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Objective To assess treatment outcomes in tuberculosis patients participating in support group meetings in five districts of Karnataka and Telangana states in southern India. Methods Tuberculosis patients from five selected districts who began treatment in 2019 were offered regular monthly support group meetings, with a focus on patients in urban slum areas with risk factors for adverse outcomes. We tracked the patients' participation in these meetings and extracted treatment outcomes from the Nikshay national tuberculosis database for the same patients in 2021. We compared treatment outcomes based on attendance of the support groups meetings. Findings Of 30 706 tuberculosis patients who started treatment in 2019, 3651 (11.9%) attended support groups meetings. Of patients who attended at least one support meeting, 94.1% (3426/3639) had successful treatment outcomes versus 88.2% (23 745/26 922) of patients who did not attend meetings (adjusted odds ratio, aOR: 2.44; 95% confidence interval, CI: 2.10-2.82). The odds of successful treatment outcomes were higher in meeting participants than non-participants for all variables examined including: age [greater than or equal to] 60 years (aOR: 3.19; 95% CI: 2.26-4.51); female sex (aOR: 3.33; 95% CI: 2.46-4.50); diabetes comorbidity (aOR: 3.03; 95% CI: 1.91-4.81); human immunodeficiency virus infection (aOR: 3.73; 95% CI: 1.76-7.93); tuberculosis retreatment (aOR: 1.69; 1.22-2.33); and drug- resistant tuberculosis (aOR: 1.93; 95% CI: 1.21-3.09). Conclusion Participation in support groups for tuberculosis patients was significantly associated with successful tuberculosis treatment outcomes, especially among high-risk groups. Expanding access to support groups could improve tuberculosis treatment outcomes at the population level. Objectif Evaluer les resultats des traitements contre la tuberculose chez les patients qui assistent aux reunions des groupes d'entraide dans cinq districts des Etats du Karnataka et du Telangana, en Inde du Sud. Methodes Dans les cinq districts selectionnes, des patients tuberculeux ayant entame un traitement en 2019 se sont vu proposer des reunions mensuelles organisees a intervalles reguliers. Ces reunions etaient principalement destinees aux patients vivant dans des bidonvilles urbains et presentant des facteurs augmentant le risque d'issue defavorable. Nous avons suivi leur participation aux reunions et avons extrait des informations therapeutiques de la base de donnees nationale Nikshay sur la tuberculose concernant les memes patients en 2021. Nous avons ensuite compare l'issue des traitements a la presence aux reunions des groupes d'entraide. Resultats Sur 30 706 patients tuberculeux ayant entame un traitement en 2019, 3651 (11,9%) ont rejoi nt des groupes d'entraide. Sur l'ensemble des patients ayant assiste a au moins une reunion, 94,1% (3426/3639) ont connu une issue favorable au traitement, contre 88,2% (23 745/26 922) chez les patients qui n'y ont pas assiste (odds ratio ajuste, ORA: 2,44; intervalle de confiance de 95%, IC: 2,10-2,82). Les probabilites de reussite du traitement etaient plus elevees chez les participants aux reunions que chez les non-participants pour toutes les variables