Active community surveillance of the impact of different tuberculosis control measures, Tiruvallur, South India, 1968-2001

Background: Tuberculosis is curable, but community surveys documenting epidemiological impact of the WHO-recommended DOTS strategy on tuberculosis prevalence have not been published. We used active community surveillance to compare the impact of DOTS with earlier programmes. Methods: We conducted tuberculosis disease surveys using random cluster sampling of a rural population in South India approximately every 2.5 years from 1968 to 1986, using radiography as a screening tool for sputum examination. In 1999, DOTS was implemented in the area. Prevalence surveys using radiography and symptom screening were conducted at the start of DOTS implementation and after 2.5 years. Results: From 1968 to 1999, culture-positive and smear-positive tuberculosis declined by 2.3 and 2.5% per annum compared with 11.9 and 5.6% after DOTS implementation. The 2.5 year period of DOTS implementation accounted for one-fourth of the decline in prevalence of culture-positive tuberculosis over 33 years. Multivariate analysis showed that prevalence of culture-positive tuberculosis decreased substantially (10.0% per annum, 95% CI: 2.8–16.6%) owing to DOTS after only slight declines related to temporal trends (2.1% annual decline, 95% CI: 1.1–3.2%) and short-course chemotherapy (1.5% annual decline, 95% CI: �9.7% to 11.5%). Under DOTS, the proportion of total cases identified through clinical care increased from 81 to 92%. Conclusions: Following DOTS implementation, prevalence of culture-positive tuberculosis decreased rapidly following a gradual decline for the previous 30 years. In the absence of a large HIV epidemic and with relatively low levels of rifampicin resistance, DOTS was associated with rapid reduction of tuberculosis prevalenc

Positron Annihilation Studies on Chemically Synthesized FeCo Alloy

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Influence of drug susceptibility on treatment outcome and susceptibility profile of 'failures' to category II regimen

Objective: To assess the influence of drug resistance on treatment outcome among patients treated with Category-II regimen and document drug susceptibility pattern of “Failures” to this regimen. Design: A retrospective analysis of patients registered from May 1999 through December 2004. Results: Treatment success was 42% among 572 patients and was similar among patients with fully susceptible or resistant but non-MDR organisms (41% of 254 and 40% of 128 patients, respectively). Among 49 MDR-TB patients, 27% had successful treatment outcome. The failure rates among patients with fully susceptible, resistant but non-MDR and MDR bacilli, were 6%, 12% and 27% respectively. Default was significantly higher among males (53% vs. 34%: p<0.01) smokers (57% vs. 36%: p <0.001), alcoholics (58% vs. 39%: p <0.001) and patients with higher initial smear grading (2+ or 3+, 56% vs. scanty or 1+, 44%: p <0.01). DST results were available for 60% (31 of 52) of failures and 10 had MDR-TB. Conclusion: The low success rate to the re-treatment regimen was mainly due to non-compliance. Failure was observed among 9% of patients and MDR-TB was 32% among Category II failures. The currently recommended Category II regimen appears to be adequate for majority of re-treatment cases

Estimation of burden of tuberculosis in India for the year 2000

Background & objectives: Data on the burden of tuberculosis (TB) in India are vital for programme planners to plan the resource requirements and for monitoring the nation-wide TB control programme. There was a need to revise the earlier estimate on the burden of TB in India based on the increase in population and current epidemiological data. This study estimates the burden of disease for the year 2000 based on recent prevalence of TB and annual risk of tuberculosis infection (ARTI) estimates. Methods: Data on prevalence generated among adults by the Tuberculosis Research Centre (TRC), Chennai, among children by National Tuberculosis Institute (NTI), Bangalore, and the ARTI estimates from the nation-wide sample survey by NTI and TRC were used for the estimation. The prevalence of disease corresponding to 1 per cent ARTI was extrapolated to different parts of the country using the estimates of ARTI and the population in those areas and added together to get the total cases. Abacillary cases that required treatment were estimated from X-ray abnormals. The estimates of bacillary, abacillary and extrapulmonary cases were then combined to get the national burden. Results: The estimated number of bacillary cases was 3.8 million (95% CI: 2.8 - 4.7). The number of abacillary cases was estimated to be 3.9 million and that for extrapulmonary cases was 0.8 million giving a total burden of 8.5 million (95% CI: 6.3-10.4) for 2000. Interpretation & conclusion: The present estimate differs from the earlier estimates because we have included the disease burden of X-ray cases that are likely to breakdown to bacillary cases in a one year period, and extrapulmonary TB cases. The current estimates provided baseline information for advocacy and planning resource allocation for TB control activities. Also, these estimates can be compared with that in future years to measure the long term impact of TB control activities in India

