Impact of dietary counselling on the nutritional status and quality of life among pulmonary tuberculosis patients - A randomized control trial

BACKGROUND & AIM

Undernutrition and TB have a bidirectional relationship, which is especially relevant in the Indian context. Undernutrition is an established risk factor for the progression of latent TB infection to active TB. Undernutrition at the population level contributes to an estimated 55% of annual TB incidence in India. TB leads to weight loss, wasting, and worsening of nutritional status. Hence, the present study aimed to determine the impact of dietary counselling on the nutritional status and the health-related quality of life of PTB patients.

MATERIALS & METHOD

This was an interventional study (randomized controlled trial) that involved patients with PTB. 46 patients (23 patients as experimental and 23 patients as a control group) were enrolled in the study from June 2019 to February 2020 and they were divided into 2 categories based on BMI (underweight and normal weight). The special dietary counselling was given to the experimental group patients and the normal protocol was followed with the control group. The patients were followed up, till completion of treatment i.e., 6 months from enrolment.

RESULTS

In our study, nearly half of the patients were underweight and DM was the predominant comorbidity. The BMI increased after dietary counselling in the experimental group than the control group (P = 0.0053) in underweight individuals. Total protein (P = 0.0025), and serum albumin (P = 0.0048) levels were found to be significantly improved in the experimental group. SGRQ symptom score (P = 0.0036) has significantly reduced in the experimental group in underweight individuals than the control group.

CONCLUSION

Personalized dietary counselling was found to have a positive impact on BMI, total protein, and albumin levels in the experimental group, especially in underweight individuals. Besides, the quality of life measured using SGRQ showed that symptom score were also significantly reduced in the experimental group than the control group.

COVID-19 Pandemic-Frontline Experiences and Lessons Learned From a Tertiary Care Teaching Hospital at a Suburban Location of Southeastern India

The key challenges to any health care setup during emergency situations, such as that of the COVID-19 pandemic would be to rapidly address hospital preparedness and response tailored to the local population, societal influences, political factors within the existing infrastructure, and workforce. Second, to adopt and moderate policies, standard operating procedures (SOPs) and guidelines issued by national and international agencies, such as WHO, CDC, and the Indian Council for Medical Research (ICMR) were tailor-made to the local conditions of the hospital and community. In this publication, we have discussed the challenges and experiences in preparation and responses to the ongoing COVID-19 pandemic at a tertiary teaching hospital situated at a suburban locale in a small union territory. Puducherry is located in the South Eastern Coromandel Coast of India. The core processes, such as hospital preparedness, adoption, and amendments to SOPs based on dynamic changes in guidelines released by the central and local government, training given to health care workers, setting up the in-house diagnostic facility, surge capacity, management of supplies during the lockdown, infection prevention, and control and patient care are discussed. We have also reinforced our experiences in translating COVID-related opportunities for research and innovation in the form of awards and research proposals for the faculty and students of our institute. The lessons learned in terms of strength and limitations on the ground level of public health during this process is worth sharing as it would provide guidance in preparing the health care setups for pre- and post-pandemic.

Identifying and Addressing Factors Contributing to Pretreatment Loss to Follow-Up of Tuberculosis Patients Referred for Treatment from Medical Colleges in Pondicherry: An Implementation Research

Background:

In India, there is no feedback regarding 34% of tuberculosis (TB) patients diagnosed and referred from medical colleges for treatment to peripheral health institutions (PHIs).

Objectives:

The aim of this study is to measure the effectiveness of the new intervention package, developed based on qualitative study in reducing pretreatment loss to follow-up (PTLFU) of all TB patients diagnosed and referred for treatment from medical colleges to PHIs.

Materials and Methods:

An intervention was developed based on the findings of in depth-interviews conducted among different stakeholders such as TB patients who did/did not report, service providers working in four medical colleges in Pondicherry. Intervention consisting of phone calls, home visits, etc., was implemented for a period of 6 months. The baseline and endline proportion of TB patients for whom feedback received was determined from the available records (Revised National TB Control Program State Task Force Quarterly reports).

Results:

Patient's ignorance, lack of faith in healthcare system, side effects and social stigma, unpleasant experience in hospitals, poor accessibility to directly observed treatment, short-course centers, drugs shortage, poor coordination between program and hospital staff were the risk factors for PTLFU. At baseline, the proportions of feedback received about TB patients referred for treatment from medical colleges to PHIs was 46%. After the initiation of interventions, it increased to 61% and 66% in the first and second quarters of 2017, respectively.

Conclusion:

Risk factors for PTLFU were multi-factorial related to both patient and health system. Simple, feasible interventions such as phone calls and home visits to TB patients were effective in reducing PTLFU.

Health-related quality of life among tuberculosis patients under Revised National Tuberculosis Control Programme in rural and urban Puducherry

BACKGROUND

Globally, tuberculosis (TB) continues to be the major public health problem. Limited research is carried out on the impact of the disease on health-related quality of life (HR-QoL). The study aims to assess the HR-QoL among TB patients during and after Directly Observed Treatment Short-course (DOTS) therapy and to compare the HR-QoL of these patients with matched neighbourhood controls.

METHODOLOGY

A community-based longitudinal study was conducted in Ariyankuppam and Bahour communes of Puducherry from January 2014 to April 2015. 92 TB patients registered for DOTS therapy during January-June 2014 were interviewed in their DOTS centres during first visit using the SF-36 questionnaire to assess their HR-QoL. During the second visit, 9 TB patients were lost to follow-up; therefore, a total of 83 patients were interviewed in their houses and, simultaneously, 83 matched neighbourhood controls were interviewed. Non-parametric tests were used to compare the HR-QoL scores. p value <0.05 was considered as statistically significant.

RESULTS

The mean HR-QoL scores had improved among TB patients upon completion of DOTS (80.8±20.3), when compared to HR-QoL scores (48.3±30) during treatment with significant difference. The HR-QoL scores of TB patients after DOTS completion (80.8±20.3) had improved to levels comparable to that of non-TB controls (77.5±29.1) without significant difference.

CONCLUSION

HR-QoL of patients suffering from TB was low. However, the study provides evidence that DOTS treatment offers a demonstrable improvement of HR-QoL among TB patients almost to the level of general population. The findings can be used in advocating the effectiveness of DOTS in TB control efforts.

Smoking-induced satellite associations in a rural population of south India: An in vitro study

Background:

Genotoxic carcinogens in cigarette smoke interact with DNA, causing cytotoxicity. Cytogenetic damage therefore seems to be an excellent biomarker for determining the effect of exposure to chromosome-damaging agents in cigarette smoke.

Purpose:

To study the utility of measurement of frequency of satellite associations (SA) as a biomarker for chromosomal damage using cytogenetic assay in peripheral blood lymphocytes.

Materials and Methods:

This study was conducted on 30 smokers and 30 nonsmokers drawn from a rural population of South India. Smokers were divided into three groups of ten each based on their smoking index (SI) (group I: SI < 150, group II: SI 150–300, and group III: SI > 300) and the frequency of SAs was studied.

Results:

The frequency of SAs was significantly greater in smokers than in nonsmokers and the frequency of SAs among the smokers was also seen to increase with increase in SI.

Conclusion:

The results of this study indicate that the genotoxic effect of cigarette smoke on chromosomes increases with smoking intensity. These findings can be used to support smoking cessation interventions.