examinees, y compris pour les [greater than or equal to] 60 ans (ORA: 3,19; IC de 95%: 2,26-4,51); les patients de sexe feminin (ORA: 3,33; IC de 95%: 2,46-4,50); celles et ceux presentant une comorbidite liee au diabete (ORA: 3,03; IC de 95%: 1,91-4,81); une infection au virus de l'immunodeficience humaine (ORA: 3,73; IC de 95%: 1,76-7,93); un retraitement contre la tuberculose (ORA: 1,69; 1,22-2,33); et enfin, une tuberculose pharmacoresistante (ORA: 1,93; IC de 95%: 1,21-3,09). Conclusion La participation des patients atteints de tuberculose aux groupes d'entraide allait de pair avec de meilleurs resultats de traitement, surtout au sein des categories a haut risque. Promouvoir l'acces a ces groupes d'entraide pourrait ameliorer l'issue des traitements contre la tuberculose a l'echelle de la population. Objetivo Evaluar los desenlaces del tratamiento en pacientes con tuberculosis que participan en reuniones de grupos de apoyo en cinco distritos de los estados de Karnataka y Telangana en el sur de la India. Metodos Se ofrecieron reuniones mensuales regulares de grupos de apoyo a los pacientes con tuberculosis de cinco distritos seleccionados que comenzaron el tratamiento en 2019, con un enfoque en los pacientes de los suburbios urbanos con factores de riesgo de desenlaces adversos. Se realizo un seguimiento de la participacion de los pacientes en estas reuniones y se extrajeron los desenlaces del tratamiento de la base de datos nacional de tuberculosis Nikshay para los mismos pacientes en 2021. Se compararon los desenlaces del tratamiento en funcion de la asistencia a las reuniones de los grupos de apoyo. Resultados De 30 706 pacientes con tuberculosis que iniciaron el tratamiento en 2019, 3651 (11,9 %) asistieron a reuniones de grupos de apoyo. De los pacientes que asistieron al menos a una reunion de apoyo, el 94,1 % (3426/3639) presentaron desenlaces exitosos del tratamiento frente al 88,2 % (23 745/26 922) de los pacientes que no asistieron a las reuniones (razon de posibilidades ajustada, RPA: 2,44; intervalo de confianza del 95 %, IC: 2,10-2,82). Las posibilidades de obtener un desenlace satisfactorio del tratamiento fueron mayores en los participantes en las reuniones que en los no participantes para todas las variables examinadas, incluyendo: edad [greater than or equal to] 60 anos (RPA: 3,19; IC del 95 %: 2,26-4,51); sexo femenino (RPA: 3,33; IC del 95 %: 2,46-4,50); comorbilidad por diabetes (RPA: 3,03; IC del 95 %: 1,91-4,81); infeccion por el virus de la inmunodeficiencia humana (RPA: 3,73; IC del 95 %: 1,76-7,93); retratamiento de la tuberculosis (RPA: 1,69; IC del 95 %: 1,22-2,33); y tuberculosis resistente (RPA: 1,93; IC del 95 %: 1,21-3,09). Conclusion La participacion en grupos de apoyo para pacientes con tuberculosis se asocio de manera significativa con el exito de los desenlaces del tratamiento de la tuberculosis, en especial entre los grupos de alto riesgo. Ampliar el acceso a los grupos de apoyo podria mejorar los desenlaces del tratamiento de la tuberculosis a nivel de la poblacion., Introduction Estimates indicate that India has the largest number of tuberculosis patients (26%) and tuberculosis-related deaths (36%) in the world. (1) India's success in tackling tuberculosis is critical to achieving [...]

