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.

Lupus glomerulonephritis: a clinicopathological correlation of 93 patients of systemic lupus erythematosus for a follow-up period of three years.

A prospective study of 93 patients (female 86, male 7) of systemic lupus erythematosus (SLE) attending NRS Medical College and Hospital was done with special reference to their renal affection. Clinical features were noted and various laboratory parameters including auto-antibodies (ANF, anti ds DNA) were performed. Histopathological study of renal biopsy was carried out both at the time of presentation and subsequently 1 and 3 years later and lupus glomerulonephritis (LN) was categorised according to World Health Organisation (WHO) classification. Among the cases, 43 (46.23%) had some form of renal involvement at presentation. Additional 9 patients (9.68%) developed renal affection during 1 year of follow-up and after 3 years another 11 patients (11.83%) developed renal affection (total 63 cases, 67.74%). Histologically commonest pattern in renal biopsy was WHO class IV (21 cases, out of 63; 33.33%) followed by class III (20 cases; 31.75%). Rebiopsy was done in 33 cases of LN and 19 cases (30.16%) showed transformation from one biopsy class to another during the study period.Thus renal involvement seen in cases of SLE had a whole spectrum of histological pattern.The outcome of renal involvement is unpredictable so also is their tendency to transform from one biopsy class to another, usually from indolent class to the more virulent ones. There is dissociation between clinical finding and histologic severity. Hence renal biopsy should be done in all cases of SLE both initially and during follow-up, regardless of their individual clinical presentation.