Center Dot Research Articles

Improving the Diagnosis of Tuberculosis through Optimization of Sputum Microscopy

Background: Patient compliance is an important component of the case detection. The feasibility of sputum examination on the same day was assessed without compromising on the quality. Materials and Methods: This study was conducted as a cross-sectional study on 215 patients attending the DOTS center in Dr. Rajendra Prasad Government Medical College, Kangra, at Tanda from July 2018 to December 2018. The patients were divided into three arms of the study based on the timing of the sputum sample. Results: There was a high correlation of the test result across all study groups. Combined for all arms, the correlation between the first spot and second spot sputum sample was 0.87, between the first spot and morning sputum sample was 0.82, and between the second spot and morning sputum sample was 0.85. There was no significant statistical difference in the sputum positivity among the groups. The loss to follow-up (LFU) was high (21.9%) for the second and third spot (early morning) samples in group 2, and no LFU was observed for the second spot (after 1 h) and morning sample in group 1 patients. Conclusion: The combination of the first and early morning samples offers a feasible mechanism to diagnose tuberculosis (TB) based on acid fast bacillus identification. Establishing the diagnosis for TB based on two sample results is feasible without any significant drop in the yield.

A STUDY OF CLINICAL AND TREATMENT PROFILE OF TUBERCULOSIS PATIENTS ATTENDING DOTS CENTRE AT PRIMARY HEALTH CENTRE

Introduction: Tuberculosis (TB) is an age-old disease killing significant number of humans over history and one of the major cause of morbidity and mortality, especially in developing and underdeveloped countries. It killed 1.4 million people annually worldwide in the year 2019. India had 2.69 million cases in 2019, according to TB report 2020. Despite the presence of the programme for it's control, TB continues to threaten the population due to emergence of more and more resistance cases challenging it's elimination. This study reflects the annual burden of tuberculosis in an area served by a Primary Health Centre in Urban Delhi and the treatment outcomes. The records of the patients attendingMethods: the DOTS centre was obtained from the treatment register at Primary Health Centre, Palam, Delhi. The records of patients visiting between April 2020 to March 2021 were included. Data analysis was done on Statistical Package for the Social Sciences (SPSS) version 22 and appropriate statistical tests were applied. The total number ofResults & Conclusion: tuberculosis patients registered from April 2020 to March 2021 were 260. Out of these 260 patients, 155 (59.6%) were pulmonary and 105 (40.4%) were extra-pulmonary. A total of 175 (67.3%) were microscopically confirmed and 85 (32.7%) were clinically/radiologically diagnosed.

Pattern of Tuberculosis, Trend and Outcome of Patients Registered at DOTS Centre of a Tertiary Care Hospital.

Tuberculosis is a common respiratory disease imposing significant health burden. Directly observed treatment short course strategy ensures patient compliance in tuberculosis treatment. The aim of this study was to assess pattern of tuberculosis, trend and outcome of patients registered at Directly observed treatment short course centre of Tribhuvan University Teaching Hospital. A retrospective observational study was conducted at Tribhuvan University Teaching Hospital. Tuberculosis patients of all age groups registered from July 2017 to June 2020 at Tribhuvan University Teaching Hospital Directly observed treatment short course centre were included. Data entry and analysis was done in SPSS version 20.0. Descriptive statistics was performed and results were interpreted in mean, frequency and percentage. A total of 2790 tuberculosis patients were included for final analysis. There were 1736 (62.2%) males. Mean age of patients was 37.94±20.28 years. Pulmonary tuberculosis was the most common type of tuberculosis seen in 948 (34%) patients. Fifty percent of total tuberculosis cases were confined to thorax. Tubercular pleural effusion and pleurisy (14.6%), central nervous system (13.2%), bone and joint (12.2%) were common forms of extrapulmonary tuberculosis. The mean incident tuberculosis cases registered annually was 697.5±95.63. Nearly half (49.1%) of the patients completed tuberculosis treatment regimen while 43.3% were referred to other Directly observed treatment short course centre as per their convenience. This study reflects the trend and pattern of tuberculosis epidemiology at tertiary care hospital of Nepal. There is a huge burden of both pulmonary and extrapulmonary tuberculosis at Tribhuvan University Teaching Hospital with slight annual variation in incident tuberculosis cases. Despite implementation of Directly observed treatment short course, the problem of non-compliance persists among the tuberculosis patients.

