ExpHBA Deep-IoT: Exponential Honey Badger Optimized Deep Learning For Breast Cancer Detection in IoT Healthcare System

Breast cancer (BC) is the most widely found disease among women in the world. The early detection of BC can frequently lessen the mortality rate as well as progress the probability of providing proper treatment. Hence, this paper focuses on devising the Exponential Honey Badger Optimization-based Deep Covolutional Neural Network (EHBO-based DCNN) for early identification of BC in the Internet of Things (IoT). Here, the Honey Badger Optimization (HBO) and Exponential Weighted Moving Average (EWMA) algorithms have been combined to create the EHBO. The EHBO is created to transfer the acquired medical data to the base station (BS) by choosing the best cluster heads to categorize the BC. Then, the statistical and texture features are extracted. Further, data augmentation is performed. Finally, the BC classification is done by DCNN. Thus, the observational outcome reveals that the EHBO-based DCNN algorithm attained outstanding performance concerning the testing accuracy, sensitivity, and specificity of 0.9051, 0.8971, and 0.9029, correspondingly. The accuracy of the proposed method is 7.23%, 6.62%, 5.39%, and 3.45% higher than the methods, such as multi-layer perceptron (MLP) classifier, deep learning, support vector machine (SVM), and ensemble-based classifier.

Smart IoT in Breast Cancer Detection Using Optimal Deep Learning

IoT in healthcare systems is currently a viable option for providing higher-quality medical care for contemporary e-healthcare. Using an Internet of Things (IoT)-based smart healthcare system, a trustworthy breast cancer classification method called Feedback Artificial Crow Search (FACS)-based Shepherd Convolutional Neural Network (ShCNN) is developed in this research. To choose the best routes, the secure routing operation is first carried out using the recommended FACS while taking fitness measures such as distance, energy, link quality, and latency into account. Then, by merging the Crow Search Algorithm (CSA) and Feedback Artificial Tree, the produced FACS is put into practice (FAT). After the completion of routing phase, the breast cancer categorization process is started at the base station. The feature extraction step is then introduced to the pre-processed input mammography image. As a result, it is possible to successfully get features including area, mean, variance, energy, contrast, correlation, skewness, homogeneity, Gray Level Co-occurrence Matrix (GLCM), and Local Gabor Binary Pattern (LGBP). The quality of the image is next enhanced through data augmentation, and finally, the developed FACS algorithm's ShCNN is used to classify breast cancer. The performance of FACS-based ShCNN is examined using six metrics, including energy, delay, accuracy, sensitivity, specificity, and True Positive Rate (TPR), with the maximum energy of 0.562 J, the least delay of 0.452 s, the highest accuracy of 91.56%, the higher sensitivity of 96.10%, the highest specificity of 91.80%, and the maximum TPR of 99.45%.

FWLICM-Deep Learning: Fuzzy Weighted Local Information C-Means Clustering-Based Lung Lobe Segmentation with Deep Learning for COVID-19 Detection

Coronavirus (COVID-19) creates an extensive range of respiratory contagions, and it is a kind of ribonucleic acid (RNA) virus, which affects both animals and humans. Moreover, COVID-19 is a new disease, which produces contamination in upper respiration alterritory and lungs. The new COVID is a rapidly spreading pathogen globally, and it threatens billions of humans' lives. However, it is significant to identify positive cases in order to avoid the spread of plague and to speedily treat infected patients. Hence, in this paper, the WSCA-based RMDL approach is devised for COVID-19 prediction by means of chest X-ray images. Moreover, Fuzzy Weighted Local Information C-Means (FWLICM) approach is devised in order to segment lung lobes. The developed FWLICM method is designed by modifying the Fuzzy Local Information C-Means (FLICM) technique. Additionally, random multimodel deep learning (RMDL) classifier is utilized for the COVID-19 prediction process. The new optimization approach, named water sine cosine algorithm (WSCA), is devised in order to obtain an effective prediction. The developed WSCA is newly designed by incorporating sine cosine algorithm (SCA) and water cycle algorithm (WCA). The developed WSCA-driven RMDL approach outperforms other COVID-19 prediction techniques with regard to accuracy, specificity, sensitivity, and dice score of 92.41%, 93.55%, 92.14%, and 90.02%.

