Drug susceptibility pattern of Mycobacterium tuberculosis isolates from patients of category-II failure of pulmonary tuberculosis under directly observed treatment short-course from north India

The major contributing factors for the causation of treatment failure in cases of pulmonary tuberculosis under Category-II directly observed treatment short-course treatment (DOTS) are treatment after default, poor treatment compliance, and development of multi-drug resistant (MDR) tuberculosis. The objective of the present study is to find out the demographic profile and drug susceptibility pattern in Category-II failure patients of pulmonary tuberculosis under Revised National Tuberculosis Control Programme (RNTCP) of India. Two hundred and twenty four patients with Category-II treatment failure of pulmonary tuberculosis were enrolled from Department of Pulmonary Medicine, at Chatrapati Sahuji Maharaj Medical University, UP, Lucknow, India, from August 2003 to July 2008. Their complete bacteriological assessment in terms of sputum smear for acid-fast bacilli, culture for Mycobacterium tuberculosis and drug sensitivity pattern were done in the Department of Microbiology. Among 224 patients, 16 (7.1%) patients were lost to follow-up and the final analysis was done among 208 (92.8%) cases. The reasons for inclusion of these 224 cases in the Category II regimen were treatment failure in the previous regimen (n = 75, 33%), default in 57% (n = 129 cases), and relapse in 8.9% (n = 20 cases). Among 208 patients, culture was positive in 170 (81.7%) cases, negative in 17 (8.1%) cases and contaminated in 21 (10%) cases. The drug sensitivity pattern of culture positive cases of Category-II failure patients revealed that, 58.2% (n = 99) had MDR tuberculosis and 40.5% (n = 69) were resistant but were non-MDR tuberculosis and 1.1 % (n = 2) cases were sensitive to all first line antituberculosis drugs.

Heat shock protein 60 of filarial parasite Brugia malayi: cDNA cloning, expression, purification and in silico modeling and analysis of its ATP binding site

We report here cloning and expression of full length mitochondrial HSP60 gene of Brugia malayi adult worm (mtHSP60bm), purification of the gene product by affinity chromatography, its in silico 3D structure and the sequence homology of the protein with Escherichia coli GroEL/ES and human HSP60. The ATP binding pocket of human HSP60 and mtHSP60bm were analyzed and compared using in silico models. The distribution of HSP60 in different life-stages of the parasite was determined using antibodies raised against recombinant mtHSP60bm (rmtHSP60bm). mtHSP60bm was present in all life-stages of the parasite except third stage infective larvae, in which it could be induced by heat-shock, and showed high degree of homology with E. coli GroEL/ES. The ATP binding pocket of HSP60 in humans, E. coli and B. malayi were also found structurally conserved. This similarity between human and mtHSP60bm might be useful in understanding the host-parasite interactions. This is the first ever report on distribution, cloning, sequence homology and ATP binding site of mtHSP60bm.

Season and tissue type affect fungal endophyte communities of the Indian medicinal plant Tinospora cordifolia more strongly than geographic location

A total of 1,151 endophytic fungal isolates representing 29 taxa were isolated from symptom-less, surface-sterilized segments of stem, leaf, petiole, and root of Tinospora cordifolia which had been collected at three locations differing in air pollution in India (Ramnagar, Banaras Hindu University, Maruadih) during three seasons (summer, monsoon, winter). Endophytes were most abundant in leaf tissues (29.38% of all isolates), followed by stem (18.16%), petiole (10.11%), and root segments (6.27%). The frequency of colonization (CF) varied more strongly among tissue type and season than location. CF was maximal during monsoon followed by winter and minimal during summer. A species each of Guignardia and Acremonium could only be isolated from leaves, whereas all other species occurred in at least two tissue types. Penicillium spp. were dominant (12.62% of all isolates), followed by Colletotrichum spp. (11.8%), Cladosporium spp. (8.9%), Chaetomium globosum (8.1%), Curvularia spp. (7.6%), and Alternaria alternata (6.8%). Species richness, evenness, and the Shannon-Wiener diversity index followed the same pattern as the CF with the tissue type and the season having the greatest effect on these indices, suggesting that tissue type and season are more influential than geography. Dissimilarity of endophyte communities in regards to species composition was highest among seasons. Colletotrichum linicola occurred almost exclusively in winter, Fusarium oxysporum only in winter and summer but never during monsoon and Curvularia lunata only in winter and during monsoon but never in summer. Emissions of NO(2), SO(2), and suspended particulate matter were negatively correlated with the CF. Ozone did not have any effect. The frequency of most species declined with increasing pollution, but some showed an opposite trend (e.g., Aspergillus flavus). Five unnamed taxa (sterile mycelia) were identified as Aspergillus tubingensis, Colletotrichum crassipes, Botryosphaeria rhodina, Aspergillus sydowii, and Pseudofusicoccum violaceum, using molecular tools. Fifteen of the 29 endophyte taxa exhibited antibacterial activity. B. rhodina (JQ031157) and C. globosum showed activity against all bacterial human pathogens tested, with the former showing higher activity than the latter.

