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Background: Tuberculosis (TB)-diabetes comorbid cases have increased in India with Karnataka among the states with the highest numbers. The comorbidity adversely affects the prognosis of individual diseases. Diabetes management is crucial to the management of TB. Aim: This study aims to understand the factors influencing diabetes management, and the barriers and challenges affecting the management of diabetes in TB-Diabetes comorbid patients in Udupi district. Materials and Methods: For this mixed-method, cross-sectional study, TB-Diabetes comorbid patients, registered under the NIKSHAY in 2018 and 2019, and government Medical Officers were included in the study. Data were analyzed using SPSS. For the qualitative study, thematic analysis was done. Results: A total of 154 participants were included in the study. The disease the participant developed first, the place of diabetes diagnosis, person initiating diabetes treatment, and counseling ( P < 0.05), were some of the factors affecting diabetes management. In addition, alcoholism, migrant status, and old age were some of the barriers in the management of diabetes among comorbid patients. Conclusion: Diabetes management of alcoholics, migrants, elderly patients, and patients without a family needs special consideration for the successful management of TB-Diabetes comorbidity.

Background: Anaemia is a global public health issue in India with anaemia prevalence of 56% among adolescent girls. While it affects all age groups, pregnant women and children are reported to be at risk. The study aims to understand the underlying factors of anaemia among adolescents. Methods: The systematic review has included all studies from the time period, 2000 to 2020 which had anaemia prevalence among adolescent girls (10 to 19 years of age). Scopus and Web of Science databases were used to browse relevant articles within April-June, 2020. Study design, sample size, anaemia prevalence, and the method of Haemoglobin estimation, were some of the information recorded. Results: A total of 88 articles were selected, out of which 20 were retained as per the inclusion criteria. Study from the east zone reported an anaemia prevalence of 36.4% and a significant association between serum ferreting levels and the severity of anaemia. The anaemia prevalence of different studies from the north, west and south zones ranged from 50-70%, 80-90%, and 30-79% respectively. Socio economic status, education of parents, prevalence of vitamin B12 deficiency was some of the important factors contributing to the prevalence were highlighted. Conclusion: Anaemia prevails across and within the different zones, it is not comparable. However, strengthening of the existing level of effort is necessary to address the issue of anaemia among adolescents in India.

The bidirectional relationship between tuberculosis (TB) and diabetes mellitus (DM) is a major concern for medical professionals and epidemiologists as DM affects the severity, progress and outcome of TB and vice versa. Patients affected with TB have a higher rate of morbidity, treatment failure and mortality. Likewise, DM triples the risk of contracting TB and therefore poses a threat to the progress made in the reduction of TB incidence. Hence, it is pivotal to address both the diseases keeping in mind the each other. It is known that adjunct therapy with immunomodulatory drugs can enhance TB immunity among diabetic patients. Metformin, a commonly used anti-diabetic drug with adenosine monophosphate-activated protein kinase (AMPK) activation property, has shown the capacity to reduce the growth of Mycobacterium tuberculosis within the cell. This drug inhibits the mitochondrial complex and possesses antiinflammatory action. Therefore, Metformin can be considered as an ideal molecule for hostdirected or host-targeted therapy for TB.

Introduction: India has witnessed a rise in TB-Diabetes co-morbid cases in the past few years. Both TB and diabetes create complications for each other not only in terms of the prognosis but also management. Glycaemic control is pivotal for the successful management of diabetes and the co-morbidity. Aim: To understand the barriers and challenges of successful management of diabetes among TB-Diabetes co-morbid patients in the Udupi district. Methods: This cross-sectional study was conducted in the Udupi district of Karnataka from January 2020 to June 2020. Purposively selected Healthcare providers under RNTCP, were interviewed using a semi-structured interview guide. Each interview was fully transcribed. Data collection was terminated on reaching data saturation. A manual thematic analysis of the interview data was done using an inductive approach. Codes and themes were generated by a critical review of the transcripts. Results: Healthcare providers stated that certain patients such as, elderly, the homeless, and those with habits like alcoholism, were particularly difficult to manage. Besides, poor socioeconomic status, misconceptions, and lack of treatment adherence often create difficulties. Finally, participants also stressed the shortage of staff which impedes efficient management of the comorbidity. Conclusion: This study identified several barriers and challenges of diabetes management among TB-Diabetes co-morbid patients. These impediments, such as alcoholism, misconceptions, staff shortage, if addressed could aid in the better management of diabetes and eventually the co-morbidity.