Stakeholders' perspective on the daily regimen of tuberculosis treatment- A qualitative approach.

INTRODUCTION: In the context of changing over from an intermittent treatment regimen to a daily regimen, it becomes crucial to understand the impact of a daily regimen on the treatment process and outcome. It enables health professionals to strengthen strategies, to enhance the quality of treatment as well as the quality of life of TB patients. The perspective of each stakeholder involved in the process is important in assessing the impact of the daily regimen. OBJECTIVES: To understand patients' and providers' perspectives on the daily regimen of Tuberculosis treatment. METHODOLOGY: A qualitative study was conducted between March 2020 to June 2020, including in-depth interviews with TB patients on treatment and DOT providers, and Key Informant Interview(KII) with TB Health Visitors(TBHV) and family members of TB patients. A thematic-network analysis approach was utilized to get the results. RESULTS: Two sub-themes emerged: (i) Acceptance of the daily regimen of treatment; (ii) operational difficulties of the daily regimen. No injections in the regimen, fewer side effects of drugs as dose depends on weight band, family members can be treatment supporter, awareness about disease and treatment, the drugs are as same as private drugs available, adherence has improved, monthly DBT were found to some of the enablers in the study. The Barriers found in the study were traveling daily to get drugs, loss of daily wages, accompanying patients daily, tracing private patients, pyridoxine is not given free in this regimen, increased workload for treatment providers, etc. CONCLUSION: The study points out that acceptance of the patient to the daily regimen is better as they have lesser side effects. The operational difficulties in the implementation of the daily regimen can be addressed by providing family members as treatment supporters.

Geospatial Mapping of Indoor Air Quality and Respiratory Illnesses in an Urban Slum.

Introduction Air pollution is a well-recognized determinant of health. The general perception has focused primarily on outdoor pollution, and indoor pollution which may be due to smoking, biomass use, an extension of outdoor pollution, etc. has been neglected. It is therefore imperative to understand the levels of indoor pollution and find out if these are associated with high rates of illnesses, particularly, respiratory diseases. Material and methods This was a cross-sectional study involving 300 houses and 727 participants in an urban slum, selected through simple random sampling. Indoor air quality was assessed using the Prana C -Air Plus air quality monitor (Prana Air, New Delhi, India). The instrument detected formaldehyde, air quality index (AQI), temperature, humidity, PM2.5, PM10 particles, and total volatile organic (TVO) compounds. Socio-demographic details were noted, and geospatial mapping was done using Q-GIS software (www.qgis.org). A questionnaire was used to survey the residents of those houses. Ethical committee clearance was obtained before starting the project. Results The mean distribution of pollution parameters over the entire study area was AQI - 67.4±65.48, PM 2.5 - 37.6±35.82 µg/m3, formaldehyde - 0.09±0.37 mg/m3, PM 10 - 43.9±38.59 µg/m3, TVO compounds - 0.43±2.13 mg/m3, CO2 - 1128.9±323.86 ppm, temperature - 23.7±21.2 degree Celsius, and PM 1 - 24.3±20.5 µg/m3; 2.6% of the participants had respiratory diseases, and a significant association was found between the AQI, TVO compounds and ventilation, and respiratory diseases (p<0.05). Conclusion Indoor air pollution not unlike outdoor pollution can have dramatic health effects and needs to be addressed to lower the overall respiratory disease burden. The AQI, TVOC, and poor ventilation/cross-ventilation are associated with respiratory illnesses. Geospatial mapping shows a concentration of cases in areas of high pollution.

Case 301: Traumatic Subarachnoid-Pleural Fistula.

HISTORY: A 38-year-old man who had been in a motor vehicle collision was referred to our institute. He was suspected of having left-sided pneumothorax. This necessitated intercostal drainage with a chest tube, which had been placed elsewhere prior to his arrival. Paraparesis was noted at the initial clinical examination, with adequately maintained vital signs, while the blood work-up revealed a mildly reduced hemoglobin level of 10.1 mg/dL (normal range, 13.8-17.2 mg/dL); however, the rest of the laboratory values were within normal limits. The patient was then immediately referred for further evaluation with CT of the brain, cervical spine, and thorax. Thereafter, serial chest radiography was performed for follow-up.

