Environmental inventory and the distribution of inorganic nutrients in a tropical estuary of the south-west coast of India

Dissolved nutrients (PO sub(4)-P, NO sub(3)-N, NO sub(2)-N and SiO sub(4)-Si) estimated in the surface and bottom waters of five selected stations of the Paravur Lake, Kerala, India, during February 1987 to January 1988 revealed distinct seasonal variations. Rainfall and land drainage play significant roles in the nutrient economy, particularly NO sub(3)-N and SiO sub(4)-Si, of this water body. Abnormally high values of PO sub(4)-P indicated extremely polluted condition at the wetting zone of the lake during the premonsoon season. SiO sub(4)-Si showed significant negative relationship with salinity

Higher risk of developing active TB among adult diabetics exposed to TB during childhood: A study from Kerala, India

Introduction: Factors associated with tuberculosis (TB) in Kerala, the southern Indian state that notifies approximately 33 microbiologically confirmed new cases per 100,000 population every year for the past two decades, are still unclear. We did a community-based case–control study in Kollam district, Kerala, to identify the individual-level risk factors for TB. Methods: Structured questionnaire was applied to 101 microbiologically confirmed new TB cases registered under Revised National Tuberculosis Control Program and 202 age- and gender-matched neighborhood controls without present or past TB. Information was sought on socioeconomic status (SES), smoking, consumption of alcohol, close contact with active TB during childhood or recent past, diabetes mellitus (DM), and other comorbid conditions. Results: Close contact with TB during childhood [odds ratio (OR) 15.88, 95% confidence interval (CI) 3.21–78.55], recent close contact with TB (OR 4.81, 95% CI 2.09–11.07), DM (OR 1.64, 95% CI 1.04–3.06), SES (OR 2.16, 95% CI 1.16–4.03), smoking more than 10 cigarettes/beedis per day (OR 3.32, 95% CI 1.27–8.96), consuming more than 10 standard drinks per week (OR 2.91, 95% CI 1.33–6.37), and the interaction term of having close contact with TB during childhood and DM at present (OR 7.37, 95% CI 1.18–50.29) were found to be associated with TB. Conclusion: Close contact with a case of TB, presence of DM, lower SES, smoking, and alcohol consumption were associated with active TB in Kollam. Having close contact with a case of TB during childhood and development of DM in later life together are significantly associated with active TB in the study population. The findings also direct further studies to confirm and explore mechanisms of interaction of diabetes with childhood exposure to TB

High diabetes prevalence among tuberculosis cases in Kerala, India.

BACKGROUND: While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-July 2011 in the state of Kerala, India, to determine the prevalence of DM. METHODOLOGY/PRINCIPAL FINDINGS: A state-wide representative sample of TB patients in Kerala was interviewed and screened for DM using glycosylated hemoglobin (HbA1c); patients self-reporting a history of DM or those with HbA1c ≥6.5% were defined as diabetic. Among 552 TB patients screened, 243(44%) had DM - 128(23%) had previously known DM and 115(21%) were newly diagnosed - with higher prevalence among males and those aged >50 years. The number needed to screen(NNS) to find one newly diagnosed case of DM was just four. Of 128 TB patients with previously known DM, 107(84%) had HbA1c ≥7% indicating poor glycemic control. CONCLUSIONS/SIGNIFICANCE: Nearly half of TB patients in Kerala have DM, and approximately half of these patients were newly-diagnosed during this survey. Routine screening of TB patients for DM using HbA1c yielded a large number of DM cases and offered earlier management opportunities which may improve TB and DM outcomes. However, the most cost-effective ways of DM screening need to be established by futher operational research

Details of the 30 TB Units (clusters) selected by cluster sampling for the study, Kerala, India, June–July 2011.

<p>Details of the 30 TB Units (clusters) selected by cluster sampling for the study, Kerala, India, June–July 2011.</p

Additional Yield of new cases of Diabetes Mellitus and Number Needed to Screen to diagnose a new case of DM among tuberculosis patients in the state of Kerala, India, June–July 2011.

<p>TB-Tuberculosis; DM- Diabetes Mellitus; NNS-Number needed to screen is defined as the reciprocal of the prevalence of newly diagnosed DM after excluding self-reported previously known cases of DM.</p

Prevalence of Diabetes Mellitus among tuberculosis patients registered for treatment in the state of Kerala, India, June–July 2011.

<p>TB-Tuberculosis; DM- Diabetes Mellitus; CI-Confidence Interval; Number with DM includes self-reported, previously known cases and those newly diagnosed with a glycosylated hemogolobin level of ≥6.5%.</p

Sampled TB units in Kerala to estimate the prevalence of Diabetes Mellitus among TB patients.

<p>Sampled TB units in Kerala to estimate the prevalence of Diabetes Mellitus among TB patients.</p

Smear conversion at three months of treatment of sputum positive Tuberculosis patients in Malappuram district, Kerala state,India from April 2010 to September 2011, by status of Diabetes Mellitus (n = 1727).

<p>RR = relative risk; CI = confidence interval.</p

Categories of Outcome of treatment of Tuberculosis in the Revised National Tuberculosis Control Programme in Malappuram District, Kerala, India, April 2010 to September 2011, by Diabetes Mellitus and Diabetes control status.

<p>MDR TB = Multi drug resistant TB.</p

Tuberculosis patients with diabetes and diabetes control.

<p>Figure shows flow of Tuberculosis patients registered under the Revised National Tuberculosis Control Programme (RNTCP) in Malappuram District, Kerala, India, from April 2010 to September 2011, by diabetes and diabetes control status. Out of 3116 TB patients, 2794(90%) know their diabetic status and of this 667(24%) are diabetic. Out of the diabetic TB patients 240(36%) know their diabetic control status during treatment and of this 103(43%) are under diabetic control during treatment.</p