Community based five pulmonary tuberculosis (PTB) surveys among adults.
Estimate sensitivity and specificity of screening tools for PTB and sputum microscopy.
For each survey site, we estimated ...sensitivity and specificity of different screening criteria and microscopy against culture; pooled estimates were obtained using Random Effects Model.
Sensitivity of cough alone, screening for any symptom (persistent cough ≥2 weeks, fever or chest pain ≥1 month, hemoptysis), any symptom or history of anti-TB treatment (h/o ATT) were 56.2%, 66% and 71.2% respectively; specificities were 95.3%, 93.8% and 92.7% respectively. X-ray when used alone for primary screening had sensitivity and specificity of 76.6% and 97.3% respectively. When used along with screening for cough, these figures were 94.3% and 93.1%, and 100% and 97.3% when used with any symptom and h/o ATT. When used for secondary screening, sensitivity and specificity of X-ray was 66.8% and 87.8% respectively after primary screening for cough, 65.0% and 89.8% after screening for any symptom, and 67.1% and 86.7% when used after screening for any symptom or h/o ATT. Pooled sensitivity and specificity of smear was 46.2% and 99.3% respectively.
Program managers may use these estimates while evaluating algorithms for active case finding.
Inland saline ground water (ISGW) has attracted great interest for commercial aquaculture of marine species in Haryana and Punjab. The silver pompano (Trachinotus blochii), a candidate for ...mariculture, was investigated for its potential to survive in inland saline water at ICAR-CIFE, Regional Centre, Rohtak, Haryana during 2015–16. The experimental set up comprised ISGW without potassium amendment, ISGW with potassium amendment and artificial sea water of 5 ppt, 10 ppt and 15 ppt salinity. In ISGW without potassium amendment, 100% mortality was observed at 12 h (5 ppt), 24 h (10 ppt) and 48 h (15 ppt). In the second experiment, three treatments (ISW5, ISW10 and ISW15) of ISGW with potassium amendment equivalent to sea water were prepared. A 100% survival was observed at all salinities in ISGW with potassium amendment, similar to the artificial seawater at the end of 90 days. Significantly higher weight gain, specific growth rate (SGR) and average daily growth (ADG) were observed at ISW10 and ISW15 than at ISW5. The plasma osmolality of silver pompano in ISW10 and ISW15 indicated that silver pompano regulates isosmotic condition to maintain the homeostasis of body. The present results indicate that silver pompano can be reared at 10 ppt to 15 ppt salinity with optimum growth and survival in potassium amended ISGW.
SETTING: Twenty-four districts in India.OBJECTIVES: To evaluate trends in annual risk of tuberculous infection (ARTI) in each of four geographically defined zones in the country.STUDY DESIGN: Two ...rounds of house-based tuberculin surveys were conducted 8-9 years apart among
children aged 1-9 years in statistically selected clusters during 2000-2003 and 2009-2010 (Surveys I and II). Altogether, 184 992 children were tested with 1 tuberculin unit (TU) of purified protein derivative (PPD) RT23 with Tween 80 in Survey I and 69 496
children with 2TU dose of PPD in Survey II. The maximum transverse diameter of induration was measured about 72 h after test administration. ARTI was computed from the prevalence of infection estimated using the mirror-image method.RESULTS: Estimated ARTI rates in different zones varied
between 1.1% and 1.9% in Survey I and 0.6% and 1.2% in Survey II. The ARTI declined by respectively 6.1% and 11.7% per year in the north and west zones; no decline was observed in the south and east zones. National level estimates were respectively 1.5% and 1.0%, with a decline of 4.5% per
year in the intervening period.CONCLUSION: Although a decline in ARTI was observed in two of the four zones and at national level, the current ARTI of about 1% in three zones suggests that further intensification of TB control activities is required.
