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R Rajeswari

Publications and source records attributed to R Rajeswari.

18 recordsLinked to original sources
PubMed2006

Initial drug susceptibility profile of M. tuberculosis among patients under TB programme in South India.

SETTING: Pulmonary tuberculosis (PTB) patients enrolled for treatment at government health facilities in a sub-district of Thiruvallur district, Tamil Nadu, India. OBJECTIVES: To determine the drug susceptibility profile among PTB patients admitted to treatment according to the Revised National Tuberculosis Control Programme (RNTCP). METHODOLOGY: From May 1999 to December 2003, two additional sputum samples were collected from all patients at the start of anti-tuberculosis treatment under DOTS and were transported to a central laboratory for Mycobacterium tuberculosis culture and drug susceptibility testing (DST). RESULTS: DST results were available for 1603 new sputum smear-positive patients; 85% of patients had organisms fully susceptible to streptomycin (S), isoniazid (H) and rifampicin (R), 10.4% any resistance to H and 1.7% to HR. Of 443 patients with history of previous anti-tuberculosis treatment, 59% had organisms susceptible to S, H and R, 37% had any resistance to H and 11.7% to HR. CONCLUSION: The DST profile showed that the vast majority of patients have drug-susceptible organisms, and that currently recommended regimens under the RNTCP would be effective in the treatment of TB.

Antitubercular Agents↗
PubMed2006

A rural public-private partnership model in tuberculosis control in south India.

SETTING: A rural tuberculosis (TB) unit in South India, 2001-2003. OBJECTIVE: To evaluate a rural public-private partnership model (PPPM) within the TB control programme (RNTCP). DESIGN: All of the private practitioners trained in modern medicine (PPs, n = 52) and the private laboratories (PLs, n = 13) in the area were listed. The PPs underwent training about the RNTCP, and PL staff were trained in sputum microscopy. PPPM included referral of TB suspects to the smear microscopy centres (government or PLs) for diagnosis and treatment of patients as per RNTCP guidelines. Patients were back-referred to the PPs. The directly observed treatment providers and centres were chosen by the PPs in consultation with their patients. The case detection rate, cure rate and profile of patients referred by the PPs were compared with those of self-reported patients. RESULTS: Of 489 TB suspects referred by the PPs, 24% were smear-positive compared to 10% of 15 278 self-reported patients (P < 0.001). Of 319 referred to PLs, 7% were smear-positive. The annual average case detection rate increased from 66 to 75 per 100 000 population. The cure rates of patients referred by the PPs were comparable to those of self-reported patients. CONCLUSIONS: This rural PPPM is effective and does not require additional staff or any direct financial incentives.

Adult↗
PubMed2005

Perceptions of tuberculosis patients about their physical, mental and social well-being: a field report from south India.

Tuberculosis (TB) often leaves its impact physically, socially and mentally on patients. The goal of current tuberculosis services is microbiological cure of tuberculosis. Understanding patients' perceptions about TB will enable better design of a client-oriented comprehensive programme for tuberculosis. We interviewed patients registered for treatment during July-December 2000 in government health facilities of two tuberculosis units of south India. Data on perceptions of their illness before the onset of illness and during the treatment period were collected, using a modified SF36 questionnaire. Health status was measured for the following: physical functioning, social role limitations due to physical and emotional problems (stigma), mental health, energy vitality, pain and general health perceptions. Of 980 patients registered, 610 (206 females) cured or treatment completed patients were interviewed at two time points. The reaction of patients to the disclosure of the diagnosis was worry (50%) and suicidal thoughts (9%). 'Good health status' was perceived initially in less than 7% of patients, and compared to the status at the onset of illness, there was significant improvement after treatment (more than 78% trend chi square p<0.05). Despite microbiological cure, 47% of patients continued to have respiratory symptoms; this was significantly higher among patients who had delayed taking action for more than 3 months. Only 54% of patients perceived 'happy mental status' at the end of treatment, and there was no change in social stigma in both men and women. Tuberculosis control programmes should address issues such as continued respiratory symptoms, persistence of stigma, and poor emotional quality of life of patients with tuberculosis, even after they are cured. As well, providing social support for the needy, timely counseling and health education of patients, which will alleviate mental and social sufferings of patients, should be considered.

Activities of Daily Living↗
PubMed2004

Gender disparities in tuberculosis: report from a rural DOTS programme in south India.

