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Introduction: Government of India launched an Aadhar-linked Direct Benefit Transfer (DBT) scheme from 1st April, 2018. Under this scheme, all notified TB patients would receive Rs 500 per month (~US$7) throughout the course of their treatment for nutritional support. Aim and Objectives: To determine the challenges faced by the health providers and patients in the implementation of Direct Benefit Transfer scheme. Methods: This was a mixed method cross-sectional study conducted on all public and private TB patients notified during the year 2019 under RNTCP (now NTEP) in district Amritsar, Punjab. Quantitative data about the availability and validation of bank accounts was obtained from the Nikshay portal after having permission from the District TB Officer. Qualitative data was obtained from the focus group discussion and in-depth interviews with the involved staff members (17) and patients (20) registered in Tuberculin units of Amritsar. Results: From the Nikshay reports, it was observed that there was significant difference between the public and private sector and between rural and urban areas. Focus group discussion was done with the TB Health Visitor (TBHV) and Senior TB supervisors (STS) and asked about the hurdles they faced. Items were identified and tabulated. In-depth interviews were conducted on 20 patients, 10 each from public and private sector respectively. Data collected was transcribed and arranged as per the themes or questions and then the information was recorded under those sub-headings. Conclusion: The major challenges observed by the providers were lack of support from the private sector, lack of awareness among people, technical issues and more work burden. Patients mostly mentioned about confidentiality issues, lack of awareness, social stigma of the disease, less amount and long and complex process.

Background: Multidrug resistant tuberculosis (MDR-TB) has become a major public health problem. It is associated with significant morbidity and mortality. The treatment success rate worldwide is around 50%. Methods: This cross-sectional study was conducted on all MDR-TB patients who were registered and being treated under PMDT services in Amritsar district from 1 st April 2014 to 31 st March 2015. The treatment outcome with their socio-demographic determinants was ascertained. Data management and analysis was done by using Microsoft excel and SPSS. Results: Out of 87 MDR-TB patients, 57 (65.5%) were males and 30 (34.4%) were females. The various treatment outcomes observed were- 30 (34.5%) cured, 19 (21.8%) treatment completed, 18 (20.7%) died, 13 (14.9%) defaulted, 4 (4.6%) shifted to XDR TB regime and 3 (3.4%) failure. Conclusions: On statistical analysis, it was observed that age (p=0.000), marital status (p=0.024), educational status (p=0.011) and occupation (p=0.002) were significantly associated with the treatment outcome. Other factors like sex, type of family and socio-economic status did not affect the treatment outcome.

Background: The world adopts DOTS strategy for TB control thought the national TB control programs in different countries and is making good progress. Despite the positive therapeutic effects, studies have shown that utilization of multidrug regimens can cause undesirable adverse drug reactions (ADRs) of varying degrees of severity, such as hepatotoxicity, gastrointestinal disorders, allergic reactions, arthralgia, neurological disorders and non-adherence to treatment as well. Methods: The study was conducted on new smear positive patients registered under DOTS in two Treatment Units (TUs) present in Amritsar city. The prevalence of various adverse effects like gastro-intestinal, hepato-biliary, visual disturbances, musculoskeletal, skin and appendages, peripheral nervous system, etc was recorded and their effect on the outcome was observed. Data management and analysis was done by using Microsoft excel and SPSS version 17.00. Results: Out of 250 patients, 149 (59.6%) were males and 101(40.4%) were females. Out of the total 250 cases, adverse effects were present in 44.4% cases. Most common adverse effects observed were gastrointestinal in 63.9% followed by fever and chills in 28.8% of cases. Conclusions: On statistical analysis, it was observed that the absence of adverse effects was significantly associated with the favourable outcome (p

Inspite of the success of RNTCP in tuberculosis control in India, the problem of drug resistant forms of tuberculosis still remains untackled. The present study focuses on the prevalence of MDR-TB, pattern of drug resistance and characteristics of MDR-TB patients in district Amritsar, Punjab in north India. The programme-related aspects studied are the challenges in effective implementation of DOTS-PLUS.A retrospective study was conducted in the month of April, 2013. The records from November 2011 to April 2013 were analysed.Amongst a total of 200 MDR-suspects as per the criterion A of RNTCP, prevalence of drug resistance was 22.50% in Cat I failures and 36.25% in Cat II fourth month or later positive. Out of 67 patients who were to be initiated on Cat IV (H and R resistant or R resistant), 55 patients were put on treatment. The total time taken by the patients from identification as MDR-TB cases to initiation of Cat IV regimen at DOTS-plus site was 17.89 days.The findings of the study highlight the need for early referral, rapid diagnosis and prompt initiation of Cat IV of MDR-TB cases to decrease morbidity, mortality and disease transmission.

