Prevalence of Stigma Among TB Patients and Its Associated Factors - A Community Based Cross-Sectional Study in Puducherry, India

Background: Tuberculosis (TB) is a disease that has both medical as well as social dimensions. Stigma and associated discrimination experienced by persons affected by TB is a barrier to the interventions towards TB elimination. A better understanding of stigma will improve the effectiveness of the interventions aimed to al-leviate the effects of TB stigma. The objectives were to measure the prevalence of self, anticipated, experi-enced stigma and its associated factors and to explore the impact of tuberculosis related stigma among TB pa-tients. Methodology: A cross-sectional study was conducted in Puducherry district, Southern India among 420 adult drug sensitive non-HIV TB patients registered under NTEP. Data was collected by face-to-face interview using standardised questionnaire. Results: The mean(±SD) age of the study participants was 44.5 (±15.03) years. Majority were males (267, 63.6%) and were married (330, 78.6%). The prevalence of stigma among TB patients was found to be 69.3%. Perceived stigma was noted in 47.1%, 33.6% had self- stigma and 26.0% had experienced stigma. On measur-ing the impact of stigma, 52.6% reported participation restriction. Illiteracy and lower-socio economic status were found to be significantly associated with TB stigma. Conclusions: Stigma among TB patients was high. Tailored patient-centric interventions to address stigma and discrimination using culturally appropriate and locally available resources are necessary

Barriers to Treatment Adherence for Female Tuberculosis (TB) Patients during the COVID-19 Pandemic: Qualitative Evidence from Front-line TB interventions in Bengaluru City, India

Background: Available evidence shows that India’s ongoing COVID?19 pandemic response has adversely affected the national tuberculosis elimination program. Objectives: The study attempted to understand the barriers to successful treatment adherence for female tuberculosis (TB) patients due to disruptions caused by the pandemic. Methods: The study draws on qualitative in?depth interviews conducted with patients and TB health visitors from Bengaluru city before and during the pandemic period using a grounded theory approach. Results: While TB has the potential to push female patients who worked in informal arrangements to joblessness and poverty, the pandemic situation has exacerbated these vulnerabilities. The pandemic situation slowed down or suspended vital frontline interventions such as active case finding, distribution of medicine, follow?up of sputum examination, monitoring of medicine intake, and patient support measures. Conclusion: The pandemic?induced barriers to treatment adherence for the vulnerable TB patients can lead to adverse treatment outcomes including disease relapse and drug resistance. It is hence suggested that there is an urgent need for recasting the frontline TB interventions in India in the context of the pandemic in order to achieve the goal of TB elimination.

Evaluation of Some Cytokines, CD4, Hepcidin, Iron Profile and Some Haematological Parameters of Pulmonary Tuberculosis Patients Coinfected with HIV in Southeast of Nigeria

The study was done to determine the levels of interferon-gamma, interleukin 6, interleukin 10, iron status, hepcidin and haematologicalparameters of patients with pulmonary tuberculosis co-infected with human immunodeficiency virus in Southeast, Nigeria. This study was carried out at the directly observed treatment-short course Tuberculosis (TB DOTS) centre of Federal Medical Centre, Umuahia, located in South-Eastern Nigeria. Therefore, sample size of 240 was used to give room for attrition. A total of two hundred and forty (240) subjects aged 18-60 years were enlisted for this study. Seven milliliters (7ml) of venous blood was collected from each subject and 2.5ml was dispensed into bottles containing di-potassium salt of ethylenediamine tetra-acetic acid (K2-EDTA) and was used for full blood count, CD4 count and HIV screening. Also, 4.5ml was dispensed into plain tubes. Serum was obtained after clotting by spinning at 3000 RPM for 10 minutes and was used for interferon gamma, interleukin-6, and interleukin-10, iron and hepcidin determination. Data was analysed using statistical package for social science (SPSS) version 20. Student t-test, ANOVA (Analysis of Variance), Pearson Product Moment and Chi-Square were the tools employed. Results were expressed as mean ± standard deviation and are presented in table and significance level was set at P<0.05.The results showed difference that was statistically significant (P<0.05) in IFN-γ (P=0.000), IL-6 (P=0.000) IL-10 (P=0.000), CD4 (P=0.000), hepcidin (P=0.000), Iron (P=0.000), TIBC (P=0.000), %TSA (P=0.001) ,WBC (P=0.000), Neutrophils (P=0.000), Lymphocyes (P=0.000), Monocytes (P=0.000), Eosinophils (P=0.000), Basophils (P=0.018), RBC (P=0.000), haemoglobin (P=0.000), PCV (P=0.000), MCV (P=0.000), MCH (P=0.000), MCHC (P=0.000), Platelets (P=0.000), ESR (P=0.000) when compared among control, TB, HIV and TB-HIV subjects respectively. The co infection of HIV on pulmonary TB patients increases the levels of the cytokines. The cytokines and hepcidin can be used as adjunct to prognostic and diagnostic markers as their levels decreased with increased duration of treatment of the patients. The study hasshown wide variations in the haemtological indices studied

