To explore the experience of primary healthcare (PHC) professionals in their professional role during the pandemic and to describe collective coping strategies.

We conducted a qualitative study using interviews, focus groups and photovoice techniques from February to September 2021. The qualitative data were transcribed, aggregated and analysed, from a hermeneutic perspective, using applied thematic analysis and ethnographic approaches.

Primary Care Health Madrid region (Spain).

Convenience sampling was used to select 71 multidisciplinary primary care professionals who were working in 12 PHCs representing diverse socioeconomic, social vulnerability and COVID impact levels in the Madrid region (Spain).

Findings from this study show how lack of protection in the early days, uncertainty about how the disease would evolve and the daily challenges they faced have had an impact on the participants' perceptions of their professional role. Nuanced differences in impact were found between men and women, age groups, professional roles and territories. The questioning of the basic foundations of primary care and the lack of prospects led to a feeling of demotivation. They perceive a wide gap between their levels of involvement and commitment, the recognition they receive and the attention to resources they need to do their work to a high standard. The support of their colleagues was seen as the most valuable resource for coping with the crisis.

The practitioners' discourses offer knowledge that could help to face new global health threats; they also identify an urgent need to restore the role and motivation of PHC professionals as part of a wider regeneration of health systems.

We hypothesised that all-cause mortality in elderly patients with obstructive sleep apnoea syndrome (OSAS) was associated with renal insufficiency.

A cohort study.

A prospective study of patients with OSAS enrolled in sleep centres/departments in multicentre hospitals in China from 2015 to 2017.

A total of 1290 patients with OSAS from six tertiary comprehensive hospitals in China were included in this study; of these, 1076 patients were included in the analysis based on inclusion and exclusion criteria.

All-cause death events were the main adverse outcomes.

During a median follow-up of 42 months, 50 patients (4.6%) died, including 24 (2.2%) cardiovascular deaths. The incidence of all-cause death and cardiovascular death was higher in patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m² than in the other groups (p<0.001). Multivariate Cox regression models showed that patients with low levels of eGFR had a higher risk of all-cause death compared with patients with high levels of eGFR (HR=8.954, 95% CI, 2.108 to 38.033; p=0.003) and cardiovascular death risk (HR=4.163, 95% CI, 1.524 to 11.375; p=0.005).

The incidence of all-cause death and cardiovascular death events increased with decreasing renal function in elderly patients with OSAS and was higher in patients with end-stage renal insufficiency. The risk of all-cause and cardiovascular deaths was highest at eGFR below 30 mL/min/1.73 m².

Exacerbations of chronic obstructive pulmonary disease (COPD) can lead to reduced lung function and worse clinical outcomes. Previous studies have reported associations between severe exacerbations and increased risk of hospitalisation and/or mortality. This meta-analysis examined the impact of moderate exacerbations on the risk of future exacerbations and all-cause mortality.

This meta-analysis included seven observational studies from the EXACOS (EXAcerbations of COPD and their OutcomeS)/AVOIDEX (Impact of AVOIDing EXacerbations of COPD) programme studies.

This meta-analysis used data from regional claims databases or electronic healthcare records from seven countries.

The individual studies included patients with a diagnosis of COPD and ≥12 months of data availability before (regarded as baseline) and after the index (ie, the date of the first COPD diagnosis), with postindex data considered the follow-up period.

The number of COPD exacerbations experienced during the baseline period (ie, the exposure variable) was used to categorise patients into the following groups: no exacerbations, one moderate exacerbation only or two or more moderate/severe exacerbations. Outcomes assessed included risk of COPD exacerbations and all-cause mortality during follow-up as a function of baseline exacerbations. For meta-analyses, all rate ratios (RRs) were log-transformed, and associations were pooled across studies using random-effects meta-analysis models.

Among 2 733 162 patients with COPD, one moderate exacerbation was significantly associated with a twofold increased risk of future exacerbations compared with having no exacerbations during baseline, with pooled RRs (95% CIs) of 2.47 (1.47 to 4.14) at 1 year, 2.49 (1.38 to 4.49) at 2 years and 2.38 (1.30 to 4.34) at 3 years postindex. The pooled RR (95% CI) for all-cause mortality was 1.30 (1.05 to 1.62), indicating a 30% increase in risk following one moderate exacerbation versus no exacerbations.

Preventing moderate exacerbations in patients with COPD should be a priority that may improve patient trajectories and outcomes.