Epidemiological profile of extrapulmonary tuberculosis and its association with diabetes in tertiary care center in Northern Kerala

Background: India accounts for 24% of the global TB burden and 29% of deaths. Although HIV is considered the most potent risk factor for TB, the high prevalence of diabetes mellitus in the world and its effect on TB burden is greater than HIV infection. DM is common in the south Indian state of Kerala with a prevalence of 16% to 20%. Objectives of current study were to describe the epidemiological profile of EPTB cases diagnosed in a tertiary care center in northern Kerala and to find the association between EPTB and DM cases.Methods: A record-based descriptive study. All TB cases from first January 2019 to December 2021 at the Government medical college Kannur Pariyaram were the study population. Data was collected from the Nikshay portal, treatment register and CBNAAT register maintained in DOTS center, Pariyaram. The data were analysed using MS Excel and SPSS 26. The Chi-square test was applied to find an association between variables. p<0.05 is considered statistically significant.Results: Of the 882 cases included in the study, 476 (53.96%) were having PTB and 406 (46.03%) were having EPTB. Among males PTB (358, 59.3%) and among females EPTB (160 ,57.6%) were more prevalent (p<0.001). In the younger age group EPTB and in the older age group PTB were more reported (p<0.001). Among EPTB, the majority of the cases (66.5%) belong to the age group 21-60 years. Smokers among PTB and EPTB were 78 (16.4%) and 33 (8.1%) respectively.Conclusions: Female gender and younger age were more associated with EPTB compared to PTB.DM and smoking were more associated with PTB compared to EPTB. Common sites of EPTB were the lymph node, abdominal, pleural, and spine.

A RETROSPECTIVE ANALYSIS OF EXTRA PULMONARY TUBERCULOSIS

Tuberculosis has been one of the major public health concerns since many years now. Around 15-20% of TB cases are found to be extrapulmonary1. Diagnosis is challenging due to its pauci bacillary nature2. The objective of this study is to determine the pattern and sites of extra pulmonary tuberculosis in patients presenting to our tertiary hospital. Materials and Methods- This is a hospital based retrospective observational study. A total of 73 patients were included in the study. Study period was 1 year (Jan 2019 – Jan 2020). Data regarding the various samples, sites and various tests done – AFB, CBNAAT were collected. Both microbiologically or clinically diagnosed extrapulmonary tuberculosis were included. Records were obtained from the medical records maintained in the DOTS centre of our hospital. Results-Majority of the patients belonged to the age group of 21-40 years (42.5%) with male (61.6%) predominance. Most common extrapulmonary site was pleura (27.8%) and least common was endometrium (1.4%). 71.2% of the cases were clinically diagnosed and 28.8% were microbiologically conrmed. CBNAAT detected TB bacilli in 23.3% of the cases. Conclusion- In our study the most common site of extrapulmonary tuberculosis was pleura presenting as pleural effusion and in majority of them TB bacilli could not be detected.

Effectiveness of sensitization programme

Tuberculosis is an infectious disease caused by mycobacterium tuberculosis. It affects the lungs and other organs. The disease is spread through the air when people who are sick with pulmonary TB expel the bacteria. Most productive age group is affected by tuberculosis. In India, 70% of all patients are aged between 15 and 54 years and 2/3 rd of male are affected with tuberculosis. The first effective pharmacological therapies were discovered. For drug-susceptible TB illness, a 6-month regimen of four first-line medicines is presently recommended: isoniazid, rifampicin, ethambutol, and pyrazinamide. AIM- Effectiveness of Sensitization Programme: infection prevention and control among patient with tuberculosis. Methodology- A Quantitative Quasi experimental research approach was used for the study. Tuberculosis patient registered with dots Centre in Rohilkhand medical college & Hospital(Experimental group) Bareilly District and Varun arjun Medical college & Rohilkhand Hospital (Control Group) Banthara, Shahjahanpur district. The level of knowledge was assessed using structured knowledge questionnaire and practice was observed by practice checklist. The pre test was conducted, Intervention was implemented and post test knowledge, practice and Attitude were assessed for the experimental group.

