Sputum Smear and Culture Conversion in Multidrug Resistance Tuberculosis Patients in Seven Districts of Central Gujarat, India: A Longitudinal Study.

OBJECTIVES: To know the sputum smear and culture conversion among multidrug resistance tuberculosis (MDR-TB) patients. MATERIALS AND METHODS: The longitudinal cohort study was conducted for 142 MDR-TB patients registered in 2010 under Revised National Tuberculosis Control Programme of Vadodara region. Three follow-ups were taken for sputum and culture examination, at completion of 6, 12, and 24 months of treatment. Individuals were interviewed to know the reasons for missed dose and default. RESULTS: The sputum smear and culture conversion rate was 43.4%, 47.7%, and 57% at 6 months, 12 months, and 24 months of follow-up, respectively. Treatment default rate was highest (15.2%) within initial 6 months of therapy. The mean time to sputum smear and culture conversion was 120.27 days and 125.02 days, respectively. CONCLUSIONS: Most of patients who were culture positive at 6 months remained so even after 12 months. There was not much difference in the time taken for culture and sputum conversion.

Treatment of Vaginal Atrophy with Vaginal Estrogen Cream in Menopausal Indian Women.

OBJECTIVES: To measure the effect of vaginal estrogen cream in the treatment of vaginal atrophy in menopausal Indian women. METHODS: A total of 50 menopausal women aged between 40 and 80 years old with symptoms of vaginal atrophy were selected and treated with 0.5 g vaginal estrogen cream, twice weekly for 12 weeks. The women were followed-up monthly where symptom score, Genital Health Clinical Evaluation (GHCE) score, vaginal pH, and vaginal maturation index (VMI) were assessed and compared to baseline data. Any adverse events were recorded. RESULTS: There was a significant improvement (p < 0.010) in complaints such as vaginal dryness, itching, burning, and dyspareunia at the end of the study period. The clinical improvement of these patients was reflected in a decrease in GHCE score on every visit. Vaginal pH and VMI score also showed statistically significant improvements (p < 0.010). No side effects with the drugs used were recorded during the study period. CONCLUSIONS: Vaginal estrogen cream causes symptomatic relief in women of menopausal age in India suffering from vaginal atrophy.

Efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome.

BACKGROUND: In spite of a few shortcomings such as over diagnosis and over treatment, syndromic management is a recommended practice in India for sexually transmitted infections (STIs). This study tries to find out the efficacy of syndromic management measured as symptomatic improvement in females with vaginal discharge syndrome. OBJECTIVE: The objective of the study is to find out the effectiveness of syndromic management in terms of symptomatic improvement among females with vaginal discharge syndrome. MATERIALS AND METHODS: A longitudinal study was conducted in Gynecology Department of Tertiary Care Hospital including 180 symptomatic females having vaginal discharge syndrome. Demographic profile, presenting complaints, menstrual history, obstetric history, partner history, and contraceptive history were noted. This was followed by clinical examination and specimen collection for laboratory tests and blood tests to find out type of STI including viral STI such as human immunodeficiency virus (HIV), herpes simplex virus (HSV), and hepatitis B surface antigen (HBsAg). Treatment was given according to syndromic management on the same day. All the participants were asked to come for follow-up after 15 days and their improvement in symptoms was noted as complete improvement, some improvement or no improvement on a five point scale. RESULTS: 63.9% cases showed complete improvement, while 36.1% showed some improvement. None of the patients was without any improvement. Vaginal discharge syndrome was most common between 20 and 30 years (43.4%), and 67.8% of symptomatic females with vaginal discharge syndrome belonged to the lower socioeconomic group. HSV infection was the most common (15%) associated viral infection with vaginal discharge syndrome, while hepatitis B infection was the least common (0.5%). HIV was reactive in 2.8% cases only. CONCLUSION: Syndromic management was found to be effective in relieving symptoms in most of the cases of vaginal discharge syndrome.