Pneumatosis Intestinalis, though cannot be considered a diagnosis, but is a rare yet concerning finding encountered among patients who have been on oxygen support. Current article is a review that has taken into account a few case studies that have studied individuals with COPD for the incidence of the condition.

Existing literature was probed for information required with the help of databases available online depending upon the access, which were PubMed, Google scholar, Ovid and Pedro. Upon looking into all the data and information case studies were selected for the article owing to the information precision regarding the condition under study.

A total of four case studies were shortlisted for the article. These were the studies conducted on individuals diagnosed with COPD and had been found to develop PI. The case studies reported the occurrence and the management of PI among COPD diagnosed individuals.

The review gives an insight about incidence of PI in patients with COPD in justification of mechanical theory proposed for PI. The first line of management being the nutritional modifications and medications and increased mobility in case of conservative treatment, while surgery might be looked up to in severe cases.

knowing the chances of incidence of this condition can help prevent occurrence of PI. Nevertheless, early diagnosis in case of PI prevailing along with COPD, particularly amongst those on support with oxygen via high flow oxygen devices, can be of benefit for the patients as it helps avoid future complication on being dealt with at a relatively lower severity and reduce the risk of mortality among such patients.

In addition to passive case finding (PCF), active case finding (ACF) strategy under National Tuberculosis Elimination Program is a vital secondary prevention intervention under National Strategic Plan (NSP). The present study was conducted to assess ACF's cost-effectiveness compared to PCF in selected public health facilities for the detection of presumptive TB cases under NTEP.

A cross-sectional study was carried out in randomly selected seven public health facilities of a health block of one district of Himachal Pradesh. Bottom-up costing method was used with bootstrapping of results to assess incremental cost-effectiveness ratio (CEAC) and cost-effectiveness acceptability curve (CEAC).

Mean cost for ACF and PCF with US$ 3325.8 and 3006.0 respectively to detect all presumptive PTB cases; and US$ 4121.2 and to US$ 3709.0 to confirm all PTB cases. Below WTP threshold (per capita income US$ 2735), WTP 80.3% of simulated ICER values were cost-effective. CEAC showed that saturation was achieved around US$ 300 indicating a likely WTP threshold at which 79.5% of simulated values were cost-effective. For both strategies, One way sensitivity analysis showed the cost is influenced mostly by human resources.

Current study used bottom-up costing method in public health care facilities observed ACF as a cost-effective strategy in reaching out for presumptive PTB. The major cost driver in both strategies is human resource for training, travelling, and administration.

BACKGROUND\OBJECTIVES: There is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10-19 years.

We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10-13 years), middle (14-17 years), and late adolescents (18-19 years)and the results were compared among the three groups. A two-sided p value of <0.05 was considered statistically significant.

The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant.

There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.

To estimate the prevalence of latent tuberculosis infection (LTBI) and the need for TB preventive treatment (TPT) among hemodialysis (HD) patients in Sudan.

We screened patients in a single HD center by two-step tuberculin skin test (TST), symptom survey, physical examination and chest radiography (CXR).

The survey included 204 patients, five of whom (2.5%) had history of previously treated TB. The proportion of TST positive patients was 12.3% after the first test and increased to 21.1% after the second test. Patients previously treated for TB were more likely to have positive TST (80 vs 20.1%, p = 0.01). We screened 184 patients for TB disease; 16.3% were symptomatic, 15.8% had CXR abnormality and 6.5% were symptomatic with CXR abnormality. Additionally, 13.6% of patients had physical signs consistent with extra-pulmonary TB without symptoms or CXR abnormality. Based on these findings, high probability of pulmonary and extra-pulmonary TB was found in 38.6% and 13.6% of patients respectively and they were referred for bacteriological confirmation. We diagnosed LTBI and prescribed TPT to 9.2% of screened patients.

In this cohort of Sudanese HD patients, 21.1% were positive after two-step TST and 52.2% were considered to have high probability of TB disease.

For underdeveloped nations like India, tuberculosis (TB) ranks high among the top killers. The global death toll from tuberculosis is 1.5 million. In addition to setting a goal of elimination by 2025, India has made Tuberculosis (TB) a priority in its Sustainable Development Goals (SDG). The government has initiated Active Case Finding (ACF) to conduct house-to-house surveys and identify cases in order to reach the target. The purpose of this research is to assess the results of ACF in tribal district.

