Survival of tuberculosis patients treated under DOTS in a rural tuberculosis unit (TU), south India.

Objective: To estimate survival probabilities and identify risk factors for death of tuberculosis (TB) patients during treatment period. Methods: TB patients registered during May 1999 to December 2004 from a rural TB unit (TU) with a population of 580 000 in Tiruvallur district, South India, formed study population. Life table and Cox’s regression methods were used. Results: Of the 3818 TB patients who were initiated on treatment, 96, 94 and 97% of category – I, II and III respectively, were surviving after completion of treatment. Higher death rates were independently associated with patient’s age (45 years), previous history of treatment, alcoholism and initial body weight (<35 kgs). Conclusion: The survival probability was found to be similar in all patients irrespective of categorization. Necessary actions need to be initiated in the programme to improve body weight and abstain from alcoholism

Weight gain in patients with tuberculosis treated under directly observed treatment short-course (DOTS)

Set up: One Tuberculosis Unit (TU) in Tiruvallur district, Tamil Nadu, India where Tuberculosis (TB) patients treated under Directly Observed Treatment Short Course (DOTS) programme. Objective: To identify the effects of weight gain among TB patients at the end of treatment on different factors such as socio-economic and demographic characteristics, smoking and drinking habits, treatment under supervision, the type of DOTS centres and problems in taking drugs. Methods: TB patients registered between May 1999 and December 2004 formed the study population. Multiple regression method was used for the analysis. Results: Among 1557 smear-positive TB patients registered under DOTS programme, the changes in weight ranged from a loss of 4 kgs to a gain of 20 kgs at the end of TB treatment; the average change in weight was 3.22 kgs. The gain in weight at the end of treatment was associated with age (<45 years), DOT at government centres, no problems in taking drugs as reported by patients and cure rate. Conclusion: The findings showed that there is an association between gain in weight with DOT at government centres and cure of patients

Quality of symptom elicitation in an epidemiological survey on tuberculosis

The quality of symptom elicited by health workers in an epidemiological survey on tuberculosis was assessed by again subjecting a 10% random sample of the persons interviewed, by the supervisory staff, independently. Three thousand four hundred and forty nine persons were thus interviewed twice. The overall estimates for overdiagnosis and under-diagnosis in the elicitation of symptoms by health workers were to the extent of 16% and 8% respectively, with minimal yield of sputum positivity from the discordant groups of persons. The additional load of 16% for sputum examination can thus be considerably reduced if health workers are well trained in symptom-elicitationscreening of the population and their work is monitored through spot supervisory checks

Seroprevalence of human immunodeficiency virus (HIV) infection among tuberculosis patients in Tamil Nadu

Background & objectives: The dual epidemic of HIV and tuberculosis is a cause for concern in those countries where these two infections are prevalent in epidemic proportions. We undertook a survey at two sites in North Arcot district of Tamil Nadu in 1992-1993, to know the seroprevalence of HIV infection among tuberculosis patients. The objective of this study was to re-examine the prevalence of HIV infection among tuberculosis patients in a repeat survey. Methods: The study was undertaken in four centres: District Tuberculosis Centre (DTC), Vellore, Tuberculosis Sanatorium, Pennathur (Vellore), District TB Centre (DTC), Kancheepuram and the Government Thiruvotteswarar Tuberculosis Hospital (GTTH), Chennai in the northern part of Tamil Nadu during 1997-1998. A total of 2361 newly diagnosed TB patients were registered in this study. HIV serology after pre-test counseling was done along with sputum examination for acid-fast bacillus by smear and culture for mycobacteria for all patients. Results: The overall HIV seroprevalence among TB patients was 4.7 per cent. The highest HIV seropositivity rate was found among patients aged 30-39 yr (10.6%). HIV seroprevalence showed a wide variation among the different centres ranging from 0.6. per cent in DTC, Kancheepuram to 9.4 per cent in Pennathur Sanatorium, Vellore. Sputum smear positivity was 88 per cent among the HIV-negative and 83 per cent among HIV-positive tuberculosis patients. Interpretation & conclusion: HIV infection is on the rise among TB patients in Tamil Nadu. Acid-fast smear microscopy is adequate for the diagnosis of pulmonary tuberculosis, and drug resistance among HIV positive patients is not a major problem at this point of time; hence antituberculosis regimens recommended by the Revised National Tuberculosis Control Program (RNTCP) can be used to treat HIV positive patients with tuberculosis

SIMULTANEOUS EVALUATION OF ABACAVIR SULFATE AS WELL AS LAMIVUDINE IN MEDICAL FORMULATIONS BY GRADIENT REVERSED-PHASE HIGH-PERFORMANCE LIQUID CHROMATOGRAPHY TECHNIQUE

Objective: A precise, accurate, simple, and gradient reversed-phase high-performance liquid chromatography (HPLC) method was adapted for the determination of abacavir sulfate (ABV) in combination with lamivudine (LMV) having tablet formulations simultaneously. This method developed has been validated as per the guidelines of ICH. Method: Waters HPLC has been used in the method with a column named Zorbax C18 with the dimensions as 4.6 nm×150 mm, 3.5 μm. Phosphate buffer (PH - 3.9) was used as Eluent - A, Eluent - B was methanol, and water and methanol (50:50 v/v) were utilized as diluents. The rate of flow was 1.5 ml/min. Results: The wavelength of detection has been detected at about 270 nm. Linearity ranges of ABV and LMV were 88–266 μg/ml and 38–116 μg/ml, respectively. Retention times of ABV (3.66 min) and LMV (10.71 min) were determined. The values of the study of percentage recovery of ABV and LMV were determined to be within 98.3–99.2%. Conclusion: The estimation of ABV and LMV in all pharmaceutical dosage forms could be performed successfully by employing this method

