Yatin Dholakia - Academia.edu (original) (raw)

Papers by Yatin Dholakia

Research paper thumbnail of Active tuberculosis case finding in a migrant slum community, Mumbai, India

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2016

Research paper thumbnail of Tuberculosis in congregate settings: Policies and practices in various facilities in Mumbai, India

The Indian journal of tuberculosis, 2017

Congregate settings and correctional facilities have high risk of transmission of tuberculosis. T... more Congregate settings and correctional facilities have high risk of transmission of tuberculosis. They should have capacity to identify and diagnose cases early and initiate prompt treatment to prevent spread to inmates and staff. Appropriate interventions should ensure completion of treatment, documentation and reporting, and prevention of reactivation of successfully treated cases. This requires support from local health authorities. Although international policies and guidelines for infection control in congregate settings are available, there is very little information on how these are practiced in such settings. Our investigation highlights the policies and practices of various congregate facilities in the city of Mumbai.

Research paper thumbnail of Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India

PLOS ONE, 2016

Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tub... more Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai. A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values. The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation. Achieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be singularly effective in curbing pathway delays.

Research paper thumbnail of Correction: Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India

PLOS ONE, 2016

[This corrects the article DOI: 10.1371/journal.pone.0152287.].

Research paper thumbnail of Use of standardised patients to assess quality of tuberculosis care

The Lancet. Infectious diseases, 2016

Research paper thumbnail of TB/ HIV coordination through Public Private Partnership: lessons from the field

The Indian journal of tuberculosis, 2013

Co-infection with tuberculosis adversely affects the quality of life of HIV infected individuals ... more Co-infection with tuberculosis adversely affects the quality of life of HIV infected individuals and additionally, HIV testing among TB patients gives an opportunity for prevention and treatment of HIV infection. TB-HIV coordination activities are therefore a good public health intervention. It was a three-year Public Private Partnership Project, implemented in four districts of Maharashtra, to improve access to public health facilities through community awareness and motivating referrals. Outreach workers were engaged to motivate patients attending Integrated Counselling and Testing Centres (ICTCs) and Designated Microscopy Centres (DMCs) for cross referrals and adherence to services. Community leaders and private health providers were sensitized to issues around TB and HIV/AIDS. 357 outreach workers referred 17,200 individuals for HIV testing and 32,549 TB suspects were referred for testing. An average of 18% TB cases (13% to 26%) and 7% (4% to 13%) HIV infected cases were identif...

Research paper thumbnail of Relapse Following Directly Observed Therapy Short Course (Dots) - a Follow Up Study

The Indian journal of tuberculosis

Summary: DO IS strategy was introduced m the RNTCP in 1993 because of its high efficiency. Howeve... more Summary: DO IS strategy was introduced m the RNTCP in 1993 because of its high efficiency. However, follow up reports on the patients completing treatment under DOTS, and considered cured, to assess relapse rate are very few. We have followed up a cohort of 2.3 16 patients, put under DOTS from 1996 tn 1998 in a Municipal Ward in Mumbai. of whom 75.55% were new patients and 24 45% were retreatment cases. The cohort had shown cure/treatment completion of 83.59% ( 1936/23 16). deaths 4.66% (108/2316), treatment failures 1.08% (25/23 16), defaulters 9.45% (219/2136) and transferred out I 2% 1287316) All the cohort patients, were followed up in their homes during August - October 1999 alter lapse of varying periods of observation. Of the 2068(89.29%) cases traced out, 3.82%(79/2068) had relapsed. I 98% (41/2068) had died and 82.68% (17107 2(168) had no complaints at the tune of follow up. The rest were either on treatment or were without treatment. Among the 41 additional deaths, there w...

Research paper thumbnail of Ethics, human rights and programmatic management of drug-resistant tuberculosis

Lung India, 2012

Submission Deadline : 28 th Feb, 2012 (Abstract to be send by email to abstractsleep@gmail.com) A... more Submission Deadline : 28 th Feb, 2012 (Abstract to be send by email to abstractsleep@gmail.com) Announcement View publication stats View publication stats

Research paper thumbnail of Survey of Diagnostic Services In the Private Health Sector of Mumbai for Assessment of Tb Case Detection

INDIAN JOURNAL OF TUBERCULOSIS, 2006

Summary Background: The exact burden of tuberculosis remains unknown due to the fact that there a... more Summary Background: The exact burden of tuberculosis remains unknown due to the fact that there are many health care providers who continue to provide care to patients suffering from tuberculosis and remain unregulated despite the DOTs strategy being implemented on a ...