All tuberculosis (TB) cases reported through the ACF process within a certain time period were included in the present cross-sectional analysis, which comprised all villages of Chhota udepur district. In order to conduct the study among the tribal community, the Health and Family Welfare Department provided funding and approval.

Among all reported cases, 3828 presumptive TB cases were identified in 2019, 3033 in 2020, 3256 in 2021, 2956 in 2022 and 3047 in 2023. In 2019, 89 tuberculosis patients were diagnosed and enrolled in treatment. This increased to 118 patients in 2020, 95 in 2021, 115 in 2022 and 103 in 2023 because of ACF activity. Considering the number of people screened for each year, the ACF screening yield of 760 per 1 lakh in 2019 slightly increased to 820 per lakh population in 2020, 780 per lakh population in 2021, 1002 per lakh population in 2022 and 950 per lakh population in 2023. This increased the total case reported.

As a result of the effects of Active Case Finding, the study found that the reporting of tuberculosis cases in the tribal district increased.

India started implementing tuberculosis preventive treatment (TPT) among all household contacts of Tuberculosis (TB) cases, as a globally accepted strategy for elimination of TB.

We aimed to assess the extent of TPT coverage and adherence; ascertain the reasons for non-initiation and non-adherence; and to determine the correlates of coverage.

We conducted a cross-sectional study in a block of Murshidabad district, West Bengal during September-November'2023. A calculated sample of 301 eligible household contacts of 'index cases' (microbiologically-confirmed drug-sensitive pulmonary TB) registered during October'22 to March'23 were studied. We interviewed the participants/respondents with pre-designed schedule and prior informed consent. Descriptive and inferential statistics were applied through Statistical Package for Social Sciences (version 20).

Of 301 contacts, 179(59.5%) individually traced/counseled at the household; 238 (79.1%) were screened for TB symptoms. TPT initiation was 74.8% (225/301) with 47.1% within seven days of treatment initiation of index case; TPT not offered by health personnel (59.2%) being major reason for non-initiation. Completion rate with adherence to full course was 69.3% (156/225); perceived lack of need (50.7%) and migration (21.7%) being major reasons for non-adherence. Overall coverage of full course TPT among total eligible contacts was only 51.8% (156/301). On multivariable logistic regression; male gender (aOR = 1.982; 95% CI = 1.004-3.915), contacts with individual tracing/counseling (aOR = 13.507; 95% CI = 6.781-26.906) and who had symptoms screening (aOR = 5.694; 95% CI = 2.223-14.587) predicted significantly higher TPT coverage.

Cascade of care indicators for TPT remains suboptimal in the area and indicates need for further strengthening of programmatic aspects of its implementation.

Latent Tuberculosis infection (LTBI) care cascade involves identification of high-risk individuals, testing, identification of LTBI, initiation of Tuberculosis Preventive therapy (TPT) and documentation of outcomes. There is a dearth of such evidence in Indian setting which needs to be further explored. Hence, this feasibility study with public private engagement was conducted with the primary objective of estimating the prevalence of LTBI among household contacts (HHCs) of pulmonary tuberculosis patients using Interferon gamma release assay (IGRA). Secondary objective was to determine the treatment outcomes among the patients of LTBI initiated on TPT.

This longitudinal community-based study was conducted in wards 47-51 at urban field practice area of our Tertiary Teaching Institute at Bhopal, Madhya Pradesh. The household contacts of pulmonary tuberculosis patients diagnosed from January-June 2022 and those who satisfied the study criteria were recruited. Those who gave consent for IGRA testing and TPT initiation were followed up for a period of 6 months to assess the treatment outcomes. Data was analyzed using R software.

Of the 64 HHCs screened, 29 were the contacts of microbiologically positive and 35 were the contacts of clinically diagnosed index Tb patients including 4 under five children. Prevalence of LTBI using IGRA was 74.5%. The Contact Investigation Coverage in the urban setting was 77.1% with TPT completion of 72.4% and TPT Coverage of 55.7%. The median time for screening the HHCs since the diagnosis of index case was 14 days while screening to diagnosis was 2.5 days and that of TPT initiation from diagnosis was 22 days.

More than half of those who were tested using IGRA were positive for LTBI. Th public private coordination helped in narrowing the time interval from diagnosis of index tb case to contact tracing and improving the TPT adherence among the HHCs. However, intensive efforts are required to narrow the screening gap of HHCs and TPT initiation. Also, reasons for loss to follow up and missed doses needs to be qualitatively explored.