Prevalence of Vitamin D3 deficiency among pediatric patients with idiopathic nephrotic syndrome in remission - A cross-sectional observational study from Vadodara, Gujarat

Background: Vitamin D deficiency occurs in nephrotic syndrome (NS) through various mechanisms, resulting in loss of both, Vitamin D binding protein and 25-(OH) D, in the urine leading to the risk of bone disorders. Objectives: The objectives of the study were to detect the prevalence of Vitamin D deficiency in children with idiopathic NS during remission. Methods: This study was conducted from April to November 2016 at the pediatric nephrology clinic at a tertiary care hospital in Vadodara. A total of 34 children were enrolled with idiopathic NS in remission, of which 14 had first attack of NS and ten of Frequently Relapsing Nephrotic Syndrome (FRNS) and Infrequently Relapsing Nephrotic Syndrome each. Vitamin D levels were measured using serum levels of 25-(OH) D by chemiluminescence method. Results: Vitamin D deficiency was observed in 28 of 34 (82%) children; of which, 16 (47%) had severe deficiency and 12 (35.2%) had mild to moderate deficiency. Children with the first attack of NS had a median Vitamin D level of 8.17 ng/ml (interquartile range [IQR] 2.9–28), IFRNS had a median of 6.8 ng/ml (IQR 2.9–33), and FRNS had the lowest median of 5.3 ng/ml (IQR 2.9–16). Although there were differences among all the 3 groups, differences were not statistically significant (Kruskal–Wallis 4.89, p=0.08) which showed decreased levels of Vitamin D. Conclusion: High prevalence of Vitamin D deficiency was observed in all 3 groups of idiopathic NS; the lowest being in FRNS. There was no significant association with lower levels of Vitamin D and relapses in NS. More research is needed to assess Vitamin D deficiency and to ensure the effect of Vitamin D supplementation for children with NS

“When treatment is more challenging than the disease” : a qualitative study of MDR-TB patient retention.

CAPRISA, 2016.Abstract available in PDF file

Cost-effectiveness of GeneXpert and LED-FM for diagnosis of pulmonary tuberculosis: A systematic review

BackgroundEarly and accurate diagnosis of tuberculosis is a priority for TB programs globally to initiate treatment early and improve treatment outcomes. Currently, Ziehl–Neelsen (ZN) stain-based microscopy, GeneXpert and Light Emitting Diode-Fluorescence Microscopy (LED-FM) are used for diagnosing pulmonary drug sensitive tuberculosis. Published evidence synthesising the cost-effectiveness of these diagnostic tools is scarce.MethodologyPubMed, EMBASE and Cost-effectiveness analysis registry were searched for studies that reported on the cost-effectiveness of GeneXpert and LED-FM, compared to ZN microscopy for diagnosing pulmonary TB. Risk of bias was assessed independently by four authors using the Consensus Health Economic Criteria (CHEC) extended checklist. The data variables included the study settings, population, type of intervention, type of comparator, year of study, duration of study, type of study design, costs for the test and the comparator and effectiveness indicators. Incremental cost-effectiveness ratio (ICER) was used for assessing the relative cost-effectiveness in this review.ResultsOf the 496 studies identified by the search, thirteen studies were included after removing duplicates and studies that did not fulfil inclusion criteria. Four studies compared LED-FM with ZN and nine studies compared GeneXpert with ZN. Three studies used patient cohorts and eight were modelling studies with hypothetical cohorts used to evaluate cost-effectiveness. All these studies were conducted from a health system perspective, with four studies utilising cost utility analysis. There were considerable variations in costing parameters and effectiveness indicators that precluded meta-analysis. The key findings from the included studies suggest that LED-FM and GeneXpert may be cost effective for pulmonary TB diagnosis from a health system perspective.ConclusionOur review identifies a consistent trend of the cost effectiveness of LED-FM and GeneXpert for pulmonary TB diagnosis in different countries with diverse context of socio-economic condition, HIV burden and geographical distribution. However, all the studies used different parameters to estimate the impact of these tools and this underscores the need for improving the methodological issues related to the conduct and reporting of cost-effectiveness studies.</div

A case control study of risk factors of coronary heart disease among patients admitted at tertiary hospital in western India