SETTING: Tiruvallur District, south India. OBJECTIVES: To examine gender differences in tuberculosis among adults aged >14 years with respect to infection and disease prevalence, health care service access, care seeking behaviour, diagnostic delay, convenience of directly observed treatment (DOT), stigma and treatment adherence. METHODS: Data were collected from 1) community survey, 2) self-referred out-patients seeking care at governmental primary health institutions (PHIs), 3) tuberculosis suspects referred for sputum microscopy at PHIs, and 4) tuberculosis patients notified under DOTS. Community survey results were compared with those for patients notified at PHIs. RESULTS: In the community, 66% of males and 57% of females had tuberculosis infection. The prevalence of smear-positive tuberculosis was 568 and 87/100,000, respectively, among males and females. Fewer males than females attended PHIs (68 men for every 100 women). Females constituted 13% of all smear-positive patients detected in the community survey, and 20% of those detected at PHIs (P < 0.05). The probability of notification decreased significantly with age among both males and females. Significantly more females than males felt inhibited discussing their illness with family (21% vs. 14%) and needed to be accompanied for DOT (11% vs. 6%). Males had twice the risk of treatment default than females (19% vs. 8%; P < 0.01). CONCLUSIONS: Despite facing greater stigma and inconvenience, women were more likely than men to access health services, be notified under DOTS and adhere to treatment. Men and elderly patients need additional support to access diagnostic and DOT services.

Adolescent↗
PubMed2003

Are community surveys to detect tuberculosis in high prevalence areas useful? Results of a comparative study from Tiruvallur District, South India.

BACKGROUND: In Tiruvallur District, South India, tuberculosis cases are detected at health facilities (HF) as part of a DOTS programme, and by screening adults through community survey (CS) as part of ongoing epidemiological research. OBJECTIVE: To compare socio-demographic, clinical and bacteriological characteristics and treatment outcomes of all patients detected at HF with those of all patients detected by CS during a 12-month period. RESULTS: Of 32,663 adults surveyed, 100 had smear-positive and 116 had smear-negative tuberculosis; of 65 smear-positive patients who began treatment, 44 were cured. Compared to HF patients, CS patients were significantly more likely to be older (AOR = 1.9), male (AOR = 2.7), non-literate (AOR = 1.7), and living in poor quality housing (AOR = 2.0), and were less likely to have cough >3 weeks (AOR = 3.4) or smear-positive tuberculosis (AOR = 4.2). Of 61 new smear-positive CS patients, 40 reported chest symptoms; of these, 32 (80%) had already consulted a health-care provider, but remained undiagnosed. CONCLUSIONS: The community survey was of little value in tuberculosis case detection even in this high-prevalence setting. Patients identified by the survey were less symptomatic and less infectious, and less than half were cured. Diagnostic services should be made more accessible to the elderly, the non-literate and men.

Adult↗
PubMed2002

Private pharmacies in tuberculosis control--a neglected link.

In most settings in India, private pharmacies dispense prescriptions for anti-tuberculosis drugs made out by private practitioners. In a cross-sectional study, we assessed the dispensing practices for tuberculosis and knowledge about the national tuberculosis programme of 300 pharmacies. In all, 2800 prescriptions were dispensed monthly by the pharmacies. Doctors' prescriptions were for durations of several months, but half of the patients bought drugs one dose at a time for self-administration. This practice might promote drug resistance. Although 95% of pharmacists were not aware of the existence of the tuberculosis programme, the majority (97%) were willing to learn and contribute towards tuberculosis control. The need and the potential of private pharmacies for participation in tuberculosis control are highlighted.

Antitubercular Agents↗
PubMed2002

Factors associated with patient and health system delays in the diagnosis of tuberculosis in South India.

OBJECTIVES: To investigate the factors associated with delay in 1) care-seeking (patient delay), and 2) diagnosis by health providers (health system delay), among smear-positive tuberculosis patients, before large-scale DOTS implementation in South India. METHODS: New smear-positive patients were interviewed using a structured questionnaire. RESULTS: Among 531 participants, the median patient, health system and total delays were 20, 23 and 60 days, respectively. Twenty-nine per cent of patients delayed seeking care for > 1 month, of whom 40% attributed the delay to their lack of awareness about TB. Men postponed seeking care for longer periods than women (P = 0.07). In multivariate analysis, the patient delay was greater if the patient had initially consulted a government provider (adjusted odds ratio [AOR] 2.2, P < or = 0.001), resided at a distance >2 km from a health facility (AOR 1.6, P = 0.04), and was an alcoholic (AOR 1.6, P = 0.04). Health system delay was >7 days among 69% of patients. Factors associated with health system delay were: first consultation with a private provider (AOR 4.0, P < 0.001), a shorter duration of cough (AOR 2.6, P = 0.001), alcoholism (P = 0.04) and patient's residence >2 km from a health facility (AOR 1.8, P = 0.02). The total delay resulted largely from a long patient delay when government providers were consulted first, and a long health system delay when private providers were consulted first. CONCLUSION: Public awareness about chest symptoms and the availability of free diagnostic services should be increased. Government and private physicians should be educated to be aware about the possibility of tuberculosis when examining out-patients. Effective referrals for smear microscopy should be developed between private and public providers.