Genomic variants of the hepatitis B virus (HBV) preS/S protein are well-known to occur. Typically, immunity is gained through recovered HBV infection or by immunization. Very rarely, there are certain mutations that may enable HBV escape from the immune detection. PreS/S mutants may present with unpredictable pathobiologic, clinical, and transmittable implications. Standard laboratory testing for genomic HBV variants is not routinely performed by reference guidelines. s-variant HBV management remains challenging. Herein is a case of s-variant chronic HBV infection in a 55-year-old man. Diagnosis and treatment are described.

In the middle of a pandemic, patients with cough and fever are thought to have SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2). It should be remembered that in the desert southwest of the United States, we have an ongoing epidemic of coccidioidomycosis (CM). There are additionally many other respiratory illnesses that could be confused with CoV-2 or overlooked. This is a case report of CoV-2 engrafted on chronic cavitary pulmonary CM. In a time where the coronavirus pandemic is becoming rampant, we demonstrate the case of a coinfection with cavitary pulmonary CM. In this case, the importance of detection of the coronavirus and treatment of the coinfection is explored.

Few international studies have investigated factors affecting domiciliary non-invasive ventilation (D-NIV) compliance, and data from the UK are limited. We assessed compliance (defined as [greater than or equal to] 4 h/night for at least 70% of the time) in a retrospective UK population study, at three time points (0-1 month, 3-4 months and 11-12 months), for all patients commenced on D-NIV over a 5-year period. A total of 359 patients were included. Non-compliant vs. compliant patients were significantly younger (median age 64 (IQR 52-72) vs. 67 (58-75) years, p = 0.032) and more likely to have schizophrenia, consistent at both 3-4 months (5% vs. 1%, p = 0.033) and 11-12 months (5% vs. 2%, p = 0.049). Repeated measures ANOVA demonstrated that the minutes [median (IQR)] of D-NIV used significantly increased at the three time points (0-1 month, 3-4 months and 11-12 months) for patients with hypertension [310 (147.5-431) vs. 341 (89-450) vs. 378 (224.5-477.5), p = 0.003]; diabetes [296.5 (132.5-417.5) vs. 342.5 (94.5-438.5) vs. 382 (247.5-476.25), p = 0.002] and heart failure [293 (177-403) vs. 326 (123-398) vs. 365 (212-493), p = 0.04]. In conclusion, younger and comorbid schizophrenic patients have lower D-NIV compliance rates, and our data suggest that persistence with D-NIV over a year may improve overall use., Author(s): Amar J. Shah [sup.1] [sup.2], Katia Florman [sup.1], Nitika Kaushal [sup.1], Hiu Fung Kwong [sup.1], Akul Karoshi [sup.1], Laura White [sup.1], Ryan Walker [sup.1], Yan-Pin Lin [sup.1], Ho Juen [...]

Against a backdrop of stalling life expectancy, the COVID-19 pandemic highlighted the need to tackle inequities in healthcare. Quality improvement has become an increasingly recognised way of tackling complex problems in healthcare. This article presents a step-by-step approach for the use of quality improvement to pursue equity at an NHS provider in England. The Model for Improvement was used to set an aim, develop a theory of change and measures, and test change ideas through plan-do-study-act cycles. A five-step sequence of improvement was used to provide a structured approach to identifying and tackling problems. Projects were designed to use a time series testing strategy in which baseline data were collected, a change was introduced and data continued to be collected over time to assess improvement. The results of three teams that have demonstrated sustained improvements were analysed using statistical process control charts. The teams' achievements included a 27% increase in access to early intervention mental health services for ethnic minority groups; a 92% reduction in racist incidents on inpatient wards; and a reduction in the gap between cervical screening rates for different age groups from 8% to 3%. Quality improvement offers those closest to the delivery of care a way of systematically making improvements in equity. Further opportunities for the field include the use of experimental designs to test combinations of interventions and potential scalability of quality improvement methods across systems with multiple partners. [ABSTRACT FROM AUTHOR]

Epithelial ovarian and fallopian cancers are aggressive lesions that rarely metastasize to the central nervous system. Brain metastases usually occur in the setting of known primary disease or widespread metastatic disease. However, in extremely rare cases, an isolated intracranial neoplasm may be the first presentation of fallopian cancer. To the best of our knowledge, only one such case has been reported previously. We present an illustrative case with multimodality imaging and histopathologic correlation of a fallopian tube carcinoma first presenting with altered mental status secondary to an isolated brain metastasis. A 64-year-old female with no pertinent medical history presented with altered mentation. Initial workup identified a 1.6 cm avidly enhancing, solitary brain lesion at the gray-white junction with associated vasogenic edema concerning for either central nervous system lymphoma or metastatic disease. Additional imaging identified a 7.5 × 3 cm left adnexal lesion, initially thought to be a hydrosalpinx with hemorrhage, but magnetic resonance imaging suggested gynecologic malignancy. No lesions elsewhere in the body were identified. Given the lack of locoregional or systemic disease, the intracranial and pelvic lesions were assumed to represent synchronous but distinct processes. The intracranial lesion was biopsied. Preliminary results were suggestive of lymphoma, but further analysis was consistent with high-grade serous carcinoma of müllerian origin. Positron emission tomography/computed tomography was performed to evaluate for other neoplastic lesions, only highlighting the intracranial and pelvic lesions. At this point, a diagnosis of metastatic fallopian cancer was made. The patient was taken for robot-assisted laparoscopy with surgical debulking of the pelvic neoplasm, pathology demonstrating high-grade serous carcinoma of the fallopian tube, matching that of the intracranial lesion. Even though rare, metastatic fallopian cancer should be considered in patients with isolated brain lesions and adnexal lesions, even in the absence of locoregional or systemic disease. [ABSTRACT FROM AUTHOR]

Byline: Amar. Shah, Anirudh. Shah Intraperitoneal bladder rupture is a rare event in the paediatric population. Road traffic accidents (RTA) and seat belt injuries are considered to be the main [...]

