Assessment of Knowledge and Practices of Referring Private Practitioners Regarding Revised National Tuberculosis Control Programme in Nagpur City - A Cross Sectional Study

Objectives: To assess knowledge, diagnostic and treatment practices of the referring private practitioners of Nagpur city regarding Revised National Tuberculosis Control Programme (RNTCP). Methods: The study involved interview of 103 Private Practitioners (PPs) of Nagpur city. Knowledge of private practitioners was assessed based on questions related to diagnosis, categorization, treatment regimens & follow up. Practices of private practitioners were assessed based on which investigations and treatment regimen they advise & whether they offer supervised treatment. Their willingness to get involved in the programme was also recorded. Results: Only 49 (47.6%) private practitioners knew sputum smear examination as primary tool of diagnosis of TB. Only half, 52 (50.5%) of the private practitioners knew number of categories of tuberculosis correctly and 64 (62.1%) private practitioners did know how to categorize TB patients. Chest X-ray and Mantoux test (38.5%) was mainly used by the PPs for TB diagnosis. 42.7% of PPs were prescribing treatment for TB and among them only 8 were prescribing as per RNTCP guidelines and just one provided treatment under direct observation. Different combination of HRZE and HRZES was prescribed for variable period ranges from 2-8 months. And only 12 (11.6%) private practitioners expressed their willingness to get involved in RNTCP for TB control. Conclusion: There is lack of adequate knowledge, diagnostic and treatment practice among PPs as per RNTCP guidelines and further encouragement is required for their participation in the programme

Supercritical CO2 Heat Transfer Study Near Critical Point in a Heated Circular Pipe

Supercritical CO2 (sCO2) power cycle is an up-and-coming technology to produce electricity from various heat sources. Apart from power cycles, sCO2 can also be used as coolant in centralized cooling system and stand-alone cooling device. However, lack of accurate predication tools such as heat transfer coefficient correlations and insufficient knowledge behind fundamental heat transfer processes can hinder its practical realization in key energy and cooling systems. The overall objective of the study is to extend fundamental knowledge about heat transfer and fluid flow processes in conduits pertinent to sCO2 power cycle. The emphasis here is investigation of heat transfer effects of three testing parameters: heat flux, inlet mass flux and inlet temperature. Experimental setup for this heat transfer study is designed considering limitations due to high pressure rating requirements and thus follows unconventional approach to calculate heat transfer coefficient. Test section chosen is a horizontal stainless steel tubing of inner diameter of 9.4 mm and heated length of 1.23 m with uniform volumetric heat generation within tubing walls. The designed test apparatus and data reduction process are validated with high pressure air experiments. Nusselt numbers are calculated at top, bottom and side- wall locations to demonstrate effects of buoyancy. Enhancement of heat transfer at bot- tom wall surfaces and deterioration at top wall surfaces is observed as the main effect of buoyancy. It was observed that effects of buoyancy increase with heat flux and decrease with mass flux. Buoyancy effects are also decreased for fluid temperatures higher than pseudocritical temperature. Nusselt numbers calculated from experimental results are compared with Nusselt number from available correlations in literature. It is hinted that near critical region where property variations are significant, one correlation alone may not accurately predict heat transfer for different regimes of geometry, mass flux and heat flux

Study of ovarian cancer at a tertiary care centre

Background: Despite major advances in case management, ovarian cancer continues to have the highest case fatality rate of all gynaecologic malignancies. There is paucity of meaningful screening and diagnostic protocols. Present study was planned with the objective of assessment of the prevalence of ovarian cancer and the associated risk factors at a tertiary care centre.Methods: The present prevalence study was conducted at a tertiary care government hospital and entailed analysis of data of 73 patients of ovarian cancer. All the participants were subjected to comprehensive history taking, followed by general, systemic, per-speculum and per-vaginal examination. Serum tumour markers of the patients were assessed. Imaging studies including ultrasound, CT or MRI abdomen/pelvis were done as per need. Final diagnosis was confirmed on histopathology and the cases were classified according to histological classification of World Health Organization.Results: Majority (41, 56.2%) were aged more than 45 years and above, most of them with one to two previous issues (64.3%). The disease was observed to be more common in postmenopausal women (65, 89%). Three fourth participants had negative family history of ovarian or breast cancer. Out of 73 patients, 31 had value of CA 125 between 150-400 U/mL and 42 had values >400 U/mL. Epithelial ovarian cancer (serous- 33, 45.2%, mucinous- 18, 24.7%) was observed to be the commonest histological type.Conclusions: To diagnose ovarian tumours early using multipronged approach with focussed risk factor identification and screening with CA-125 is very important and is strongly recommended

Learning orbital dynamics of binary black hole systems from gravitational wave measurements