DOTS Reaches Socially Marginalized Population in the Community : A Study from a Rural Area of South India

We report here that the Directly Observed Treatment, Short course (DOTS) is reaching all tuberculosis patients in the community irrespective of social classification based on the analysis from the tuberculosis prevalence survey and programme performance during 1999-2003 from a rural area in Tamilnadu, South India. New smear- positive cases treated under a DOTS programme were classified in two groups namely; scheduled caste living in colony and other population. The prevalence of smear- positive cases among the scheduled caste population was 1.9 times higher than the other population and this was reflected in the notification also. The successful treatment outcome was also similar in these two groups (75% and 78% respectively; overall 77%). From these findings it is concluded that people living in colony have equal access to DOTS as those in the village

Relationship of ARTI to incidence and prevalence of tuberculosis in a district of South India

Background: Performance of tuberculosis (TB) control programme depends on the functioning of health facilities (HFs). TB control programmes have been evaluated based on the programme indicators of conversion and cure. We have attempted to correlate the programme performance based on the availability of staff and their performance at the HF level. Objective: To correlate the performance of HFs to programme indicators, conversion and cure of patients treated under DOTS, in a district of south India. Design: Analysis of the data on new sputum smear-positive cases registered in 17 HFs during 1999-2003 was undertaken using TB register. The HFs with a low conversion or cure rates were identified and the reasons for the same were analysed. A scoring system was designed for the functioning of the HFs based on staff availability, supervision and review meetings which was correlated with programme performance. Univariate and multivariate analyses were performed. Results: Of 1893 new smear-positive patients registered during the study period, conversion was 1582 (83.6%) with cure rate of 76.4% (1447 of 1893), 254 (13.4%) default, 94 (5.0%) failure and 85 (4.5%) death. The conversion rates increased from 76% in 1999 to 87% in 2003; a statistically significant trend (c2 = 15.9; P<0.001). Similarly, a significant increase in trend (c2 = 4.0; P < 0.05) was observed in cure rates also (71 to 80%). The HFs were broadly classified into four groups namely; poor, fair, good and very good based on functioning scores .Correlation co-efficient was 0.77 between functioning of the HFs and conversion, and 0.76 between functioning and cure (P<0.01). Lack of regular review meetings was found to be independently associated with poor programme performance. Conclusion: Availability of staff such as Medical Officer, Laboratory Technician, and regular supervisory visits and review meetings are essential for a well functioning of programme. There is significant impact on DOTS with good functioning of HFs

Annual Risk of Tuberculosis infection in Chennai City

Aim: To study the proportion of children infected with Mycobacterium Tuberculosis in Chennai city. Methodology: A cluster sampling methodology was adopted to select an estimated sample size of 7000 children from five corporation zones selected systematically from ten zones of the city. A total of 7098 children aged 1-9 years were subjected to Mantoux and test read; 1897 (27%) from slum area and 5201 (73%) from non-slum area. Results: The prevalence of infection among children without BCG scar was estimated to be 10.5 % (ARTI of 2.0%) and was similar to that among children irrespective of scar status. The prevalence of infection was higher among children in slum areas (11.1%; ARTI 2.1%) compared to non-slum areas (8.9%; ARTI 1.7%); but the difference was not statistically different. Conclusion: The tuberculosis situation in Chennai as measured by risk of infection was higher in urban city area than rural areas and comparable to that found in other cities as reported from earlier studies. This information can be used as baseline information for monitoring the epidemiological trends in Chennai city in future

The influence of swelling on elastic properties of polyacrylamide hydrogels

Polyacrylamide (PAM) hydrogels are commonly used as substrates for cell mechanical and mechanobiological studies because of their tunable stiffness and ease of handling. The dependence of bulk rheological and local elastic properties (assessed by Atomic Force Microscopy, or AFM) of PAM hydrogels on its composition and polymerization temperature has been extensively studied. PAM hydrogels swell when immersed in media, but the influence of swelling on local elastic properties is poorly characterized. Direct measurements of the effect of swelling on PAM elastic properties are scarce. We report here, for the first time, the direct measurements of volumetric swelling and local elastic properties of PAM gels throughout the post-polymerization swelling process until equilibrium. First, local and global elastic properties (measured by rheology), were obtained during polymerization in the absence of swelling, and showed good agreement with each other. Four PAM hydrogel compositions were characterized thus, with corresponding storage shear moduli (as measured immediately after polymerization) of 4,530 Pa (termed stiffest), 2,900 Pa (stiff), 538 Pa (soft), and 260 Pa (softest). Next, all compositions were subjected to swelling in phosphate buffered saline. Swelling ratios and local elastic moduli were measured at 0, 3, 6, 9, 12, and 24 h post-polymerization for the soft and softest compositions, and once daily till 6 days post-polymerization for all four compositions. For the stiffest and stiff gels, swelling ratio, and local elastic modulus changed negligibly with time, while for the soft and softest gels, substantial changes between Day 0 and Day 1 were found for both swelling ratio (increased by 21.6 and 133%, respectively), and local elastic modulus decreased (by 33.7 and 33.3%, respectively), substantially. Experimental data were analyzed by a model that combined ideal elastomer mechanics and poroelastic swelling kinetics model. Model predictions confirmed the validity of present measurements with respect to past studies where swelling and elastic properties were not measured simultaneously. The present study underlines the important effect swelling can have on PAM elastic properties and provides detailed quantitative data to guide the duration taken to reach equilibrium—a useful information for cell mechanics experiments. In addition, the simultaneous measurements of swelling and local elastic moduli provide novel data for the validation of theoretical models