Development of Knowledge, Attitude and Practice Questionnaire for Patients with Diabetes Mellitus

Diabetes is one of the most common chronic diseases worldwide. The number of people with type 2 diabetes began to rise globally in the 1990 s, and since 2000, the world has seen a dramatic increase. There is a need to assess Knowledge, Attitude and Practice (KAP) of patients with diabetes in order to aid in future development of control programs and techniques for effective health education and patients counselling. this study was intended to develop a KAP questionnaire. It is a 27-question closed ended questionnaire with 12 knowledge, 8 attitude and 7 practice questions. Each correct answer was given a score 1 and the incorrect answer was given 0. Total scores of Knowledges, Attitude and Practice were added together to yield the final KAP score, where 25 was the highest and 0 was the least KAP score a subject could get. The questionnaire was reviewed by doctors and fellow pharmacists. Reliability of the questionnaire was calculated using “Kuder Richardson 21 (KR21)” method using a sample data of KAP score from 20 patients. After applying the formula, the scores obtained for Knowledge, Attitude, Practice and KAP were 0.71, 0.80, 0.71, and 0.75 respectively. The results show that the questionnaire is a valid instrument that allows an assessment of knowledge, attitudes and practices levels of patients with diabetes mellitus

Properties of cellulose/Thespesia Lampas short fibers bio-composite films

Abstract: Cellulose was dissolved in pre cooled environment friendly solvent (aq.7% sodium hydroxide+12% urea) and regenerated with 5%H2SO4 as coagulation bath. Using cellulose as matrix and alkali treated short natural fibers extracted from the newly identified Thespesia Lampas plant as reinforcement, the green composite films were prepared. The effect of fiber loading on the tensile properties and thermal stability was studied. The fractographs indicated better interfacial bonding between the fibers and cellulose. The crystallinity of the composite films was found to be lower than the matrix and decreased with increasing fiber content. In spite of better interfacial bonding, the tensile properties of the composites were found to be lower than those of the matrix and decreased with increasing fiber content and this behavior was attributed to the random orientation of the fibers in the composites. The thermal stability of the composite films was higher than the matrix and increased with fiber content

Diisobutyl 4-(3-eth­oxy-4-hy­droxy­phen­yl)-2,6-dimethyl-1,4-dihydro­pyridine-3,5-dicarboxyl­ate

The asymmetric unit of the title compound, C25H35NO6, contains two independent mol­ecules. In each mol­ecule, the 1,4-dihydro­pyridine ring adopts a flattened boat conformation. The dihedral angles between the 1,4-dihydro­pyridine and benzene rings are 87.55 (7) and 87.23 (7)°. In one of these mol­ecules, one of the isobutyl groups is disordered over two sets of sites, with an occupancy ratio of 0.890 (2):0.110 (2). In the crystal, mol­ecules are linked through N—H⋯O, O—H⋯O and C—H⋯O hydrogen bonds forming two-dimensional networks parallel to the ab plane. The crystal structure is further stabilized by weak C—H⋯π inter­actions

Tensile and thermal properties of poly(lactic acid)/eggshell powder composite films

Biodegradable composite films of poly(lactic acid) (PLA)=eggshell powder (ESP) were prepared by the composite film casting method using chloroform as the solvent. ESP was loaded in PLA in 1 to 5 wt.%. The films were subjected to tensile, FT-IR spectral, thermogravimetric, X-ray, and microscopic analyses. The tensile strength and modulus of the composite films were found to be higher than those of PLA and increased with ESP content up to 4 wt.% and then decreased. A reverse trend was observed in the case of percentage elongation at break. The X-ray diffractograms of the composite films indicated an increase in crystallinity with ESP content. The optical micrographs indicated uniform distribution of ESP particles in the composite films. However, the fractographs indicated agglomeration of ESP particles at 5 wt.% loading. The FT-IR spectra revealed no specific interactions between PLA and ESP. The thermal stability of the composite films increased with ESP content

Trajectories of tuberculosis-specific interferon-gamma release assay responses among medical and nursing students in rural India

