Statistical evaluation involving corneal March speckle a new nonparametric tactic

BACKGROUND India accounts for quarter of global rifampin-resistant/multi-drug resistant-tuberculosis (RR/MDR-TB). Knowledge on risk-factors and distribution of MDR-TB at district level is limited. OBJECTIVE Study prevalence and risk factors of MDR-TB in tuberculosis patients in hilly districts of Himachal Pradesh, India. METHODS Between July 2012-June 2013, TB patients registered under the Revised National Tuberculosis Control Program in Kangra and Una districts suspected of MDR-TB were referred for Xpert® MTB/RIF testing at the Delek Hospital, Dharamsala by the district TB Office. RESULTS Of 378 patients enrolled (median age 45 years; 85% males), 18% (n = 68) were rifampin-resistant. Among Xpert positives (n = 305), distributions of RR-TB were 10% (n = 9/89) for recurrent cases who had received TB treatment for less then 2-months, 15% each for new (n = 9/59) or recurrent cases (n = 5/34) remaining smear positive between 2 and 4 months of treatment, 36% (n = 41/113) for treatment failures, and 40% (n = 2/5) for loss to follow-ups. Of the sputum-smear positives, 15% (n = 51/338) were Xpert negative. Seeking care in the private sector was associated with higher risk of RR-TB (OR1.85; 95% CI0.87-3.9). CONCLUSION Prevalence of RR-TB is generally high in patients suspected of MDR-TB in the hilly districts of Himachal Pradesh. High prevalence during early phase of treatment can suggest primary transmission of DR-TB. Universal drug susceptibility testing and innovative case finding strategies will benefit patients living in mountain districts with inadequate access to healthcare. The high proportion of sputum-smear positive but Xpert negative cases may be due to non-tubercular mycobacterial disease. PURPOSE Comparative evaluation of front loading sputum microscopic approach versus standard Revised National Tuberculosis Control Programme (RNTCP) spot morning approach for diagnosis of pulmonary tuberculosis. METHODS All cases coming to the designated microscopy centre, Microbiology in this tertiary care centre with presumptive diagnosis of pulmonary tuberculosis were enrolled for the study population after taking informed consent. The sputum sample collection, staining and reporting were done according to standard RNTCP guidelines. RESULTS This study shows the probable non-inferiority of the frontloading sputum smear microscopy over the standard RNTCP approach. CONCLUSION The front loading smear microscopy could be considered a suitable alternate to standard RNTCP approach in an area with high drop out during diagnostic testing pathway. BACKGROUND In India, daily regimen with fixed-dose combination along with 99DOTS adherence tool and one-stop service at Anti-Retroviral Treatment (ART) centres for HIV infected Tuberculosis (TB) patients was launched in 2017. No systematic evaluation of its implementation has been done so far in a tertiary care setting in urban India. METHODS A mixed-methods study was conducted at National Institute of Tuberculosis and Respiratory Diseases, Delhi in 2018-19. Missed doses, average adherence and treatment outcomes were compared across 99DOTS dashboard and TB treatment card. In-depth interviews of patients and health care providers were conducted to explore the implementation challenges and benefits. RESULTS Median of missed doses recorded during intensive and continuation phase were 56 and 68 respectively in 99DOTS as compared to 0 in the TB Treatment card (p less then 0.0001). Average adherence was observed to be 27% in 99DOTS versus 99% in the TB treatment card (p less then 0.0001). Technical issues like software malfunction, logistic difficulties such as missing custom envelops and patient's inability to give call were reported. Role clarity among ART and TB program staff was ambiguous, which contributed to poor information flow between them. Patient benefits such as reduced stigma, less travel costs and reduced work absenteeism were reported. CONCLUSION Success of 99DOTS program under programmatic condition needs webtool stability, uninterrupted logistic supplies (envelops), training of staff and better coordination between TB and HIV program personnel. Despite the challenges in its implementation, the benefit of this tool in terms of greater convenience and reduced stigma for patients is encouraging. OBJECTIVE To determine clinical profile of osteoarticular tuberculosis (TB) in children. METHODS Cross-sectional analysis from 2007 to 2013. All patients diagnosed with bone TB, spinal TB or TB abscesses were included. RESULTS Out of 1318 children with TB, 39 (2.96%) had osteoarticular TB, of which 16 (42%) had osteomyelitis, 8 (20.5%) had spinal involvement, 7 (17.9%) had TB synovitis, 2 (5.1%) had psoas abscess and 6 (15.4%) had abscesses. The mean age of presentation was 7.1 ± 3.5 years (range 2-14 years). Of the 33 cases in which a culture was done, 25 (64%) showed a positive culture. Drug sensitivity tests were done in 21 patients of which 10 (47.6%) tested were drug resistant, of which 4 (36.4%) were multidrug resistant (MDR), 2 (18.2%) were extensively drug resistant (XDR), 3 were pre-XDR (27.3%) and 1 was polyresistant (9.1%). Nine (23.1%) patients had TB in the past with a treatment duration of 8.3 ± 5.3 months. Contact with a TB patient had occurred in 10 (25.6%) cases. click here Associated pulmonary TB were seen in 6 (15.39%) and TB meningitis were seen in 1 (2.6%) patients. Surgical intervention was needed in 11 (28.2%) patients of which 5 (45.5%) underwent curettage, drainage was done in 1 (9.1%), arthrotomy in 4 (36.4%) and spinal surgery in 1 (9.1%) patient. CONCLUSION Drug resistant osteoarticular TB is an emerging problem in children. BACKGROUND "Active case finding among key populations" is one of the four main thrust areas under the National Strategic Plan for Tuberculosis (NSP) 2017-25. OBJECTIVE This study aims to actively screen for TB symptoms and disease among migrant brick kiln workers and their care seeking behaviour for the symptoms through a private-public partnership effort. METHODS This was a cross sectional study conducted among all migrant brick kiln workers working in the brick kilns in the field practice area of the Rural Health Centre of a medical college hospital. A pretested structured questionnaire was used for the interview. Productive Cough with or without other symptoms for 2 weeks or more was considered suggestive of TB. Sputum smear microscopy and Gene Xpert were used to diagnose TB among symptomatics. SPSS version 16.0 was used for analysis. RESULTS Among 580 brick kiln workers, the prevalence of TB symptoms was 9.7%. Upon sputum examination, one was found to be positive for TB. Smoking was found to be associated with TB symptoms (p  less then  0.