MVPO Predictor: Deep Learning-Based Tumor Classification and Survival Prediction of Brain Tumor Patients with MRI Using Multi-Verse Political Optimizer

Brain tumor is a severe nervous disorder that causes damage to health and often leads to death. Therefore, it is significant to classify the brain tumor at an early stage as it increases the survival rate of patients. One of the commonly employed imaging modalities for brain tumor classification is Magnetic Resonance Imaging (MRI). However, it is relatively complex to perform the brain tumor classification process due to the variations of type, shape, size and tumor location. To overcome such issues and classify the tumor more accurately, a deep learning classifier named Deep Maxout network is developed to classify the tumor into different grades. Based on the classification result, the features connected with the tumor grades are effectively acquired to make the survival prediction process. Deep learning is an effective and robust classifier model employed to perform the tumor classification or detection process with the MRI modality. Here, the survival prediction of tumor patients is carried out by the Deep Long Short-Term Memory (LSTM) classifier. Accordingly, the proposed method achieved higher performance using accuracy, sensitivity, specificity and prediction error with the values of 0.9434, 0.9324, 0.9202 and 0.0579.

Computer-Aided Diagnosis System for Alzheimer's Disease Using Positron Emission Tomography Images

Alzheimer's disease (AD) is a kind of neurological brain disease. It is an irretrievable, neurodegenerative brain disorder. There are no pills or drugs to cure AD. Therefore, an early diagnosis may help the physician to make accurate analysis and to provide better treatment. With the advent of computational intelligence techniques, machine learning models have made tremendous progress in brain images analysis using MRI, SPECT and PEI. However, accurate analysis of brain scans is an extremely challenging task. The main focus of this paper is to design a Computer Aided Diagnosis (CAD) system using Long-Term Short Memory (LSTM) to improve classification rate and determine suitable attributes that can differentiate AD from Healthy Control (HC) subjects. First, 3D PET images are preprocessed, converted into many groups of 2D images and then grouped into many subsets at certain interval. Subsequently, different features including first order statistical, Gray Level Co-occurrence Matrix and wavelet energy of all sub-bands are extracted from each group, combined and taken as feature vectors. LSTM is designed and employed for classifying PET brain images into HC and AD subjects based on the feature vectors. Finally, the developed system is validated on 18FDG-PET images collected from 188 subjects including 105 HC and 83 AD subjects from ADNI database. Efficacy of the developed CAD system is analyzed using different features. Numerical results revealed that the developed CAD system yields classification accuracy of 98.9% when using combined features, showing outstanding performance.

Evaluation of diuretic efficacy and antiurolithiatic potential of ethanolic leaf extract of Annona squamosa Linn. in experimental animal models

OBJECTIVE:

The study is to investigate the diuretic and antiurolithiatic activities of ethanolic leaf extract of Annona squamosa Linn. in experimental animals.

MATERIALS AND METHODS:

For both studies, Wistar albino rats and two doses of extract (250 and 500 mg/kg) were used. Diuretic activity was evaluated by Lipschitz model. Urine volume and urine pH were noted, the concentration of sodium and potassium was estimated by flame photometry, and diuretic index, natriuretic index, and Lipschitz values were calculated from the results. Furosemide was used as a positive control. Ethylene glycol-induced urolithiasis model was used for antiurolithiatic study. Urine volume, urine pH, body weight, and biochemical parameters such as calcium, urea, uric acid, and creatine both from serum and urine were estimated. Antioxidant parameters and histopathological analysis of the kidney were evaluated. Cystone was used as a positive control in this study. Results were expressed as mean ± standard error of mean. Statistical analysis was carried out using one-way analysis of variance, followed by Dunnett's multiple comparison tests.

RESULTS:

In both diuretic and antiurolithiatic studies, both doses of the extract showed efficacy, and the dose of 500 mg/kg has shown a significant effect compared to positive control and negative control.

CONCLUSION:

The dose of 500 mg/kg showed a promising diuretic and antiurolithiatic activity.

Bioactive potential analysis of brown seaweed Sargassum wightii using UV-VIS and FT-IR

The current study was investigated to explore the biogenic molecules of Sargassum wightii collected from the south east of Tamil Nadu, India. The biogenic molecules extracted from Sargassum wightii by using methanol as a solvent and the analysis was carried out by using UV-Visible spectroscopy and FT-IR. The UV-Visible spectrum of the methanolic extract of Sargassum wightii exposed the existence of the biogenic molecules separated from 200 - 1100 nm among the absorption. The incidence of peaks from 234-676 nm discovered the presence of flavonoids and its derivatives. The unprocessed methanolic extract of Sargassum wightii was travelled in to FT-IR and it indicated the being of phenols and flavonoids their functional groups such as alcohol, alkane, carboxylic acids, esters, ethers, alkynes and aromatics. From the results, the future aim of this study is necessary to develop the target site to treat dreadful diseases. Keywords: Sargassum Wightii, FT-IR, UV-Visible Spectroscopy, Phytochemical analysis.

