Sputum conversion at the end of intensive phase of Category-1 regimen in the treatment of pulmonary tuberculosis patients with diabetes mellitus or HIV infection: An analysis of risk factors

Background & objectives: New smear-positive pulmonary tuberculosis (PTB) patients in the Revised National Tuberculosis Control Programme (RNTCP) are treated with a 6-month short-course chemotherapy (SCC) regimen irrespective of co-morbid conditions. We undertook this retrospective analysis to compare sputum conversion rates (smear, culture) at the end of intensive phase (IP) of Category-1 regimen among patients admitted to concurrent controlled clinical trials: pulmonary tuberculosis alone (PTB) or with type 2 diabetes mellitus (DM-TB) or HIV infection (HIV-TB), and to identify the risk factors influencing sputum conversion. Methods: In this retrospective analysis sputum conversion rates at the end of intensive phase (IP) in three concurrent studies undertaken among PTB, DM-TB and HIV-TB patients, during 1998 – 2002 at the Tuberculosis Research Centre (TRC), Chennai, were compared. Sputum smears were examined by fluorescent microscopy. HIV infected patients did not receive anti-retroviral treatment (ART). Patients with DM were treated with oral hypoglycaemic drugs or insulin (sc). Results: The study population included 98, 92 and 88 patients in the PTB, DM-TB and HIV-TB studies. At the end of IP the smear conversion (58, 61, and 62%) and culture conversion (86, 88 and 92%) rates were similar in the three groups respectively. The variables associated with lack of sputum smear or culture conversion were age >45 yr, higher pre-treatment smear and culture grading, and extent of the radiographic involvement. Interpretation & conclusions: Our findings confirm that the current policy of the control programme to treat all pulmonary TB patients with or with out co-morbid conditions with Category-I regimen appears to be appropriate

Status of AIDS Orphans in Chennai, South India

As the AIDS epidemic progresses, there is a shift from focusing on the individual to the family. Often described as a family disease, the AIDS pandemic is leaving millions orphaned in its wake. AIDS Orphans are children who have lost one or both parents to AIDS. In the Indian context, little is known about what happens to these children. This study was planned to assess the status of AIDS orphans. The sample was from a population of HIV-positive patients enrolled in clinical trials at the division of HIV / AIDS of the Tuberculosis Research Center, Chennai, India. Some of the patients had succumbed to the illness and left behind children. Caregivers of these children were interviewed using a semi structured interview schedule. This paper discusses the status of 140 AIDS orphans belonging to 67 families who had lost one or both parent due to AIDS. Twenty six percent had lost both parents and 50% of the surviving parents were sero positive. Ten percent of the children were sero positive while the sero status of 41% was not known. Their mothers cared more than half of the orphans for, while maternal relatives cared for 24%

Buffering Effect of Spousal Support on Stress Levels in Mothers of Children with a Diagnosis of Autism Spectrum Disorder in Kerala, India

Objectives Bringing up a child with the diagnosis of autism spectrum disorder (ASD) can be highly stressful. This study aimed to assess perceived stress, level of spousal support, emotion-focused coping styles, and other potentially associated factors among mothers accompanying children diagnosed with ASD for care from selected institutions in Kerala, India. Materials and Methods Consenting parents accompanying children to therapeutic programs in selected institutions were administered a semi structured interview schedule incorporating questions of the vernacular version of the Perceived Stress Scale (PSS-10), emotion-based coping strategies, spousal support in care of the child diagnosed with ASD, and possible-associated factors. Since internal consistency of stress and coping questionnaires were low, principal component analysis was used to extract composite variables with reasonable psychometric characteristics for stress and coping. Statistical Analysis Ordinal logistic regression was performed with a three-level stress category as the outcome variable. Results High stress was significantly associated with low spousal support (adjusted odds ratio or AOR: 2.80; 95% confidence intervals or CI 1.28–6.11), having a completely dependent child (AOR 4.24 [95% CI 1.92–9.38]), and low acceptance levels (AOR 2.60 [95% CI 1.14–5.89]). Unlike mothers with high spousal support, mothers with low spousal support were likely to have difficulty in interacting with others (p = 0.02) and a low level of acceptance (p = 0.05). Conclusion Spousal support is important to preserve psychological health in mothers of children diagnosed with ASD. Mothers with low spousal support may need interventions that help increase acceptance levels or decrease avoidant behavior

ALTERATION IN RENAL FUNCTION FOLLOWING LOOP DIURETICS IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE

Objective: The objective of the study was to monitor the impact of loop diuretic therapy in patients with acute decompensated heart failure (ADHF) and to assess other predictors of renal dysfunction in patients with ADHF. Methods: An observational study over a period of 6 months from January 2018 to June 2018 in the Department of Cardiology, in a Tertiary Care Teaching Hospital, Coimbatore, Tamil Nadu. Patients on diuretic therapy (loop diuretic) were enrolled. Patients with prior chronic kidney disease were excluded from the study. The patients were evaluated based on change in serum creatinine (SCr) and other contributing factors were assessed by acute kidney injury network and worsening of renal function criteria. Results: A total of 135 patients were enrolled, of which 73% were males and 27% were females. The mean age of the subjects was 61.55±13 years. The baseline means SCr was 1.62±0.92 mg/dl. On evaluation, 41% were really affected and 59% remain unaffected. Factors such as hypertension (p=0.047) and angiotensin-converting enzyme inhibitors (ACE-I) (p=0.023) were found to be significant predictors of renal injury. Conclusion: Variation in renal function in ADHF patients was multifactorial. The direct influence of loop diuretics on renal function was present but was not well established. Hypertension and ACE-I have found to show influence in the development of renal injury as contributing factors. There exists both positive and negative consequence of loop diuretics on renal function