Is it worth treating category I failure patients with category II regimen?

Background: Very little information is available on the drug susceptibility profile among patients who are treated with standardized short-course chemotherapy regimens under programme conditions. Methods: Sputum samples were collected from new sputum smear-positive patients declared ‘failure’ after treatment with Category I regimen under tuberculosis control programme using DOTS strategy from a rural area of Tamil Nadu. Results: Of 1463 patients started on Category I regimen between May1999 and December 2002, 74 cases were declared as ‘failures’ (smear positive at 5/6 months of treatment). We collected sputum samples from 60 (81%) of 74 ‘failures’ and 27% (16 of 60) of them were culture-negative for M tuberculosis and 17% (10 of 60) had organisms resistant to Isoniazid and Rifampicin (MDR TB). Conclusion: Based on the drug susceptibility profile at the time of ‘failure’, treating Category I ‘failures’ with Category II regimen with close monitoring appears to be justified

Association of conversion & cure with initial smear grading among new smear positive pulmonary tuberculosis patients treated with Category I regimen

Background & objective: Early diagnosis of tuberculosis (TB) is important for initiating treatment to gain cure. The present investigation was undertaken to study the association of conversion and cure with initial smear grading among pulmonary tuberculosis (TB) patients registered in a directly observed treatment – short course (DOTS) programme in Tiruvallur district, south India. Methods: All new smear positive cases registered from May, 1999 to December, 2002 were analysed for conversion and cure related to initial smear grading. Results: Of the 1463 patients, 1206(82.4%) were converted at the end of the intensive phase and 1109 (75.8%) were declared ‘cured’ after the completion of treatment. The cure rate decreased as the initial smear grading increased and the decrease in trend was statistically significant (P=0.01). Similarly, a significant decrease in conversion rate was also observed with increase in initial smear grading (P<0.001). In multivariate analysis, lower cure rate was significantly associated with patient’s age (AOR=1.5, 95% CI=1.1-2.1), alcoholism (AOR=1.7, 95% CI 1.2- 2.4) and conversion at the end of intensive phase (AOR=3.5, 95% CI= 2.6-4.8). Interpretation & conclusion: Cure and conversion rates were linearly associated with initial smear grading. High default and death rates were responsible for low cure and conversion. The proportion of patients who required extension of treatment and those who had an unfavourable treatment outcome were significantly higher among patients with a 3+ initial smear grading. This reiterates the need to pay more attention in motivating these patients to return to regular treatment and sustained commitment in the control of tuberculosis. There is a need to extend the treatment for one more month in the intensive phase of treatment

Management of Multi Drug Resistance Tuberculosis in the Field: Tuberculosis Research Centre Experience