Melasma is a common dermatologic condition affecting all skin types. Increasing rates of melasma warrant identification of a reliable topical treatment. In recent years, off-label tranexamic acid (TA) has emerged as a potential treatment of melasma. Although the mechanism of action remains unclear, it is thought that TA inhibits melanin synthesis by blocking the interaction between melanocytes and keratinocytes while reversing the abnormal dermal changes associated with melasma. Our study assessed the efficacy of TA solution 5% for the treatment of melasma in patients with darker skin types. [ABSTRACT FROM AUTHOR]

Background: Reducing malnutrition through food supplementation is a critical component of the WHO End Tuberculosis (TB) strategy. A results-based financing (RBF) initiative in Madhya Pradesh, India—called Mukti—introduced an intensive nutrition intervention, including home visits, counseling, food basket distribution, and assistance in obtaining government benefits. Phase 1 of the program (Dhar District), implemented by ChildFund India (ChildFund) and funded by USAID, coincided with the COVID-19 lockdown in 2020. Under an RBF reimbursement scheme, ChildFund was paid based on treatment retention for 6 months and weight gain of 6 kg for adults. Methods: The evaluation used a mixed methods approach. Qualitative components included interviews with key informants and focus groups with program participants. Quantitative components included an analysis of program data (i.e., patient demographics, receipt of program services, and weight gain). An impact analysis of retention in treatment used data from a government database. A difference-in-differences model was used to compare results from baseline data and the program period for Dhar District to similar data for the adjacent Jhabua District. Results: The program was well implemented and appreciated by patients and providers. Patients received an average of 10.2 home visits and 6.2 food baskets. While all age and sex groups gained weight significantly over their 6-month treatment period, there was no program impact on treatment retention. Seventy-six percent of patients achieved both outcome goals. And though average program costs were under budget, ChildFund experienced a loss in the results-based financing scheme, which was covered by USAID to continue program expansion. Conclusions: Implementing a nutrition supplementation and education program for TB patients in India is feasible. The intervention improved weight gain despite COVID-19-related lockdowns. The Mukti program did not impact treatment retention, which was already high at baseline. Program costs were modest, but the results-based financing reimbursement scheme resulted in a loss for the implementer. Overall, the RBF model led to an increased focus on outcomes for program staff and other stakeholders, which led to more efficient service delivery. Future research should examine total costs (including donated staff time) more extensively to determine the cost-effectiveness of Mukti and similar interventions. [ABSTRACT FROM AUTHOR]

Background/Aims: Asthma in children and young people represents a substantial burden to the healthcare system, with these patients requiring frequent emergency care and having poorer health outcomes, leading to high system costs and poor patient experiences. This study used quality improvement methodology to achieve the triple aim of improved outcomes, better experience and reduced costs for those aged 0–16 years with asthma in north east London. Methods: A multidisciplinary project team used quality improvement methods to implement and assess two interventions: a community high-risk asthma clinic and educational asthma-friendly school groups, both of which were delivered by a specialist asthma nurse. Population-level outcomes included asthma control test scores, accident and emergency department admissions and costs. Intervention-specific outcomes included number of clinic consultations delivered, did-not-attend rates and participant confidence ratings following the school sessions. Results: Accident and emergency admissions for asthma reduced by 52%, with a 50% reduction in average monthly acute care costs. Asthma control test scores improved significantly, from an average of 18.56 to 22.34 out of a maximum score of 25 (P=0.000) following the interventions. Participants in the asthma-friendly school groups reported increased confidence in both day-to-day and emergency asthma management at the end of their sessions. Conclusions: Having dedicated specialist asthma nurse input in the community and using school-based interventions can help to improve asthma care for children and young people, reducing the burden of frequent accident and emergency department admissions. Using quality improvement methods in pursuit of triple aim outcomes can help teams to work towards a shared goal. [ABSTRACT FROM AUTHOR]