BackgroundCoronary heart disease (CHD) is a major cause of death in the world. In this study, various risk factors of CHD were explored.AimsTo find out association of CHD with its risk factors in Western India.Methods A 100 cases of first episode of Acute Coronary Syndrome (ACS) patients and 200 age and sex matched controls from medical wards of a government run tertiary care hospital were interviewed through modified WHO STEPS questionnaire along with physical examination and anthropometric measurements. Data was cleaned and analysed through SPSS.Results On bivariate analysis current smoking status [OR=2.906 (1.69–4.98)], BMI [OR=2.6492 (1.49–4.72)], waist circumference [OR=1.7051 (1.01–2.88)] and positive family history [OR=2.0457 (1.07–3.91)] were found to be significantly associated with ACS cases. On multivariate analysis, BMI [OR=2.612 (1.376–4.959)] and current smoking status [OR=3.005 (1.791–5.042)] were found to be significantly associated with ACS cases.ConclusionOut of conventional risk factors, BMI and current smoking status were the only risk factors which had positive association with CHD in this study

Time to LFU following initiation of MDR-TB treatment at the Drug Resistant TB Site at Vadodara, Gujarat, India using Kaplan-Meier’s analysis.

<p>Time to LFU following initiation of MDR-TB treatment at the Drug Resistant TB Site at Vadodara, Gujarat, India using Kaplan-Meier’s analysis.</p

MDR-TB treatment outcomes of patients at at Drug Resistant TB Centre in Vadodara, Gujarat, India.

<p>*Transferred out and not recorded 10</p><p>^#Not recorded 2</p><p>MDR-TB treatment outcomes of patients at at Drug Resistant TB Centre in Vadodara, Gujarat, India.</p

Baseline characteristics of MDR-TB patients on treatment, LFU and non-LFU patients at Drug Resistant TB Centre in Vadodara, Gujarat, India.

<p>*Number varies according to data available from records IQR-Inter Quartile Range; DOT-Direct Observed Treatment; IP- Intensive Phase; CP-Continuation Phase.</p><p>Baseline characteristics of MDR-TB patients on treatment, LFU and non-LFU patients at Drug Resistant TB Centre in Vadodara, Gujarat, India.</p

Time to culture conversion among LFU and non-LFU groups using Kaplan-Meier’s analysis.

<p>Time to culture conversion among LFU and non-LFU groups using Kaplan-Meier’s analysis.</p

Thematic analysis for “Reasons for loss to follow up.

<p>Thematic analysis for “Reasons for loss to follow up.</p

‘M-TRACK’ (mobile phone reminders and electronic tracking tool) cuts the risk of pre-treatment loss to follow-up by 80% among people living with HIV under programme settings: a mixed-methods study from Gujarat, India

Background: In 2016, the National AIDS Control Programme (NACP) in Gujarat, India implemented an innovative intervention called ‘M-TRACK’ (mobile phone reminders once every week for four weeks after diagnosis and electronic patient tracking tool) to reduce pre-treatment loss to follow-up (LFU) among people living with HIV (PLHIV) in Vadodara district while other districts received standard of care. Objectives: To assess the effectiveness of M-TRACK in reducing pre-treatment LFU (proportion of diagnosed PLHIV not registering for HIV care by four weeks after diagnosis) and to explore the implementation enablers and challenges from health care providers’ and PLHIV perspective. Methods: An explanatory mixed-methods study design was used wherein the quantitative phase (cohort study with two groups: Vadodara district exposed to M-TRACK and Rajkot district as unexposed) was followed by a qualitative phase (descriptive study involving group interview with 16 health care providers, personal interviews with two programme managers and telephonic interviews with 16 PLHIV). Data were collected during October 2016 to February 2017. Results: During the pre-M-TRACK period (July–September 2016), the LFU proportion was similar [13% (25/191) in Vadodara; 15% (21/141) in Rajkot (p = 0.8)]. During the M-TRACK period (October–December 2016), LFU decreased to 4% (9/209) in Vadodara (exposed), whereas it remained similar at 16% (18/113) in Rajkot (unexposed) district (p = 0.02). PLHIV exposed to M-TRACK had an 80% lower risk of LFU (aRR 0.2; 95% CI: 0.1–0.5) compared with standard care, after adjusting for socio-demographics, time and clustering at district level. During interviews, M-TRACK was welcomed by both PLHIV and the counsellors. The latter felt it saved time by obviating the need for home visits and helped in documentation. Inconvenience of using landline phone available at the health facility, lack of budgets for reimbursement of mobile call expenses and internet connectivity problems were the key implementation challenges. Conclusion: M-TRACK was highly effective in reducing the gap between diagnosis and treatment. It may be considered for scale-up after addressing the challenges noted