Is Tuberculosis Treatment Truly Free? A Study to Identify Key Factors Contributing to the Catastrophic Cost of TB Care in Pakistan

Background: The interplay between financial deprivation and tuberculosis (TB) is considered one of the vital socio-economic determinants of disease. This is the first study of its kind to be carried in Pakistan, which aims to identify leading factors contributing towards catastrophic costs of TB diagnosis and management in order to help policy makers. Methodology: From four tertiary care hospitals (TCH) in Islamabad and Rawalpindi, 400 TB patients were interviewed through a cross-sectional survey. The patient’s pre and post-TB income and direct and indirect costs for treatment were analysed following WHO recommendations. Multivariable logistic regression model was used to identify the determinants of catastrophic total cost. Results: For TB management expenditures, the median (interquartile range) of total costs by households was Rs. 58,175 Rs (32,050 - 97,500). At 20% threshold, 67% of TB patient’s households were affected by catastrophic costs. The determinants of the catastrophic total cost were as follows: patient/guardian employed (adjusted odds ratio [aOR] = 3.428, 95% confidence interval [CI]: 1.900 - 6.186), patient/guardian the only breadwinner (aOR = 1.751, 95% CI: 1.011 - 3.032), follow-up visits at current health facility (aOR = 1.352, 95% CI: 1.223 - 1.494), job loss (aOR = 3.381, 95% CI: 1.512 - 7.561), and unpaid sick leaves (aOR = 2.862, 95% CI: 1.249 - 6.558). Conclusion: The financial deprivation experienced by patients of low socio-economic status increases as TB treatment proceeds. This negatively impacts the treatment adherence, resulting in poor treatment outcomes due to income and job loss. Outcomes are exacerbated if the family has single breadwinner and treatment requires follow-up visits.

A Novel Beamforming Emulating Photonic Nanojets for Wireless Relay Networks

In this article,a low-cost electromagnetic structure emulating photonic nanojets is utilized to improve the efficiency of wireless relay networks.The spectral element method,due to its high accuracy,is used to verify the efficiency of the proposed structure by solving the associate field distribution.The application of optimal single-relay selection method shows that full diversity gain with low complexity can be achieved.In this paper,the proposed technique using smart relays combines the aforementioned two methods to attain the benefits of both methods by achieving the highest coding and diversity gain and enhances the overall network performance in terms of bit error rate(BER).Moreover,we analytically prove the advantage of using the proposed technique.In our simulations,it can be shown that the proposed technique outperforms the best known state-of-the-art single relay selection technique.Furthermore,the BER expressions obtained from the theoretical analysis are perfectly matched to those obtained from the conducted simulations.

Bitter Melon (Momordica Charantia) Reduces Serum Sialic Acid in Type2 Diabetics: Evidence to Delay the Process of Atherosclerosis

More than 1000 herbal products have been used by diverse cultures of the world to treat hyperglycemia and among them bitter melon (Momordica charantia) is one of the most popular herbal resource. The beneficial effects of bitter melon is not limited to hypoglycaemia only, but it also ameliorates diet induced obesity, insulin resistance and exhibit cardioprotective effects. The present study attempts to investigate the effect of bitter melon fruit juice on a newly investigated risk factor, sialic acid in type2 diabetics. A total of 40 type2 diabetic patients, divided into group A (n = 20) and group B (n = 20) were investigated during the present study. The patients of group A were following bitter melon fruit juice treatment along with diet control, whereas the patients of group B were on diet control only. Serum sialic acid (SSA) decreased in group A from 66.20 ± 2.30 mg/dl to 63.50 ± 2.10 mg/dl (<0.11) but, increased in group B from 66.50 ± 1.70 mg/dl to 68.20 ± 2.50 mg/dl (<0.12), compared to baseline. Post-treatment between group comparison revealed a significant difference (<0.05). The beneficial effects on fasting plasma glucose (FPG) and glycohemoglobin (HbA1-c) were also greater in group A compared to group B as was the case with blood lipids, weight and blood pressure. The study provides another mechanism for the cardioprotective effect of bitter melon and further strengthens its value in the management of type2 diabetes.