Prevalence of Risk Factors of Diabetes Among Urban Poor South Indian Population

OBJECTIVE

The objective of the study was to assess the prevalence of risk factors of diabetes among urban poor population in Chennai, Tamil Nadu, South India.

STUDY AND METHODS

A cross-sectional study was conducted from Dec-2010 to Feb-2011 in Chennai city. Five hundred twenty-nine subjects aged above 18 years (409 women and 120 men) habitants of three slums were randomly selected. A structured questionnaire was used to collect the socio-demographic and clinical information. Anthropometric measures, blood pressure and random blood glucose (RCBG) estimation were done. Dietary intake was assessed using 24-hour diet recall and duration of physical activity/day in all components was recorded.

RESULTS

The mean age and BMI of the study population was 45.4±12.8 years and 25.8±4.9 kg/m2 respectively. About 20.4% were illiterate and 34.8% were either unemployed, retired or housewives. Median family income per month was 3000 INR. Prevalence of obesity (≥25 kg/m2) was 57.3% and central obesity (≥90 cms in male and ≥80 cms in female) was 75.7%. The median duration spent in walking, standing and sitting were 30, 120, and 240 minutes/day respectively. There was a gross inadequacy in vegetable intake. The prevalence of self-reported diabetes and hypertension was 20.8% and 24.2%, respectively. Among the subjects without a previous diagnosis of diabetes, 12.5% had RCBG ≥140 mgs. 10.6% were diagnosed with hypertension.

CONCLUSIONS

Sedentarism coupled with unhealthy diet pattern are the major contributing factors for the higher prevalence of diabetes and hypertension in urban poor population.

Effect of diabetes on treatment outcome of smear-positive pulmonary tuberculosis--a report from South India

AIM

To assess the effect of diabetes on tuberculosis (TB) treatment outcome and sputum conversion among new smear-positive (NSP) cases registered under Directly Observed Treatment Short Course in South India.

METHODS

Details on sputum conversion and TB treatment outcome were collected from case records of NSP cases (N = 332; M/F 247:85) registered at TB units of three districts in Tamil Nadu. Subjects were screened for diabetes and categorized as diabetic (TBDM) (n = 96; 73:23) and non-diabetic (TBnonDM) (n = 149; 109:40).

RESULTS

Among 245 selected TB patients, 93.5% were cured, 1.6% completed TB treatment, 2% had TB treatment failure (TF), and 0.4% had treatment default (TD), 0.4% with MDR-TB and 2% death rate. At the end of intensive phase of TB treatment, 14.7% remained sputum positive in the TBDM group, whereas it was 3.5% in the TBnonDM group. Mean duration (days) for sputum conversion was higher in the TBDM group (64.2 ± 10.5) compared to the TBnonDM group (61.5 ± 7.5) (p<0.001). TF rate was higher (4.2% vs 0.7%) and MDR-TB (1%) was also seen in the TBDM group. No death and TD were seen among DM whereas it was 3.4 and 0.7% in TBnonDM.

CONCLUSIONS

Delayed sputum conversion and high TB treatment failure rates were common in NSP cases with diabetes.

Synthesis and characterization of surface-enhanced Raman-scattered gold nanoparticles

In this paper, we report a simple, rapid, and robust method to synthesize surface-enhanced Raman-scattered gold nanoparticles (GNPs) based on green chemistry. Vitis vinifera L. extract was used to synthesize noncytotoxic Raman-active GNPs. These GNPs were characterized by ultraviolet-visible spectroscopy, dynamic light-scattering, Fourier-transform infrared (FTIR), transmission electron microscopy (TEM), X-ray diffraction (XRD), and Raman spectroscopy. The characteristic surface plasmon-resonance band at ~ 528 nm is indicative of spherical particles, and this was confirmed by TEM. The N-H and C-O stretches in FTIR spectroscopy indicated the presence of protein molecules. The predominant XRD plane at (111) and (200) indicated the crystalline nature and purity of GNPs. GNPs were stable in the buffers used for biological studies, and exhibited no cytotoxicity in noncancerous MIO-M1 (Müller glial) and MDA-MB-453 (breast cancer) cell lines. The GNPs exhibited Raman spectral peaks at 570, 788, and 1,102 cm(-1). These new GNPs have potential applications in cancer diagnosis, therapy, and ultrasensitive biomarker detection.

