Burdwan Medical College

The elevated expenses associated with tuberculosis (TB), can hinder access to treatment and adherence.

This study was done to find out catastrophic cost (defined as 20% of the total annual income) resulting from treatment and diagnosis of TB, factors associated with it and delineated the coping mechanisms employed by the affected individuals and their families.

A cross sectional study was conducted for a period of 6 months, September 2023 to February 2024, among 146 patients registered in the Tuberculosis Unit (TU) of Bhatar block, Purba Bardhaman District,West Bengal. A pre validated questionnaire was used for interviewing the patients. Data was analysed using the principles of descriptive statistics, organised and presented in the form of tables.

Out of 146 tuberculosis (TB) patients, the study revealed mean total cost incurred for TB-related services amounted to Rs 30,046 ± Rs 9406 with direct cost of Rs 2964.26 ± Rs 990.3 and indirect cost of Rs 27,406 ± Rs 9,351.54(36.9%) of the study population reported that their families faced catastrophic costs. Coping strategies like taking loan emerged as the most prevalent means, with 45(30.8%) patients reporting it followed by selling livestock which was prevalent among 14(9.6%) of them.

In spite of the implementation of Universal Health Coverage, TB-affected households still faces the risk of catastrophic total costs. A cost-mitigation policy and financial protection should be provided additionally along with better health care facility to all patients.

Dipeptidyl peptidase 4 (DPP-4) inhibitors are primarily excreted renally. Linagliptin is an exception with excretion primarily through enterohepatic system and is expected to have a better renal profile, though real-world data are scarce. Comparative studies on the renal safety and glycaemic control with linagliptin versus popular DPP-4 inhibitors such as vildagliptin are crucial, especially in the background of COVID-19 pandemic that hugely impacted glycemic control in India’s large type 2 diabetes mellitus (T2DM) population.

Adult T2DM patients not controlled with metformin alone, added linagliptin (5 mg once daily) or vildagliptin (50 mg twice daily) in the tertiary care outpatient department setting were included in the study. Parameters such as glycosylated hemoglobin, fasting blood glucose, postprandial blood glucose, blood urea nitrogen, serum creatinine, estimated glomerular filtration rate (eGFR), change in renal function, glycemic control, and clinical parameters were compared at baseline, 2 months, and 6 months of treatment. All adverse events were analyzed using the WHO-UMC scale.

Both groups achieved similar glycemic control, however, accompanied with impairment of renal parameters after 6 months. Compared to linagliptin, almost 300% rise in creatinine and 140% fall in eGFR were noted in the vildagliptin recipients. However, the difference in serum creatinine or eGFR could not attain statistical significance in the study.

Both linagliptin and vildagliptin can help to achieve glycemic control despite possible influence of the COVID-19 pandemic and are generally well tolerated. However, renal functions are better preserved with linagliptin. Further studies involving a larger sample size and longer follow-up are recommended before generalization of the findings of the present study.

Promoting neuroplasticity for better recovery and function restoration has lately become the focus of rehabilitation techniques for individuals with neurologic disorders. A rapidly expanding medical specialty, neuromodulation includes a broad variety of methods for activating particular neurological pathways, such as Transcranial magnetic stimulation (TMS), Transcranial direct current stimulation (tDCS), peripheral nerve stimulation, and SCS, among many others. Research on the use of neuromodulation in the context of spinal cord injury (SCI) is limited, in contrast to the abundance of literature on its potential benefits in chronic pain treatment. Combining exercise with non-invasive neuromodulation improves recovery outcomes for some patient groups, according to our research. While we mostly focus on the motor components of recovery, we do briefly mention the non-motor effects of these disorders. The difficulties of applying ideas in clinical practice and the gaps in the existing research are also brought to light. In order to better customize the individual neuroplastic responses associated with each disease, we identify research gaps and propose routes for future investigations. This review is useful for rehabilitation professionals and researchers since it focuses on neuroplastic exercise treatments for specific illnesses and diagnoses. Few studies have used long-term randomized-controlled trials, even though these approaches have great promise for enhancing overall functionality and impairment levels. If these novel modalities may be therapeutically employed to reduce pain, restore function, and improve the quality of life for individuals impacted, then more study is required to support them.