A study on tuberculosis disease disclosure patterns and its associated factors: Findings from a prospective observational study in Chennai

BACKGROUND: Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations. METHODS: This prospective observational study was conducted in Chennai Corporation treatment units during 2019–2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status. RESULTS: A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44–58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150–180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46–55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p71%). CONCLUSION: Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings could inform in developing interventions to facilitate disclosure of disease status in a beneficial way for TB patients

An influence of dew point temperature on the occurrence of Mycobacterium tuberculosis disease in Chennai, India.

Climate factors such as dew point temperature, relative humidity and atmospheric temperature may be crucial for the spread of tuberculosis. This study was conducted for the first time to investigate the relationship of climatic factors with TB occurrence in an Indian setting. Daily tuberculosis notification data during 2008-2015 were generated from the National Treatment Elimination Program, and analogous daily climatic data were obtained from the Regional Meteorological Centre at Chennai city, Tamil Nadu, India. The decomposition method was adopted to split the series into deterministic and non-deterministic components, such as seasonal, non-seasonal, trend and cyclical, and non-deterministic climate factors. A generalized linear model was used to assess the relation independently. TB disease progression from latent stage infection to active was supported by higher dew point temperature and moderate temperature. It had a significant association with TB progression in the summer and monsoon seasons. The relative humidity may be favored in the winter and post-monsoon. The water tiny dew droplets may support the TB bacterium to recuperate in the environment

Measuring tuberculosis patient perceived quality of care in public and public-private mix settings in India: an instrument development and validation study.

BACKGROUND At present, there are no validated quantitative scales available to measure patient-centred quality of care in health facilities providing services for tuberculosis (TB) patients in India and low-income and middle-income countries. METHODS Initial themes and items reflective of TB patient's perceived quality of care were developed using qualitative interviews. Content adequacy of the items were ascertained through Content validity Index (CVI) and content validity ratio (CVR). Pilot testing of the questionnaire for assessing validity and reliability was undertaken among 714 patients with TB. Sampling adequacy and sphericity were tested by Kaiser-Meyer-Olkin and Bartlett's test, respectively. Exploratory and confirmatory factor analysis was undertaken to test validity. Cronbach's α and test-retest scores were used to test reliability. RESULTS A 32-item tool measuring patient-perceived quality of TB distributed across five domains was developed initially based on a CVI and CVR cut-off score of 0.78 and cognitive interviews with patients with TB. Bartlett's test results showed a strong significance f (χ=3756 and p1 which accounted for 60.9% of the total variance of items. Correlation (z-value >1.96) between items and factors was highly significant and Cronbach's α was acceptable for the global scale (0.76) for the four factors. Intraclass correlation coefficient and the test retest scores for four factors were (<0.001) significant. CONCLUSION We validated a measurement tool for patient-perceived quality of care for TB (PPQCTB) which measured the patient's satisfaction with healthcare provider and services. PPQCTB tool could enrich quality of care evaluation frameworks for TB health services in India

Recurrent Fusion Genes in Gastric Cancer: CLDN18-ARHGAP26 Induces Loss of Epithelial Integrity.

Genome rearrangements, a hallmark of cancer, can result in gene fusions with oncogenic properties. Using DNA paired-end-tag (DNA-PET) whole-genome sequencing, we analyzed 15 gastric cancers (GCs) from Southeast Asians. Rearrangements were enriched in open chromatin and shaped by chromatin structure. We identified seven rearrangement hot spots and 136 gene fusions. In three out of 100 GC cases, we found recurrent fusions between CLDN18, a tight junction gene, and ARHGAP26, a gene encoding a RHOA inhibitor. Epithelial cell lines expressing CLDN18-ARHGAP26 displayed a dramatic loss of epithelial phenotype and long protrusions indicative of epithelial-mesenchymal transition (EMT). Fusion-positive cell lines showed impaired barrier properties, reduced cell-cell and cell-extracellular matrix adhesion, retarded wound healing, and inhibition of RHOA. Gain of invasion was seen in cancer cell lines expressing the fusion. Thus, CLDN18-ARHGAP26 mediates epithelial disintegration, possibly leading to stomach H(+) leakage, and the fusion might contribute to invasiveness once a cell is transformed. Cell Rep 2015 Jul 14; 12(2):272-285

Validation and clinical implementation of commercial secondary check software with heterogeneity corrections