Research paper thumbnail of Chest X-rays and associated clinical parameters in pulmonary tuberculosis cases from the National Tuberculosis Programme, Mumbai

Research paper thumbnail of Clinical profile and treatment outcomes of drug-resistant tuberculosis before directly observed treatment strategy plus: Lessons for the program

Lung India : official organ of Indian Chest Society, 2013

Characteristics and treatment outcomes of patients with drug-resistant tuberculosis (DR TB) befor... more Characteristics and treatment outcomes of patients with drug-resistant tuberculosis (DR TB) before introduction of directly observed treatment strategy (DOTS) plus are infrequently reported. To study clinical characteristics and treatment outcomes of drug-resistant TB patients. A TB unit in Mumbai. A retrospective analysis of DR TB patients attending a TB unit and taking treatment at NGOs was performed. Of the 34 cases, 5 (14%) had mycobacterium other than tuberculosis, 24 were pulmonary TB, 4 extra-pulmonary TB, and one both. Three were HIV-infected, two had diabetes. Two cases were treatment naive. Of the 29 cases studied, 3 (11%) were mono-resistant, 20 (69%) were multidrug-resistant (MDR) TB with E/Z/EZ resistance; 4 were pure MDR TB. One case had XDR TB, 13 (44.8%) had resistance to at least one conventional second-line drug. Seven cases had adverse drug reaction, four requiring drug substitution. Two patients are on treatment; 14 of the remaining 27 (51%) were successfully tre...

Research paper thumbnail of A Cohort Analysis from a Rural Ngo TB Control Project

The Indian journal of tuberculosis

Summary : Passive case-finding is the accepted method for new case detection. In the revised Nati... more Summary : Passive case-finding is the accepted method for new case detection. In the revised National TB programme, stress has been placed on case-holding and treatment completion till cure is achieved. Therefore, the results of the TB control activities of a community based health project in a rural set UP are presented. During the year 1994,124 cases of tuberculosis were registered and treated; 111 of the 124 cases (89%) completed their treatment and were cured; 5 (4%) died and 8 (6.5%) were lost to follow-up. Of the 111 cases, none missed their appointment days and were very regular. After nearly one year of follow up none of the patients has relapsed.

Research paper thumbnail of A Comparative Study of Pernoxid vs Chlophedianol

Research paper thumbnail of Ayurvedic therapy and HIV-1 infection

Impact of Ayurvedic intervention on the Natural History of HIV-1 infected individuals in Mumbai, ... more Impact of Ayurvedic intervention on the Natural History of HIV-1 infected individuals in Mumbai, India. A sub cohort of HIV-1 infected individuals recruited for the Natural History study was created. Patients who opted for Ayurvedic therapy and had taken at least six months treatment were recruited. Others formed the controls. Patients on or previous antiretroviral treatment were excluded. WHO clinical staging and national guidelines for treatment of Opportunistic Infections and tuberculosis were followed. Progression of HIV disease was assessed clinically. Results: Of 206 patients analysed retrospectively, 104, 55 and 47 patients were initially in the asymptomatic, ARC and AIDS stage. 90/104 (86.5%) asymptomatic individuals did not progress to higher stage (2.0 p-y follow up); 14/104 (13.5%) progressed to ARC, whereas 27/55 (47%) remained symptom free (follow up 1.9 p-y) probably indicating nonprogression or reversal of stage. The progression of ARC to AIDS occurred in 11% and ARC ...

Research paper thumbnail of Advocacy, Sensitization & Training

Research paper thumbnail of Profile of NGOs involved in management of MDR TB in Mumbai before rollout of DOTS Plus

Indian Journal of Tuberculosis, 2015

Research paper thumbnail of Observations on categorisation of new TB cases: implications for controlling drug resistance

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2007

In the context of rising rates of drug-resistant tuberculosis (TB) in India, this communication p... more In the context of rising rates of drug-resistant tuberculosis (TB) in India, this communication presents some field observations during screening of new cases registered with the Revised National Tuberculosis Control Programme (RNTCP) in urban and rural areas of Maharashtra, India. It appears that erroneous categorisation and treatment that contributes to multiple drug resistance results from a lack of patient screening for previous treatment, ambiguity in categorisation and reluctance to disclose a history of anti-tuberculosis treatment. Suggested measures include detailed screening of new cases, computerisation of patient records and an empathetic dialogue between patient and health care provider.