There has been an increase in the adoption of quality improvement methods to tackle complex problems in healthcare. One of the key requisites for sustainable quality improvement is ensuring that organisations have the capacity and capability to make these changes effectively. This article uses a case study methodology to describe the learning from 9 years of developing, delivering and evaluating quality improvement learning programmes at East London NHS Foundation Trust. The key quality improvement learning progammes are evaluated using a Kirkpatrick framework across four levels: reaction, learning, behaviour and outcomes. Five key principles were identified: using a dosing approach; standardising development, delivery and evaluation; developing a community to support learners; making training relevant; and the importance of leadership. However, the authors believe that more research is needed to develop standardised approaches to evaluating quality improvement capability building and to understand why some quality improvement projects are less successful than others. [ABSTRACT FROM AUTHOR]

In 2021, 38 healthcare teams across England and Wales took part in the national enjoying work quality improvement collaborative, which aimed to enhance staff wellbeing and create joy in work. Participating teams were supported to use quality improvement methodology and tools as part of a national learning network. At the end of the programme, 16 teams saw an improvement in at least one outcome measure, while 17 teams saw a sustained deterioration in at least one outcome measure. Aggregate data from all teams demonstrated improvements from baseline in all three outcome measures, with a 51% average improvement in the percentage of people who frequently enjoyed being at work, a 41% average improvement in the percentage of people experiencing no symptoms of burnout and a 42% average improvement in the percentage of people who were extremely likely to recommend their team as a place to work. As the first programme on this topic at a national scale, these findings provide ideas for change that can be adapted or replicated by clinical and non-clinical teams to improve their joy and wellbeing at work, and build their understanding of the barriers they may face and what is needed to overcome them. From the ideas tested and the learning from across the collaborative, a theory of change for enhancing staff wellbeing and joy in work has been created to inform future work in this area. [ABSTRACT FROM AUTHOR]

Micturating cystourethrography (MCUG) is a very commonly performed diagnostic procedure in pediatric urology. Although considered to be simple, safe, and cost-effective, it can incur some complications. Bladder rupture during MCUG is a very rare complication and only a handful of cases have been reported in world literature. We report the case of a 2.5-month-old boy who had intraperitoneal bladder rupture during an MCUG needing surgical repair. At operation, the child had a bladder tear at the dome of the bladder which was repaired successfully. The postoperative recovery was uneventful and the child is doing well in follow-up. Although individual management of bladder rupture may differ, a majority of infants need surgery for the same. Thorough vigil and attention to the technique are a must to prevent such incidents in children. [ABSTRACT FROM AUTHOR]

Ritual circumcision in children remains a trivialized procedure in some countries, especially in rural areas. It is often performed by unqualified paramedical personnel, or even by religious workers whose notions of surgery and asepsis are uncertain. Although it is thought to be a minor procedure, major complications with sexual or even life-threatening prognosis can occur. Amputation of the glans during circumcision is a rare incidence secondary to poor application of operating principles. We report the case of a 1 1/2-year-old boy who underwent a progressive amputation of the glans after a ritual circumcision by a religious worker. The child was brought 10 days after the procedure with totally amputated, nonsalvageable glans. A urethral meatoplasty was performed to enable proper voiding and prevent meatal stenosis. The child has been in follow-up for the past 6 months without any urinary symptoms. [ABSTRACT FROM AUTHOR]

India has been implementing active case-finding (ACF) for TB among marginalised and vulnerable (high-risk) populations since 2017. The effectiveness of ACF cycle(s) is dependent on the use of appropriate screening and diagnostic tools and meeting quality indicators. To determine the number of ACF cycles implemented in 2021 at national, state (n = 36) and district (n = 768) level and quality indicators for the first ACF cycle. In this descriptive study, aggregate TB program data for each ACF activity that was extracted was further aggregated against each ACF cycle at the district level in 2021. One ACF cycle was the period identified to cover all the high-risk populations in the district. Three TB ACF quality indicators were calculated: percentage population screened (≥10%), percentage tested among screened (≥4.8%) and percentage diagnosed among tested (≥5%). We also calculated the number needed to screen (NNS) for diagnosing one person with TB (≤1538). Of 768 TB districts, ACF data for 111 were not available. Of the remaining 657 districts, 642 (98%) implemented one, and 15 implemented two to three ACF cycles. None of the districts or states met all three TB ACF quality indicators' cut-offs. At the national level, for the first ACF cycle, 9.3% of the population were screened, 1% of the screened were tested and 3.7% of the tested were diagnosed. The NNS was 2824: acceptable (≤1538) in institutional facilities and poor for population-based groups. Data were not consistently available to calculate the percentage of i) high-risk population covered, ii) presumptive TB among screened and iii) tested among presumptive. In 2021, India implemented one ACF cycle with sub-optimal ACF quality indicators. Reducing the losses between screening and testing, improving data quality and sensitising stakeholders regarding the importance of meeting all ACF quality indicators are recommended. [ABSTRACT FROM AUTHOR]

