Kondagunta Sivaprasad, Professor of Electrical Engineering travels to India

Professor Kondagunta Sivaprasad traveled to Chennai, India, to investigate the possibility of an undergraduate exchange

REASONS FOR PATIENT DELAYS & HEALTH SYSTEM DELAYS FOR TUBERCULOSIS IN SOUTH INDIA

Background: Globally, the burden of Tuberculosis is escalating. Early diagnosis and prompt initiation of tuberculosis treatment is essential for an effective tuberculosis control programme. Objectives: To study the self reported reasons for patient and health system (diagnosis & treatment) delays in Tuberculosis patients. Methods: A community based cross sectional study was conducted among 98 new sputum positive TB cases aged > 15 years registered under RNTCP from Oct 2006 to June 2007 & receiving treatment under DOTS in Udupi taluk by interviewing them. Results: Total 98 patients were recruited and 68% were males. Out of 17 patients with patient delays, 82% felt that their symptoms were not severe, 71% felt that patient delay was due to lack of awareness and 71% did not take it seriously. Out of 86 patients with health system delays, 82.6% of patients mentioned that doctor has not advised for sputum examination, 76.7% of patients told that they first consulted a private doctor, 21% of them mentioned that doctor was unaware to diagnose TB. Conclusion: Symptoms not severe is the main reason for the patient delay and doctor didn’t advise for sputum examination is the main reason for health system delays

Targeting apoptosis in solid tumors: the role of bortezomib from preclinical to clinical evidence.

The ubiquitin-proteasome pathway is the main proteolytic system present in the nucleus and cytoplasm of all eukaryotic cells. Apoptosis activation induced by ubiquitin-proteasome pathway inhibition makes the proteasome a new target of anticancer therapy. Bortezomib is the first proteasome inhibitor to be approved by the US FDA; in 2003 as a third line and in 2005 as a second line therapy for the treatment of multiple myeloma only. This review focuses on the use of bortezomib, not only in its therapeutic role but also, more specifically, in its biologic role and discusses the most recent applications of the drug in solid tumors, both at a preclinical and clinical level

Impact of low birth weight and breastfeeding practices on the nutritional status of children aged 2 to 5 years in the slums

Malnutrition among children in developing countries is a major public health problem, especially in India. Inappropriate feeding practices, in combination with other causes such as infection and food shortage, may be responsible for 1/3rd of malnutrition. Moreover, the risk of mortality is inversely related to children's height-for-age and weight-for-height. The aim: To assess the nutritional status of children aged 2 to 5 years in the urban field practice area of SVIMS-Sri Padmavathi Medical College for Women, Tirupati and to determine the impact of low birth weight, breastfeeding practices and other related factors on the nutritional status of the above study population. Materials and methods: This is a community-based observational cross-sectional study conducted among 282 children aged 2 to 5 years in the urban field practice area of SVIMS-Sri Padmavathi Medical College for Women, Tirupati. Socio-demographic data, Birth history, breastfeeding practices and anthropometric measurements were noted in the study questionnaire. Nutritional status was determined using HAZ, WHZ and WAZ scores of WHO child growth standards. Data was entered and analyzed using IBM SPSS Statistics 26 version to test for association between categorical variables, and a p-value < 0.05 was considered statistically significant. Results: A total of 282 school children with mean age of 39.9 (+10.4) months participated in the study, of which 132 (46.8 %) were boys and 150 (53.2 %) were girls. This study observed exclusive breastfeeding in 193 (68.4 %) children. Prevalence of stunting, wasting and being underweight were 22 %, 12.4 % and 23.8 %, respectively. A statistically significant association was found between stunting (p=0.006) and underweight (p=0.001) with low birth weight children. Conclusions: The present study revealed a high prevalence of malnutrition, especially stunting, a common outcome of long-term malnutrition among young children. Low birth weight and inappropriate breastfeeding practices result in long-term adverse consequences on the nutrition of preschool children, which should be prevented through appropriate strategies

Arecanut and Tobacco use Among School Children

BackgroundAreca nut is the fourth most commonly used psychoactive substance in the world after caffeine, alcohol and nicotine. Its use is considered a benign and socially acceptable habit among most Indians. Like tobacco, chewing areca nut also leads to oral and oropharyngeal cancers. Chewing of these substances usually starts early in life leading to a multitude of problems in adulthood. This study was conducted among high school students to determine the prevalence and explore the awareness of health hazards associated with these substances.Method  This cross sectional study was carried out in Vantamuri village, South India. All consenting school children of 7th, 8th and 9th class were interviewed individually using a pretested questionnaire about their chewing habits. This was followed by a thorough oral cavity examination for all.ResultsOut of 392 participants 62.5% were boys. Mean age of all participants was 14.8 ± 1.13 years.  The prevalence of areca nut usage among boys and girls was 27.3% and 6.1% while it was 2.4% for gutka (contains tobacco) amongst boys.  Majority of students started chewing between 13 and 14 years. About 49% of users were chewing these substances regularly for more than a year. Addictive tendencies were seen in two users. 43% of users chewed the same product used by their family members (

Diagnosis of Pulmonary Tuberculosis

BackgroundIn India majority of patients with respiratory symptoms initially consult private doctor. Few studies have been performed on the role of private practitioners in TB control. The present study was planned to assess the private practitioners approach in the diagnosis of pulmonary tuberculosis.Method  A Cross Sectional study was conducted between September 2008 and October 2009 in rural and urban area of Udupi taluk. The study population included all modern medicine general practitioners and all the specialists practicing Internal Medicine, Chest Medicine, and Paediatrics. The non response rate was 8%. About 15 practitioners who were not in the list were interviewed during field visits. So, the total number of practitioners interviewed was 116.                                                              ResultsThe majority (67.4%) of general practitioners and physicians opted for sputum examination as the investigation of choice to diagnose pulmonary Tuberculosis. About 26.1% of general practitioners and physicians used both sputum and chest x-ray to diagnose pulmonary tuberculosis. About 6.5% used chest x-ray alone. However, about 58.3% of paediatricians preferred both sputum and chest x-ray to diagnose pulmonary tuberculosis. ConclusionRelying only on chest x-ray to diagnose pulmonary tuberculosis may lead to over-diagnosis, over-medication and unnecessary utilization of resources. There is a need to improve the awareness among private practitioners regarding the importance of sputum smear examination to diagnose pulmonary tuberculosis

Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

Lymphatic Filariasis and Mass Drug Administration

BackgroundA third of world’s filariasis cases occur in India. As a result Mass Drug Administration (MDA) was commenced in 1997 with the aim of eliminating this disease by 2015. However the coverage of MDA was not satisfactory. The underlying reasons for the poor coverage need to be identified. This study was conducted to assess the awareness of health personnel of lymphatic filariasis and the MDA programme.Method  This cross-sectional study was conducted in Kundapura taluk of Karnataka state in India during the 6th round of the MDA which was held between December 11 to 13, 2009. 78 health personnel who were posted for drug distribution were selected by convenience sampling. After obtaining informed consent health personnel were interviewed individually using a semi-structured questionnaire. Performance of health personnel was assessed according to points scored for their responses.ResultsThe mean age of all participants were 22.7± 8.9 years, 74(94.1%) were females and 58(74.4%) were nursing students. Only 17 (21.8%) participants had prior experience before taking part in this round of MDA. Only 4 (5.1%) participants achieved good scores while 45 (57.7%) got average scores. Performance scores were significantly better among paramedical workers (