Analysis on the factors that influence the treatment outcome of Tibetan nationality new smear-positive pulmonary tuberculosis patients in Qinghai Province / 中华疾病控制杂志

@#Objective To analyze the treatment outcome and related influencing factors of Tibet- an nationality new smear-positive pulmonary tuberculosis patients in Qinghai Province，so as to provide evidence for tuberculosis control and treatment among Tibetan population． Methods Statistical analysis was conducted on 5 564 Tibetan nationality new smear-positive pulmonary tuberculosis cases in Qinghai province who were reported in the China Tuberculosis Information Management System and approved to receive treatment from 2008 to 2017． The main influencing factors were detected by unconditional Logistic regression model analysis，dependent variable was successful treatment or not，independent variables were other factors related to the treatment outcome． Ｒesults The treatment success rate of Tibetan nationality new smear-positive pulmonary tuberculosis cases was 87. 1% ( 4 848 /5 564) ，and the adverse outcome rate was 12. 9% ( 716 /5 564) ． Unconditional Logistic regression model analysis indicated that non-full- course supervision management，living in agricultural and pastoral area，having severe disease，floating population，and age older than 60 years were risk factors of adverse outcome． The odds ratio( OＲ) 95% confidence interval( CI) of the above risk factors were 13. 044( 10. 671-15. 944) ，2. 305( 1. 703-3. 119) ， 2. 090( 1. 346-3. 243) ，1. 967( 1. 443-2. 682) ，and 1. 909( 1. 410-2. 586) ． Clinical consultation，farmers and herdsmen were protective factors． The OＲ( 95% CI) were 0. 451( 0. 375-0. 543) ，and 0. 786( 0. 627- 0. 985) ． Conclusions Treatment success rate of Tibetan nationality new smear positive pulmonary tuberculosis cases was low． Therefore，the directly observed treatment short-course ( DOTS) strategy should be strictly implemented and the full-course supervision management should be strengthened to improve the treatment success rate． More attention should be paid to the elderly，severe，floating，agricultural and pastoral populations among the Tibetan population．

To assess the pulmonary impairment in treated pulmonary tuberculosis patients using spirometry

Background: Tuberculosis is one of the leading causes of death due to infectious Disease worldwide, with an estimated 8.9 million new cases and 1.6 million Deaths worldwide. Aim: To study the type and degree of pulmonary impairment in treated pulmonary Tuberculosis patients using spirometry. To co -relate present symptoms and radiological findings and to assess the degree of impairment. For identification of impairment (obstructive, restrictive or mixed) that contribute to long term disability and decreased quality of life. Materials and methods: Retrospective observational study was done in Meenakshi Medical College Hospital. A total of 75 treated pulmonary tuberculosis patients were taken for study with clinical data, chest x-ray pattern, smoking and biomass fuel exposure history were recorded. Their pulmonary function was assessed using spirometry. Results: All patients were symptomatic and most common symptom was breathlessness. Chest radiograph showing 1 or 2 zones involved patients were 40 (53.3%) and more than 3 zones involved were 35 (46.7%).Most of the patients 51 (68%) showed a Restrictive pattern in spirometry, 10 (13.3%) showed an obstructive pattern and 14 (18.7%) showed a mixed pattern. Smoking and Biomass fuel exposure did not show a significant co-relation with spirometry pattern but initial sputum positive patients and defaulter patients showed a significant co-relation with spirometry pattern. Conclusion: The most common pulmonary impairment pattern in treated pulmonary tuberculosis patients was Restrictive pattern. Hence pulmonary tuberculosis need follow up even after treatment for early detection and treatment for their pulmonary disability