Polysaccharide nanofibrous scaffolds as a model for in vitro skin tissue regeneration

Tissue engineering and nanotechnology have advanced a general strategy combining the cellular elements of living tissue with sophisticated functional biocomposites to produce living structures of sufficient size and function at a low cost for clinical relevance. Xylan, a natural polysaccharide was electrospun along with polyvinyl alcohol (PVA) to produce Xylan/PVA nanofibers for skin tissue engineering. The Xylan/PVA glutaraldehyde (Glu) vapor cross-linked nanofibers were characterized by SEM, FT-IR, tensile testing and water contact angle measurements to analyze the morphology, functional groups, mechanical properties and wettability of the fibers for skin tissue regeneration. The cell-biomaterial interactions were studied by culturing human foreskin fibroblasts on Xylan/PVA Glu vapor cross-linked and Xylan/PVA/Glu blend nanofibrous scaffolds. The observed results showed that the mechanical properties (72 %) and fibroblast proliferation significantly increased up to 23 % (P < 0.05) in 48 h Glu vapor cross-linked nanofibers compared to 24 h Glu vapor cross-linked Xylan/PVA nanofibers. The present study may prove that the natural biodegradable Xylan/PVA nanofibrous scaffolds have good potential for fibroblast adhesion, proliferation and cell matrix interactions relevant for skin tissue regeneration.

Spectroscopic characterization of alkali modified zinc-tellurite glasses doped with neodymium

Neodymium doped zinc-tellurite glasses of composition TeO(2)-ZnO-Na(2)O-Li(2)O have been prepared and characterized for their thermal, structural and optical properties. Differential thermal analysis revealed reasonably good forming tendency of the glass composition. FTIR spectra were used to analyze the functional groups present in the glass. Judd-Ofelt intensity parameters were derived from the absorption spectrum and used to calculate the radiative lifetime, branching ratio and stimulated emission cross-section for (4)F(3/2)-->(4)I(9/2, 11/2, 13/2) transitions. The quantum efficiency of the (4)F(3/2) level is comparable to the typical values obtained for the Nd(2)O(3)-doped glasses. The decay properties for higher concentration of Nd(2)O(3) were analyzed using Inokuti-Hirayama model to investigate the non-radiative relaxation of the (4)F(3/2) emitting level. The experimental values of branching ratio and saturation intensity of (4)F(3/2)-->(4)I(11/2) transition and calculated spectroscopic quality factor indicate the favourable lasing action in these glasses.

India’s Revised National Tuberculosis Control Programme (RNTCP)

Tuberculosis (TB) remains the leading cause of death in India, which bears nearly 20 per cent of the global burden. In 1992, a review of the TB control programme identified frequent shortages of drugs and inadequate staff and budget as some of the reasons for poor case detection and treatment completion rates. Since 1993, India has revised the programme with the assistance from the World Bank, the World Health Organisation (WHO) and bilateral donors. This article makes an attempt to review the relationship between the TB control experience and external aid for TB control over a period in India. Expenditures by the Revised National Tuberculosis Control Programme (RNTCP) had increased considerably from US$ 36 million in 2002 to US$ 67 million in 2008 and according to the WHO, in Global TB Control Report for 2008 there were no funding gaps reported for TB control since year 2002. More funding came from grants and a World Bank loan. By March 2006, 100 per cent of the population had been covered under RNTCP. Since the inception of RNTCP more than 8 million patients have been initiated on treatment with the treatment success rate of 86 per cent. This suggests that having a committed programme with good funding has helped in improving the performance of the TB control programme.

On the efficient compression of FMRI data series of brain

Four dimensional medical images, namely fMRI, require a large volume of memory to store the data. Compression techniques are therefore used for the storage and transmission of these medical images. This paper proposes a coding scheme for volumetric images which in the first stage recognizes significant images and in the second stage compresses those images using a JPEG-LS coding scheme. An example implementation for 4D fMRI data series of brain stored in ANALYZE file format is illustrated in this paper. The proposed scheme provides efficient compression for 4D fMRI medical images.

Degradation of Pesticide by Photocatalytic Ozonation Process and Study of Synergistic Effect by Comparison with Photocatalysis and UV/Ozonation Processes

Synergistic effect of TiO

A Comparison of Costs to Patients with Tuberculosis Treated in a DOTS Programme with Those in a Non-DOTS Programme in South India

Tuberculosis is a curable disease, yet it is the largest single infectious cause of death among adults in the world. India accounts for one-third of the global TB burden. Its economic burden in India is enormous as it perpetuates and exacerbates poverty. The revised national Tuberculosis Control Programme (the DOTS Strategy) is currently being implemented in India. The purpose of this study was to compare the costs to tuberculosis patients treated in a DOTS Programme with the costs to patients treated in a non-DOTS Programme in south India.

