Background: The average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from $55 to $8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016–2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India. Objectives: The objectives of the study were among the newly diagnosed and previously treated tuberculosis (TB) patients, to (a) estimate patient costs during diagnosis and intensive phase of treatment, (b) determine the proportion of households experiencing catastrophic costs, and (c) explore coping strategies. Methods: An explanatory mixed methods design comprising both quantitative cost description and qualitative descriptive component was used. Catastrophic cost was defined as total TB care costs exceeding 20% of annual household income. Results: Of 102 TB patients included, two-thirds (69%) were male, 6% were HIV positive, and 45% reported at least one episode of hospitalization for TB care. The median (IQR) total cost of TB care was US$195 (52.1, 492.9) with a direct cost of US$65.3 (22.3, 156.5) and indirect cost of US$50.2 (0.9, 295.1). Overall, 32.4% of households experienced catastrophic costs due to TB care, significantly higher in patients with HIV coinfection (p = 0.009) and hospitalization (p = 0.009). Pledging jewels and borrowing money were major coping strategies. Cash assistance was the expected remedy from the patient perspective. Conclusion: Despite free TB care under NTP, more than a third incurred catastrophic costs towards TB care.

Background:We investigated anti-diabetic, hypolipedimic and antioxidant activity of hydroalcoholic extract from leaves and fruit peel of Punica granatum.Materials and Methods:Streptozotocin induced diabetic Wister rats were used in this study consisting of seven groups of six animals each. Groups (1) normal control, (2) diabetic control, (3) leaves extract 100 mg/kg b.w. of P. granatum, (4) leaves extract 200 mg/kg b.w. of P. granatum, (5) fruit peel extract 100 mg/kg b.w. of P. granatum, (6) peel extract 200 mg/kg b.w. of P. granatum and (7) glibenclamide respectively. Fasting blood sugar was recorded on 1st, 7th, 14th, 21st and 28th day. At the end of the experiment Lipid profile and levels of antioxidants were determined. Safety profile of both extracts was evaluated using acute and chronic toxicity studies.Results:Higher dose of fruit peel extract of P. granatum (PEPG) and glibenclamide significantly lowered blood glucose level from 7th day onwards however glibenclamide was found to be more effective. Leaves extract at higher dose and fruit extract at lower dose also significantly lowered blood glucose level from 14th day onwards. Leaves extract at lower dose also significantly lowered blood glucose level from 21st day onwards. Glibenclamide and higher dose of fruit PEPG extract significantly reduced the total cholesterol, triglyceride levels and significantly increased the high density lipoprotein cholesterol level. Glibenclamide followed by higher dose was found more effective in reducing plasma thiobarbituric acid reactive substances and increasing levels of antioxidant enzymes (superoxide dismutase and catalase). No toxicity was observed even when both extracts were administered at 10 times of higher dose used in this study and no significant changes were seen when it were used chronically.Conclusion:Leaves and fruit PEPG possesses significant anti-diabetic, hypolipedimic and antioxidant properties. This study supports the traditional use of P. granatum in diabetes. Fruit peel which is normally thrown by many while eating pomegranate fruit is having anti-diabetic, hypolipedimic and Antioxidant activity. Furthermore high therapeutic index is safe for chronic use.

Background Coronavirus disease is primarily transmitted through the respiratory route and bodily contact. The fatality in COVID-19 cases was alarming in the initial days. This study analyzes hematological and biochemical markers of COVID-19 non-survivors . Material and methods In this single-center study, records of 249 patients hospitalized with COVID-19 were studied for hematological profile and biochemical markers. Records of patients with laboratory-confirmed COVID-19 disease hospitalized between April 14, 2020, to August 15, 2020, were included in the analysis. Results Significantly, the disease mortality was associated with increased procalcitonin ( P < 0.05), C-reactive protein ( P < 0.05), aspartate transaminase ( P < 0.05), serum potassium ( P < 0.05), neutrophils count ( P < 0.05), white blood cell count ( P < 0.05), prothrombin time ( P < 0.05) and activated prothrombin time ( P < 0.05) in patients reported abnormal x-ray findings. Further, patients with abnormal radiological findings significantly showed a reduced level of lymphocyte counts ( P < 0.05), oxygen saturation ( P < 0.05), and partial oxygen pressure ( P < 0.05). Reduced level of aspartate aminotransferase ( P < 0.05), alanine aminotransferase ( P < 0.05) and lactate dehydrogenase ( P < 0.05) reported significant association with mortality among patients with COVID-19. Conclusions The clinicians may consider the hematological and biochemical parameters in the patients with COVID-19 in future decision-making. These indicators might support clinical decisions to identify high fatality cases and poor diagnosis in the initial admission phase. In COVID-19 patients, we recommend close monitoring on procalcitonin, C-reactive protein, neutrophils count, and white blood cell count as a clinical indicator for potential progression to critical illness.

No abstract