Setting: Multi-drug TB resistant (resistant to isoniazid and rifampicin) patients identified from a rural and urban area. Objective: To study the feasibility of managing MDR TB patients under field conditions where DOTS programme has been implemented Methods: MDR TB Patients identified among patients treated under DOTS in the rural area and from cases referred by the NGO when MDR TB was suspected form the study population. Culture and drug susceptibility testing were done at Tuberculosis Research Centre (TRC). Treatment regimen was decided on individual basis. After a period of initial hospitalization, treatment was continued in the respective peripheral health facility or with the NGO after identifying a DOT provider in the field. Patients attended TRC at monthly intervals for clinical, sociological and bacteriological evaluations. Drugs for the month were pre-packed and handed over to the respective center. Results: A total of 66 MDR TB patients (46 from the rural and 20 from the NGO) started on treatment form the study population and among them 20 (30%) were resistant to one or more second line drugs (Eto, Ofx, Km) including a case of “XDR TB”. Less than half the patients stayed in the hospital for more than 10 days. The treatment was provided partially under supervision. Providing injection was identified to be a major problem. Response to treatment could be correctly predicted based on the 6-month smear results in 40 of 42 regular patients. Successful treatment outcome was observed only in 37% of cases with a high default of 24%. Adverse reactions necessitating modification of treatment was required only for three patients. Implications Despite having reliable DST and drug logistics, the main challenge was to maintain patients on such prolonged treatment by identifying a provider closer to the patient who can also give injection, have social skills and manage of minor adverse reactions

Monkeypox Detection Through Watershed Segmentation and Appending 2D CNN Based Auto Encoder: Monkeypox Detection Through CNN-Auto Encoder

Monkeypox, a viral zoonosis, may spread from animals to people. Fever, rashes, and swollen lymph nodes might create medical complications. Its symptoms resemble smallpox. To prevent monkey pox sickness, you must be prepared and treat it immediately. Public health systems should be aware of effective monkeypox mitigation methods because to its global health impacts. Watershed segmentation using CNN-based auto encoder detected monkeypox. Monkeypox may be distinguished from other skin infections. Watershed segmentation, elevation map utilisingsobel, and region-based feature extraction function well on impacted skin photos. Segmenting Monekypox images is tough due to similarities and variations across classes and the difficulties of focusing on skin lesions. Unsupervised learning models like the convolutional autoencoder duplicate the input image in the output layer. Encoders, ConvNets that produce low-dimensional images, process images passed via them

Analysis of acetabular cup positioning and functional outcome in total hip replacement

INTRODUCTION: Total hip replacement, nowadays have become commonly performed reconstructive hip procedure for various hip disorders. In total hip replacement, the position of acetabular cup version is one of the important factor which influence the functional outcome of Total hip replacement. The dislocation rate and good availability of hip movements are majorly depends on acetabular cup version. AIM: The aim of this study is an analysis of acetabular cup positioning and functional outcome in total hip replacement. MATERIALS AND METHODS: This retrospective study was conducted at Govt. Royapettah hospital, to analyse acetabular cup placement and functional outcome in THR, the period between 2013 to 2015. Study Population: 20 HIPS. Method of selection: 20 patients selected randomly from MRD department who complied with our study without any drop out. METHOD: 1. CT examination of acetabular cup 2. Analysis of functional outcome according to Harris hip score This study was conducted during my training period. All these patients were called over phone to attend the ortho OPD. This study had been done to assess the post oprative acetabular cup positioning and functional outcome of total hip replacement done for various indications. All patients were assessed post operatively with CT scan of pelvis for cup version. These patients were also examined clinically to analyze the functional outcome based on Harris hip score at the latest follow up. The results were compared and analysed in these randomly selected patients. RESULTS AND CONCLUSIONS: All patients were assessed clinically using the HARRIS HIP SCORE SYSTEM [modified] for hip function in our study. 1. We had one case of dislocation with associated sciatic nerve palsy due to retroverted acetabular cup which was corrected by revision THR. Now the patient had recovered from nerve palsy and had good functional outcome 2. Limb length discrepancy: we had significant LLD of >3.2 cm in one case, other 5 cases had around 1 cm shortening on operated limb. 3. None of our patients had infection in our study. 4. In our study, 90% of patients had excellent functional outcome, 5% of patients had good functional outcome and 5% of patients had fair functional outcome. 5. In our study, 90% of acetabular cup positions were in acceptable range. Only 10% of acetabular cups were in excessive anteversion, 6. The cases with excessive anteversion were not associated with dislocation of joint. But had no internal rotation. 7. CT scan based acetabular cup measurement has given good predication of our intra operative free hand assessment of acetabular cup positioning