Adult↗
PubMed2001

Serial evaluation of serum neopterin in HIV seronegative patients treated for tuberculosis.

OBJECTIVE: To delineate the course of serum neopterin (s-neo) concentrations in patients with pulmonary tuberculosis who are on anti-tuberculosis therapy. DESIGN: S-neo concentrations were measured by high performance liquid chromatography (HPLC) in 39 patients treated for pulmonary tuberculosis at pretreatment, at one month and at end of treatment. It was also measured in 11 relapse cases and their matched controls at the above time points and at the time of relapse. The results were correlated with bacteriological and radiological findings. RESULTS: All patients had elevated levels of s-neo at pretreatment which had declined at 1 month and were near normal at the end of treatment. The decline was more significant in patients with moderate lesions, suggesting that immune activation is maximum in this group of patients. The mean decrease was 37% at one month and 66% at the end of treatment. The corresponding decreases were 11% and 56% in patients with limited lesions and 11% and 45% in those with extensive lesions. It continued to fall after completion of therapy in patients who did not relapse, whereas an increase after completion of therapy was associated with bacteriologically proven relapse. CONCLUSIONS: The measurement of s-neo concentration could be of help in evaluating response to therapy. This study provides a rational basis for the association between s-neo concentration and relapse.

Adult↗
PubMed1999

Socio-economic impact of tuberculosis on patients and family in India.

OBJECTIVE: To quantify the socio-economic impact of tuberculosis on patients and their families from the costs incurred by patients in rural and urban areas. DESIGN: An interview schedule prepared from 17 focus group discussions was used to collect socio-economic demographic characteristics, employment, income particulars, expenditure on illness and effects on children from newly detected sputum-positive pulmonary tuberculosis patients. The direct and indirect costs included money spent on diagnosis, drugs, investigations, travel and loss of wages. Total costs were projected for the entire 6 months of treatment. RESULTS: The study population consisted of 304 patients (government health care 202, non governmental organisation 77, private practitioner 25), 120 of whom were females. Mean direct cost was Rs.2052/-, indirect Rs.3934/-, and total cost was Rs.5986/- ($171 US). The mean number of work days lost was 83 and mean debts totalled Rs.2079/-. Both rural and urban female patients faced rejection by their families (15%). Eleven per cent of schoolchildren discontinued their studies; an additional 8% took up employment to support their family. CONCLUSIONS: The total costs, and particularly indirect costs due to TB, were relatively high. The average period of loss of wages was 3 months. Care giving activities of female patients decreased significantly, and a fifth of schoolchildren discontinued their studies.

Absenteeism↗
PubMed1997

Short-course chemotherapy in the treatment of Pott's paraplegia: report on five year follow-up.

OBJECTIVE: To assess the efficacy of 9-month short-course chemotherapy (SCC) and to study the pattern of neurological recovery in patients with Pott's paraplegia. DESIGN: Patients with recent onset of spastic paraplegia due to clinically and radiologically active spinal tuberculosis involving vertebral bodies of level D4-L1 were treated with streptomycin, rifampicin, isoniazid and ethambutol daily for the first 2 months, followed by rifampicin plus isoniazid twice weekly for the next 7 months. The study was conducted in 2 phases. In the first phase 10 patients were admitted to the open trial where all patients had undergone modified Hong Kong surgery in addition to chemotherapy. In the next phase 23 patients enrolled in the study were randomly allocated to receive either chemotherapy alone or surgery plus chemotherapy. All the patients were followed for 5 years from the start of treatment. A scoring system was devised to predict neurological recovery. RESULTS: In all, 33 patients were admitted and treated with SCC. Thirteen patients were allocated to the chemotherapy (CHEM) regimen; of these 3 patients had to be operated upon for clinical deterioration; the remaining 20 had surgery plus chemotherapy; 4 were excluded for various reasons, leaving 29 patients in the analysis. None relapsed requiring treatment. CONCLUSION: A combination of surgery (when indicated) and SCC of 9 months' duration is effective in the treatment of Pott's paraplegia. All patients had neurological recovery by the end of 9 months; 8 recovered with chemotherapy alone. Complete motor recovery was seen in 62% by the 3rd month and 90% by the 6th month.

