BackgroundAmong healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India.Methodology/Principal FindingsAmong 535 nursing students enrolled in 2007, 468 gave consent to participate, and 436 underwent two-step tuberculin skin testing (TST). A majority (95%) were females, and almost 80% were under 22 years of age. Detailed TB exposure information was obtained using interviews and clinical log books. Prevalence of latent TB infection (LTBI) was estimated using Bayesian latent class analyses (LCA). Logistic regression analyses were done to determine the association between LTBI prevalence and TB exposure and risk factors. 219 of 436 students (50.2%, 95% CI: 45.4–55.0) were TST positive using the 10 mm or greater cut-off. Based on the LCA, the prevalence of LTBI was 47.8% (95% credible interval 17.8% to 65.6%). In the multivariate analysis, TST positivity was strongly associated with time spent in health care, after adjusting for age at entry into healthcare.ConclusionsOur study showed a high prevalence of LTBI even in young nursing trainees. With the recent TB infection control (TBIC) policy guidance from the World Health Organization as the reference, Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement TBIC interventions, and enhance capacity for TBIC at the country level. Young trainees and nurses, in particular, will need to be targeted for TBIC interventions.

BackgroundNurses in developing countries are frequently exposed to infectious tuberculosis (TB) patients, and have a high prevalence of TB infection. To estimate the incidence of new TB infection, we recruited a cohort of young nursing trainees at the Christian Medical College in Southern India. Annual tuberculin skin testing (TST) was conducted to assess the annual risk of TB infection (ARTI) in this cohort.Methodology/Principal Findings436 nursing students completed baseline two-step TST testing in 2007 and 217 were TST-negative and therefore eligible for repeat testing in 2008. 181 subjects completed a detailed questionnaire on exposure to tuberculosis from workplace and social contacts. A physician verified the questionnaire and clinical log book and screened the subjects for symptoms of active TB. The majority of nursing students (96.7%) were females, almost 84% were under 22 years of age, and 80% had BCG scars. Among those students who underwent repeat testing in 2008, 14 had TST conversions using the ATS/CDC/IDSA conversion definition of 10 mm or greater increase over baseline. The ARTI was therefore estimated as 7.8% (95%CI: 4.3–12.8%). This was significantly higher than the national average ARTI of 1.5%. Sputum collection and caring for pulmonary TB patients were both high risk activities that were associated with TST conversions in this young nursing cohort.ConclusionsOur study showed a high ARTI among young nursing trainees, substantially higher than that seen in the general Indian population. Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement internationally recommended TB infection control interventions to protect its health care workforce.

There was a significant improvement in the knowledge (p<0.001) and practice (p<0.003) of nurses in the experimental group following the educational programme.

To study the clinical characteristics of rheumatoid arthritis (RA) patients attending the rheumatology unit in a private hospital. The demographic characteristics, laboratory parameters, comorbidities, articular manifestations and pattern of prescriptions were studied from the case records. A total of 75 RA patients were studied. Female preponderance was observed and the ratio was found to be 3:1. The frequent laboratory measurements were found to be erythrocyte sedimentation rate (ESR), hemoglobin (Hb), and other hematological parameters. The articular manifestations were found to be knee, wrist, ankle, shoulder and elbow joints. The most common comorbidity was found to be hypertension and diabetes mellitus. The prescription pattern revealed the disease modifying antirheumatic drugs (DMARDs) as the first line drugs followed by steroids and non-steroidal antiinflammatory drugs (NSAIDs). The first line DMARD was found to be methotrexate. The tendency of polypharmacy was more and the most combination was DMARD with a steroid and NSAID. The trend reveals aggressive therapy among rheumatologists. Frequent monitoring of adverse drug reactions like hepatic abnormalities for DMARDs and bone densitometry for oral glucocorticoids and drug interactions could further improve the quality of life of RA patients.

: The cardiovascular complications of type 2 diabetes mellitus (T2DM) include myocardial infarction, heart failure, peripheral vascular disease and, stroke and retinopathy, nephropathy and neuropathy are microvascular complications. While the newer therapies like glitazones or even dipeptidyl-peptidase-IV (DPP-IV) inhibitors increase the risk of therapy, the Glucagon Like Peptide-1 Receptor Agonists (GLP-1RAs), were reported as suitable alternates. The GLP-1RAs reduce the major adverse cardiovascular events (MACE), have anti-atherogenic potential, possess pleiotropic activity. The GLP-1RAs were found to improve neuroprotection, enhance neuronal growth, reduce the incidence of stroke, and found to improve central insulin resistance. The GLP-1RAs are beneficial in improving the glycemic profile, prevents macroalbuminuria and reduces the decline in eGFR and beneficial in improving renal protection. The renal benefits of add on therapy of GLP-1RAs with SGLT-2 inhibitors have composite renal outcomes such as suppression of inflammatory pathways, improvement in natriuresis, diuresis, and also found to be nephroprotective. Improvement in glycemic control with reduction in body weight and intraglomerular pressure and prevention of tubular injury makes the GLP-1RAs as suitable add-on therapies in improving cardiorenal outcomes. Obesity important contributor of insulin resistance and a reduction in weight is an important therapeutic option in addressing diabetic-obesity. It also reduces the damage to blood-retinal-barrier, thus beneficial in halting the development of diabetic retinopathy. In diabetic complications, glycemic control, addressing insulin resistance through weight loss, controlling atherosclerosis through anti-inflammatory effects and cardio-renal-neuro protection, makes GLP-1RAs a suitable therapeutic strategy on long-term treatment of T2DM. This review discusses the role of GLP-1RAs in diabetes, the dosage, mono or combination therapy with other antidiabetics in long-term treatment and its effect in uncontrolled diabetes.