The timing of death in patients with tuberculosis who die during anti-tuberculosis treatment in Andhra Pradesh, South India

Background: India has 2.0 million estimated tuberculosis (TB) cases per annum with an estimated 280,000 TBrelated deaths per year. Understanding when in the course of TB treatment patients die is important for determining the type of intervention to be offered and crucially when this intervention should be given. The objectives of the current study were to determine in a large cohort of TB patients in India:- i) treatment outcomes including the number who died while on treatment, ii) the month of death and iii) characteristics associated with “early” death, occurring in the initial 8 weeks of treatment. Methods: This was a retrospective study in 16 selected Designated Microscopy Centres (DMCs) in Hyderabad, Krishna and Adilabad districts of Andhra Pradesh, South India. A review was performed of treatment cards and medical records of all TB patients (adults and children) registered and placed on standardized anti-tuberculosis treatment from January 2005 to September 2009. Results: There were 8,240 TB patients (5183 males) of whom 492 (6%) were known to have died during treatment. Case-fatality was higher in those previously treated (12%) and lower in those with extra-pulmonary TB (2%). There was an even distribution of deaths during anti-tuberculosis treatment, with 28% of all patients dying in the first 8 weeks of treatment. Increasing age and new as compared to recurrent TB disease were significantly associated with “early death”. Conclusion: In this large cohort of TB patients, deaths occurred with an even frequency throughout anti-TB treatment. Reasons may relate to i) the treatment of the disease itself, raising concerns about drug adherence, quality of anti-tuberculosis drugs or the presence of undetected drug resistance and ii) co-morbidities, such as HIV/ AIDS and diabetes mellitus, which are known to influence mortality. More research in this area from prospective and retrospective studies is needed

Prevalence and predictors of stress during COVID pandemic among health-care workers in India: A systematic review

The COVID-19 pandemic is one of its kinds of public health emergencies that the world is grappling with. The health-care workers (HCWs) were at the forefront of the battle against this scourge. As a result of continuous service delivery, they experienced stress and burnout which varied from the type of HCWs, gender, type of service, and the length of service rendered by them. Given the context, this systematic review assessed the prevalence and predictors of stress among different types of HCWs in India. The systematic review was conducted using PubMed search engine and 13 articles were selected for the purpose of review. Of the 13 studies identified, 11 studies were carried out predominantly in India or in some Indian states and 2 studies were multinational studies, in which samples were also drawn from India. Of these 13 studies, 6, 5, 3, 2, and 2 studies were conducted among the doctors, specialists, nurses, dentists, and allied HCWs in India, respectively. It was observed that the prevalence of stress among HCWs varied with age, gender, type of HCWs, place of work, and duration of work, and the predictors were long working hours, continuous contact with patients, fear of self-infection, stigmatization, and fear of carrying the infection to the family. Stress and burnout among HCWs are inevitable; however, there should be ways and means to have coping behavior else the same would affect the professionals' personal life and patient care. Hence, appropriate measures need to be taken to address this issue by the HCWs themselves, government, and other social sectors organizations