Socio-Demographic Profile and Treatment Outcomes of Tuberculosis Patients Diagnosed In a Government Civil Hospital of Northern India: A Cross-Sectional Study

Background: Tuberculosis remain a worldwide public health problem and is one of the top 10 causes of death globally. Millions of people continue to fall sick with TB each year. We conducted the present study to evaluate the Socio-demographic Profile and treatment outcomes of Tuberculosis Patients Diagnosed in a Government Civil Hospital of Northern India. Material and Methods: This cross-sectional record-based study was conducted at Civil Hospital Jogindernagar of Himachal Pradesh. We collected information using a self-designed, structured questionnaire containing information regarding various sociodemographic and clinical variables. Information was collected from Tuberculosis (TB) notification register kept at DOTS centre. Statistical analysis was done using statistical software Epi Info v7.2.2. Results: There were total 74 patients of tuberculosis were registered from Jan 2020 to June 2020 at DOTS center in Civil Hospital, Jogindernagar, Himachal Pradesh Among the total, 54 27(73%%) were 21-60 years of age. Mean age of patients were 44.78±17.01 years. Majority of patients, 56(75.7%) were male and 51(68.9%) belong to lower middle class. 46 (62.25) were pulmonary TB cases while 28 (37.8%) were extra pulmonary cases. Among the total, 26(35.1%) cases were clinically diagnosed, 11(14.9%) cases were Clinically diagnosed or Diagnosed by FNAC while 37(50.0%) cases Microbiological confirmed cases. 29( 39.2%) cases were Contact of TB/DRTB Cases , 29(39.2%) were tobacco user while 16(21.6%) had other risk factors. None of the case Reactive HIV status, 8(10.8%) had Diabetes while 27(35.5%) had associated Cervical lymphadenopathy. 71(95.8%) were cured after completing ATT, 1(1.4%) were become defaulter , 1(1.4%) Shifted to MDR Treatment and (1.4%) was died. Conclusion: Study concluded that most of the patients were males, belonged to lower socioeconomic status , in productive age group and of pulmonary TB. Treatment success rate is good but still need to improve, to make it 100 percent.

Towards an analytical solution for the triple quantum dot shuttle

In this paper we look for analytical solutions of the triple-quantum-dot shuttle (TQDS) in the linear tunneling regime. This system consists of three quantum dots arranged in a straight line, where the end dots remain fixed while the center dot oscillates between them and its motion is modeled by a quantum harmonic oscillator. In the linear tunneling approximation for the Hamiltonian HˆTQDS, we consider an analytical method developed by Kuś and Lewenstein in 1986 that enables us to find exact isolated solutions for a Hamiltonian of the HˆTQDS-type using the Bargmann representation. This allows us to obtain some energy values and their respective eigenvectors with the condition that the parameters that describe the system comply with certain constraints called compatibility conditions. The latter give rise to the possibility of developing a criterion that leads us to establish under what conditions the Kuś method is applicable in the solution of systems represented by Hamiltonians of the HˆTQDS-type.

Predictors of Delay in Diagnosis and Treatment for Tuberculosis in North India: A Cross Sectional Analytical Study

Introduction: Tuberculosis (TB) has been a continuous major public health problem.The treatment delay affects an individual, the community, a country’s health and economy. In general, it is very difficult to quantify the crisis in country’s health and economy, especially in the era of MDR-TB, from suffering and death of economically productive individuals from such preventable and treatable disease because of delayed initiation of treatment.Understanding the causes behind delay in diagnosis and treatment is essential for all partners involved in tuberculosis control. Material and Methods: The cross-sectional study was conducted among the patients of tuberculosis diagnosed at I.G.M.C. Shimla from 1st August 2018 through 31st July 2019.A structured, validated and pretested questionnaire was adapted from the WHO multi country tuberculosis treatment delay survey. Questionnaire consists of basic demographic profile of patients, type of tuberculosis and associated co-morbidities, TB knowledge, attitude toward TB and regarding potential delays. Data was collected from patients at the time of their registration for treatment at DOTS centre. Results: The most common levels of delays identified in study participants were patient delay and health care provider delay.The mean delay at patient level was 66 days and delay at health care provider was 83 days. Total delay among participants was 130 days.Among all study participants, 31.03% thought that their symptoms would go at their own. The economic constraint was found in 22.41 %.Reason of delay among 41.42 % participants was Late diagnosis at level of health care provider. Out of total, 18.5% who visited private practitioner, were not diagnosed. Conclusion: There was a delay of 66 days for seeking treatment and 84 days for diagnosis of tuberculosis at health care provider level. A longer delay was revealed in smoker, residents of rural area and patients from low income group for seeking treatment.The delay at the level of health care provider was significantly associated in participants who travelled less than five kilometers to reach first health facility for seeking treatment.