BACKGROUND. Sex, emotion, and reproduction are fundamental and tightly entwined aspects of human behavior. At a population level in humans, both the desire for sexual stimulation and the desire to bond with a partner are important precursors to reproduction. However, the relationships between these processes are incompletely understood. The limbic brain system has key roles in sexual and emotional behaviors, and is a likely candidate system for the integration of behavior with the hormonal reproductive axis. We investigated the effects of kisspeptin, a recently identified key reproductive hormone, on limbic brain activity and behavior. METHODS. Using a combination of functional neuroimaging and hormonal and psychometric analyses, we compared the effects of kisspeptin versus vehicle administration in 29 healthy heterosexual young men. RESULTS. We demonstrated that kisspeptin administration enhanced limbic brain activity specifically in response to sexual and couple-bonding stimuli. Furthermore, kisspeptin's enhancement of limbic brain structures correlated with psychometric measures of reward, drive, mood, and sexual aversion, providing functional significance. In addition, kisspeptin administration attenuated negative mood. CONCLUSIONS. Collectively, our data provide evidence of an undescribed role for kisspeptin in integrating sexual and emotional brain processing with reproduction in humans. These results have important implications for our understanding of reproductive biology and are highly relevant to the current pharmacological development of kisspeptin as a potential therapeutic agent for patients with common disorders of reproductive function. FUNDING. National Institute for Health Research (NIHR), Wellcome Trust (Ref 080268), and the Medical Research Council (MRC)., Introduction Unraveling the intrinsic links among sex, emotion, and reproduction relies on a focused exploration of putative factors. Identifying a factor that unites these fundamental components of human behavior has [...]

Staff wellbeing is increasingly linked to good outcomes for service users in healthcare. Therefore, it is important for organisations to find ways to focus on wellbeing and staff experience at work. This article shares learning from 5 years of using the Institute for Healthcare Improvement's joy in work framework, coupled with quality improvement methods to enhance staff experience and wellbeing. This demonstrates how teams were brought together in a collaborative learning system to apply quality improvement to enhance joy in work. Key steps are shared for other organisations wanting to undertake this work, including the application of improvement methods to empower teams locally to develop, design and test change ideas, and measure their impact. The design of systems and structures required to meaningfully bring teams together and the type of leadership that enhances this work are also considered. Key learning points for other organisations include the need for improvement principles to iterate the organisational approach, make measurement simple, encourage a bias to action and make the work fun. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis (TB) is the most common infectious disease caused by mycobacterium tuberculosis. Apart from the lungs, tuberculosis also affects the bone marrow. There are significant hematological abnormalities that occur in association with tuberculosis. So we can use these hematological parameters as a marker for the diagnosis, prognosis, and response to therapy. Aims: To evaluate the hematological parameters in pulmonary tuberculosis patients. Methods and Materials: A total of 70 diagnosed tuberculosis patients and 70 healthy controls were selected by purposive sampling in this study. About 4 ml of venous blood was collected with proper aseptic precaution. 2 ml ethylenediamine tetra acetic acid (EDTA) tube blood was used for hematological analysis by using Siemens Advia 2120i 5-part hematology analyzer. Rest 2 ml blood was used for measurement of erythrocyte sedimentation rate (ESR) by Wintrobe's method. Results: The hemoglobin, packed cell volume (PCV), and blood indices values were significantly lower compared to healthy controls in both sexes. White blood cell (WBC) count, absolute neutrophil count, platelet count, and ESR values were significantly increased in tuberculosis patients as compared to healthy controls and were found to be statistically significant (P-value < 0.05). Conclusions: To measure hematological parameters in tuberculosis is a simple and cost-effective method to predict the course of the disease and monitor complications in developing countries like India. [ABSTRACT FROM AUTHOR]