Adolescent↗
PubMed1997

Late onset paraplegia--a sequela to Pott's disease. A report on imaging, prevention and management.

Late onset paraplegia is a neurological complication that develops after a variable period in a patient with healed tuberculous disease of the vertebrae. In this retrospective analysis clinical features, imaging in diagnosis and treatment of this condition are described among 5 cases seen over a period of 5 years. This complication occurred even after successful treatment of initial spinal lesions with rifampicin-containing regimens. Magnetic resonance imaging was useful in pinpointing the exact pathology; one case had syrinx and two cases had marked internal gibbus with cord atrophy. Of the two cases who accepted surgical treatment, one improved.

Adolescent↗
PubMed1997

Study of the feasibility of involving male student volunteers in case holding in an urban tuberculosis programme.

This paper reports the feasibility of involving unpaid National Service Scheme (NSS) male student volunteers in a city-based tuberculosis (TB) programme in supplying drugs and retrieving non-complaint TB patients. Twenty-five students were selected after assessing their attitude and were trained on TB drug delivery, home visits and motivation of non-compliant patients. Twenty-three sputum positive patients identified in a medical camp were started on an 8-month short-course chemotherapy regimen. Students supplied the drugs on a weekly basis and defaulters were visited. The treatment completion rate was 83% and defaulter retrieval was 57%. All patients had sputum smear conversion by 2 months and one relapsed during the 24-month follow-up.

Adolescent↗
PubMed1995

A controlled clinical trial of short-course chemotherapy for tuberculoma of the brain.

OBJECTIVE: The efficacy of a short-course regimen in the treatment of brain tuberculoma and computerised tomography (CT) scan appearance before, during and after antituberculosis treatment was studied in a controlled clinical trial. DESIGN: Patients aged over 5 years with tuberculoma of the brain diagnosed by CT scan were randomly allocated to one of the following 2 regimens: Regimen 1: rifampicin, isoniazid and pyrazinamide daily for an initial 3 months followed by rifampicin and isoniazid twice-weekly for 6 months. Regimen 2: rifampicin, isoniazid and pyrazinamide thrice-weekly for an initial 3 months followed by rifampicin and isoniazid twice-weekly for 6 months. The patients were followed intensively for 2 years from the start of treatment. RESULTS: Of the 108 patients analysed (regimen 1: 56, regimen 2: 52), at the end of treatment clinical status was normal in 91% in regimen 1 and 88% in regimen 2. Of the 91 patients with scan assessments, CT scan lesions disappeared at 24 months in 77% of 47 patients in regimen 1 and 80% of 44 in regimen 2, and in both groups 88% of the patients were clinically normal. None had relapses requiring treatment. CONCLUSIONS: Short-course regimens of 9 months' duration are effective in the treatment of tuberculoma of the brain; clinical recovery was faster than scan clearance.

Adolescent↗
PubMed1984

Pharmacokinetics of methotrexate in adult Indian patients and its relationship to nutritional status.

Since anticancer drugs have a low therapeutic index, any significant change in the pharmacokinetics of a drug would have a bearing on therapeutic efficacy and drug toxicity. Nutritional deficiencies have been shown to affect the four processes of pharmacokinetics, ie, absorption, distribution, biotransformation, and excretion. Malnutrition and undernutrition are widely prevalent in India and thus it was thought to be of practical importance to study the effect of initial nutritional status on the overall kinetics of methotrexate, a widely used anticancer drug. The results of the study reveal that relative weight correlates well with the anthropometric parameters, nutritional parameters, and dietary intake and may be used as a marker of nutritional status. When grouped on the basis of relative weights, the undernourished patients revealed a significant (P less than 0.01) prolongation of biological half-life and a significant (P less than 0.001) reduction in clearance. Based on these results, relative weight has been proposed as a basis for drug dosage determinations in place of the existing practice of administering antineoplastic drugs on the basis of body surface area or body weight alone.

Adult↗
PubMed1976

Microcephaly.

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Child, Preschool↗