Association of socio-demographic profile with types of tuberculosis among patients attending a rural DOTS centre in central Kerala, South India

Background: Re-evaluation of the epidemiological profile of tuberculosis (TB) patients can help to eliminate the number of cases. This study was aimed to analyse the association of socio-demographic profile with type of TB among patients attending a rural DOTS centre in central Kerala.Methods: A cross sectional study was conducted among TB patients at a rural DOTS clinic in central Kerala during January 2020-June 2021. Various socio-demographic parameters such as age, gender and socio-economic status and comorbidities of patients with pulmonary and extrapulmonary TB were retrieved from the DOTS register. The data was analyzed.Results: A total of 241 patients (134 males and 107 females) were enrolled. In general, age group 41-60 years showed maximum incidence (p=0.0283). Lower middle (32.7%) and middle class (36.5%) strata constituted the majority of burden (p=0.9091). The distribution of cases was not associated to occupation (p=0.06). Extrapulmonary form (55%) was found to be predominant with very poor awareness (p=0.06). A significant delay of at least 1-3 months in recognizing the symptoms and thus the clinical diagnosis particularly in extrapulmonary cases was found. Diabetes mellitus was the most frequent comorbidity in TB patients.Conclusions: The prevalence was most common in age group 41-60 years without any association to occupation. Since the diabetes mellitus is the most frequent comorbidity in TB patients, early screening will make an effective management. Society oriented awareness programme about the extrapulmonary TB is inevitable.

Indian tubercular belly: A prospective study of 140 patients of abdominal tuberculosis and their outcomes

ABSTRACTBackground:Abdominal tuberculosis is an important yet ignored entity in the spectrum of tuberculosis which has been dominated by pulmonary tuberculosis. Diagnosis and treatment are often delayed due to nonspecific symptoms. In this study, we aimed to highlight the clinical features, diagnostic methods and outcomes of abdominal tuberculosis.Methods:A prospective study was conducted in tertiary referral centre where all patients referred to drug distribution centres (DOTS centre) for abdominal tuberculosis were identified. Their demographic clinical and radiological profile was evaluated. These patients were followed-up for their treatment course for complications and outcomes.Results:A total of 140 patients who were labelled abdominal tuberculosis over a period of 2 years were reviewed at tuberculosis drug distribution centre (DOTS). Mean age of study population was 35.42 ± 12.53 years and majority of the population were males, 58.6% (82). The most common presenting symptom was abdominal pain which was seen in 82.8% (n = 116) of the patients, followed by feverin 65.6% (n = 92); 22.8% (n = 32) were seropositive for HIV and 44.2% (n = 62) had luminal tuberculosis of which ileocecal was the most common site. Peritoneum was second most common site which was involved in 26.4% (n = 37) of the patients followed by mixed tuberculosis involving more than one type. Confirmed diagnosis was achieved in 74 patients (52.8%), while the remaining 66 patients (47.14%) were diagnosed clinically. During follow-up, 12 patients were lost to follow-up; 113 (80.7%) had complete response, while 3 (2.14%) patients died during treatment.Conclusion:Abdominal tuberculosis usually presents with nonspecific complaints which require high index of suspicion. Most patients require only medical therapy which has good results.

