Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers

BACKGROUND:Nepal has achieved a significant reduction of TB incidence over the past decades. Nevertheless, TB patients continue to experience barriers in access, diagnosis and completion of the treatment. The main objective of this study was to explore the factors affecting the access to the health services, diagnosis and the treatment completion for TB patients in central and western Nepal. METHODS:Data were collected using in-depth interviews (IDI) with the TB patients (n = 4); Focus Group Discussions (FGDs) with TB suspected patients (n = 16); Semi Strucutred Interviews (SSIs) with health workers (n = 24) and traditional healers (n = 2); and FGDs with community members (n = 8). All data were audio recorded, transcribed and translated to English. All transcriptions underwent thematic analysis using qualitative data analysis software: Atlas.ti. RESULTS:Barriers to access to the health centre were the long distance, poor road conditions, and costs associated with travelling. In addition, lack of awareness of TB and its consequences, and the belief, prompted many respondents to visit traditional healers. Early diagnosis of TB was hindered by lack of trained health personnel to use the equipment, lack of equipment and irregular presence of health workers. Additional barriers that impeded the adherence and treatment completion were the need to visit health centre daily for DOTS treatment and associated constraints, complex treatment regimen, and the stigma. CONCLUSIONS:Barriers embedded in health services and care seekers' characteristics can be dealt by strengthening the peripheral health services. A continuous availability of (trained) human resources and equipment for diagnosis is critical. As well as increasing the awareness and collaborating with the traditional healers, health services utilization can be enhanced by compensating the costs associated with it, including the modification in current DOTS strategy by providing medicine for a longer term under the supervision of a family member, peer or a community volunteer

Advances and challenges in thyroid cancer: the interplay of genetic modulators, targeted therapies, and AI-driven approaches

Thyroid cancer continues to exhibit a rising incidence globally, predominantly affecting women. Despite stable mortality rates, the unique characteristics of thyroid carcinoma warrant a distinct approach. Differentiated thyroid cancer, comprising most cases, is effectively managed through standard treatments such as thyroidectomy and radioiodine therapy. However, rarer variants, including anaplastic thyroid carcinoma, necessitate specialized interventions, often employing targeted therapies. Although these drugs focus on symptom management, they are not curative. This review delves into the fundamental modulators of thyroid cancers, encompassing genetic, epigenetic, and non-coding RNA factors while exploring their intricate interplay and influence. Epigenetic modifications directly affect the expression of causal genes, while long non-coding RNAs impact the function and expression of micro-RNAs, culminating in tumorigenesis. Additionally, this article provides a concise overview of the advantages and disadvantages associated with pharmacological and non-pharmacological therapeutic interventions in thyroid cancer. Furthermore, with technological advancements, integrating modern software and computing into healthcare and medical practices has become increasingly prevalent. Artificial intelligence and machine learning techniques hold the potential to predict treatment outcomes, analyze data, and develop personalized therapeutic approaches catering to patient specificity. In thyroid cancer, cutting-edge machine learning and deep learning technologies analyze factors such as ultrasonography results for tumor textures and biopsy samples from fine needle aspirations, paving the way for a more accurate and effective therapeutic landscape in the near future.</p

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Assessment of Sulphate and Iron Contamination and Seasonal Variations in the Water Resources of a Damodar Valley Coalfield, India: A Case Study

The aim of the present study was to assess the sulphate (SO2−4 ) and iron (Fe) contamination and seasonal variations in the water resources (groundwater, surface water, and mine water) of the West Bokaro coalfield region, India. One hundred and twenty-four water resources samples were collected from the coalfield during the post- and pre-monsoon seasons. The concentrations of SO2−4 were determined using ion chromatography and Fe concentrations were analyzed using inductively coupled plasma mass spectrometry. A statistical analysis was used to easily understand the seasonal variations of the elements in the water resources of the area. The concentrations of SO2−4 and Fe in the water resources were higher in the pre-monsoon season than in the post-monsoon season, irrespective of location. The water resources of the coalfield were contaminated with high concentrations of SO2−4 and Fe, and would require suitable treatment before drinking, domestic and industrial uses

Evaluation of Surface Water Quality by Using GIS and a Heavy Metal Pollution Index (HPI) Model in a Coal Mining Area, India

Twenty eight surface water samples were collected from fourteen sites of the West Bokaro coalfield, India. The concentration of Mn, Cu, Zn, Ni, As, Se, Al, Cr, Ba, and Fe were analyzed using inductively coupled plasma mass spectrometry (ICP-MS) for determination of seasonal fluctuations and a heavy metal pollution index (HPI). The HPI values were below the critical pollution index value of 100. Metal concentrations were higher in the pre-monsoon season as compared to the post-monsoon season. The Zn, Ni, Mn, As, Se, Al, Ba, Cu, and Cr concentrations did not exceed the desirable limits for drinking water in either season. However, at many sites, concentrations of Fe were above the desirable limit of the WHO (2006) and Indian drinking water standard (BIS 2003) in both seasons. The water that contained higher concentrations of Fe would require treatment before domestic us