Delayed treatment of tuberculosis patients in rural areas of Yogyakarta province, Indonesia

<p>Abstract</p> <p>Background</p> <p>In year 2000, the entire population in Indonesia was 201 million and 57.6 percent of that was living in rural areas. This paper reports analyses that address to what extent the rural structure influence the way TB patients seek care prior to diagnosis by a DOTS facility.</p> <p>Methods</p> <p>We documented healthcare utilization pattern of smear positive TB patients prior to diagnosis and treatment by DOTS services (health centre, chest clinic, public and private hospital) in Yogyakarta province. We calculated the delay in treatment as the number of weeks between the onset of symptoms and the start of DOTS treatment. Statistical analysis was carried out with Epi Info version 3.3 (October 5, 2004).</p> <p>Results</p> <p>The only factor which was significantly associated with total delay was urban-rural setting (p = < 0.0001). The median total delay for TB patients in urban districts was 8 (1^stQuartile = 4; 3^rdQuartile = 12) weeks compared to 12 (1^stQuartile = 7; 3^rdQuartile = 23) weeks for patients in rural districts. Multivariate analysis suggested no confounding between individual factors and urban-rural setting remained as the main factor for total delay (p = < 0.0001). Primary health centre was the first choice provider for most (38.7%) of these TB patients. Urban-rural setting was also the only factor which was significantly associated with choice of first provider (p = 0.03).</p> <p>Conclusion</p> <p>Improving access to DOTS services in rural areas is an area of vital importance in aiming to make progress toward achieving TB control targets in Indonesia.</p

and Ashok Kumar Das e

Abstract- Background: Hypertension, an important risk factor for cardiovascular disease (CVD), accounts for 57 % and 24 % of deaths due to stroke and coronary artery disease, respectively. Even blood pressure (BP) in prehypertension category (systolic BP 120-139 mm Hg and/or diastolic BP 80-89 mm Hg) hold 3 times more risk for CVD than normal BP (systolic BP &lt;120 mm Hg and diastolic BP &lt;80 mm Hg). We sought to compare the markers of inflammation and insulin resistance in age and body mass index (BMI) matched prehypertensive and normotensive subjects, and to evaluate the association of prehypertension BP status with markers of inflammation and insulin resistance. Methods: A total of 572 participants in the age group 20-60 years of both gender without any known CVD from the community were recruited (Aug 2010 to Dec 2011). After considering the BP, inclusion and exclusion criteria and writte

Listening as a Tool for Transformative Change in Families and Neighborhoods:The case of SALT

Consistent listening to community voices throughout the life cycle of programs and interventions is increasingly recognized as a key to sustainable transformation of communities. Current listening approaches rely on the agency in the listener to listen at individual and mass levels. However, the absence of engagement of agency in the listened to limits its transformation potential to individual levels. SALT (Support/Appreciate/Listen/Team) based listening connects to the agency of the listened to at scale through home- and neighborhood-based conversations. Experiences of using SALT in drug de-addiction, a community development via a corporate social responsibility program, and a suicide survivor support program reveal three distinct characteristics of transformation at scale. These are as follows: (1) SALT is a mindset that listens to strengths, hopes, and concerns in people; (2) listening and agency building at scale is embedded in a process of home- and neighborhood-based reflective learning; and (3) empowerment of communities beyond geographic boundaries is possible through organic transfer and adaptation of organizational practices. Acknowledging the common humanity that underlies the listener and listened to opens doors for deep listening, mutual listening, and transformative listening in homes, neighborhoods, and institutions

Increased protein carbonylation and decreased antioxidant status in anemic H. pylori infected patients: Effect of treatment

Background/Aim: Collective evidences suggest the causal association of Helicobacter pylori infection with iron deficiency anemia. Generation of free radicals against this bacterium can lead to turbulence in oxidative-antioxidative system. This study was undertaken to evaluate the marker of oxidative protein injury, protein carbonylation, and total antioxidant status in anemic H. pylori0-infected patients and to observe the alteration in them after treatment for 1 month with oral ferrous sulfate and anti-H. pylori therapy. Twenty anemic H. pylori-infected patients were randomly divided into 2 groups. The H. pylori-infected patients in Group I received both iron supplementation and anti-H pylori therapy, whereas patients in Group II received only the iron supplementation. Fifteen healthy volunteers served as controls. All the study parameters were estimated after 1 month of the treatment. Materials and Methods: Protein carbonylation and total antioxidant status were estimated using colorimetric method. Hematologic parameters were evaluated using Sysmex-K-100 automated cell counter. Results: In anemic H. pylori-infected patients, the protein carbonyls (PCOs) were significantly increased, whereas the total antioxidant status, iron, hemoglobin, and ferritin levels were significantly decreased compared with the controls. In Group I, while the PCOs level decreased significantly, there was a significant increase in the total antioxidant status, iron, hemoglobin, and ferritin levels after 1 month. No significant alterations were noted in the levels of PCOs, total antioxidant status, iron, hemoglobin, or ferritin in Group II patients after 1 month of the treatment. Conclusions: The findings from this study indicate that treatment for both anemia and H. pylori infections is required for lowering the oxidative stress markers, which synergistically bring about an appropriate correction of anemia soon in these patients

