Delay in DOTS for new pulmonary tuberculosis patient from rural area of Wardha District, India

Vast majority of active tuberculosis patients seeks treatment, do so promptly, still many patients spend a great deal of time and money “shopping for health” and too often they do not receive either accurate diagnosis or effective treatment, despite spending considerable resources. Objective: To find out the time taken to, for diagnosis of tuberculosis and to put patient on DOTS from the onset of symptoms and pattern of health seeking behavior of new pulmonary tuberculosis patients. A cross-sectional rapid assessment using qualitative (FGD) and quantitative (Interview) methods conducted at DOTS center of tertiary care hospital from rural Wardha. Participants: 53 pulmonary tuberculosis patients already on DOTS, in intensive phase. Main outcome measure: Delay in initiation of DOTS & health seeking behavior Results: Median total delay for starting DOTS was 111 days, (range: 10 to 321 days). Patient delay was more than provider delay. Patients delay was more in patients above 60 years, illiterate, per-capita income below 650 Rupees and HIV TB co-infection. Pattern of health seeking behavior was complex. Family physician was the preferred health care provider. Patient visited on an average four providers and spent around 1450 rupees (only direct cost) before DOTS begin. Time taken from the onset of symptoms and start of DOT is a cause of concern for the tuberculosis control program. Early case detection is important rather than mere achieving target of 70% new case detection. Program manager needs to implement locally relevant & focused strategies for early case detection to improve the treatment success, especially in rural area of India

Prospective study on quality of newborn care

Background: Quality of services provided by health care provider, the closest health functionary to the community has impact on neonatal mortality. Aims: Study on quality of newborn care in rural areas.  Settings and Design: This is a prospective study in the field practice areas of J.N. Medical College and areas under primary health centre of public health care system in Wardha district.  Methods and Material: Modified quality check list on the basis of PHC MAP module guidelines for assessing the quality of service-module 6-user’s guide was prepared. Face to face interview with 205 (group-A/104 nos + group-B/101 nos) mother of newborn was method to collected information in three postnatal visits.  Statistical analysis: Quality (verbal response) of each service was quantified as acceptable, average and worst.  Quality of both the groups was compared by calculating P-value after utilizing Z-test.  Results: Over all acceptable quality of medical history was 30.03%, physical examination was 21.73%, preventive service was 91.17% and counseling was 24.83%. Significant difference between two groups were found on history taking for (cry, breathing and body movement of baby), recording weight and counseling regarding exclusive breast feeding for first 6 month of life. Worst quality in this study were observed in history for anything applying to eyes, umbilical cord stump and complication of baby for which appropriate management was taken. Except for weight recording and examination of head and fontanels all other variables under physical examination were not acceptable. Counseling regarding high risk condition of baby was only 13.66%. Conclusion: Existing newborn services except immunization is inadequate and needs to be strengthened especially physical examination and counseling services

A brief overview on the utilization of high strength steel (HSS) for automotive structural welding applications

High-strength steels are now increasingly used in automotive structural applications owing to their resilience, crashworthiness, and ease of manufacturing. This paper reviews the application of high-strength steels for the automotive structure, describing the condition of the steel after been put in the car structures. Thereafter, the importance of advanced high strength boron steel is highlighted, and its weldability is discussed. Current issues related to welding and changes in microstructure are discussed. It is imperative that Boron steel is gaining widespread attention due to its good mechanical characteristic in car structures and its weldability remains a topic of significant research interest. Lastly, the important considerations are summarized

Primary Care Management of Plantar Fasciitis

Plantar fasciitis (PF) is present in 10% of the population and is the most common cause of plantar heel pain. PF is painful, can alter daily activities and presents as a sharp pain localized to the plantar foot and medial heel. The underlying etiology involves microtrauma to the plantar fascia, specifically at its insertion point on the calcaneus. Successful management of plantar fasciitis is typically achieved with the conservative therapy approaches discussed

The Effect of Laser Power and Laser Scan Passes on Bending Angle of Stainless Steel AISI 304 Laser Bending

The application of laser bending of thin sheet metal are quite limited given that this forming process is widely used in various industries. The aim of this paper is to study the effect of laser power and laser scan passes on bending angle of stainless steel AISI 304 lasers bending. This study considers using parametric combinations of laser power and laser scan passes (number of loops) as the laser bending process parameters. The corresponding effects of these process parameters on bending angle of stainless-steel thin sheet metal (t = 0.1 mm) was observed. The results obtained shows that the bending angle increased with increased in laser power and laser scan passes, meaning that these parameters does significantly affect the bending angle. Other than bending angle, there were also a few bulges observed at certain location along the laser scan path for certain parametric combination of process parameters tested