AbstractBackgroundInterferon gamma release assays (IGRAs) have been shown to be highly dynamic tests when used in serial testing for TB infection. However, there is little information demonstrating a clear association between TB exposure and IGRA responses over time, particularly in high TB incidence settings.ObjectivesTo assess whether QuantiFERON-TB Gold In-Tube (QFT) responses are associated with occupational TB exposures in a cohort of young health care trainees in India.MethodsAll medical and nursing students at Mahatma Gandhi Institute of Medical Sciences were approached. Participants were followed up for 18months; QFT was performed 4 times, once every 6months. Various modeling approaches were used to define IFN-gamma trajectories and correlations with TB exposure.ResultsAmong 270 medical and nursing trainees, high rates of conversions (6.3–20.9%) and reversions (20.0–26.2%) were found depending on the definitions used. Stable converters were more likely to have had TB exposure in hospital pre-study. Recent occupational exposures were not consistently associated with QFT responses over time.ConclusionIFN-gamma responses and rates of change could not be explained by occupational exposure investigated. High conversion and subsequent reversion rates suggest many health care workers (HCWs) would revert in the absence of treatment, either by clearing the infection naturally or due to fluctuations in the underlying immunological response and/or poor assay reproducibility. QFT may not be an ideal diagnostic test for repeated screening of HCWs in a high TB incidence setting

(E)-2-(2,3-Dimethyl­anilino)-N′-[2-methyl-5-(prop-1-en-2-yl)cyclo­hex-2-enyl­idene]benzohydrazide

The asymmetric unit of the title compound, C25H29N3O, comprises two crystallographically independent mol­ecules. The dihedral angles between the benzene rings in the two mol­ecules are 59.7 (2) and 61.27 (18)°. The cyclo­hexene rings adopt sofa and half-chair conformations. In the crystal, mol­ecules are connected via N—H⋯O and weak C—H⋯O hydrogen bonds, forming chains along the a axis. In each mol­ecule, there is an intra­molecular N—H⋯O hydrogen bond

Operational Challenges in Diagnosing Multi-Drug Resistant TB and Initiating Treatment in Andhra Pradesh, India

Revised National TB Control Programme (RNTCP), Andhra Pradesh, India. There is limited information on whether MDR-TB suspects are identified, undergo diagnostic assessment and are initiated on treatment according to the programme guidelines.To assess i) using the programme definition, the number and proportion of MDR-TB suspects in a large cohort of TB patients on first-line treatment under RNTCP ii) the proportion of these MDR-TB suspects who underwent diagnosis for MDR-TB and iii) the number and proportion of those diagnosed as MDR-TB who were successfully initiated on treatment.A retrospective cohort analysis, by reviewing RNTCP records and reports, was conducted in four districts of Andhra Pradesh, India, among patients registered for first line treatment during October 2008 to December 2009.Among 23,999 TB patients registered for treatment there were 559 (2%) MDR-TB suspects (according to programme definition) of which 307 (55%) underwent diagnosis and amongst these 169 (55%) were found to be MDR-TB. Of the MDR-TB patients, 112 (66%) were successfully initiated on treatment. Amongst those eligible for MDR-TB services, significant proportions are lost during the diagnostic and treatment initiation pathway due to a variety of operational challenges. The programme needs to urgently address these challenges for effective delivery and utilisation of the MDR-TB services

HSV1/2 Genital Infection in Mice Cause Reversible Delayed Gastrointestinal Transit: A Model for Enteric Myopathy

