BackgroundManagement of multidrug-resistant TB (MDR-TB) patients co-infected with human immunodeficiency virus (HIV) is highly challenging. Such patients are subject to long and potentially toxic treatments and may develop a number of different psychiatric illnesses such as anxiety and depressive disorders. A mental health assessment before MDR-TB treatment initiation may assist in early diagnosis and better management of psychiatric illnesses in patients already having two stigmatising and debilitating diseases.ObjectiveTo address limited evidence on the baseline psychiatric conditions of HIV-infected MDR-TB patients, we aimed to document the levels of depressive symptoms at baseline, and any alteration following individualized clinical and psychological support during MDR-TB therapy, using the Patient Health Questionnaire-9 (PHQ-9) tool, among HIV-infected patients.DesignThis was a retrospective review of the medical records of an adult (aged >15 years) HIV/MDR-TB cohort registered for care during the period of August 2012 through to March 2014.ResultsA total of 45 HIV/MDR-TB patients underwent baseline assessment using the PHQ-9 tool, and seven (16%) were found to have depressive symptoms. Of these, four patients had moderate to severe depressive symptoms. Individualized psychological and clinical support was administered to these patients. Reassessments were carried out for all patients after 3 months of follow-up, except one, who died during the period. Among these 44 patients, three with baseline depressive symptoms still had depressive symptoms. However, improvements were observed in all but one after 3 months of follow-up.ConclusionPsychiatric illnesses, including depressive symptoms, during MDR-TB treatment demand attention. Routine administration of baseline mental health assessments by trained staff has the potential to assist in determining appropriate measures for the management of depressive symptoms during MDR-TB treatment, and help in improving overall treatment outcomes. We recommend regular monitoring of mental health status by trained counsellors or clinical staff, using simple, validated and cost-effective tools.

The aim of the study was to determine if heart rate variability (HRV) showed any changes in patients with newly diagnosed epilepsy in comparison with controls. Sixty‐five patients with epilepsy (38 males and 27 females), aged 30–50 years, who had never previously received treatment with antiepileptic drugs were eligible for inclusion in this study. Resting electrocardiogram (ECG) at spontaneous respiration was recorded for 5 min in supine position. Time‐domain analysis, frequency‐domain analysis, and Poincare plot of HRV were recorded from ECG. In time‐domain measures, the square root of the mean of the sum of the squares of differences between adjacent RR intervals (RMSSD) and percentage of consecutive RR intervals that differ by more than 50 msec (pNN50) were significantly less in patients with epilepsy. In frequency‐domain measures, high frequency [(HF) msec2], HF (nu), and low frequency [LF (msec2)] were significantly less in patients with epilepsy while LF (nu) and LF/HF were significantly high in patients with epilepsy. In Poincare plot, standard deviation perpendicular to line of Poincare plot (SD1) and standard deviation along the line of entity in Poincare plot (SD2) were significantly less in patients with epilepsy. Our results suggest that epileptic patients have an impact on the cardiac autonomic function as measured by HRV.

Background:Residual radiological lesions may persist even after successful treatment of tuberculosis. There is insufficient data as to the nature and magnitude of these opacities in the treated cases of tuberculosis.Aims and Objectives:This study evaluates the nature and magnitude of residual radiological opacities and of complete radiological resolution in new successfully treated cases of tuberculosis.Design:Four hundred and forty one new cases of pulmonary, pleural or mediastinal tuberculosis were radiologically evaluated by chest x-ray, PA view, at the start and end of a successful treatment, which was as per the World Health Organization (WHO), Revised National Tuberculosis Control Program (RNTCP), and Directly Observed Treatment, Short-Course (DOTS) guidelines. Patients with a previous history of tuberculosis or other lung conditions, treatment failure, retreatment cases, and multidrug tuberculosis (MDR-TB) cases were excluded.Results:Residual x-ray lesions were seen in 178 cases of tuberculosis (40.36%). Complete radiological resolution was seen in 263 cases (59.64%). Of the residual lesions, 67.4% were parenchymal were parenchymal in nature, 23.59% were pleural lesions and 8.99% were mediastinal lesions. Out of the 126 sputum-positive cases, 70% (n = 88)had residual lesions on chest x-ray whereas of the 315 sputum-negative cases 28.5%, (n = 99) had radiological residual lesions.Conclusion:Residual radiological opacities are seen in a large proportion of treated cases of tuberculosis (40%). Pulmonary lesions show more residual lesions (67%) than pleural (23%) and mediastinal lesions (9%).

The purpose of this study was of two-fold: first, to estimate the back strength of inter-university hockey players and, second, to search the correlation of it with selected anthropometric characteristics. To serve this purpose, a total of seven anthropometric characteristics, viz. height, weight, BMI, hip circumference, percent body fat, percent lean body mass and back strength and two physical fitness variables, viz. flexibility measures and abdominal muscle endurance were measured on purposely selected 110 inter-university hockey players (58 males and 52 females) aged 18-24 years collected from six universities participated in the Inter-university Championship organized in Guru Nanak Dev University, Amritsar, Punjab, India during 10 to 17 September, 2010. An adequate number of controls were also taken from the same place for comparisons. Results indicated significant differences (p < .05 -.000) between hockey players and their control counterparts in weight, BMI, hip circumference (only in male players), flexibility measures, abdominal muscle endurance (both in male and female players), percent body fat and percent lean body mass (only in male players) and back strength (only in female players). In hockey players, back strength has significantly positive correlations (p< .05-.01) with all the variables studied (except flexibility measures).

Background People with drug-resistant tuberculosis (DR-TB) are known to suffer from many mental-health disorders. This study aims to describe the proportion of patients diagnosed with psychiatric comorbidities, the different psychiatric diagnoses made, and treatment outcomes among DR-TB patients with or without psychiatric comorbidity and initiated on DR-TB treatment between January 2012 and March 2019 at Médecins Sans Frontières independent clinic in Mumbai, India. Methods This is a retrospective study using routinely collected clinical data. DR-TB care included individualised treatment, psychosocial support, and integrated psychiatric care. Results During the study period, 341 DR-TB patients were enrolled, with a median age of 25 years (IQR:20.0–36.5 years), 185 (54.2%) females, 143 (41.9%) with PreXDR-TB, and 140 (41.0%) with XDR-TB. All 341 patients were screened by a counsellor, 119 (34.9%) were referred for psychiatric evaluation, and 102 (29.9% of 341) were diagnosed with a psychiatric comorbidity. Among 102 diagnosed with a psychiatric comorbidity, 48 (47.0%) were diagnosed at baseline, and 86 (84.3%), or 25.2% of all 341 patients enrolled, were treated with psychotropic drugs. Depressive disorders were diagnosed in 49 (48.0%), mixed anxiety and depression in 24 (23.5%), neurocognitive disorders and anxiety in five (4.9%), and medication induced psychosis in two (2.0%). No anti-TB drugs were significantly associated with psychiatric comorbidities developed during treatment. Of 102 DR-TB patients with a psychiatric comorbidity, 75.5% (77) had successful DR-TB treatment outcomes, compared to 61.1% (146/239) not diagnosed with a psychiatric comorbidity (p = 0.014). Conclusion In our setting, among people started on DR-TB treatment, and with a complex TB resistance profile, about one in three patients experienced a psychiatric comorbidity, of which half developed this comorbidity during treatment. With comprehensive psychiatric care integrated into DR-TB care delivery, treatment outcomes were at least as good among those with psychiatric comorbidities compared to those without such comorbidities.