Patients registered between June and December 2000 (455 in DOTS area, 441 in non-DOTS area) in Tiruvallur district were interviewed, collecting information on demographics, socio-economic characteristics of patients, expenditure incurred due to illness, and effect of illness on employment.

Results showed that in the DOTS area, treatment success rate was higher, patient costs were less, and patients returned to work early. These findings establish the economic benefits to patients treated under DOTS and lend support to rapid expansion of the programme, particularly in low-income countries.

Evaluation of post-treatment health-related quality of life (HRQoL) among tuberculosis patients

BACKGROUND

Health-related quality of life (HRQoL) measures the impact of a disease by assessing the health status of patients.

OBJECTIVE

To assess the HRQoL of tuberculosis (TB) patients one year after treatment completion.

METHODS

Patients registered under the TB control programme from July 2002 to June 2003 in a TB Unit in south India were interviewed one year after successful completion of treatment. Data on HRQoL were collected using the SF-36 questionnaire, which covers physical, mental and social well-being components. Data on economic well-being were also collected. Scores were given for all domains.

RESULT

Of 436 TB patients interviewed, the mean scores for social, physical, mental and economic well-being were respectively 84, 74, 68 and 62 on a scale of 100. The well-being scores were significantly related to age, sex, education, employment and persistent symptoms. There was a significant association between economic and social well-being.

CONCLUSION

This study suggests that the HRQoL of TB patients one year after successful completion of treatment under the TB control programme was normal for most of the domains studied and was associated with age, literacy and employment, income, smoking, alcoholism and persistence of symptoms.

A rural public-private partnership model in tuberculosis control in south India

SETTING

A rural tuberculosis (TB) unit in South India, 2001-2003.

OBJECTIVE

To evaluate a rural public-private partnership model (PPPM) within the TB control programme (RNTCP).

DESIGN

All of the private practitioners trained in modern medicine (PPs, n = 52) and the private laboratories (PLs, n = 13) in the area were listed. The PPs underwent training about the RNTCP, and PL staff were trained in sputum microscopy. PPPM included referral of TB suspects to the smear microscopy centres (government or PLs) for diagnosis and treatment of patients as per RNTCP guidelines. Patients were back-referred to the PPs. The directly observed treatment providers and centres were chosen by the PPs in consultation with their patients. The case detection rate, cure rate and profile of patients referred by the PPs were compared with those of self-reported patients.

RESULTS

Of 489 TB suspects referred by the PPs, 24% were smear-positive compared to 10% of 15 278 self-reported patients (P < 0.001). Of 319 referred to PLs, 7% were smear-positive. The annual average case detection rate increased from 66 to 75 per 100 000 population. The cure rates of patients referred by the PPs were comparable to those of self-reported patients.

CONCLUSIONS

This rural PPPM is effective and does not require additional staff or any direct financial incentives.

Initial drug susceptibility profile of M. tuberculosis among patients under TB programme in South India

SETTING

Pulmonary tuberculosis (PTB) patients enrolled for treatment at government health facilities in a sub-district of Thiruvallur district, Tamil Nadu, India.

OBJECTIVES

To determine the drug susceptibility profile among PTB patients admitted to treatment according to the Revised National Tuberculosis Control Programme (RNTCP).

METHODOLOGY

From May 1999 to December 2003, two additional sputum samples were collected from all patients at the start of anti-tuberculosis treatment under DOTS and were transported to a central laboratory for Mycobacterium tuberculosis culture and drug susceptibility testing (DST).

RESULTS

DST results were available for 1603 new sputum smear-positive patients; 85% of patients had organisms fully susceptible to streptomycin (S), isoniazid (H) and rifampicin (R), 10.4% any resistance to H and 1.7% to HR. Of 443 patients with history of previous anti-tuberculosis treatment, 59% had organisms susceptible to S, H and R, 37% had any resistance to H and 11.7% to HR.

CONCLUSION

The DST profile showed that the vast majority of patients have drug-susceptible organisms, and that currently recommended regimens under the RNTCP would be effective in the treatment of TB.

Perceptions of tuberculosis patients about their physical, mental and social well-being: a field report from south India