We introduce a gravitational waveform inversion strategy that discovers mechanical models of binary black hole (BBH) systems. We show that only a single time series of (possibly noisy) waveform data is necessary to construct the equations of motion for a BBH system. Starting with a class of universal differential equations parameterized by feed-forward neural networks, our strategy involves the construction of a space of plausible mechanical models and a physics-informed constrained optimization within that space to minimize the waveform error. We apply our method to various BBH systems including extreme and comparable mass ratio systems in eccentric and non-eccentric orbits. We show the resulting differential equations apply to time durations longer than the training interval, and relativistic effects, such as perihelion precession, radiation reaction, and orbital plunge, are automatically accounted for. The methods outlined here provide a new, data-driven approach to studying the dynamics of binary black hole systems

Comparison of clonidine and fentanyl as an adjuvant to bupivacaine in unilateral spinal anaesthesia

Background: Various adjuvants to local anaesthetics are added to improve the quality of subarachnoid block in unilateral anaesthesia during lower limb surgeries. The present study was conducted with the aim to evaluate the efficacy of combination of clonidine-bupivacaine and fentanyl-bupivacaine.Methods: This randomized study was conducted on 60 patients at tertiary care center (Topiwala National Medical College, Mumbai) for 2 years. They were divided into 2 groups consisting of 30 in each. Group BC receives Inj. bupivacaine 0.5% (hyperbaric) 7.5 mg (1.5 ml) with inj. clonidine 15 µg (0.1 ml) intrathecally and Group BF receives Inj. bupivacaine 0.5% (hyperbaric) 7.5 mg (1.5 ml) with inj. fentanyl 15 µg (0.3 ml) intrathecally. The time of onset and duration and level of sensory and motor block, time to complete sensory and motor block recovery and duration of spinal anaesthesia, intraoperative and postoperative hemodynamics and side effects if any were noted.Results: The time of onset and duration of sensory and motor block was lesser in group BF compared to BC but the difference was statistically not significant (p>0.05). Duration of analgesia was also higher in group BF. Intraoperative and postoperative changes in hemodynamic parameters, oxygen saturation, and respiratory rate were comparable, and no significant changes are observed, and all are with in normal range (p<0.05). Pruritus was noticed in group BF (10%). None of the patient in both groups show any side effects such as respiratory depression and nausea, vomiting.Conclusions: We conclude that addition of fentanyl and clonidine to hyperbaric bupivacaine produces almost similar effect in unilateral spinal anaesthesia for lower limb surgery without prolonged motor blockade, haemodynamic instability, respiratory depression and nausea and vomiting with good sedation and postoperative analgesia. Although the incidence of pruritus is more with fentanyl, it is not distressing for patients

A study on seroprevalence of hepatotropic viruses among HIV-positive individuals attending the integrated counselling and testing centre (ICTC) in Mayo hospital of Nagpur city, Maharashtra, India

Background: Infection with human immunodeficiency virus type-1 and its end stage, acquired immunodeficiency syndrome is the major public health challenge of modern time. A variety of exogenously acquired infectious agents appear to influence the pace of HIV replication, the destruction of CD4+ T cells, and HIV transmission to infants and sexual partners. More persistent elevations in plasma HIV levels have been seen in patients with chronic infections (such as those with tuberculosis and herpes and hepatitis viruses), and such co-infected patients have a more rapid loss of CD4+ T cells and an increased rate of progression to AIDS and death. Within India, variable co-infection rates have been reported from region to region. With the above background, the present study was undertaken to study the seroprevalence of hepatotropic viruses (Hepatitis B virus and Hepatitis C virus) in HIV-positive individuals attending the Integrated Counselling and Testing Centre (ICTC) in Mayo hospital of Nagpur city, Maharashtra, India.  Methods: The current prospective study was conducted in the department of microbiology, Indira Gandhi government medical college and Mayo general hospital, Nagpur (Maharashtra) from August 2005 to August 2007. All the patients attending ICTC were included in the study. 300 HIV negative matched controls were also included in the study. All the individuals who were positive for HIV infection were selected for this study and further tested for the presence of hepatitis B surface antigen (HBsAg) and anti-HCV antibodies. Data was compiled in MS excel. Then it was analyzed using online statistical calculator and chi square test were applied with value of P <0.05 was considered statistically significant for interpretation of finding.  Results: Maximum numbers of HIV positive patients (38.8%) were in age group of 31-40 years. Present study showed male preponderance in HIV positive patients. Males showed a slightly high seroprevalence of HBsAg (9.21%) compared to females (7.57%) among HIV positive patients. The difference in positivity of two viral agents studied in HIV positive patients was highly significant as compared to HIV-negative individuals (P <0.001).  Conclusion: On the basis of the findings that the co-infection of hepatotropic viruses (HBV and HCV) were significantly higher in HIV positive cases than controls, the study concludes that the chronic viral hepatitis is a serious concern in HIV-infected patients. Thus, there is an urgent need to ensure the screening of the same in HIV-infected patients.