Treatment outcome among cases of multidrug-resistant tuberculosis (MDR TB) in Western India: A prospective study.

Multidrug-resistant TB has become a significant public health problem in a number of countries and an obstacle to effective TB control. Therefore, the present study sought to determine the treatment outcome in patients with MDR TB in seven districts and to examine the factors affecting the treatment outcome. A prospective cohort study was carried out by enrolling all the registered patients in DOTs Plus center of Vadodara district from February 2010 to December 2010. A total of 142 patients were interviewed using a pre-tested semi-structured questionnaire at the DOTS centers of seven districts of Gujarat or at their homes in cases of defaulters/death. After 24 months, of those 145 patients, 48 (33.10%) were declared cured, 8 (5.50%) had completed their treatment, 43 (29.70%) patients died during the treatment, and 32 (21.10%) patients defaulted during treatment. Factors associated with a significant difference in the outcomes were income, marital status, and education. Only education significantly affected treatment outcome upon applying logistic regression. Therefore, proper counseling on drug adherence should be applied at the programmatic level.

Evaluation of the effect of Block Level Awareness Campaign on performance indicators of National Leprosy Elimination Program in Vadodara district, Gujarat, India.

BACKGROUND: Leprosy is probably the oldest disease afflicting mankind and a public health problem for centuries. Many cases are hidden or undiagnosed, especially due to social stigma, and neglect of painless patches. Between years 2001 and 2005, during which time active surveillance for detection of leprosy was in practice, a steep fall in the prevalence rate (PR) of leprosy was observed. However, during later years, leprosy program discontinued active surveillance for detection of leprosy cases. Presently block level awareness campaign (BLAC) is a special measure undertaken in a campaign mode during September-November in priority areas, (PR>1/10000 population), during which information, education and communication (IEC) activities and active surveillance of leprosy cases is done. AIMS: To evaluate the effect of Block Level Awareness Campaign on performance indicators of national leprosy elimination program (NLEP) in Vadodara district. METHODS: The campaign was carried out for 6 days in 12 talukas of Vadodara district by the district leprosy office, Vadodara. Trained teams of health workers carried out information, education and communication (IEC) activity and active surveillance by undertaking house to house survey in each primary health centre (PHC) area. Suspected cases were identified by the team and confirmed clinically by medical officers in the primary health centre of the corresponding areas. A district nucleus team (DNT) validated these confirmed cases. These data were compared with the district's national leprosy eradication programme (NLEP) data for the same year, 2012 and the previous year, 2011. RESULTS: A total of 1,574,586 persons, comprising 76%of the population surveyed, were screened for leprosy, which resulted in detection of 358 clinically confirmed new cases of leprosy, out of which 225 (62.8%) were paucibacillary (PB) and 133 (37.2%) were multibacillary (MB) leprosy. Of these cases, 14 (4%) had deformities, and 37 (10.3%) were children. LIMITATIONS: Only 76% of the population could be covered. Histopathological confirmation of the diagnosis was not undertaken. Because of the large number of health workers invovled, variations in their skills may have influenced the diagnosis of suspected cases. CONCLUSIONS: Active surveillance linked to focused block level campaigns can be useful tools to detect new hidden leprosy cases.

Sexually transmitted infections in women: A correlation of clinical and laboratory diagnosis in cases of vaginal discharge syndrome.

AIMS: This study compares the clinical and laboratory diagnosis of vaginal discharge syndrome. SETTINGS AND DESIGN: This cross-sectional study was carried out at the gynaecology outpatient department of a tertiary care hospital in Gujarat, India. MATERIAL AND METHODS: Total of 180 females diagnosed as vaginal discharge or cervicitis based on syndromic approach and were recruited for the study. Their clinical profile was noted and they were investigated for bacterial vaginosis, trichomoniasis, candidiasis, gonorrhoea and chlamydia infection. RESULTS: Lower abdominal pain (35%) followed by burning micturition (23.9%) were the common associated complaints. Bacterial vaginosis was the most common clinical diagnosis, while trichomoniasis was least common. Upon laboratory investigation, 35.6% of cases of vaginal discharge and 12% of cases of cervicitis tested positive. Percentage of cases confirmed by laboratory investigation was 50, 27.8 and 41.7 for bacterial vaginosis, trichomoniasis and candidiasis respectively. CONCLUSION: Among all the females diagnosed as vaginal discharge syndrome, a very small percentage actually turned out to be positive upon laboratory testing.