Drug Resistance Rate of New Pulmonary Tuberculosis Patients Treated from the Private Sector in 2003~2005 / 결핵및호흡기질환

BACKGROUND: Surveillance of TB drug resistance (DR) is essential for providing information on the magnitude and trends in resistance, for developing treatment guidelines and for monitoring the effect of interventions. Up to now national surveys of drug resistance of M. tuberculosis have been conducted four times since 1994 among patients registered at health centers. The purpose of this study is to estimate the prevalence of primary drug resistance among new cases identified in private sector, and to compare it with the previous national drug resistance surveys. METHODS: The study collected results of drug susceptibility testing (DST) performed at the Korean Institute of Tuberculosis by the request of private sector from January 2003 to December 2005, and then finally selected new cases for the analysis from the database of Korean TB Surveillance (KTBS) by matching patients' name and social identification numbers. RESULTS: Of the 5,132 new patients included in the study, 689 (13.4%) patients were found to have drug resistance at least one drug, 530 patients (10.3%) were isoniazid resistant, 195 patients (3.8%) were multi-drug resistant (MDR), and 21 patients (0.4%) were extensively drug resistant (XDR). The rate of drug resistance tended to decrease annually but it was not statistically significant. When compared with previous national DR surveys in 2003 and in 2004 respectively, they were not significantly different. CONCLUSION: The prevalence of DR among new cases managed in the private sector did not show significant difference from that of new patients registered in the public sector in the same year.

Comparison of nutritional status between tuberculosis patients and controls: A study from North 24 Parganas district in West Bengal, India

The nutritional status of tuberculosis patients (TBP) and controls (CT) was compared among adult (> 20 years) Bengalees in Shyamnagar, Barrackpore, Naihati and Jagaddal of North 24 Parganas District, West Bengal, India. The subjects included 310 men (154 TBP and 156 CT) and 246 women (128 TBP and 118 CT). The mean ages of TBP men was 36.4 years (CT = 34.5) and that of TBP women was 26.4 years (CT = 25.6). Variables compared included weight, height, fat mass, fat mass index, mid-upper arm fat area, and skinfolds. Results revealed that TBP had significantly lower means for all variables (except for height in men) compared to CT in both sexes. In men, the highest percent differences between the two groups were observed for fat mass (FM: 60.1%), fat mass index (FMI: 59.2%) and suprailiac skinfold (SUPSF: 58.8%). In women, the highest percent differences between the two groups were observed for SUPSF (59.7), mid-upper arm fat area (MUAFA: 58.1), triceps skinfold (TSF: 51.4), biceps skinfold (BSF: 51.2), FM (51.2) and FMI (49.0). Regression analyses confirmed that tuberculosis status had significant impact (p < 0.0001) on all anthropometric and body composition characteristics compared (except for height in men) in both sexes. Among men, tuberculosis status explained the highest percent variation in percent body fat (PBF: 57.2%), FMI (56.0%) and FM (55.6%). In women, tuberculosis status explained the highest amount of variation in PBF (67.9), TSF (63.5%), BSF (62.8), FMI (61.0) and FM(60.7). Results of contingency chi-square tests revealed that there were significant differences in the frequency of undernutrition between TBP and CT in men (χ2 = 73.13361) and women (χ2 = 59.0000). The frequencies of undernutrition were significantly more common among TBP, in both men (56.5%) as well as women (51.6%). This study provided evidence that there was significant differential amount of loss in fat and muscle measures in tuberculosis patients.