Delay in diagnosis of tuberculosis in Rawalpindi, Pakistan

<p>Abstract</p> <p>Background</p> <p>Delay in diagnosis and treatment of tuberculosis (TB) may enhance the chances of morbidity and mortality and play a key role in continuous transmission of the bacilli. The objective of this study was to describe health care seeking behavior of suspected TB patients and initial diagnostic work up prior to consultation and diagnosis at National TB Center (NTC).</p> <p>Findings</p> <p>Interviews of 252 sputum smear positive patients were taken from NTC, Rawalpindi. The duration between on-set of symptoms and start of treatment was considered as the total delay and correlated with general characteristics of TB patients. The proportion of males and females were 49.6% and 50.4% with median age of 25 and 24 years respectively. A median delay of 56 days (8 weeks) was observed which was significantly associated with age, cough and fever. More than 50% of the current patients had a history of contact with previously diagnosed TB patients. The majority of patients (63%) visited health care providers within three weeks of appearance of symptoms but only thirty five percent were investigated for TB diagnosis.</p> <p>Conclusion</p> <p>Cough and fever are being ignored as likely symptoms of TB by patients as well as health care providers resulting in delay. Engaging private practitioners through public private mix (PPM) approach for expansion of TB diagnosis and increasing public awareness could be more beneficial to reduce delay.</p

Geographical variation in morphology of Chaetosiphella stipae stipae Hille Ris Lambers, 1947 (Hemiptera: Aphididae: Chaitophorinae)

Chaetosiphella stipae stipae is a xerothermophilous aphid, associated with Palaearctic temperate steppe zones or dry mountain valleys, where there are grasses from the genus Stipa. Its geographical distribution shows several populations that are spread from Spain, across Europe and Asia Minor, to Mongolia and China. Geographical variation in chaetotaxy and other morphological features were the basis to consider whether individuals from different populations are still the same species. Moreover, using Ch. stipae stipae and Stipa species occurrences, as well as climatic variables, we predict potential geographical distributions of the aphid and its steppe habitat. Additionally, for Stipa species we projected current climatic conditions under four climate change scenarios for 2050 and 2070. While highly variable, our results of morphometric analysis demonstrates that all Ch. stipae stipae populations are one very variable subspecies. And in view of predicted climate change, we expect reduction of Stipa grasslands. The disappearance of these ecosystems could result in stronger separation of the East-European and Asian steppes as well as European ‘warm-stage’ refuges. Therefore, the geographic morphological variability that we see today in the aphid subspecies Ch. stipae stipae may in the future lead to speciation and creation of separate subspecies or species

A cross-sectional investigation of regional patterns of diet and cardio-metabolic risk in India

<p>Abstract</p> <p>Background</p> <p>The role of diet in India's rapidly progressing chronic disease epidemic is unclear; moreover, diet may vary considerably across North-South regions.</p> <p>Methods</p> <p>The India Health Study was a multicenter study of men and women aged 35-69, who provided diet, lifestyle, and medical histories, as well as blood pressure, fasting blood, urine, and anthropometric measurements. In each region (Delhi, n = 824; Mumbai, n = 743; Trivandrum, n = 2,247), we identified two dietary patterns with factor analysis. In multiple logistic regression models adjusted for age, gender, education, income, marital status, religion, physical activity, tobacco, alcohol, and total energy intake, we investigated associations between regional dietary patterns and abdominal adiposity, hypertension, diabetes, and dyslipidemia.</p> <p>Results</p> <p>Across the regions, more than 80% of the participants met the criteria for abdominal adiposity and 10 to 28% of participants were considered diabetic. In Delhi, the "fruit and dairy" dietary pattern was positively associated with abdominal adiposity [highest versus lowest tertile, multivariate-adjusted OR and 95% CI: 2.32 (1.03-5.23); P_trend= 0.008] and hypertension [2.20 (1.47-3.31); P_trend< 0.0001]. In Trivandrum, the "pulses and rice" pattern was inversely related to diabetes [0.70 (0.51-0.95); P_trend= 0.03] and the "snacks and sweets" pattern was positively associated with abdominal adiposity [2.05 (1.34-3.14); P_trend= 0.03]. In Mumbai, the "fruit and vegetable" pattern was inversely associated with hypertension [0.63 (0.40-0.99); P_trend= 0.05] and the "snack and meat" pattern appeared to be positively associated with abdominal adiposity.</p> <p>Conclusions</p> <p>Cardio-metabolic risk factors were highly prevalent in this population. Across all regions, we found little evidence of a Westernized diet; however, dietary patterns characterized by animal products, fried snacks, or sweets appeared to be positively associated with abdominal adiposity. Conversely, more traditional diets in the Southern regions were inversely related to diabetes and hypertension. Continued investigation of diet, as well as other environmental and biological factors, will be needed to better understand the risk profile in this population and potential means of prevention.</p

Estrus Synchronization and Conception Rates Using Locally Prepared Methylacetoxy- progesterone Sponges in Cyclic and Acyclic Nili-Ravi Buffaloes (Bubalus bubalis)

A study was conducted to evaluate the efficacy of locally prepared intra-vaginal methylacetoxyprogesterone (MAP) sponges for estrus synchronization and conception rate in cyclic and acyclic Nili-Ravi buffaloes. In the first experiment, 20 buffaloes were divided into treated and control groups (n: 10 each) and again sub-grouped into cyclic (n: 4) and acyclic (n: 6) lots in each group, depending on their ovarian status. MAP sponges were placed in the vagina of buffaloes of treated groups for 16 days. After sponge removal, buffaloes were monitored for estrus. Serum progesterone concentrations were determined in synchronized animals for one estrous cycle using radioimmunoassay. Overall, synchronization rate in MAP-treated groups was significantly higher (P<0.05) as compared to controls (60 vs. 0%). However, it differed non-significantly between cyclic and acyclic buffaloes of treated groups (75 vs. 50%). At estrus, mean serum progesterone in synchronized animals was at basal level (0.26±0.08 and 0.32±0.27 ngml-1 in cyclic and acyclic treated groups, respectively). It attained peak levels of 3.00±1.80 to 3.45±0.44 ngml-1 on d-14, then dropped on d-18 and declined to basal values at the next estrus. In the second experiment, the effect of a MAP-based treatment was compared with an 11-days apart double injection prostaglandin (PGF2α) treatment for synchronization of estrus and conception rates. The estrus synchronization and conception rates obtained by PGF2α protocol were non-significantly higher than those of MAP-based protocol (90 vs. 70% and 44.44 vs. 42.86%). The synchronization and conception rates of cyclic buffaloes (80 & 50%, respectively) receiving MAP-based regimen were also non-significantly higher from acyclic ones (50 & 33%, respectively) receiving the same protocol. In conclusion, the treatment with locally prepared MAP sponges proved effective in synchronizing estrus and comparable with prostaglandin regimen in terms of conception rates in Nili-Ravi buffaloes