Case 301.

History A 38-year-old man who had been in a motor vehicle collision was referred to our institute. He was suspected of having left-sided pneumothorax. This necessitated intercostal drainage with a chest tube, which had been placed elsewhere prior to his arrival. Paraparesis was noted on the initial clinical examination, with adequately maintained vital signs, while the blood work-up revealed a mildly reduced hemoglobin level of 10.1 mg/dL (normal range, 13.8-17.2 mg/dL); however, the rest of the laboratory values were within normal limits (Figs 1-5). The patient was then immediately referred for further evaluation with CT of the brain, cervical spine, and thorax. Thereafter, serial chest radiography was performed for follow-up.

Geographic information system and foldscope technology in detecting intestinal parasitic infections among school children of South India.

BACKGROUND: Effective and efficient use of technological advances will ease public health interventions and also help in reaching a larger population. Geographic Information System (GIS) and Foldscope are two such technologies, which have promising utilities in public health. Identifying intestinal parasitic infections early through feasible technologies will help in their effective management. With this objective, this study was conducted to assess the prevalence of intestinal parasitic infections among school children in southern districts of Karnataka, India. METHODS: This cross-sectional study was conducted among randomly selected 10 urban, 10 rural, and 5 tribal schools of southern districts of Karnataka. A total of 1052 children studying in these schools were selected. Stool samples were collected and examined under Foldscope for parasitic infestation. The schools where children with worm infestations present were plotted in the GIS map. FINDINGS: Among 1052 children included in this study, 139 (13.2%) were found to have an intestinal parasitic infestation. Among these children, 24.6% were in the age group of 5-9 years, 12.2% were males, and 14.4% were females. Urban students had higher odds (2.765) of parasitic infections compared to rural students. Mean age, height, and weight were significantly lesser among subjects with a worm infestation. INTERPRETATION: Utility of Foldscope and GIS was found to be feasible and effective in the detection and mapping of parasitic infestations. The prevalence of parasitic infestation was found to be high among urban school children. Age, weight, height, and urban residence were found to be the major predictors of outcome.

Diagnostic Significance of Ultrasonographic Markers and Score in Detection of Gestational Diabetes Mellitus in the Indian Subcontinent.

ABSTRACT: In most countries, only high-risk women are screened for gestational diabetes mellitus (GDM). In addition, a onetime early screening test may miss GDM as it may be diagnosable between 24 and 28 weeks. Thus, it is preferable to have alternative tests to classify women as high risk for GDM and keep them under regular follow-up. A total of 120 women with singleton pregnancies and established maternal and/or pregnancy-related risk factors for GDM and who provided informed consent were subjected to an obstetric ultrasound scan at/or after 24 weeks' gestation followed by administration of a 2-hour 75-g oral glucose tolerance test. Various ultrasound markers were determined/measured. Each ultrasound GDM marker was assigned 1 point to create the ultrasound gestational diabetes screening (UGDS) score. All ultrasound GDM markers positively correlated to the disease (P < 0.0001). The strongest independent predictor of GDM was an immature appearance of placenta (relative risk, 49.09; 95% confidence interval, 7.04-342.28; P < 0.0001). Receiver operator characteristics showed an area under the curve of 96.9%, confirming good ability of the UGDS to discriminate between positive and negative oral glucose tolerance test. A UGDS score of 4, providing diagnostic efficiency of 92%, sensitivity of 93.2%, specificity of 92%, positive predictive value of 85.4%, and negative predictive value of 96.4%, is proposed by this study. This study suggests that ultrasound markers significantly vary in GDM compared with normal pregnancy women and that UGDS is a good predictor of GDM. The UGDS may be considered an adjunct to current screening tools for GDM.