Risk factors associated with delays in seeking treatment and diagnosis of tuberculosis patients at DOTS center of a tertiary care institute in Himachal Pradesh

Background: Delays in diagnosis of tuberculosis (TB) is still a problem at all levels of health care. Understanding the etiology of these delays is essential for all stakeholders involved in TB control. This study was done to find the delays related to health-care seeking behavior, diagnosis, and major contributors to such delays among newly diagnosed patients of TB. Methods: This cross-sectional study was conducted from August 1, 2018, to July 2019 among the patients of TB diagnosed at Indira Gandhi Medical College, Shimla. A consecutive sample of 105 patients was enrolled for the study. Newly diagnosed cases aged 18 years and above were included in the study. Prevalence ratio with 95% confidence interval was calculated for risk factors associated with the identified delays. Results: At the patient level around 55% reported a delay of more than 14 days in seeking care with a median delay of 45 days (interquartile range [IQR] of 30–60 days). Nearly 67% patients were found to have a diagnostic delay of more than 7 days at the health-care provider level (Median 30 days; IQR 12.5–54.7 days). Delayed initiation of treatment after 7 days of diagnosis was found in 6.6% cases (Median 10 days; IQR 8–15 days) and all of these were patients of extra pulmonary TB. Delay was significantly associated (P = 0.01) with patients who travelled <5 km to reach the health facility. Conclusion: Inter-sectoral coordination, refresher trainings of health-care providers, patient education and capacity building for diagnostics at peripheral institutions can reduce delay in diagnosis and treatment of TB.

Effectiveness of two tobacco cessation methods among TB patients.

BACKGROUND: Tobacco and TB are the world´s two greatest public health problems. Exposure to tobacco has been shown to be associated with higher risk of acquiring TB and adverse outcomes such as relapse and TB mortality.OBJECTIVE: To assess and compare self-reported tobacco quit status and biochemically verified cotinine levels among TB patients at different time intervals among two study groups.METHODS: A cluster, randomised controlled trial was conducted on TB patients attending DOTS centres in Delhi, India, who reported using tobacco in any form. Participants were assigned into one of two treatment groups. Centres were randomly assigned to two intervention groups: 1) integrated intervention using behavioural counselling with nicotine replacement therapy (NRT) gum, and 2) intervention using behavioural counselling alone (50 each in intervention and control group). The subjects were followed at Week 1, Month 1, Month 3 and Month 6 for tobacco cessation.RESULTS: At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting tobacco than those who received the conventional TB treatment alone (78.7% vs. 57.8%; P < 0.03).CONCLUSION: DOTS with tobacco use dependence treatment was successful in our study in helping TB patients to quit tobacco dependence and should therefore be offered to every tobacco user.

Default in Tuberculosis Treatment among Women Registered in DOTS Center of Taplejung District, Nepal: A Descriptive Study

INTRODUCTION: Default is one of the unfavourable outcomes for patients on DOTS and represents an important challenge for the control program. Therefore, this study was designed to assess default in tuberculosis (TB) treatment among women registered in DOTS center at Taplejung District of Nepal. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted at Taplejung district of Nepal in thethe year 2016. Records of TB patients from all DOTS centre for one year were obtained and treatment default cases for women were identified. Face to face interview was conducted by using semi-structured questionnaire to collect data from the patients. The data were entered and analyzed in MS Excel software. RESULTS: Out of total 30 female TB patients, 72.0% of respondents belonged to the age group of 15-49 years where as 73.3% of the respondents were Kirat and from Dalit caste ethnicity. Less than half of the respondents (48.0%) thought, feeling better after medication, was the reason for default TB. A second major cause for default in tuberculosis treatment was distance to reach DOTS center (12.0%) and lack of food at home (10.0%). Likewise, few respondents said lack of family support (6.7%), thinking about side effects (6.7%), medicine not working (3.3%) and stigma (6.7%) were the reasons for the default in tuberculosis treatment. CONCLUSIONS: Majority of the respondents left treatment because they felt better after medication. A second major reason for default in TB treatment was distance to reach DOTS center. The findings may be helpful in planning modifications in DOTS program of Nepal.