Clinical profile of leprosy patients: a prospective study.

INTRODUCTION: Early diagnosis and early adequate drug treatment is very important aspect to reduce the load in cases of leprosy. So, correct labeling of paucibacillary and multibacillary cases is a prerequisite for the adequate treatment. Confirmation of diagnosis is an important indication for histopathological examination in doubtful cases. OBJECTIVES: The present study was carried out to know the clinical profile of leprosy patients, concordance between clinical and histopathological diagnosis in cases of leprosy, and to assess the therapeutic efficacy of antileprosy therapy. STUDY DESIGN: Two hundred and fifty clinically diagnosed leprosy patients attending skin outdoor patient department (OPD) were included in the study. Slit skin smear was performed in all the cases. In that case concordance between clinical and histology can be determined only in 30 cases. All the patients were treated with MDT (multidrug therapy) as per WHO guideline. RESULTS: A total of 250 patients attended the clinic with male to female ratio of 1.7:1. The highest incidence was noted in 17-40 years of age group. In the clinical disease spectrum, 40% patients were in the borderline spectrum followed by tuberculoid leprosy (TT) (29.2%), lepromatous leprosy (LL) (26.8%), and 3.9% of indeterminate leprosy (IL). A total of 18% of patients were of primary neuritic leprosy. A total of 8.3% patients had definite history of contact in the family or neighborhood. Clinicopathological correlation was noted in 60% of patients with maximum disparity (52.9%) in the borderline group of patients. A total of 52.8% were MB (Multibacillary) and 47.2% were PB (Paucibacillary) cases. Morphological index became negative after 6 months in all patients. Mean fall of bacteriological index after 6 months was 0.19, while after 1 year, it was 1.05. CONCLUSION: Timely diagnosis and adequate treatment of cases with MDT is most effective. Histopathological examination is must in doubtful cases of leprosy.

Validation of vaginal discharge syndrome among pregnant women attending obstetrics clinic, in the tertiary hospital of Western India.

INTRODUCTION: Sexually transmitted infections (STIs) are major public health problem. The laboratory tests for diagnosing STI are often unavailable or too expensive. Therefore, World Health Organization has recommended a syndromic approach for diagnosis and management of STI/reproductive tract infections (RTIs). Very few studies so far had evaluated effectiveness of the syndromic approach in diagnosing STI/RTIs in pregnancy. AIMS AND OBJECTIVES: Validation of syndromic management for vaginal discharge syndrome in pregnancy. MATERIALS AND METHODS: A cross-sectional study was carried out which included 233 pregnant females attending obstetric clinic. They were subjected to clinical examination, vaginal swab collection, and serological tests. RESULTS: A total of 183 (78.54%) pregnant females had vaginal discharge on clinical examination and Candida albicans was the most common clinical diagnosis among them. Of 183 cases diagnosed clinically as vaginal discharge syndrome, 38 (20.7%) were tested positive in laboratory investigations. Out of 50 clinically negative cases, 9 (18%) were detected positive for one of the STIs on laboratory testing. CONCLUSION: Syndromic approach for management of vaginal discharge syndrome resulted in over-treatment of 78% (false positive) and under-diagnosis of 19.1% (false negative) pregnant females. Hence, integration of antenatal screening services in the form of laboratory tests for vaginal discharge is recommended.

Dietary pattern of schoolgoing adolescents in urban Baroda, India.