Dengue infection in central India: a 5 years study at a tertiary care hospital

Background: Dengue is one of the most important mosquito borne viral disease with wide spectrum of clinical presentation and often with unpredictable clinical evolution and outcome. Approximately 50 million infections occur annually world-wide, but what’s the real size of the problem in India?  Nobody truly knows...!!  Present study was carried out to determine seropositivity, clinical profile and seasonal variation of dengue infection in central India.Methods: Study was carried out from January 2012 to December 2016. Blood samples were collected from 15,606 patients with dengue like clinical illness and serum was separated. All the samples were subjected to IgM antibody detection by dengue MAC ELISA.Results: Prevalence of dengue in dengue suspected cases was found to be 24.49% (3,822/15,606). Maximum number of positive cases, 1,548 (40.50%) were in the age group of 0-10 years. Males (60.83%) were affected more than females (39.17%). Peak was observed in the months of August, September, October and November. Common presenting features were fever followed by myalgia, arthralgia, headache and bleeding manifestations. Significant drop in platelet count was observed in patients with dengue shock syndrome and dengue haemorrhagic fever.Conclusions: Number of dengue cases in central India are on increase and continued surveillance is essential to determine epidemiological and seasonal trend

Agricultura natural de presupuesto cero en India – Desde su inicio hasta su institucionalización

This paper delineates the growth of Zero Budget Natural Farming (ZBNF) in India. From its origins as a peasant-led social movement in the state of Karnataka, to becoming institutionalized in a state program in Andhra Pradesh, ZBNF is attaining scale and reaching more and more peasant families. We look at some of the key factors that have triggered ZBNFs growth, as well as highlight some of the challenges and contradictions that may arise in the institutionalization process.Este documento delinea el crecimiento de la agricultura natural de presupuesto cero (ZBNF, por sus siglas en inglés) en India. Desde sus orígenes como movimiento social dirigido por campesinos en el estado de Karnataka, hasta su institucionalización en un programa estatal en Andhra Pradesh, la ZBNF ha alcanzado una mayor escala, llegando así a cada vez más familias campesinas. Examinamos algunos de los factores clave que desencadenaron su crecimiento y destacamos algunos de los retos y las contradicciones que pueden surgir en el proceso de su institucionalización

Microbiological profile of patients attending sexually transmitted infection/reproductive tract infection clinic in a tertiary care hospital

Background: Sexually transmitted infections (STIs)/reproductive tract infections (RTIs) are an important public health problem worldwide. Growing spread of RTIs/STIs are an augmenting factor for HIV transmission. Due to lack of adequate laboratory infrastructure, there is limited data. Hence information regarding STIs lies essentially on syndromic basis.Methods: This was an observational, cross-sectional study carried from June 2016 to September 2016 with sample size of 300 patients attending STI/RTI clinic. Various samples were collected like scrapings, exudates and swabs from ulcerative lesions for microscopy. Urethral, vaginal and cervical swabs for wet mount, gram stain and culture. Blood sample were collected for RPR, TPHA, ELISA HSV II, HIV, HBsAg. Processing and identification of organism as per NACO guidelines.Results: Out of total 300 cases, 255 (85%) are females and 45 (15%) are males. Maximum cases are from 25-44 years age group. Genital discharge syndrome is more common in females while genital ulcerative syndrome more in males. Coinfection with HIV is found in 17% cases. Herpes genitals (20%) is the most common causative agent for ulcerative STIs in males. VDS is the most common syndrome in Females. Candida (27.8%), G. vaginalis (12.2%) and T. vaginalis (3.5%).Conclusions: Viral and fungal STIs are more common than bacterial STIs. Targeted intervention and contact tracing as done for HIV should be effectively emphasised for STI/RTI also. Syndromic approach should be supplemented by Laboratory diagnosis for more effective outcome

NS1 ANTIGEN DETECTION BY ELISA IN EARLY LABORATORY DIAGNOSIS OF DENGUE INFECTION

Introduction: Dengue is a major public health problem in tropical and sub-tropical regions of the world and it is known for serious life threatening complications. Detection of IgM antibodies forms the mainstay for diagnosis of dengue infection. However, IgM antibodies develop after 4-5 days of infection and there is an urgent need for an alternative diagnostic tools that can detect dengue infection earlier. Aim and Objectives: To evaluate the efficacy of NS1 antigen ELISA for early diagnosis of dengue virus infection in a tertiary care hospital Methods- A total of 2106 serum samples from patients with suspected dengue infection were tested for dengue NS1 antigen and IgM antibody detection by ELISA. Results: 765 (36.32%) were positive for dengue NS1 antigen and 857 (40.69%) were positive for dengue IgM antibody. NS1 antigen was detectable in patient sera from day 1 onwards however; dengue IgM antibody was detected from day 3 onwards. Out of 765 NS1 antigen positive samples, 562 (73.46%) were positive in acute phase of illness and 203 (26.54%) were positive in convalescent phase of illness. Out of 857 MAC ELISA positive samples, 312 (36.41%) were from acute phase of illness and 545 (63.59%) were from early convalescent phase of illness. Combination of two tests resulted in increase in the positivity rate to 52.66% as against to independent positivity rate of 36.32% of NS1 ELISA and 40.69% of MAC ELISA. Conclusion: Combined use of NS1 antigen assay with MAC ELISA test could significantly improve diagnostic sensitivity of dengue infectio