Treatment Outcome of Pulmonary and Extra Pulmonary Tuberculosis Patients Registered at DOTS Centre in a Tertiary Care Hospital, Mysuru, Karnataka, India

Aim: To compare the personal variables, clinical characteristics and treatment outcome of Pulmonary and Extra Pulmonary Tuberculosis (EPTB) patients.&#x0D; Settings and Design: A Retrospective observational study was conducted in Directly Observed Treatment Short term (DOTS) centre of teaching hospital, Mysuru, Karnataka state in India from December 2019 to December 2020.&#x0D; Methods and Materials: All newly diagnosed patients were registered and followed up during their course of treatment to assess treatment outcome. Data is collected by using personal variable proforma and clinical characteristic form.&#x0D; Results: Among 197 tuberculosis (TB) patients’ 120(60.91%) were suffering with EPTB and the remaining 77(39.08%) have the PTB. Majority 101(51.26%) patients were diagnosed by microbiological confirmation and remaining 96(48.73%) were clinically diagnosed. Even though majority 140 (71.06%) completed the treatment only 10(5.07%) were cured. About 16(8.12%) TB patients have treatment failure and were lost to follow up. The treatment success rate was (0.5%). Confirming the presence of TB by microbiologically and clinically is having influence in diagnosis of EPTB, as well as consumption of alcohol was having statistical significance inferring these clinical characteristics having influence in developing EPTB. Residence of the patient is a risk factor for the treatment outcome as per calculated odds ratio&#x0D; Conclusion: The mean treatment success rate of PTB patients was 80.59% and in EPTB was 73.33%. The treatment success rate was not significantly affected by gender, age and type of TB. .

COMPARISON OF CLINICO-SOCIAL PROFILE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN TERTIARY CARE HOSPITAL IN A RURALAREA: A RETROSPECTIVE STUDY

BACKGROUND AND OBJECTIVES: The burden of tuberculosis (TB) in India is the highest accounting for 26% of the global incidence. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). India accounts for a fourth of the global burden of TB and 29% of global mortality. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristic between pulmonary TB (PTB) and extrapulmonary TB (EPTB). MATERIALS AND METHODOLOGY:Aretrospective analysis was carried of 348 patients diagnosed in DOTS centre, Pravara Rural Hospital, Loni. Characteristics of demographic and clinical characteristics were obtained from medical case records. RESULTS:Among the 348 cases, 71.3% were PTB and 28.7% were EPTB including, pleural (36%), meningeal (27%) and lymphatic (20%) cases. The male to female ratio in PTB and EPTB are 1.99 and 1.22 respectively. EPTB was more common at younger age (&lt;25 years). Tobacco addiction (10.9%), diabetes mellitus (4.03%), HIV positivity (12.1%) and history of contact with Tb patients (17.7%) were more likely to be associated with PTB. CONCLUSION:Increased awareness of the risk factors may facilitate early case nding and better management outcomes for these patients.

Fluorescein Diacetate Vital staining for detecting viability of acid-fast bacilli in sputum of pulmonary tuberculosis patients

ObjectiveTo compare the performance of the Fluorescein diacetate (FDA) vital staining method with Ziehl-Neelsen staining method in detecting the viability of acid-fast bacilli using MGIT culture as “reference standard”. MethodsThis was a single centre prospective observational study conducted from October 2015 to November 2016. Microbiologically confirmed ZN-Smear positive (3+) sputum specimens were obtained from 30 pulmonary tuberculosis patients taking anti-tuberculosis treatment at DOTS centre of NITRD, New Delhi. Patients were made available to collect the first baseline sputum sample before commencing treatment, and an early morning sputum sample was collected as per RNTCP guidelines. After starting treatment, sputum specimens were collected weekly in the first month and thereafter twice-weekly until 18th week. All sputum specimens from patients receiving anti-tuberculosis treatment were examined using Ziehl-Neelsen (ZN) smear microscopy, FDA vital staining, and MGIT culture. ResultOut of 360 follow up sputum specimens collected from 30 adult microbiologically confirmed ZN- Smear (3+) pulmonary tuberculosis patients, 146 were ZN-positive and 130 FDA-positive. Of 130 FDA-positive sputum samples, mycobacteria tuberculosis (MTB) growth was found in 116 sputum samples, of which 116 sputum specimens were positive for FDA. Additionally, 14 culture-negative specimens were FDA positive. No FDA-negative sputum samples were positive for MGIT culture. Among ZN positive specimens, FDA had 100% sensitivity and 85.3% specificity with an accuracy of 96.58% for the detection of viable mycobacteria. Among ZN negative sputum specimens, FDA had comparatively high specificity (95.7%). Using positive MGIT culture as a reference for viability, negative predictive value (NPV) and positive predictive value (PPV) from FDA vital staining method were found to be 100 and 89% respectively. ConclusionFDA staining is a simple and rapid tool for identifying viable MTB bacilli. Because of its excellent NPV and encouraging specificity, FDA staining is useful to identify patients with non-viable bacilli (FDA negative) among retreatment cases at diagnosis and patients on anti-tuberculosis treatment for both drug-sensitive and drug-resistant tuberculosis for follow up for the response of treatment.