In an interesting investigation by Khoury-Hanold et al. (1), genital infection of mice with herpes simplex virus 1 (HSV1) were reported to cause multiple pelvic organ involvement and obstruction. A small subset of mice succumbed after the first week of HSV1 infection. The authors inferred that the mice died due to toxic megacolon. In a severe form of mechanical and/or functional obstruction involving gross dilation of the colon and profound toxemia, the presentation is called “toxic megacolon.” The representative observations by Khoury-Hanold likely do not resemble toxic megacolon. The colon was only slightly dilated and benign appearing. Importantly, HSV1 infection affected the postjunctional mechanisms of smooth muscle relaxation like the sildenafil-response proteins, which may have been responsible for defective nitrergic neurotransmission and the delayed transit. Orally administered polyethylene glycol reversed the gastrointestinal “obstruction,” suggesting a mild functional type of slowed luminal transit, resembling constipation, rather than toxic megacolon, which cannot be reversed by an osmotic laxative without perforating the gut. The authors suggest that the mice did not develop HSV1 encephalitis, the commonly known cause of mortality. The premature death of some of the mice could be related to the bladder outlet obstruction, whose backflow effects may alter renal function, electrolyte abnormalities and death. Muscle strip recordings of mechanical relaxation after electrical field stimulation of gastrointestinal, urinary bladder or cavernosal tissues shall help obtain objective quantitative evidence of whether HSV infection indeed cause pelvic multi-organ dysfunction and impairment of autonomic neurotransmission and postjunctional electromechanical relaxation mechanisms of these organs

Sputum Smear Microscopy at Two Months into Continuation-Phase: Should It Be Done in All Patients with Sputum Smear-Positive Tuberculosis?

BACKGROUND: The Revised National Tuberculosis Control Program (RNTCP) of India recommends follow-up sputum smear examination at two months into the continuation phase of treatment. The main intent of this (mid-CP) follow-up is to detect patients not responding to treatment around two-three months earlier than at the end of the treatment. However, the utility of mid-CP follow-up under programmatic conditions has been questioned. We undertook a multi-district study to determine if mid-CP follow-up is able to detect cases of treatment failures early among all types of patients with sputum smear-positive TB. METHODOLOGY: We reviewed existing records of patients with sputum smear-positive TB registered under the RNTCP in 43 districts across three states of India during a three month period in 2009. We estimated proportions of patients that could be detected as a case of treatment failure early, and assessed the impact of various policy options on laboratory workload and number needed to test to detect one case of treatment failure early. RESULTS: Of 10055 cases, mid-CP follow-up was done in 6944 (69%) cases. Mid-CP follow-up could benefit 117/8015 (1.5%) new and 206/2040 (10%) previously-treated sputum smear-positive cases by detecting their treatment failure early. Under the current policy, 31 patients had to be tested to detect one case of treatment failure early. All cases of treatment failure would still be detected early if mid-CP follow-up were discontinued for new sputum smear-positive cases who become sputum smear-negative after the intensive-phase of treatment. This would reduce the related laboratory workload by 69% and only 10 patients would need to be tested to detect one case of treatment failure early. CONCLUSION: Discontinuation of mid-CP follow-up among new sputum smear-positive cases who become sputum smear-negative after completing the intensive-phase of treatment will reduce the laboratory workload without impacting overall early detection of cases of treatment failure

How Do Patients Who Fail First-Line TB Treatment but Who Are Not Placed on an MDR-TB Regimen Fare in South India?

SETTING: Seven districts in Andhra Pradesh, South India. OBJECTIVES: To a) determine treatment outcomes of patients who fail first line anti-TB treatment and are not placed on an multi-drug resistant TB (MDR-TB) regimen, and b) relate the treatment outcomes to culture and drug susceptibility patterns (C&DST). DESIGN: Retrospective cohort study using routine programme data and Mycobacterium TB Culture C&DST between July 2008 and December 2009. RESULTS: There were 202 individuals given a re-treatment regimen and included in the study. Overall treatment outcomes were: 68 (34%) with treatment success, 84 (42%) failed, 36 (18%) died, 13 (6.5%) defaulted and 1 transferred out. Treatment success for category I and II failures was low at 37%. In those with positive cultures, 81 had pan-sensitive strains with 31 (38%) showing treatment success, while 61 had drug-resistance strains with 9 (15%) showing treatment success. In 58 patients with negative cultures, 28 (48%) showed treatment success. CONCLUSION: Treatment outcomes of patients who fail a first-line anti-TB treatment and who are not placed on an MDR-TB regimen are unacceptably poor. The worst outcomes are seen among category II failures and those with negative cultures or drug-resistance. There are important programmatic implications which need to be addressed