High Frequency Of Thyroid Dysfunction In Indian Patients With Vitiligo

This Study was carried out look for any association of vitiligo with autoimmune thyroid disease and to find out clinical characteristics of vitiligo, which may predict such and association. Thirty-five consecutive cases of vitiligo were enrolled for this study. Besides recording the clinical features of vitiligo and thyroid disease, antithyroid autoantibody assays (anthi-thyroglobulin, anti-TPO) and thyroid hormone profiles were done in these cases and 30 appropriately age and sex matched controls. Radioactive iodine uptake (RAIU) thyroid scintiscan was done for all the cases and controls. Amongst the vitiligo cases, vitiligo vulgaris was the commonest type (45.70&#x0025;), while mucosal vitiligo constituted 22.8&#x0025; of cases. No Patient was found to have thyroid disease clinically; however, on assays, thyroid abnormality (endocrine, immunological or both) was found in 57.1&#x0025; of the cases as against 10&#x0025; of the controls (p&lt;0.05). Autonatibody positivity was found in 31.4&#x0025; of the cases as against 10&#x0025; of the controls (p&lt;0.05). Biochemical abnormality (predominantly hyperthyroidism) was found in 40&#x0025; of the cases as against 6.7&#x0025; of the controls (p&lt;0.05). Four patients with hyperthyroidism showed diffuse increase in uptake on RAIU scan and auto antibody poisitivity, thus were diagnosed as Grave&#x00E2;&#x20AC;s disease. An early age at onset was found in patients with thyroid disease. Mucosal vitiligo was found in 35&#x0025; of the cases with thyroid dysfunction as against 6.7&#x0025; in those without (p&lt;0.05) with was the most unique finding of the study. To conclude, we would like to stress that patients with vitiligo should be screened for thyroid dysfunction, especially those with mucosal vitiligo

Quercetin Modulates Nrf2 and NF-κB/TLR-4 Pathways to Protect against Isoniazid and Rifampicin Induced Hepatotoxicity in vivo

Isoniazid and rifampicin are crucial for treating tuberculosis (TB); however, they can cause severe hepatotoxicity leading to liver failure. Therapeutic options are limited and ineffective. We hypothesized that prophylaxis with quercetin attenuates isoniazid and rifampicin induced liver injury. We randomly divided Wistar rats into seven groups (n=6). The animals received isoniazid and rifampicin or were co-treated with quercetin or silymarin for 28 days. The protective effect of quercetin was assessed using liver function tests and liver histology. NRF2 and NF-κB pathways were explored to elucidate the mechanism of action. Quercetin co-administration prevented the elevation of ALT, AST, ALP and bilirubin compared to isoniazid and rifampicin treatment alone. In the histological analysis, we observed that quercetin prophylaxis lessened the severity of hepatic necrosis and inflammation compared to the anti-TB drug treated group. Quercetin attenuated anti-TB drug induced oxidative stress by increasing NRF2 activation and expression, boosting endogenous antioxidant levels. Additionally, quercetin blocked inflammatory mediators HMGB-1 and IFN-γ, inhibiting activation of the NF-κB/TLR-4 axis. Quercetin protects against anti-TB liver injury by activating NRF2 and blocking NF-κB/TLR-4.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Profile of risk factors for Non-Communicable Diseases (NCDs) in a highly urbanized district of India: Findings from Puducherry district-wide STEPS Survey, 2019-20.

IntroductionRapid urbanization and industrialization drives the rising burden of Non-Communicable Diseases (NCDs) worldwide that are characterized by uptake of unhealthy lifestyle such as tobacco and alcohol use, physical inactivity and unhealthy diet. In India, the prevalence of various NCDs and its risk factors shows wide variations across geographic regions necessitating region-specific evidence for population-based prevention and control of NCDs.ObjectiveTo estimate the prevalence of behavioral and biological risk factors of NCDs among adult population (18-69 years) in the Puducherry district located in Southern part of India.MethodologyWe surveyed adults using the World Health Organization (WHO) prescribed STEPwise approach to NCD surveillance (STEPS) during February 2019 to February 2020. A total of 2560 individuals were selected from urban and rural areas (50 clusters in each) through multi-stage cluster random sampling method. STEPS instrument was used to assess behavioral and physical measurements. Fasting blood sample was collected to estimate biochemical risk factors (Diabetes, Hypercholesterolemia) of NCDs.ResultsAmong men, alcohol use 40.4% (95% CI: 37.4-43.4) was almost twice higher compared to tobacco use 24.4% (95% CI: 21.7-26.9). Nearly half of the population was physically inactive 45.8% (95% CI: 43.8-47.8) and obese 46.1% (95% CI: 44-48.1). Hypertension and diabetes mellitus were present among one-third 33.6% (95% CI: 31.6-35.5) and one-fourth 26.7% (95% CI: 24.1-29.1) of the population which were significantly higher among men (37.1% vs 30.8% and 31.6% vs 23.2% respectively). Physical inactivity and overweight/obesity increased with increasing education levels. Tobacco and alcohol use was more common among men, whereas physical inactivity with obesity and hypercholesterolemia was higher among women.ConclusionWe found high prevalence of various NCDs and its risk factors among the adult population of Puducherry district

Altered oxidant-antioxidant status in non-obese men with moderate essential hypertension

Background : Although a wide number of experimental evidences are available regarding oxidant-antioxidant disturbance in hypertension, clinical data supporting it is lacking in men in early stages of hypertension. Aims: The objective of the study was to evaluate oxidative status and antioxidant activities in males with stage I essential hypertension. Materials and Methods : Thirty hypertensives and 21 normotensives were included in the study. Protein carbonyl, reduced glutathione, glutathione peroxidase, catalase and fasting glucose were assessed in both the groups. Statistical Analysis : Results were analyzed by student′s ′t′ test and linear regression analysis test. Results : Plasma protein carbonyl and glutathione peroxidase were significantly increased, and catalase and GSH were significantly reduced in the hypertensive group compared to normotensive subjects. There was a significant negative correlation between glutathione peroxidase and catalase in the test group. Conclusions : The data from the present study indicates an alteration in oxidant-antioxidant status in non-obese men in early stages of essential hypertension