Tuberculosis (TB) often leaves its impact physically, socially and mentally on patients. The goal of current tuberculosis services is microbiological cure of tuberculosis. Understanding patients' perceptions about TB will enable better design of a client-oriented comprehensive programme for tuberculosis. We interviewed patients registered for treatment during July-December 2000 in government health facilities of two tuberculosis units of south India. Data on perceptions of their illness before the onset of illness and during the treatment period were collected, using a modified SF36 questionnaire. Health status was measured for the following: physical functioning, social role limitations due to physical and emotional problems (stigma), mental health, energy vitality, pain and general health perceptions. Of 980 patients registered, 610 (206 females) cured or treatment completed patients were interviewed at two time points. The reaction of patients to the disclosure of the diagnosis was worry (50%) and suicidal thoughts (9%). 'Good health status' was perceived initially in less than 7% of patients, and compared to the status at the onset of illness, there was significant improvement after treatment (more than 78% trend chi square p<0.05). Despite microbiological cure, 47% of patients continued to have respiratory symptoms; this was significantly higher among patients who had delayed taking action for more than 3 months. Only 54% of patients perceived 'happy mental status' at the end of treatment, and there was no change in social stigma in both men and women. Tuberculosis control programmes should address issues such as continued respiratory symptoms, persistence of stigma, and poor emotional quality of life of patients with tuberculosis, even after they are cured. As well, providing social support for the needy, timely counseling and health education of patients, which will alleviate mental and social sufferings of patients, should be considered.

Gender disparities in tuberculosis: report from a rural DOTS programme in south India

SETTING

Tiruvallur District, south India.

OBJECTIVES

To examine gender differences in tuberculosis among adults aged >14 years with respect to infection and disease prevalence, health care service access, care seeking behaviour, diagnostic delay, convenience of directly observed treatment (DOT), stigma and treatment adherence.

METHODS

Data were collected from 1) community survey, 2) self-referred out-patients seeking care at governmental primary health institutions (PHIs), 3) tuberculosis suspects referred for sputum microscopy at PHIs, and 4) tuberculosis patients notified under DOTS. Community survey results were compared with those for patients notified at PHIs.

RESULTS

In the community, 66% of males and 57% of females had tuberculosis infection. The prevalence of smear-positive tuberculosis was 568 and 87/100,000, respectively, among males and females. Fewer males than females attended PHIs (68 men for every 100 women). Females constituted 13% of all smear-positive patients detected in the community survey, and 20% of those detected at PHIs (P < 0.05). The probability of notification decreased significantly with age among both males and females. Significantly more females than males felt inhibited discussing their illness with family (21% vs. 14%) and needed to be accompanied for DOT (11% vs. 6%). Males had twice the risk of treatment default than females (19% vs. 8%; P < 0.01).

CONCLUSIONS

Despite facing greater stigma and inconvenience, women were more likely than men to access health services, be notified under DOTS and adhere to treatment. Men and elderly patients need additional support to access diagnostic and DOT services.

Are community surveys to detect tuberculosis in high prevalence areas useful? Results of a comparative study from Tiruvallur District, South India

BACKGROUND

In Tiruvallur District, South India, tuberculosis cases are detected at health facilities (HF) as part of a DOTS programme, and by screening adults through community survey (CS) as part of ongoing epidemiological research.

OBJECTIVE

To compare socio-demographic, clinical and bacteriological characteristics and treatment outcomes of all patients detected at HF with those of all patients detected by CS during a 12-month period.

RESULTS

Of 32,663 adults surveyed, 100 had smear-positive and 116 had smear-negative tuberculosis; of 65 smear-positive patients who began treatment, 44 were cured. Compared to HF patients, CS patients were significantly more likely to be older (AOR = 1.9), male (AOR = 2.7), non-literate (AOR = 1.7), and living in poor quality housing (AOR = 2.0), and were less likely to have cough >3 weeks (AOR = 3.4) or smear-positive tuberculosis (AOR = 4.2). Of 61 new smear-positive CS patients, 40 reported chest symptoms; of these, 32 (80%) had already consulted a health-care provider, but remained undiagnosed.

CONCLUSIONS

The community survey was of little value in tuberculosis case detection even in this high-prevalence setting. Patients identified by the survey were less symptomatic and less infectious, and less than half were cured. Diagnostic services should be made more accessible to the elderly, the non-literate and men.

Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India

OBJECTIVES

To investigate the factors associated with delay in 1) care-seeking (patient delay), and 2) diagnosis by health providers (health system delay), among smear-positive tuberculosis patients, before large-scale DOTS implementation in South India.

METHODS

New smear-positive patients were interviewed using a structured questionnaire.

RESULTS

Among 531 participants, the median patient, health system and total delays were 20, 23 and 60 days, respectively. Twenty-nine per cent of patients delayed seeking care for > 1 month, of whom 40% attributed the delay to their lack of awareness about TB. Men postponed seeking care for longer periods than women (P = 0.07). In multivariate analysis, the patient delay was greater if the patient had initially consulted a government provider (adjusted odds ratio [AOR] 2.2, P < or = 0.001), resided at a distance >2 km from a health facility (AOR 1.6, P = 0.04), and was an alcoholic (AOR 1.6, P = 0.04). Health system delay was >7 days among 69% of patients. Factors associated with health system delay were: first consultation with a private provider (AOR 4.0, P < 0.001), a shorter duration of cough (AOR 2.6, P = 0.001), alcoholism (P = 0.04) and patient's residence >2 km from a health facility (AOR 1.8, P = 0.02). The total delay resulted largely from a long patient delay when government providers were consulted first, and a long health system delay when private providers were consulted first.