Delay in diagnosis and treatment among registered TB patients in Directly Observed Treatment Short Course cum Designated Microscopy Centres in South Delhi

Background: Knowing delays in treatment seeking and subsequent treatment initiation among the TB patients is important and its detailed understanding is crucial in modifying the treatment seeking behaviour which can help in reducing the TB burden and the transmission in the community. Aim &amp; Objective: To study the treatment seeking behaviour including the delays in initiation of treatment along with its determinants; among tuberculosis patients aged &gt; 15 years in Mehrauli area of Delhi. Settings and Design: A longitudinal follow up study conducted in two randomly selected DMC cum DOTS centres in Mehrauli area of Delhi from January 2018 to April 2018. Methods and Material: Patients of both sexes of age &gt; 15 years, registered under RNTCP from January to April 2018 in the randomly selected DOTS centres i.e. Mehrauli DMC cum DOTS and Chattarpur DMC cum DOTS centre were included in the study. Self-designed, pretested interview schedule and records of DMC were used to collect the relevant information. Statistical analysis used: Information collected in the Performa was coded and entered in Statistical Package for Social Sciences (SPSS) version 12. Results: The mean patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 48.91 ± 130.38 days, 91.09 ± 155.97 days, 6.25 ± 6.29 days, 62.72 ± 119.48 days and 97.33 ± 155.06 days respectively. The median patients delay, diagnostic delay, treatment delay, health care system delay and total delay was 15 days, 45 days, 5 days, 35 days and 54 days respectively. Conclusions: The major reasons for patient’s delay were lack of awareness regarding the symptoms of TB and self-medication and for health care system delay it was treatment from private health care providers.

Electronic properties and quasi-zero-energy states of graphene quantum dots

In this paper, research has been carried out on the electronic properties of nanostructured graphene. We focus our attention on trapped states of the proposed systems such as spherical and toroidal graphene quantum dots (GQDs). Using a continuum model, by solving the Dirac-Weyl equation, and applying periodic boundary conditions of two types, i.e., either with zigzag edges only or with both armchair and zigzag edges, we obtain analytical results for energy levels yielding self-similar energy bands located subsequently one after another on the energy scale. Only for the toroidal quantum dot (owing to the lack of curvature) the distribution of electron density is like Bohr atomic orbitals. However, although the quasi-zero-energy band exists for both spherical and toroidal quantum dots, no electron density is present on this band for the toroidal quantum dot. This causes the formation of a pseudogap between the hole and electron bands because of the absence of the electron density at the quantum dot center, like in the case of an ordinary atom. Conversely, the confinement of the charge-carrier density is observed for both geometries of GQDs.

Detection of active mycobacterium tuberculosis at 6th month exit among declared successfully treated cases in Pakistan

ObjectivesTuberculosis (TB) is a significant public health concern, and the basis of successful anti-tuberculosis treatment (ATT) rests on the complete eradication of live bacilli from a patient. This study was conducted to detect the live TB bacilli in Lowenstein Jensen culture media among exit cases of TB who were declared successfully treated, either cured or treatment completed. MethodsThis cross-sectional study was conducted across Pakistan. Fifty-eight active TB DOTS centers were selected. The sample size of 3355 TB cases were equally distributed in all DOTS facilities. A detailed questionnaire was developed to record the information from TB DOTS and patients. After successful treatment, the sputum was taken from TB cases and examined to detect live bacilli on L-J culture. ResultsA total of 3355 TB cases were enrolled in the study. The male to female proportion was 1704(50.9%) and 1651(49.2%). Initially, 1993(59.4%) cases were cured, and 1362(40.6%) were declared as treatment completed cases. At exit, 324(9.65%) cases were again ZN smear-positive, and 328(9.77%) were positive on L-J culture, after being declared successfully treated for TB. ConclusionsTo eradicate live TB bacilli, all TB cases should be subjected to L-J culture at the end of ATT.