Incidence and risk factors for extensively drug-resistant tuberculosis in Delhi region.

BACKGROUND: India with a major burden of multidrug-resistant tuberculosis (MDR-TB) does not have national level data on this hazardous disease. Since 2006, emergence of extensively drug-resistant TB (XDR-TB) is considered a serious threat to global TB control. This study highlights the demographic and clinical risk factors associated with XDR-TB in Delhi. METHODS: The study was conducted during April 2007 to May 2010. Six hundred eleven MDR-TB suspects were enrolled from four tertiary care hospitals, treating TB patients in Delhi and the demographic details recorded. Sputum samples were cultured using rapid, automated liquid culture system (MGIT 960). Drug susceptibility testing (DST) for Rifampicin (RIF) and Isoniazid (INH) was performed for all positive M. tuberculosis (M.tb) cultures. All MDR-TB isolates were tested for sensitivity to second-line drugs [Amikacin (AMK), Capreomycin (CAP), Ofloxacin (OFX), Ethionamide (ETA)]. RESULTS/FINDINGS: Of 611, 483 patients were infected with MDR M. tuberculosis (M.tb) strains. Eighteen MDR-TB isolates (3.7%) were XDR M.tb strains. Family history of TB (p 0.045), socioeconomic status (p 0.013), concomitant illness (p 0.001) and previous intake of 2(nd) line injectable drugs (p 0.001) were significantly associated with occurrence of XDR-TB. Only two of the patients enrolled were HIV seropositive, but had a negative culture for M. tuberculosis. 56/483 isolates were pre-XDR M. tuberculosis, though the occurrence of pre-XDR-TB did not show any significant demographical associations. CONCLUSIONS: The actual incidence and prevalence rate of XDR-TB in India is not available, although some scattered data is available. This study raises a concern about existence of XDR-TB in India, though small, signaling a need to strengthen the TB control program for early diagnosis of both tuberculosis and drug resistance in order to break the chains of transmission

Evaluating Awareness and Practices Pertaining to Radioactive Waste Management among Scrap Dealers in Delhi, India

<div><p>Objectives</p><p>With nuclear technology rapidly taking the spotlight in the last 50 years, radiation accidents seem to be a harsh reality of the modern world. The Mayapuri Radiation accident of 2010 was the worst radiation accident India has yet dealt with. Two years thereafter, we designed a study to assess the awareness and practices regarding radioactive waste among scrap dealers aiming to assess deficiencies in radiation disaster preparedness.</p><p>Methodology</p><p>A community based cross-sectional study. The study population consisted of 209 volunteers (from 108 scrap dealerships) including 108 shop-owners and 101 workers segregated as Group A consisting of 54 dealerships in Mayapuri and Group B of 54 dealerships from the rest of the city. Subjects were then interviewed using a semi-structured questionnaire.</p><p>Results</p><p>Awareness about radioactive waste varied significantly with level of education (p = 0.024), Kuppuswamy's socio-economic scale (p = 0.005), age of the scrap dealer (p = 0.049) and his work experience (p = 0.045). The larger dealerships in Mayapuri were more aware about radioactive waste (p = 0.0004), the accident in 2010 (p = 0.0002), the symbol for radiation hazard (p = 0.016), as well as the emergency guidelines and the agencies to contact in the event of a radiation accident.</p><p>Conclusions</p><p>Our findings seem to signify that while governmental and non-governmental agencies were successful in implementing prompt disaster response and awareness programs, the community continues to be inadequately prepared. These go on to suggest that though concerted awareness and training programs do benefit the affected community, economic and social development is the key to disaster prevention and mitigation.</p></div

Variation of Awareness and Practices regarding Radioactive Waste and its management with the Demographic Characters of the scrap dealers.

<p>*Percentages expressed as a fraction of dealers aware about radioactive wastes.</p

Chronology of events in the Mayapuri Radiation Accident, 2010.

<p>Chronology of events in the Mayapuri Radiation Accident, 2010.</p

Comparison of clinical characteristics (categorical values) of MDR, p-XDR and XDR-TB isolates.

<p>P values were calculated using chi-square test, values <0.05 considerd as significant.</p><p>CXR = Chest X-Ray, MDR-TB = Multi Drug Resistant Tuberculosis, p-XDR-TB = Pre Extensively Drug Resistant Tuberculosis, XDR-TB = Extensively Drug Resistant Tuberculosis, FQS = Fluroquinolones, BCG =  Bacillus Calmette–Guérin.</p><p><b>Boldface</b> indicates statistically significant differences.</p

Diagram shows the distribution of multidrug-resistant/pre-extensively drug-resistant and extensively drug-resistant <i>M. tuberculosis</i> isolates with additional resistance profile.

<p>Diagram shows the distribution of multidrug-resistant/pre-extensively drug-resistant and extensively drug-resistant <i>M. tuberculosis</i> isolates with additional resistance profile.</p