Background. TB diagnostic and treatment services in India are provided free of cost in the programmatic context across the country. There are different costs incurred during health care utilization, and this study was conducted to estimate such costs. Methodology. A longitudinal study was conducted among patients of three urban tuberculosis units (TUs) of Davangere, Belagavi, and Bengaluru, Karnataka. Trained data collectors administered a validated questionnaire and recorded monthly costs incurred by the patients which are expressed in median Indian National Rupees (INR). The analysis was done using SPSS version 23.0. A p value of <0.05 was taken as statistically significant. Results. Among 214 patients, about 37%, 42%, and 21% belonged to Davangere, Belagavi, and Bengaluru, respectively. Median total pre- and postdiagnostic costs incurred across the three TUs were 3800 and 4000 INR, respectively. The direct nonmedical cost was higher for accommodation (median cost of 800 INR) and direct medical cost for non-TB drugs (median cost of 2000 INR). However, maximum direct medical and nonmedical costs were attributed to hospital admissions (1200 INR) and accommodation costs (700 INR) in the postdiagnostic period, respectively. The median indirect cost incurred was 300 INR overall, and the maximum total indirect cost was 40000 INR in the postdiagnostic period. About one-third of patients faced loss of income and 19.6% faced coping costs. Patients spent about 6.7% (0.97%–52.3%) of their income on TB treatment. About 12.3% patients faced catastrophic expenditure. Median cost was significantly higher among those seeking private health care facilities (12100 INR in private vs. 6800 INR in public; p<0.05) during the prediagnostic period. Prediagnostic and diagnostic out-of-pocket expenditures (OPE) were significantly higher across all the three centres (p<0.05). Conclusion. The TB patients experienced untoward expenditure under programmatic settings. The costs encountered by one in eight patients were catastrophic by nature.

Background:Fluorosis is an endemic disease which results due to excess exposure to high fluoride from different sources. The climatic factors and dependency on ground water add to the risk of fluorosis in Kolar. In addition to it, the epidemiological studies conducted on fluorosis in Kolar are very few.Aims:(1) To estimate age-specific prevalence of dental fluorosis in the study population. (2) To determine the proportion of study subjects with non-skeletal manifestations of fluorosis (3) To assess and compare the influence of various socio-epidemiological factors in the occurrence of dental fluorosis among the study population in areas with high and normal fluoride.Methodology:A cross-sectional study was conducted among the residents of three randomly selected villages, Thimmasandra and Batwarahalli (high fluoride) and Maddinayakanahalli (normal fluoride) belonging to Bangarpet taluk, Kolar for 1 year. Dental fluorosis was assessed by the Dean's grading. Non-skeletal manifestations were elicited based on clinical features. Fluoride levels of drinking water sources were estimated by ion-electrode method. The Chi-square and Fisher's exact tests were used to see the difference in proportions and a P value of <0.05 was considered for statistical significance.Results:The prevalence of dental and non-skeletal fluorosis in the study groups with high and normal fluoride groups were 13.17%, 5.5%, 3.84%, 1.9%, respectively. The prevalence of dental fluorosis was significantly higher among the children and adolescents compared to adults (P < 0.05).Conclusion:Dental fluorosis is a public health problem mainly affecting children and adolescents in Bangarpet.

PurposeRandomized trials on the effect of external beam radiotherapy (EBRT) with or without vaginal brachytherapy (VBT) for endometrial carcinoma are very few. In view of this, the current study was conducted with the hypothesizes: whether the escalated dose of 26 Gy (VBT alone) in comparison with various major international trials (PORTEC-2) has any difference in rates of disease-free and overall survival with fewer adverse effects in low resource setting like India.Material and methodsAn open-labeled, non-inferiority, randomized control trial was undertaken at a regional cancer center among patients with stage IA or IB high-intermediate risk endometrial carcinoma. A total of 50 patients were divided equally among two arms of combined EBRT with VBT (arm I) and VBT alone (arm II). A dose of 50-50.4 Gy in 25-28 fractions of EBRT with 2 fractions of VBT 6.5 Gy each were delivered to patients in arm I and 4 fractions of VBT 6.5 Gy each to patients in arm II, and were followed up for 60 months.ResultsDuring the median follow-up of 36.5 months, two patients developed loco-regional recurrence in arm II, three (arm II), and one (arm I) developed distant metastasis. The 5-year survival rates for arms I and II were 96.0% vs. 92.0% overall, and 88.0% vs. 84.0% disease-free, respectively, and were not found to be statistically significantly different. Dermatological, gastro-intestinal toxicities, and cystitis were lower in the VBT group compared to combined group.ConclusionsVBT alone is as effective as EBRT+VBT in ensuring loco-regional control and achieving comparable survival rates, with fewer toxic effects for patients with stage I intermediate- and high-risk endometrial carcinoma. The dose escalation did not make a difference in the survival rates and was like in the other major trials (PORTEC-2).

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