CONCLUSION

Public awareness about chest symptoms and the availability of free diagnostic services should be increased. Government and private physicians should be educated to be aware about the possibility of tuberculosis when examining out-patients. Effective referrals for smear microscopy should be developed between private and public providers.

Private pharmacies in tuberculosis control--a neglected link

In most settings in India, private pharmacies dispense prescriptions for anti-tuberculosis drugs made out by private practitioners. In a cross-sectional study, we assessed the dispensing practices for tuberculosis and knowledge about the national tuberculosis programme of 300 pharmacies. In all, 2800 prescriptions were dispensed monthly by the pharmacies. Doctors' prescriptions were for durations of several months, but half of the patients bought drugs one dose at a time for self-administration. This practice might promote drug resistance. Although 95% of pharmacists were not aware of the existence of the tuberculosis programme, the majority (97%) were willing to learn and contribute towards tuberculosis control. The need and the potential of private pharmacies for participation in tuberculosis control are highlighted.

Serial evaluation of serum neopterin in HIV seronegative patients treated for tuberculosis

OBJECTIVE

To delineate the course of serum neopterin (s-neo) concentrations in patients with pulmonary tuberculosis who are on anti-tuberculosis therapy.

DESIGN

S-neo concentrations were measured by high performance liquid chromatography (HPLC) in 39 patients treated for pulmonary tuberculosis at pretreatment, at one month and at end of treatment. It was also measured in 11 relapse cases and their matched controls at the above time points and at the time of relapse. The results were correlated with bacteriological and radiological findings.

RESULTS

All patients had elevated levels of s-neo at pretreatment which had declined at 1 month and were near normal at the end of treatment. The decline was more significant in patients with moderate lesions, suggesting that immune activation is maximum in this group of patients. The mean decrease was 37% at one month and 66% at the end of treatment. The corresponding decreases were 11% and 56% in patients with limited lesions and 11% and 45% in those with extensive lesions. It continued to fall after completion of therapy in patients who did not relapse, whereas an increase after completion of therapy was associated with bacteriologically proven relapse.

CONCLUSIONS

The measurement of s-neo concentration could be of help in evaluating response to therapy. This study provides a rational basis for the association between s-neo concentration and relapse.

Socio-economic impact of tuberculosis on patients and family in India

OBJECTIVE

To quantify the socio-economic impact of tuberculosis on patients and their families from the costs incurred by patients in rural and urban areas.

DESIGN

An interview schedule prepared from 17 focus group discussions was used to collect socio-economic demographic characteristics, employment, income particulars, expenditure on illness and effects on children from newly detected sputum-positive pulmonary tuberculosis patients. The direct and indirect costs included money spent on diagnosis, drugs, investigations, travel and loss of wages. Total costs were projected for the entire 6 months of treatment.

RESULTS

The study population consisted of 304 patients (government health care 202, non governmental organisation 77, private practitioner 25), 120 of whom were females. Mean direct cost was Rs.2052/-, indirect Rs.3934/-, and total cost was Rs.5986/- ($171 US). The mean number of work days lost was 83 and mean debts totalled Rs.2079/-. Both rural and urban female patients faced rejection by their families (15%). Eleven per cent of schoolchildren discontinued their studies; an additional 8% took up employment to support their family.

CONCLUSIONS

The total costs, and particularly indirect costs due to TB, were relatively high. The average period of loss of wages was 3 months. Care giving activities of female patients decreased significantly, and a fifth of schoolchildren discontinued their studies.

Study of the feasibility of involving male student volunteers in case holding in an urban tuberculosis programme

This paper reports the feasibility of involving unpaid National Service Scheme (NSS) male student volunteers in a city-based tuberculosis (TB) programme in supplying drugs and retrieving non-complaint TB patients. Twenty-five students were selected after assessing their attitude and were trained on TB drug delivery, home visits and motivation of non-compliant patients. Twenty-three sputum positive patients identified in a medical camp were started on an 8-month short-course chemotherapy regimen. Students supplied the drugs on a weekly basis and defaulters were visited. The treatment completion rate was 83% and defaulter retrieval was 57%. All patients had sputum smear conversion by 2 months and one relapsed during the 24-month follow-up.

