Tuberculosis Contact Screening and Isoniazid Preventive Therapy in a South Indian District: Operational Issues for Programmatic Consideration

BACKGROUND: Under India's Revised National Tuberculosis Control Programme (RNTCP), all household contacts of sputum smear positive Pulmonary Tuberculosis (PTB) patients are screened for TB. In the absence of active TB disease, household contacts aged <6 years are eligible for Isoniazid Preventive Therapy (IPT) (5 milligrams/kilogram body weight/day) for 6 months. OBJECTIVES: To estimate the number of household contacts aged <6 years, of sputum smear positive PTB patients registered for treatment under RNTCP from April to June'2008 in Krishna District, to assess the extent to which they are screened for TB disease and in its absence initiated on IPT. METHODS: A cross sectional study was conducted. Households of all smear positive PTB cases (n = 848) registered for treatment from April to June'2008 were included. Data on the number of household contacts aged <6 years, the extent to which they were screened for TB disease, and the status of initiation of IPT, was collected. RESULTS: Households of 825 (97%) patients were visited, and 172 household contacts aged <6 years were identified. Of them, 116 (67%) were evaluated for TB disease; none were found to be TB diseased and 97 (84%) contacts were initiated on IPT and 19 (16%) contacts were not initiated on IPT due to shortage of INH tablets in peripheral health centers. The reasons for non-evaluation of the remaining eligible children (n = 56, 33%) include no home visit by the health staff in 25 contacts, home visit done but not evaluated in 31 contacts. House-hold contacts in rural areas were less likely to be evaluated and initiated on IPT [risk ratio 6.65 (95% CI; 3.06-14.42)]. CONCLUSION: Contact screening and IPT implementation under routine programmatic conditions is sub-optimal. There is an urgent need to sensitize all concerned programme staff on its importance and establishment of mechanisms for rigorous monitoring

Acute abducens nerve palsy as a presenting feature in carotid-cavernous fistula in a 6-year-old girl

Carotid-cavernous fistulas (CCF) are abnormal communications between the internal carotid artery and the cavernous sinus. Traumatic carotid-cavernous fistulae are rare potential complications of craniofacial trauma. Typical findings of CCF are proptosis, chemosis, headache, oculomotor or abducens nerve palsy, trigeminal pain and pulsating bruit over the temporal skull and the bulb.CCF are reported very rarely in childhood. This report describes the clinical and radiological findings of a pediatric patient presented with CCF

Structure Of A Thionucleoside - 5'-Deoxy-5',6-Epithio-5,6-Dihydro-2',3'-Ortho-Isopropylidene-3-Methyluridine

C13HlsN205 S, M r = 314.35, orthorhombic, P212121 with a = 39.526 (4), b = 6.607 (2), c = 5.661 (2) A, Z = 4, V = 1478.36 A 3, D c = 1.412 Mg m -3, Cu Ka radiation. Final R = 0.073 for 1154 observed counter reflections. The sulphur atom is in a pseudo-equatorial position with respect to the dihydrouracil ring. The sugar pucker is predominantly O(l')-exo unlike the C(3')-exo,C(4')-endo observed for 2',3' O-isopropylideneuridine (ISPU). The fivemembered dioxolane ring has C(7) displaced by 0.497 (7)A from the best plane through atoms 0(2'), C(2'), C(3'), 0(3'), in contrast to ISPU where 0(3') shows the maximum deviation

HIV, sexually transmitted infections and sexual behaviour of male clients of female sex workers in Andhra Pradesh, Tamil Nadu and Maharashtra, India: results of a cross-sectional survey

Objective: To characterize and describe patterns of HIV, sexually transmitted infections (STI) and sexual behaviour of male clients of female sex workers (FSW). Methods: A cross-sectional study was conducted among 4821 clients of FSW from 12 districts in three states in India: Andhra Pradesh, Maharashtra and Tamil Nadu. A structured questionnaire was administered to elicit demographic characteristics and sexual behavioural patterns. Blood and urine samples were tested for HIV, syphilis and herpes simplex type 2 serology, gonococal and chlamydial infection. Results: The median age of clients surveyed was 30 years; 57% were married and 64% had a steady sexual partner; 61% had sex with more than one FSW and 39% had four or more sexual encounters in the past month. The prevalence of HIV ranged from 2.0% to 10.9%, syphilis ranged from 3.1% to 10.1%; gonorrhoea and chlamydia ranged between 0% and 4.5%. Clients older than 30 years [odds ratio (OR) 1.65; 95% confidence interval (CI) 1.33–2.05] and having a different mix of commercial and non-commercial partners (OR 1.56; 95% CI 1.25–1.96) had a higher volume of sex acts with FSW. Inconsistent condom use with FSW was significantly associated with older clients (OR 4.2; 95% CI 3.33–5.29), illiteracy (OR 1.39; 95% CI 1.14–1.69), age <18 years at first paid sex (OR 1.83; 95% CI 1.24–2.70) and having different FSW partners in the past month (OR 1.64; 95% CI 1.23–2.18). Conclusion: Clients of FSW studied here constitute a significant bridge group for HIV and other STI, because of their high volume of different sexual partners and very low consistent condom use. HIV prevention programmes need to address male clients

Improving Query Evaluation with Approximate Functional Dependency Based Decompositions

We investigate how relational restructuring may be used to improve query performance