Research paper thumbnail of Chest X-rays and associated clinical parameters in pulmonary Tubercolosis cases from the National Tubercolosis Program, Mumbai, India

Infectious Disease Reports, 2012

The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis co... more The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB) and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions) were analyzed to identify associations with biological/clinical parameters through univariate and multivariate logistic regression. Failures demonstrated associations between extensive lesions and high glycosylated hemoglobin (GHb) levels (P=0.028) and male gender (P=0.03). An association was also detected between cavitation and MDR (P=0.048). In new cases, bilateral cavities were associated with MDR (P=0.018) and male gender (P=0.01), low body mass index with infiltrates (P=0.008), and smoking with cavitation (P=0.0238). Strains belonging to the Manu1 spoligotype were associated with mild lesions (P=0.002). Poor outcome showed borderline significance with extensive lesions at onset (P=0.053). Furthermore, amongst new cases, smoking, the Central Asian Strain (CAS) spoligotype and high GHb were associated with cavitation, whereas only CAS spoligotypes and high GHb were associated with extensive lesions. The study highlighted associations between certain clinical parameters and X-ray evidence which support the potential of X-rays to predict TB, MDRTB and poor outcome. The use of Xrays as an additional tool to shorten diagnostic delay and shortlist MDR suspects amongst nonresponders to TB treatment should be explored in a setting with limited resources coping with a high MDR case load such as Mumbai.

Research paper thumbnail of Severe weight loss: the predominant clinical presentation of tuberculosis in patients with HIV infection in India

The National medical journal of India

Tuberculosis is endemic in India and its prevalence is reported to be increasing in patients with... more Tuberculosis is endemic in India and its prevalence is reported to be increasing in patients with human immuno-deficiency virus (HIV) infection. Several factors, including the level of immune deficiency, influence the clinical presentation of HIV-associated tuberculosis. Between April 1994 and April 1996, 1820 patients with confirmed HIV infection were studied for their clinical, radiological and laboratory parameters. Severe weight loss was observed as a frequent presenting complaint. Hence, a case-control analysis was performed using severe weight loss as the presenting criterion among HIV-seropositive patients. Of the 1820 patients with HIV infection, 410 (23%) presented with severe weight loss of > 10% of body weight within the preceding month. Of these 410 patients, 176 (43%) had tuberculosis, 94 (23%) had chronic diarrhoea, and 89 (22%) had recurrent fever. Among 176 patients with tuberculosis, the following types of HIV-associated tuberculosis were seen: 115/176 (66%) had ...

Research paper thumbnail of Tuberculosis Control Involvement of Private Medical Sector One to One Approach: Mumbai Experience

INTER AIDE UCITC Tuberculosis Control Involving private medical sector: the Mumbai experience ___... more INTER AIDE UCITC Tuberculosis Control Involving private medical sector: the Mumbai experience _______________________________________________________________________________________ INTER AIDE -UCITC 1 Acknowledgments

Research paper thumbnail of Active tuberculosis case finding in a migrant slum community, Mumbai, India

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2016

Research paper thumbnail of Tuberculosis in congregate settings: Policies and practices in various facilities in Mumbai, India

The Indian journal of tuberculosis, 2017

Congregate settings and correctional facilities have high risk of transmission of tuberculosis. T... more Congregate settings and correctional facilities have high risk of transmission of tuberculosis. They should have capacity to identify and diagnose cases early and initiate prompt treatment to prevent spread to inmates and staff. Appropriate interventions should ensure completion of treatment, documentation and reporting, and prevention of reactivation of successfully treated cases. This requires support from local health authorities. Although international policies and guidelines for infection control in congregate settings are available, there is very little information on how these are practiced in such settings. Our investigation highlights the policies and practices of various congregate facilities in the city of Mumbai.

