Martensennedergaard2301

BACKGROUND Tuberculosis burden is still high and smoking prevalence among males has increased in India. It is found that increased morbidity, mortality and relapse among TB smokers. METHOD Setting Patients from two Revised National Tuberculosis Control Program Centres of Tamilnadu form the study population. OBJECTIVE To compare the effectiveness of Bupropion therapy along with standard counselling versus enhanced counseling versus standard counseling for smoking cessation among TB patients. STUDY DESIGN Cluster randomized effectiveness trial. PROCEDURE Patients from each of the thirty-six Designated Microscopic Centres were randomly allocated to receive one of the three interventions using cluster randomization. Smoking cessation was assessed by self-reporting and confirmed by Carbon monoxide(CO) monitors, done at three-time points and TB treatment outcome at the end of ATT. RESULTS Out of 517 male patients enrolled to the study, the smoking status is available only to 381 subjects. The proportion of patients who have quit smoking in drug, enhanced and standard arms at the end of treatment was 67%, 83% and 52% (P=  less then  0.001). There was no statistical significance in response to TB treatment between those who quit and those who did not (Favourable response 99.2% vs 97.6%). CONCLUSION Both enhanced counselling arm and drug arm are effective strategies for smoking cessation among TB patients and their implementation in the TB programs are recommended. INTRODUCTION The. Boteti sub-district in Botswana has a high TB notification rate of 356 per 100 000 population in 2013, a Treatment completion rate of 55%, 13% cure rate, and 4% defaulter rate in 2014. The high TB notification and defaulter rates with lower cure and treatment success rates in this sub-district relative to the country, are indicative of certain determinants that may be hampering TB control. The aim of this study was to determine the factors associated drug sensitive TB treatment outcomes. METHODS A retrospective cohort study was conducted amongst all the new-smear positive adult pulmonary TB patients who registered and/or completed the treatment period at the six selected health-care centres in Boteti sub-district, between 1 January 2015 and 31 January 2017. An interviewer-administered questionnaire in the patient's language of choice- Setswana or English was utilised for data collection. Adjusted risk ratios (ARR) and their respective 95% confidence intervals (95% CI) were used for expressing associations. RESULTS Fifty-eight (56.9%) patients were successfully cured compared to 44 (43.1%) who successfully completed treatment. Patients that attended the clinics by foot (ARR 3.38) (P  less then  0.05), females (ARR 1.25) and HIV negative patients (ARR 1.20) were more likely to achieve TB cure. Patients that attended the facility with a vehicle were 2.12 (P  less then  0.000), a primary school and above education (ARR 1.59), travelled less than 5 km (ARR 1.05) and less than 38 years of age (ARR1.02) were more likely to complete TB treatment. CONCLUSION A comprehensive health promotion approach based on the Ottawa charter principles to should be developed and implemented. AIM To study the incidence, pattern of tuberculosis, Its risk factors, and prognosis in renal transplantation recipients in Indian population. SETTINGS AND DESIGN This study retrospectively analyzed the patients who underwent renal transplantation at Ramaiah medical college Hospitals, India from 2004 to 2015. METHODS AND MATERIAL The study enrolled 244 patients. Diagnosis was based on radio0imaging, sputum smear, culture and polymerase chainreaction and histology. STATISTICAL ANALYSIS USED A descriptive univariate analysis was performed to identify the individual risk factors. RESULTS The TB infection was present in 21/244 (8.6%) renal transplantation patients (mean age ± SD = 44.3 ± 12.9 years). Pulmonary tuberculosis was the commonest (57%) followed by extrapulmonary tuberculosis (43%). Type II diabetes mellitus (DM) (14.6%; p = 0.0169)was significant risk factor. H-1152 Majority of the patients (n = 18, 10.7%) were on standard tripledrug immunosuppression. The median duration of anti0tubercular therapy was 14 months and crude mortality was 19%. CONCLUSIONS High index of suspicion for tuberculosis is require d in renal transplant recipients owing to their immunocompromised status and atypical presentations. Higher age, DM and use of immunosuppressants increase the risk for post0renal transplantation tuberculosis. Interactions between anti0tubercular drugs and immunosuppressants need to be considered in these patients. BACKGROUND India, world's leading Tuberculosis burden country envisions to End-TB by optimally engaging private-sector, in-spite of several unsuccessful attempts of optimal private sector engagement. Private Provider Interface Agency (PPIA), a new initiative for private-sector engagement, studied the private-sector networking and dynamics to understand the spread, typology of providers and facilities and their relations in TB case management, which was critical to design an intervention to engage private-sector. We report the observations of this exercise for a larger readership. METHOD ology It is a descriptive analysis of mapping data (quantitative) and perceived factors influencing their engagement in the PPIA network (qualitative). RESULTS Of 7396 doctors, 2773 chemists and 747 laboratories mapped, 3776 (51%) doctors, 353 (13%) chemists and 255 (34%) laboratories were prioritized and engaged. While allopathic doctors highly varied between wards (mean ratio 48/100,000 population; range 13-131), non-allopathic doctors were more evenly distributed (mean ratio 58/100,000 population; range 36-83). The mean ratio between non-allopathic to allopathic doctors was 1.75. Return benefit, apprehension on continuity of funding and issues of working with the Government were top three concerns of private providers during engagement. Similarly, irrational business expectations, expectation of advance financing for surety and fear of getting branded as TB clinic were three top reasons for non-engagement. CONCLUSION A systematic study of dynamics of existing networking, typology and spread of private providers and using this information in establishing an ecosystem of referral network for TB control activities is crucial in an effort towards optimal engagement of private health providers. Understanding the factors influencing the network dynamics helped PPIA in effective engagement of private health providers in the project.