Diet plays a very important role in growth and development of adolescents, during which the development of healthy eating habits is of supreme importance. There is a dual burden of undernutrition and overnutrition in this age-group. The study assessed the food habits, food preferences, and dietary pattern of schoolgoing urban adolescents in Baroda, India. Both quantitative and qualitative methods were used in this study. A quantitative survey was carried out using a pre-tested self-administered structured questionnaire among 1,440 students from class 6 to 12 in 7 English medium and 23 Gujarati medium schools. Focus group discussions, 5 each with adolescent boys and girls, were held, along with 5 focus group discussions with teachers of Gujarati and English medium schools. Nearly 80% of adolescents had consumed regular food, like dal, rice, chapati, and vegetables, including green leafy vegetables. Nearly 50% of them had consumed chocolates, and about one-third consumed fast foods. Nearly 60% of adolescents had their breakfast daily while the remaining missed taking breakfast daily. Nearly one-third of adolescents were missing a meal once or twice a week. A large majority had consumed regular foods. However, more than half of them had consumed chocolates, soft drinks, and over one-third had taken fast foods.

HIV serostatus disclosure: Experiences and perceptions of people living with HIV/AIDS and their service providers in Gujarat, India.

BACKGROUND: Human immunodeficiency virus (HIV) disclosure offers important benefits to people living with HIV/AIDS. However, fear of discrimination, blame, and disruption of family relationships can make disclosure a difficult decision. Barriers to HIV disclosure are influenced by the particular culture within which the individuals live. Although many studies have assessed such barriers in the U.S., very few studies have explored the factors that facilitate or prevent HIV disclosure in India. Understanding these factors is critical to the refinement, development, and implementation of a counseling intervention to facilitate disclosure. MATERIALS AND METHODS: To explore these factors, we conducted 30 in-depth interviews in the local language with HIV- positive individuals from the Integrated Counselling and Testing Centre in Gujarat, India, assessing the experiences, perceived barriers, and facilitators to disclosure. To triangulate the findings, we conducted two focus group discussions with HIV medical and non-medical service providers, respectively. RESULTS: Perceived HIV-associated stigma, fear of discrimination, and fear of family breakdown acted as barriers to HIV disclosure. Most people living with HIV/AIDS came to know of their HIV status due to poor physical health, spousal HIV-positive status, or a positive HIV test during pregnancy. Some wives only learned of their husbands' HIV positive status after their husbands died. The focus group participants confirmed similar findings. Disclosure had serious implications for individuals living with HIV, such as divorce, maltreatment, ostracism, and decisions regarding child bearing. INTERPRETATION AND CONCLUSION: The identified barriers and facilitators in the present study can be used to augment training of HIV service providers working in voluntary counseling and testing centers in India.

Reproductive health awareness among urban school going adolescents in Vadodara city.

AIMS: To identify the reproductive health issues associated with adolescence and the readiness to avail services like Adolescent Friendly Clinic (AFC) among urban school going children. MATERIALS AND METHODS: A quantitative survey was carried out using a self-administered structured questionnaire among 1440 (748 girls and 692 boys) students from classes 6 -12 in 7 English medium and 23 Gujarati medium schools. Focus group discussions, 5 each with adolescent boys and girls and teachers were held from Gujarati and English medium schools. RESULTS: A higher proportion of boys and girls could identify visible external changes in the opposite sex as compared to the changes not seen outwardly. The sources of information on human reproduction for most of the boys and girls were schoolbooks, television, teachers, friends and parents in the same order. Over two-thirds of the boys and girls expressed a need for more information on reproduction. Teachers also perceived that adolescents, though curious, lacked opportunities for open discussions to answer their queries related to reproductive health. One-third of the boys and one-fourth of the girls had heard about contraception. Two-thirds of boys and girls had heard of HIV/AIDS, and about half of them correctly knew various modes of transmission of HIV. Majority of the adolescents expressed their readiness to use the services of Adolescent Friendly Centre. CONCLUSIONS AND RECOMMENDATIONS: Information on the human reproductive system and related issues on reproductive health need special attention. Teachers' sensitization to adolescent health care is required.