Research paper thumbnail of Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India

PLOS ONE, 2016

Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tub... more Timely diagnosis and treatment initiation are critical to reduce the chain of transmission of Tuberculosis (TB) in places like Mumbai, where almost 60% of the inhabitants reside in overcrowded slums. This study documents the pathway from the onset of symptoms suggestive of TB to initiation of TB treatment and examines factors responsible for delay among uncomplicated pulmonary TB patients in Mumbai. A population-based retrospective survey was conducted in the slums of 15 high TB burden administrative wards to identify 153 self-reported TB patients. Subsequently in-depth interviews of 76 consenting patients that fit the inclusion criteria were undertaken using an open-ended interview schedule. Mean total, first care seeking, diagnosis and treatment initiation duration and delays were computed for new and retreatment patients. Patients showing defined delays were divided into outliers and non-outliers for all three delays using the median values. The mean duration for the total pathway was 65 days with 29% of patients being outliers. Importantly the mean duration of first care seeking was similar in new (24 days) and retreatment patients (25 days). Diagnostic duration contributed to 55% of the total pathway largely in new patients. Treatment initiation was noted to be the least among the three durations with mean duration in retreatment patients twice that of new patients. Significantly more female patients experienced diagnostic delay. Major shift of patients from the private to public sector and non-allopaths to allopaths was observed, particularly for treatment initiation. Achieving positive behavioural changes in providers (especially non-allopaths) and patients needs to be considered in TB control strategies. Specific attention is required in counselling of TB patients so that timely care seeking is effected at the time of relapse. Prioritizing improvement of environmental health in vulnerable locations and provision of point of care diagnostics would be singularly effective in curbing pathway delays.

Research paper thumbnail of Correction: Durations and Delays in Care Seeking, Diagnosis and Treatment Initiation in Uncomplicated Pulmonary Tuberculosis Patients in Mumbai, India

PLOS ONE, 2016

[This corrects the article DOI: 10.1371/journal.pone.0152287.].

Research paper thumbnail of Use of standardised patients to assess quality of tuberculosis care

The Lancet. Infectious diseases, 2016

Research paper thumbnail of TB/ HIV coordination through Public Private Partnership: lessons from the field

The Indian journal of tuberculosis, 2013

Co-infection with tuberculosis adversely affects the quality of life of HIV infected individuals ... more Co-infection with tuberculosis adversely affects the quality of life of HIV infected individuals and additionally, HIV testing among TB patients gives an opportunity for prevention and treatment of HIV infection. TB-HIV coordination activities are therefore a good public health intervention. It was a three-year Public Private Partnership Project, implemented in four districts of Maharashtra, to improve access to public health facilities through community awareness and motivating referrals. Outreach workers were engaged to motivate patients attending Integrated Counselling and Testing Centres (ICTCs) and Designated Microscopy Centres (DMCs) for cross referrals and adherence to services. Community leaders and private health providers were sensitized to issues around TB and HIV/AIDS. 357 outreach workers referred 17,200 individuals for HIV testing and 32,549 TB suspects were referred for testing. An average of 18% TB cases (13% to 26%) and 7% (4% to 13%) HIV infected cases were identif...

Research paper thumbnail of Relapse Following Directly Observed Therapy Short Course (Dots) - a Follow Up Study

The Indian journal of tuberculosis

Summary: DO IS strategy was introduced m the RNTCP in 1993 because of its high efficiency. Howeve... more Summary: DO IS strategy was introduced m the RNTCP in 1993 because of its high efficiency. However, follow up reports on the patients completing treatment under DOTS, and considered cured, to assess relapse rate are very few. We have followed up a cohort of 2.3 16 patients, put under DOTS from 1996 tn 1998 in a Municipal Ward in Mumbai. of whom 75.55% were new patients and 24 45% were retreatment cases. The cohort had shown cure/treatment completion of 83.59% ( 1936/23 16). deaths 4.66% (108/2316), treatment failures 1.08% (25/23 16), defaulters 9.45% (219/2136) and transferred out I 2% 1287316) All the cohort patients, were followed up in their homes during August - October 1999 alter lapse of varying periods of observation. Of the 2068(89.29%) cases traced out, 3.82%(79/2068) had relapsed. I 98% (41/2068) had died and 82.68% (17107 2(168) had no complaints at the tune of follow up. The rest were either on treatment or were without treatment. Among the 41 additional deaths, there w...