BACKGROUND: For the diagnosis of smear-negative pulmonary tuberculosis (PTB), India's Revised National Tuberculosis Control Programme (RNTCP) recommends a course of broad-spectrum antibiotics after ...negative smear on initial sputum examination, followed by repeat sputum examination and
chest X-ray (CXR).OBJECTIVES: 1) To ascertain the proportion of presumptive PTB patients smear-negative on initial sputum examination who completed the diagnostic algorithm, and 2) to investigate barriers to the completion of the algorithm.METHODS: In Karnataka State, India, 256 study
participants were interviewed in 2012 to ascertain the number of days antibiotics had been prescribed and consumed, the number of re-visits to health centre(s), whether repeat sputum examinations had been performed, whether or not CXR had been performed and when, and whether PTB had been diagnosed.
In-depth interviews were conducted with 19 medical officers.RESULTS: The diagnostic algorithm was completed in 13 (5.1%) of 256 participants; three were diagnosed with PTB without completing the algorithm. Most medical officers were unaware of the algorithm, had trained 5-10 years
previously, prescribed antibiotics for <10 days and advised CXR without repeat sputum examination, irrespective of the number of days of antibiotic treatment. Other main reasons for non-completion of algorithm were patients not returning to the health centres and a proportion switching
to the private sector.CONCLUSION: Refresher training courses, raising patient awareness and active follow-up of patients to complete the algorithm are suggested.
Six years of GPS measurements of crustal deformation in the Godavari failed rift (GFR) of stable India plate suggest very localized deformation. Elsewhere, all along the GFR the deformation is very ...low (<1.5mm/yr). Localized deformation (up to 3.3±0.5mm/yr) at least at two sites, implying compression on steep faults located on the southern margin of the GFR, is coincident with the region characterized by high level low-magnitude seismicity of past six years and implies strain accumulation for future moderate to strong magnitude earthquake in the region. The localized deformation is consistent with the view about deformation in such regions where seismicity migrates and deformation rate changes with time.
► Overall insignificant deformation in the Godavari failed rift region. ► Localized high deformation in a small region within the failed rift. ► Migration in the seismicity and temporal variation in the deformation rate. ► Localized high deformation region is a probable site for future earthquake.
SETTING: School-based survey in the mountainous nation of Bhutan.OBJECTIVE: To estimate the annual risk of tuberculous infection (ARTI) among children aged 6-8 years.DESIGN: A national-level ...tuberculin survey was carried out among children attending 64 schools selected
by two-stage cluster sampling. The study population was comprised of children without and with bacille Calmette-Guérin (BCG) scar. Tuberculin testing was performed using 2 tuberculin units of purified protein derivative RT23. The maximum transverse diameter of induration was measured
at 48-72 h.RESULTS: Of 6087 satisfactorily test-read children, 82% had a BCG scar. The frequency distribution of tuberculin reaction sizes in all children (with and without BCG scar) did not reveal the mode for tuberculous reactions. The mode seen at 17 mm among children without
BCG scar was applied to estimate the prevalence of infection among all children using the mirror-image method. Estimation was also undertaken by shifting the mode by 1 mm on either side. The ARTI computed from the prevalence thus estimated varied between 0.2% and 0.7%. There was no difference
in the prevalence of infection by BCG scar status, implying that the estimated ARTI was not influenced by BCG-induced tuberculin sensitivity.CONCLUSION: The ARTI has declined in Bhutan compared to the 1991 survey estimate of 1.9%.
In a sub-district level hospital in South India, the proportion of patients with abnormal chest X-ray (CXR) was evaluated among smear-negative, Xpert® MTB/RIF (Xpert) positive individuals with ...pulmonary tuberculosis (PTB) symptoms; 384 smear-negative PTB individuals with
PTB symptoms and without a history of anti-tuberculosis treatment underwent CXR and Xpert testing of one sputum specimen. Of 378 individuals with both Xpert and CXR results available, 14 were positive for Mycobacterium tuberculosis. Of these, 13 (92.9%) had an abnormal CXR and one was
normal. This study highlights the usefulness of CXR before Xpert testing, which needs further validation.
