BACKGROUND:The spread of drug-resistant tuberculosis has challenged tuberculosis control strategies globally. The present study aims to analyze the frequency of mutations in rpoB, katG and inhA genes in strains of M. tuberculosis complex (MTBC) circulating in Central India. It is anticipated that the findings may provide a starting point to understand the evolutionary success of drug-resistant strains of MTBC in this region.METHODS:Line probe assay was carried out on 720 consecutive sputum samples of MDR suspects from June 2012 to May 2013. Mutation frequencies in the rpoB, katG and inhA genes were analyzed.RESULTS:Mutations were identified in 269 (37.6%) samples, as follows: 55 (7.6%) samples had mutations conferring resistance to only isoniazid, 84 (11.6%) had mutations conferring resistance to only rifampicin and 130 (18%) isolates had mutations conferring resistance to both isoniazid and rifampicin. The most frequent mutation in the rpoB gene was at codon S531L, seen in 141 (19.5%) isolates. The most frequent mutation in the katG gene was at codon S315T1, seen in 151 (20.9%) isolates; and in the inhA gene at codon C15T, seen in 21 (2.9%) isolates. Some unidentified mutations were also observed.CONCLUSION:The patterns and the frequency of the mutations identified in this study indicate the most frequent mutations at S531L codon in the rpoB gene, S315T1 codon in the katG gene and C15T codon in the promoter region of the inhA gene. Controlling the emergence and spread of MDR TB requires an understanding of the evolution of these mutations.

Pueraria tuberosa D.C. has been used as a ‘Rasayana’ in the ayurvedic medicine as well as in swelling of joints and treatment of rheumatism. In current study; Immunomodulatory potential of the ethanolic extract of tubers of Pueraria tuberosa D.C. has been evaluated in vivo using animal models like Delayed type of hypersensitivity, Haemagglutination antibody titre assay, carbon clearance assay and cyclophosphamide-induced myelosuppression in mice. Results demonstrated that the Ethanolic extract of Pueraria tuberosa caused a significant inhibition of delayed-type hypersensitivity (DTH) reaction and Humoral antibody titre suggesting a potential role in inhibition of adaptive immune response or cells. Ethanolic extract of Pueraria tuberosa also potentiated function of the mononuclear phagocytic system by increase in phagocytosis and proection from myelosuppression in mice treated with cyclophosphamide. Our preliminary study demonstrate the immunomodulatory potential of Pueraria tuberosa which should be further evaluated in various autoimmune disease models for efficacy in different pathological conditions.

Providing effective discharge instructions, appropriate dose uptitration, education regarding heart failure (HF) monitoring, and strict follow-up have all been shown to decrease readmissions for HF but are all underutilized. The authors developed and evaluated the impact of a quality-improvement HF checklist as a tool to remind physicians to improve quality of care in HF patients. The checklist was used in randomly selected patients admitted with a primary diagnosis of acute decompensated HF. It included documentation regarding medications and dose uptitration, relevant counseling, and follow-up instructions at discharge. The checklist was used in 48 patients, and this checklist group was compared with 48 patients as a randomly selected control group. Higher proportions of patients were taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in the checklist group compared with the control group (40 of 48 vs 23 of 48, P<.001). Compared with the controls, the rate of dose uptitration for β-blockers and/or ACE inhibitors/ARBs was more common in the checklist group (4 of 48 vs 21 of 48, P<.001). Both 30-day (19% to 6%) and 6-month (42% to 23%) readmissions were lower in the checklist group. The use of an HF checklist was associated with better quality of care and decreased readmission rates for patients admitted with HF.

Background: Approximately 33% to 40% of older adults with heart failure are re-hospitalized within three months of discharge. The 6 month readmission rate is as high as 50%. Studies have shown that upward titration of ACE I, ARB and beta-blockers after discharge resulted in reduced hospital re-admission rates, improved functional capacity and quality of life. In our quality improvement project two groups of patients admitted with primary diagnoses of CHF were studied. A discharge checklist was developed for the second group and its effect on dose titration and readmissions was studied. Methods: For the first group, all patients readmitted within 3 months for CHF from April 1, 2007 to December 31, 2007 were identified. The primary end point was the difference in dosage of ACE I/ARB and B- blockers between discharge and readmission. For the second group a CHF discharge checklist was used randomly in patients admitted with primary diagnoses of CHF from August 2008 to October 2009. Checklist included documentation regarding dose titration, relevant counselling, education and follow up instructions. Results: The first group had 127 readmissions for CHF within 3 months of discharge. The second had 48 patients in which CHF discharge checklist was used. The characteristics of two populations is shown in the Table. Second group readmissions for CHF were decreased after using the checklist from 68% (15/22) to 36% (8/22, p = 0.3). Compared to prior to using the checklist, the total number of readmissions within 6 months of discharge were reduced significantly from 25 to 9 (p = 0.04). Up titration of diuretics in the hospital was associated with decreased readmissions (p=0.07, 4/14 vs 0/8). Conclusion: The use of CHF discharge checklist significantly improves dose titration of heart failure medications and decreases the total number of readmissions due to CHF. Furthermore among drug dose titration, up titration of diuretics tend to decrease CHF readmissions. Baseline characteristics of the two study groups and effect of discharge checklist on dose titration Baseline characteristic Study group 1 Study group 2 (discharge checklist) p - value Age (mean +/− SD) in years 75.94 +/− 13.1 75.97 +/− 13.1 CHF readmissions 180 of 318 25 of 48 0.8 Women 70 of 127 21 of 48 0.47 Dose titration of beta blocker 16 of 127 17 of 48 0.008 Dose titration of ACE I/ARB 7 of 127 7 of 48 0.07 Dose titration of diuretic 16 of 127 11 of 48 0.17 Dose titration in beta blocker + ACE I/ARB 19 of 127 21 of 48 0.004 Dose titration in beta blocker + ACE I/ARB + diuretic 31 of 127 27 of 48 0.009

PURPOSE: The 6-month readmission rate for congestive heart failure (CHF) is as high as 50%. Studies have shown that upward titration of ACE inhibitor (ACE I) or angiotensin receptor blocker (ARB) and beta-blockers after discharge resulted in reduced hospital re-admission rates, improved functional capacity and quality of life. Despite compelling scientific evidence and readily accessible national guidelines, life-prolonging agents remain underused. We present our community based randomized controlled trial to show the effect of quality improvement discharge tool in CHF.