Research paper thumbnail of Ethics, human rights and programmatic management of drug-resistant tuberculosis

Lung India, 2012

Submission Deadline : 28 th Feb, 2012 (Abstract to be send by email to abstractsleep@gmail.com) A... more Submission Deadline : 28 th Feb, 2012 (Abstract to be send by email to abstractsleep@gmail.com) Announcement View publication stats View publication stats

Research paper thumbnail of Survey of Diagnostic Services In the Private Health Sector of Mumbai for Assessment of Tb Case Detection

INDIAN JOURNAL OF TUBERCULOSIS, 2006

Summary Background: The exact burden of tuberculosis remains unknown due to the fact that there a... more Summary Background: The exact burden of tuberculosis remains unknown due to the fact that there are many health care providers who continue to provide care to patients suffering from tuberculosis and remain unregulated despite the DOTs strategy being implemented on a ...

Research paper thumbnail of Chest X-rays and associated clinical parameters in pulmonary tuberculosis cases from the National Tuberculosis Programme, Mumbai

Research paper thumbnail of Clinical profile and treatment outcomes of drug-resistant tuberculosis before directly observed treatment strategy plus: Lessons for the program

Lung India : official organ of Indian Chest Society, 2013

Characteristics and treatment outcomes of patients with drug-resistant tuberculosis (DR TB) befor... more Characteristics and treatment outcomes of patients with drug-resistant tuberculosis (DR TB) before introduction of directly observed treatment strategy (DOTS) plus are infrequently reported. To study clinical characteristics and treatment outcomes of drug-resistant TB patients. A TB unit in Mumbai. A retrospective analysis of DR TB patients attending a TB unit and taking treatment at NGOs was performed. Of the 34 cases, 5 (14%) had mycobacterium other than tuberculosis, 24 were pulmonary TB, 4 extra-pulmonary TB, and one both. Three were HIV-infected, two had diabetes. Two cases were treatment naive. Of the 29 cases studied, 3 (11%) were mono-resistant, 20 (69%) were multidrug-resistant (MDR) TB with E/Z/EZ resistance; 4 were pure MDR TB. One case had XDR TB, 13 (44.8%) had resistance to at least one conventional second-line drug. Seven cases had adverse drug reaction, four requiring drug substitution. Two patients are on treatment; 14 of the remaining 27 (51%) were successfully tre...

Research paper thumbnail of A Cohort Analysis from a Rural Ngo TB Control Project

The Indian journal of tuberculosis

Summary : Passive case-finding is the accepted method for new case detection. In the revised Nati... more Summary : Passive case-finding is the accepted method for new case detection. In the revised National TB programme, stress has been placed on case-holding and treatment completion till cure is achieved. Therefore, the results of the TB control activities of a community based health project in a rural set UP are presented. During the year 1994,124 cases of tuberculosis were registered and treated; 111 of the 124 cases (89%) completed their treatment and were cured; 5 (4%) died and 8 (6.5%) were lost to follow-up. Of the 111 cases, none missed their appointment days and were very regular. After nearly one year of follow up none of the patients has relapsed.

Research paper thumbnail of A Comparative Study of Pernoxid vs Chlophedianol

Research paper thumbnail of Ayurvedic therapy and HIV-1 infection

Impact of Ayurvedic intervention on the Natural History of HIV-1 infected individuals in Mumbai, ... more Impact of Ayurvedic intervention on the Natural History of HIV-1 infected individuals in Mumbai, India. A sub cohort of HIV-1 infected individuals recruited for the Natural History study was created. Patients who opted for Ayurvedic therapy and had taken at least six months treatment were recruited. Others formed the controls. Patients on or previous antiretroviral treatment were excluded. WHO clinical staging and national guidelines for treatment of Opportunistic Infections and tuberculosis were followed. Progression of HIV disease was assessed clinically. Results: Of 206 patients analysed retrospectively, 104, 55 and 47 patients were initially in the asymptomatic, ARC and AIDS stage. 90/104 (86.5%) asymptomatic individuals did not progress to higher stage (2.0 p-y follow up); 14/104 (13.5%) progressed to ARC, whereas 27/55 (47%) remained symptom free (follow up 1.9 p-y) probably indicating nonprogression or reversal of stage. The progression of ARC to AIDS occurred in 11% and ARC ...