SETTING: A South Indian district providing anti-tuberculosis services through the Revised National TB Control Programme (RNTCP) and private health care facilities.OBJECTIVE: To ascertain the profile ...of tuberculosis (TB) patients diagnosed and/or treated in private health care facilities.METHODS:
Data on TB cases diagnosed and/or treated in all clinical departments of the medical college, 83 nursing homes and RNTCP health care facilities were collected prospectively.RESULTS: About 83% of new TB cases recorded in the private medical college, 47% in nursing homes and 24.5% in RNTCP
TB registers were extra-pulmonary. The proportion of retreatment cases was respectively 5.5%, 9.6% and 19.8%. The proportion of males and those in the economically productive age group were similar in the three data sources. About 94% of cases diagnosed in the medical college and 55% in nursing
homes were registered for treatment under the RNTCP. About 11% of the smear-positive patients diagnosed in RNTCP were initial defaulters.CONCLUSION: The proportion of extra-pulmonary cases was higher in the medical college and nursing homes and that of retreatment cases was lower than
in the RNTCP.
SETTING: Four districts of Karnataka State, India, that have implemented the National Tuberculosis Control Programme (RNTCP).OBJECTIVE: To assess the proportion of patients diagnosed according to the ...nationally recommended algorithm among new smear-negative (NSN) PTB cases registered
under the RNTCP.METHODS: Information on 201 registered NSN-PTB patients as regards date of initial sputum examination, repeat sputum examination and chest X-ray (CXR) if undertaken, treatment initiation and number of days of antibiotic treatment after initial sputum examination, were collected
through record review and patient interviews. In patients with negative or unknown human immunodeficiency virus (HIV) status, the algorithm was considered completed if the patient underwent initial sputum examination, antibiotic trial for 10 days, repeat sputum examination 10 days
after initial sputum examination, CXR after repeat sputum examination and anti-tuberculosis treatment 10 days after initial sputum examination. In HIV-positive patients, the algorithm was considered completed if CXR was performed after or at the same time as initial sputum examination.RESULTS:
Complete information was available for 170 patients. Of these, the algorithm was completed in 14 (8.2%, 95%CI 0.9-15.5): 1/140 patients with negative or unknown HIV status and 13/30 HIV-positive patients.CONCLUSION: The algorithm was not completed in most patients registered for
treatment. Measures are needed to improve the diagnostic process for smear-negative PTB.
► An attempt is made to understand the frequency and lapse time dependence of attenuation characteristics of Kumaun Himalaya. ► The result indicates that the crust in the study area is highly ...heterogeneous and tectonically very active. ► Strong frequency dependence behavior is observed for this region which could be related to the size of heterogeneities. ► Increase in Qc values with the lapse time suggests that the deeper crust is less heterogeneous than the shallower part. ► We find turbidity decays rapidly with depth for Kumaun Himalaya which is apparent for other parts of Himalaya.
We have analyzed local earthquake data set consists of 84 well located events, recorded by a digital seismic network in the Kumaun Himalaya region during 2004–2007 to study seismic attenuation characteristics of the region. Single back-scattering assumption is used to estimate coda Q (Qc) values of the region at frequency range of 1.5, 3, 6, 8, 12 and 18Hz for different lapse time window length. The values of Qc show a ubiquitous observation of frequency dependence and follow a substantially similar trend as observed in other tectonically active parts of the Himalaya. The lapse time dependencies of coda waves are investigated which reveal that by increasing lapse time window from 20 to 50s, Q0 (Qc at 1Hz) increases from 64±2 to 230±19 while frequency dependent parameter n decreases from 1.08 to 0.81. Increase in Qc with lapse time indicates decrease in heterogeneity with depth. The observed values of Q0 and n infer that the medium beneath the study area is highly heterogeneous and tectonically very active. The variation of Qc with lapse time at 1.5Hz follow a similar pattern with the theoretically predicted values of Gusev (1995) although the frequency parameter n does not match with the model. It may suggest that the turbidity decays rapidly with depth for the Kumaun Himalaya. Our results are comparable with those obtained from tectonically active regions in the world.