Effect of laser parameters on colour marking of Ti6Al4V titanium alloy

Colour laser marking is a contemporary method for adding colours onto metal surfaces, suitable for creating logos, barcodes, metal crafts, and jewelry. This study focused on colour laser marking on the biomedical alloy Ti6Al4V (TC4), examining how different colours manifest on its surface. Power settings ranged from 9 W to 18 W, while frequencies spanned 500 kHz to 2000 kHz. The research investigated how altering laser frequency and defocus distance influenced colour variation. Surface features were assessed using 3D optical microscopy, revealing texture and roughness traits. Results illustrated a spectrum of colours, shifting from the alloy's original silver hue to shades like blue, gold, orange, shiny silver, violet, and several greys. Each colour displayed distinct surface texture and roughness parameters. The highest mean roughness of 2.504 μm occurred with grey, while silver had the lowest at 0.504 μm. Nevertheless, trends differed when measuring parameters like maximum peak-to-valley height and valley depth, emphasizing surface topography's role in colour effects. This research advances the understanding of colour laser marking's intricacies on TC4 alloy, providing insights into optimizing laser settings for specific colour outcomes and underlining the nuanced relationship between colour, texture, and surface characteristics

Risk factors for respiratory failure in Guillain-Barre syndrome in Bangladesh: a prospective study

Objective: We investigated clinical, biological, and electrophysiological risk factors for mechanical ventilation (MV) and patient outcomes in Bangladesh using one of the largest, prospective Guillain-Barre syndrome (GBS) cohorts in developing world. Methods: A total of 693 GBS patients were included in two GBS studies conducted between 2006 and 2016 in Dhaka, Bangladesh. Associations between baseline characteristics and MV were tested using Fisher’s exact test, v2 test, or Mann–Whitney U-test, as appropriate. Risk factors for MV were assessed using multivariate logistic regression. Survival analysis was performed using Kaplan–Meier method; comparisons between groups performed using logrank test. Results: Of 693 patients, 155 (23%) required MV (median age, 26 years; interquartile range [IQR] 17–40). Among the ventilated patients, males were predominant (68%) than females. The most significant risk factor for MV was bulbar involvement (adjusted odds ratio [AOR]:19.07; 95% CI = 89.00– 192.57, P = 0.012). Other independently associated factors included dysautonomia (AOR:4.88; 95% CI = 1.49–15.98, P = 0.009) and severe muscle weakness at study entry (AOR:6.12; 95% CI = 0.64–58.57, P = 0.048). At 6 months after disease onset, 20% of ventilated and 52% of non-ventilated patients (P < 0.001) had recovered completely or with minor symptoms. Mortality rate was significantly higher among ventilated patients than non-ventilated patients (41% vs. 7%, P < 0.001). Interpretation: Bulbar involvement, dysautonomia and severe muscle weakness were identified as the most important risk factors for MV among GBS patients from Bangladesh. The findings may help to develop predictive models for MV in GBS in developing countries to identify impending respiratory failure and proper clinical management of GBS patients

Co-encapsulation of human serum albumin and superparamagnetic iron oxide in PLGA nanoparticles: Part I. Effect of process variables on the mean size

PLGA (poly d,l-lactic-co-glycolic acid) nanoparticles (NPs) encapsulating magnetite nanoparticles (MNPs) along with a model drug human serum albumin (HSA) were prepared by double emulsion solvent evaporation method. This Part I will focus on size and size distribution of prepared NPs, whereas encapsulation efficiency will be discussed in Part II. It was found that mean hydrodynamic particle size was influenced by five important process variables. To explore their effects, a five-factorial, three-level experimental design and statistical analysis were carried out using STATISTICA® software. Effect of process variables on the mean size of nanoparticles was investigated and finally conditions to minimize size of NPs were proposed. GAMS™/MINOS software was used for optimization. The mean hydrodynamic size of nanoparticles ranged from 115 to 329 nm depending on the process conditions. Smallest possible mean particle size can be achieved by using low polymer concentration and high dispersion energy (enough sonication time) along with small aqueous/organic volume ratio

an individual participant data meta-analysis

Background The impact of neuraminidase inhibitors (NAIs) on influenza-related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection. Methods A worldwide meta- analysis of individual participant data from 20 634 hospitalised patients with laboratory-confirmed A(H1N1)pdm09 (n = 20 021) or clinically diagnosed (n = 613) ‘pandemic influenza’. The primary outcome was radiologically confirmed IRP. Odds ratios (OR) were estimated using generalised linear mixed modelling, adjusting for NAI treatment propensity, antibiotics and corticosteroids. Results Of 20 634 included participants, 5978 (29·0%) had IRP; conversely, 3349 (16·2%) had confirmed the absence of radiographic pneumonia (the comparator). Early NAI treatment (within 2 days of symptom onset) versus no NAI was not significantly associated with IRP [adj. OR 0·83 (95% CI 0·64–1·06; P = 0·136)]. Among the 5978 patients with IRP, early NAI treatment versus none did not impact on mortality [adj. OR = 0·72 (0·44–1·17; P = 0·180)] or likelihood of requiring ventilatory support [adj. OR = 1·17 (0·71–1·92; P = 0·537)], but early treatment versus later significantly reduced mortality [adj. OR = 0·70 (0·55–0·88; P = 0·003)] and likelihood of requiring ventilatory support [adj. OR = 0·68 (0·54–0·85; P = 0·001)]. Conclusions Early NAI treatment of patients hospitalised with A(H1N1)pdm09 virus infection versus no treatment did not reduce the likelihood of IRP. However, in patients who developed IRP, early NAI treatment versus later reduced the likelihood of mortality and needing ventilatory support