefulness of Lipistat in the prevention of ischemic heart disease.

Oxyfedrine in myocardial stunning.

Effect of oxyfedrine (OXF)(1 mg/kg) administered just before reperfusion (post-treatment) was investigated in a canine model of myocardial stunning. In the saline-treated animals, myocardial stunning was evidenced by fall in MAP, decrease in LV peak (+) dP/dt, rise in LVEDP and incomplete regeneration of myocardial ATP, after reperfusion. OXF was found to be effective in preventing the haemodynamic and metabolic changes associated with myocardial stunning.

Recovery from reperfusion injury in intact canine heart by nifedipine.

Effect of nifedipine post-treatment (100 micrograms/kg slow bolus followed by 3 micrograms/kg/min infusion) on the functional and metabolic changes of the heart after a brief regional ischemia (I) (20 min.) followed by 1 hr of reperfusion (R) was studied in pentobarbitone-anaesthetized open-chest coronary ligated dogs. In the control group, 1 hr of reperfusion failed to cause any significant recovery of the depressed LVdP/dtmax and that of the elevated LVEDP (LVdP/dtmax, pre-ischemic: 2720 +/- 90 mm Hg/sec., 20 min. of I: 2410 +/- 120 mm Hg/sec and 60 min. of R: 2210 +/- 130 mm Hg/sec. LVEDP, pre-ischemic: 5.25 +/- 0.2 mm Hg, 20 min. of I: 10.5 +/- 0.9 mm Hg and 60 min. of R: 7.5 +/- 0.5 mm Hg). However, 1 hr of reperfusion caused a significant recovery of ischemia-induced depletion of myocardial creatine phosphate (CP) content only, but not that of ATP. On post-treatment with nifedipine (i.e., infusion started just before reperfusion), there was a significant recovery in LVEDP (8.25 +/- 0.6 mm Hg after 20 min. of ischemia to 5.0 +/- 0.4 mm Hg after 1 hr of reperfusion) and there was no further deterioration in LVdP/dtmax, as observed in untreated dogs. More significantly, nifedipine caused a near normal recovery of both ATP and CP contents of the affected myocardium. Therefore, the present study shows that post-ischemic administration of nifedipine prevented reperfusion injury of the ischemic myocardium, as evidenced by both functional and metabolic recovery.

Effect of verapamil post-treatment in myocardial reperfusion injury.

Effect of verapamil post-treatment (0.2 mg/kg bolus, followed by 0.01 mg/kg/min infusion) on the functional and metabolic changes of the heart after a brief regional ischemia (20 min) followed by 1 hr of reperfusion was studied in open-chest pentobarbitone anaesthetized dogs. In control dogs 1 hr of reperfusion failed to cause any improvement of depressed myocardial contractility (LVdP/dtmax and LVEDP) caused by 20 min of ischemia, which confirmed the earlier reported phenomenon of 'Stunned Myocardium'. Myocardial ischemia caused a significant loss of high-energy phosphate (HEP) content of the affected myocardium (ATP decreased by 60% and CP decreased by 75% of non-ischemic level). Following 1 hr of reperfusion, myocardial ATP was not replenished, though creatine phosphate became near normal. When verapamil was administered just before reperfusion, it showed a profound beneficial effect on the incidence of fatal reperfusion arrhythmias. At the end of 1 hr of reperfusion in this group, the recovery of the myocardial contractility was incomplete, but a significant replenishment of the myocardial HEP content was observed. Thus verapamil post-treatment can prevent reperfusion-induced myocardial injury but functional recovery may be delayed due to the drug's inherent direct myocardial depressant effect.

Isoproterenol fails to produce myocardial necrosis in streptozotocin-induced diabetic rats.

Biochemical alterations in the hearts of non-diabetic and 5 weeks of streptozotocin-induced diabetic rats following isoproterenol (ISO) administration were compared. Serum lactate dehydrogenase (LDH) and myocardial adenosine triphosphate (ATP), creatine phosphate (CP), lactate and glycogen were used as indices of myocardial injury. Hearts from diabetic rats (blood glucose greater than 350 mg/dl), before ISO administration, had normal lactate levels but significantly low high-energy phosphate (HEP) levels and high glycogen levels in comparison to non-diabetic rats. No difference was observed in serum LDH levels between these two groups. ISO administration to non-diabetic rats caused myocardial necrosis as evidenced by a significant depletion of myocardial glycogen and HEPs along with significant myocardial lactate accumulation and an increase in serum LDH. However, the hearts from diabetic rats failed to show any significant HEP depletion, accumulation of lactate and leakage of LDH into serum following ISO-administration, though myocardial glycogen level was significantly lowered. These observations, in conjunction with earlier reports, point to the hypothesis that, in diabetes, there are certain alterations in the sarcolemma which hamper the process by which ISO causes myocardial necrosis.