Research paper thumbnail of Advocacy, Sensitization & Training

Research paper thumbnail of Profile of NGOs involved in management of MDR TB in Mumbai before rollout of DOTS Plus

Indian Journal of Tuberculosis, 2015

Research paper thumbnail of Observations on categorisation of new TB cases: implications for controlling drug resistance

The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2007

In the context of rising rates of drug-resistant tuberculosis (TB) in India, this communication p... more In the context of rising rates of drug-resistant tuberculosis (TB) in India, this communication presents some field observations during screening of new cases registered with the Revised National Tuberculosis Control Programme (RNTCP) in urban and rural areas of Maharashtra, India. It appears that erroneous categorisation and treatment that contributes to multiple drug resistance results from a lack of patient screening for previous treatment, ambiguity in categorisation and reluctance to disclose a history of anti-tuberculosis treatment. Suggested measures include detailed screening of new cases, computerisation of patient records and an empathetic dialogue between patient and health care provider.

Research paper thumbnail of Chest X-rays and associated clinical parameters in pulmonary Tubercolosis cases from the National Tubercolosis Program, Mumbai, India

Infectious Disease Reports, 2012

The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis co... more The study was carried out in pulmonary tuberculosis (PTB) patients from the local Tuberculosis control programme, Mumbai, India. It examined features of chest X-rays and their correlation with clinical parameters for possible application in suspected multidrug resistant TB (MDRTB) and to predict outcome in new and treatment failure PTB cases. X-ray features (infiltrate, cavitation, miliary shadows, pleural effusion, mediastinal lymphadenopathy and extent of lesions) were analyzed to identify associations with biological/clinical parameters through univariate and multivariate logistic regression. Failures demonstrated associations between extensive lesions and high glycosylated hemoglobin (GHb) levels (P=0.028) and male gender (P=0.03). An association was also detected between cavitation and MDR (P=0.048). In new cases, bilateral cavities were associated with MDR (P=0.018) and male gender (P=0.01), low body mass index with infiltrates (P=0.008), and smoking with cavitation (P=0.0238). Strains belonging to the Manu1 spoligotype were associated with mild lesions (P=0.002). Poor outcome showed borderline significance with extensive lesions at onset (P=0.053). Furthermore, amongst new cases, smoking, the Central Asian Strain (CAS) spoligotype and high GHb were associated with cavitation, whereas only CAS spoligotypes and high GHb were associated with extensive lesions. The study highlighted associations between certain clinical parameters and X-ray evidence which support the potential of X-rays to predict TB, MDRTB and poor outcome. The use of Xrays as an additional tool to shorten diagnostic delay and shortlist MDR suspects amongst nonresponders to TB treatment should be explored in a setting with limited resources coping with a high MDR case load such as Mumbai.

Research paper thumbnail of Severe weight loss: the predominant clinical presentation of tuberculosis in patients with HIV infection in India

The National medical journal of India

Tuberculosis is endemic in India and its prevalence is reported to be increasing in patients with... more Tuberculosis is endemic in India and its prevalence is reported to be increasing in patients with human immuno-deficiency virus (HIV) infection. Several factors, including the level of immune deficiency, influence the clinical presentation of HIV-associated tuberculosis. Between April 1994 and April 1996, 1820 patients with confirmed HIV infection were studied for their clinical, radiological and laboratory parameters. Severe weight loss was observed as a frequent presenting complaint. Hence, a case-control analysis was performed using severe weight loss as the presenting criterion among HIV-seropositive patients. Of the 1820 patients with HIV infection, 410 (23%) presented with severe weight loss of > 10% of body weight within the preceding month. Of these 410 patients, 176 (43%) had tuberculosis, 94 (23%) had chronic diarrhoea, and 89 (22%) had recurrent fever. Among 176 patients with tuberculosis, the following types of HIV-associated tuberculosis were seen: 115/176 (66%) had ...

Research paper thumbnail of Tuberculosis Control Involvement of Private Medical Sector One to One Approach: Mumbai Experience

INTER AIDE UCITC Tuberculosis Control Involving private medical sector: the Mumbai experience ___... more INTER AIDE UCITC Tuberculosis Control Involving private medical sector: the Mumbai experience _______________________________________________________________________________________ INTER AIDE -UCITC 1 Acknowledgments