Background: Although the current approach to TB control focuses on case detection and treatment, recent studies suggest that this strategy might not be sufficient to achieve this goal and it may also be necessary to reduce risk factors that contribute to the occurrence of tuberculosis infection and/or disease. Such risk factors may act at one of several steps in the natural history of the disease. The life time risk of breaking down to disease among those infected with TB is 10–15%, which gets increased to 10% per year amongst those co-infected with HIV. Other determinants such as diabetes mellitus, smoking tobacco products, alcohol abuse and malnutrition also increase the risk of progression from infection to TB disease.Methods: The study was conducted on new smear positive patients registered under Directly observed treatment, short course (DOTS) in two Treatment Units (TUs) present in Amritsar city. The patients were enquired about their socio-demographic profile, family history, occupational history and associated co-morbidities and addictions. Data management and analysis was done by using Microsoft excel and SPSS version 17.00. Results: Out of 250 patients, 149 (59.6%) were males and 101(40.4%) were females. Male preponderance, with male to female ratio of 1.5:1 was seen. Out of the total 250 cases, 7.2% of the cases had associated diabetes mellitus, 1.2 % had hypertension and only 1 case was of asthma. While enquiring for addictions, it was observed that 28.8% of the cases were alcoholic, 17.2% were smokers, 8% had the habit of tobacco chewing and 6% were drug abusers. Favourable outcome was significantly higher in non-addicted cases while presence of co-morbidities was found to have no effect on the treatment outcome.Conclusions: In the present study, it was observed that favourable outcome was significantly associated with the absence of addictions. So, it is concluded that prevention of tuberculosis should include effective screening especially among high risk groups in order to ensure early detection and aggressive treatment.

Background: The association between tuberculosis (TB) and malnutrition has been recognized for a long time. A body mass index (BMI) below 18.5 increases the risk of TB by 2–3 times. Conversely, an increase in body weight lowers the risk. Objective: To assess the nutritional status and change of patients’ bodyweight over time depending on TB treatment outcome. Materials and Methods: The study was conducted on newly identified smear-positive patients registered under DOTS in two treatment units present in Amritsar city, Punjab, India. BMI of every patient was calculated from the weight and height measurements at the time of registration and again on completion of treatment. Nutritional requirement of the subjects was calculated using the Harris–Benedict equation. Data management and analysis was done by using Microsoft excel and SPSS software, version 17.00. Results: Of 250 patients, 149 (59.6%) were men and 101 (40.4%) women. Male preponderance, with male to female ratio of 1.5:1 was seen; 97.3% of the total men and all of the women were taking diet deficient in calories. It was observed that, in the beginning, 69.2% patients were underweight among which 34% are severely underweight having BMI < 16 kg/m2; 29.6% cases were having normal BMI, while only 1.2% cases were preobese. At the end of treatment, it was evident that 62.8% of the cases were still underweight, 34.9% of the cases showed normal BMI, and 2.3% were in the preobese category. Conclusion: In this study, it was observed that that mean BMI in cured cases at the end of treatment was higher when compared with cases with outcome as failure. The results were found to be statistically significant. So, it was concluded that poor nutritional status is associated with unfavorable outcome in TB.

1 In unanaesthetized pigeons, kept at room temperature (20-23 degrees C) the effects on cloacal temperature were examined of catecholamines, phenoxybenzamine and propranolol, injected into the cerebral ventricles.2 Noradrenaline, adrenaline, dopamine and isoprenaline caused a fall in cloacal temperature.3 Phenoxybenzamine produced a long-lasting small rise in cloacal temperature. This rise is attributed to removal of the hypothermic effect of noradrenaline released continuously from adrenergic neurones ending in the anterior hypothalamus. Propranolol produced a slight fall in cloacal temperature.4 The hypothermic effects of noradrenaline, adrenaline and dopamine were prevented by phenoxybenzamine but not by propranolol. They are therefore attributed to activation of alpha-adrenoceptors.5 The hypothermic effect of isoprenaline was not prevented by either phenoxybenzamine or propranolol. The effect can therefore not be attributed to activation of either alpha or beta-adrenoceptors. Propranolol actually accentuated the isoprenaline-induced hypothermia.

Apomorphine provokes pecking and emesis in pigeons. These effects are mediated through activation of dopamine receptors. In the present paper the effect of apomorphine on the body temperature was studied and an attempt made to determine whether the receptors mediating pecking, emesis, thermoregulatory effects, etc. were similar or different in their transmitter reactivity.

1. In unanaesthetized pigeons the effect on cloacal temperature was studied of acetylcholine (ACh), carbachol, atropine and (+)-tubocurarine injected into a cannulated lateral cerebral ventricle. The experiments were carried out at an ambient temperature of 19-25 degrees C. 2. ACh or carbachol injected intraventricularly produced hyperthermia, and in larger doses hyperthermia followed by hypothermia. These were central effects because they were not obtained when these drugs were injected in the same doses intravenously. 3. Atropine injected intraventricularly produced hypothermia which was greater and longer lasting than the hypothermia produced with the same dose of atropine injected intravenously. After the intraventricular injection of atropine the hyperthermic effects of ACh and of carbachol were abolished. 4. (+)-Tubocurarine injected intraventricularly produced a long-lasting hyperthermia in doses which had no effect on temperature when injected intravenously. After the intraventricular injection of tubocurarine the hypothermic effects of ACh and of carbachol were abolished. 5. It is concluded that the effects of ACh had carbachol imitate the effects of ACh released from cholinergic neurones in the central pathway involved in temperature regulation. The hypothermic effect of atropine is attributed to unmasking the activity of continuously released ACh acting on nicotinic receptors, and the hyperthermic effect of tubocurarine to unmasking the activity of continuously released ACh acting on muscarinic receptors.