Late onset paraplegia--a sequela to Pott's disease. A report on imaging, prevention and management

Late onset paraplegia is a neurological complication that develops after a variable period in a patient with healed tuberculous disease of the vertebrae. In this retrospective analysis clinical features, imaging in diagnosis and treatment of this condition are described among 5 cases seen over a period of 5 years. This complication occurred even after successful treatment of initial spinal lesions with rifampicin-containing regimens. Magnetic resonance imaging was useful in pinpointing the exact pathology; one case had syrinx and two cases had marked internal gibbus with cord atrophy. Of the two cases who accepted surgical treatment, one improved.

Short-course chemotherapy in the treatment of Pott's paraplegia: report on five year follow-up

OBJECTIVE

To assess the efficacy of 9-month short-course chemotherapy (SCC) and to study the pattern of neurological recovery in patients with Pott's paraplegia.

DESIGN

Patients with recent onset of spastic paraplegia due to clinically and radiologically active spinal tuberculosis involving vertebral bodies of level D4-L1 were treated with streptomycin, rifampicin, isoniazid and ethambutol daily for the first 2 months, followed by rifampicin plus isoniazid twice weekly for the next 7 months. The study was conducted in 2 phases. In the first phase 10 patients were admitted to the open trial where all patients had undergone modified Hong Kong surgery in addition to chemotherapy. In the next phase 23 patients enrolled in the study were randomly allocated to receive either chemotherapy alone or surgery plus chemotherapy. All the patients were followed for 5 years from the start of treatment. A scoring system was devised to predict neurological recovery.

RESULTS

In all, 33 patients were admitted and treated with SCC. Thirteen patients were allocated to the chemotherapy (CHEM) regimen; of these 3 patients had to be operated upon for clinical deterioration; the remaining 20 had surgery plus chemotherapy; 4 were excluded for various reasons, leaving 29 patients in the analysis. None relapsed requiring treatment.

CONCLUSION

A combination of surgery (when indicated) and SCC of 9 months' duration is effective in the treatment of Pott's paraplegia. All patients had neurological recovery by the end of 9 months; 8 recovered with chemotherapy alone. Complete motor recovery was seen in 62% by the 3rd month and 90% by the 6th month.

A controlled clinical trial of short-course chemotherapy for tuberculoma of the brain

OBJECTIVE

The efficacy of a short-course regimen in the treatment of brain tuberculoma and computerised tomography (CT) scan appearance before, during and after antituberculosis treatment was studied in a controlled clinical trial.

DESIGN

Patients aged over 5 years with tuberculoma of the brain diagnosed by CT scan were randomly allocated to one of the following 2 regimens: Regimen 1: rifampicin, isoniazid and pyrazinamide daily for an initial 3 months followed by rifampicin and isoniazid twice-weekly for 6 months. Regimen 2: rifampicin, isoniazid and pyrazinamide thrice-weekly for an initial 3 months followed by rifampicin and isoniazid twice-weekly for 6 months. The patients were followed intensively for 2 years from the start of treatment.

RESULTS

Of the 108 patients analysed (regimen 1: 56, regimen 2: 52), at the end of treatment clinical status was normal in 91% in regimen 1 and 88% in regimen 2. Of the 91 patients with scan assessments, CT scan lesions disappeared at 24 months in 77% of 47 patients in regimen 1 and 80% of 44 in regimen 2, and in both groups 88% of the patients were clinically normal. None had relapses requiring treatment.

CONCLUSIONS

Short-course regimens of 9 months' duration are effective in the treatment of tuberculoma of the brain; clinical recovery was faster than scan clearance.

Pharmacokinetics of methotrexate in adult Indian patients and its relationship to nutritional status

Since anticancer drugs have a low therapeutic index, any significant change in the pharmacokinetics of a drug would have a bearing on therapeutic efficacy and drug toxicity. Nutritional deficiencies have been shown to affect the four processes of pharmacokinetics, ie, absorption, distribution, biotransformation, and excretion. Malnutrition and undernutrition are widely prevalent in India and thus it was thought to be of practical importance to study the effect of initial nutritional status on the overall kinetics of methotrexate, a widely used anticancer drug. The results of the study reveal that relative weight correlates well with the anthropometric parameters, nutritional parameters, and dietary intake and may be used as a marker of nutritional status. When grouped on the basis of relative weights, the undernourished patients revealed a significant (P less than 0.01) prolongation of biological half-life and a significant (P less than 0.001) reduction in clearance. Based on these results, relative weight has been proposed as a basis for drug dosage determinations in place of the existing practice of administering antineoplastic drugs on the basis of body surface area or body weight alone.