AimTo validate and implement PTW diamond secondary check software (SCS) in a routine clinical use.BackgroundThe secondary independent monitor unit or dose calculation verifications have led to a significant increase in the workflow associated with QA treatments. Modelling, validation and commissioning are necessary steps thereby making it a useful tool for QA.Materials and methodsPTW Diamond SCS is capable of calculating VMAT fields, based on modified Clarkson integration, accounting for multi-leaf collimators (MLC) transmission and measured collimator scatter factors. Validation for heterogeneity corrections is made using circular phantom with inserts of various density materials. 150 VMAT plans were compared using (i) plans calculated in homogeneous cylindrical phantom and (ii) VMAT plans calculated with heterogeneity corrections using electron density values for each organ.ResultsDiamond SCS calculated dose for homogeneous cylindrical phantom resulted in average deviation of (0.1[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]2.14%) with Eclipse TPS calculated dose and (−2.0[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.66%) with absolute measured dose. PTW's OCTAVIUS-4D phantom with 729 ion chamber detector array measurements agreed well with Eclipse TPS calculated dose showing an average deviation of (−1.69[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.56%). Diamond SCS dose calculations were performed with heterogeneity corrections for 124 VMAT plans with isocentre at a region above −350[[ce:hsp sp="0.25"/]]HU. The overall MU variations between Diamond SCS and TPS Acuros-XB algorithms were within ±5%.ConclusionHence, the Diamond SCS can be used as an additional tool along with phantom measurements for patient specific quality assurance of VMAT plans with heterogeneity corrections having isocentre at a region above −350[[ce:hsp sp="0.25"/]]HU

STUDIES ON THE INHIBITIVE EFFECT OF 3-HYDROXYFLAVONE ON THE ACID CORROSION OF MILD STEEL

The corrosion inhibition effect of 3-hydroxyflavone was studied on mild steel in 1 M hydrochloric acid (HCl). The anticorrosive effect was evaluated by weight loss and electrochemical methods which include Tafel polarization and AC impedance studies at 300 K. In weight loss method, the inhibition efficiency increased with increase in inhibitor concentration, and decreased with increase in temperature and immersion time, and acid concentration. The inhibitor showed maximum efficiency of 91% at 4 × 10-4 M concentration in 1 M hydrochloric acid. The Tafel polarization study showed that the inhibitor behaves likely as cathodic type. The corrosion inhibition effect measured by weight loss method and electrochemical studies was in good agreement with each other. The surface analysis was done by using scanning electron microscope (SEM). Several adsorption isotherms are assessed to study the adsorption behavior of the inhibitor on the mild steel surface. The negative value of ΔGads indicates the spontaneous adsorption of the inhibitor on mild steel surface.Adsorption isotherm, corrosion inhibition, electrochemical studies, 3-hydroxyflavone

The association between body mass index, abdominal fatness, and weight change and the risk of adult asthma: a systematic review and meta-analysis of cohort studies

Abstract Obesity has been associated with increased risk of adult asthma, however, not all studies have found a clear association between overweight and the incidence of asthma, and data on other adiposity measures have been limited. Hence, we aimed to summarize evidence on association between adiposity and adult asthma. Relevant studies were retrieved through searches conducted in PubMed, and EMBASE up to March 2021. A total of sixteen studies (63,952 cases and 1,161,169 participants) were included in the quantitative synthesis. The summary RR was 1.32 (95% CI 1.21–1.44, I2 = 94.6%, pheterogeneity < 0.0001, n = 13) per 5 kg/m2 increase in BMI, 1.26 (95% CI 1.09–1.46, I2 = 88.6%, pheterogeneity < 0.0001, n = 5) per 10 cm increase in waist circumference and 1.33 (95% CI 1.22–1.44, I2 = 62.3%, pheterogeneity= 0.05, n = 4) per 10 kg increase in weight gain. Although the test for nonlinearity was significant for BMI (pnonlinearity < 0.00001), weight change (pnonlinearity = 0.002), and waist circumference (pnonlinearity = 0.02), there was a clear dose-response relationship between higher levels of adiposity and asthma risk. The magnitude of the associations and the consistency of the results across studies and adiposity measures provide strong evidence that overweight and obesity, waist circumference and weight gain increases asthma risk. These findings support policies to curb the global epidemic of overweight and obesity