Effect of Pueraria tuberosa DC. (Indian Kudzu) on blood pressure, fibrinolysis and oxidative stress in patients with stage 1 hypertension

The Indian Kudzu (Pueraria tuberosa DC.) is an important medicinal plant widely used in Indian and Chinese traditional systems of medicine. The present study is an attempt to evaluate effect of its tubers on blood pressure, coagulation parameters and antioxidant status in patients with stage 1 (primary) hypertension. In a long-term, single blinded, placebo controlled study; 15 patients with stage 1 hypertension (group 1), were administered 3 g P. tuberosa in two divided doses while another 15 patients (group II) were administered matched placebo for a period of twelve weeks. A significant fall of 25, 11 and 16 mmHg was observed in systolic (p < 0.001), diastolic (p < 0.05) and mean (p < 0.001) blood pressure, respectively at the end of the study. Along with blood pressure reduction, there was a significant (p < 0.01) reduction in plasma fibrinogen and significant enhancement of plasma fibrinolytic activity (p < 0.001) and serum total antioxidant status (p < 0.05). It was tolerated well without any untoward side effects.

Adenosine Deaminase (ADA) Level in Tubercular Pleural Effusion

STUDY OBJECTIVE:

To study the value of adenosine deaminase level in tuber-cular pleural effusion.

DESIGN:

A hospital based observational study.

SETTING:

Out and In patients service of department of Tuberculosis & Chest Diseases, MLN Medical College Allahabad.

PATIENTS:

50 consecutive patients of pleural effusion, who were above the age of 12 years, were studied.

RESULTS:

Pleural fluid adenosine deaminase was more than 36 IU/L (36 to 229.7 IU/L) in tubercular pleural effusion (34 patients). In case of malignancy no. of patients was 08 and pleural fluid adenosine deaminase was more than 18.5 IU/L (18.5 to 87.6 IU/L). While in one case of hypoprotenemiea pleural fluid adenosine deaminase was 8.21 IU/L. If 36 IU/L is taken as cut of limit the sensitiv-ity and specificity of ADA for tuberculosis is 100 % and 77.7 %. More than 100 IU/L was exclusively seen in tubercular pleural effusion.

CONCLUSION:

ADA > 100IU/L was observed in TB only.

A study to evaluate asbestos fiber burden in lung and pleural malignancies

BACKGROUND

There is scarcity of data on asbestos fiber burden in lung and pleural malignancies.

AIM

To evaluate asbestos fiber burden in biopsy samples of suspected lung and pleural malignancies.

STUDY DESIGN

This was a single-centre, observational study.

STUDY PERIOD

From August 2010 to July 2010.

SETTING

Department of Pulmonary Medicine, CSMMU, UP, Lucknow, a tertiary care hospital in India.

STUDY POPULATION

Suspected cases of lung and pleural malignancy.

MATERIALS AND METHODS

Biopsy tissues taken by computed tomography (CT)-guided biopsy, bronchoscopic biopsy, and pleural biopsy by Cope's needle were analyzed for histopathology and asbestos burden by Haq et al.'s method.

RESULTS

20 patients were studied. Mean fiber burden was 9.25 × 10 4 fibers/g. Average burden in lung malignancies (11 patients) was 9.178 × 10 4 fibers/g and in pleural tissue (9 patients) was 9.332 × 10 4fibers/g. Among the different cell types, mean fiber burden in squamous cell carcinoma was 8.99 × 10 4 fibers/g, in adenocarcinoma was 9.71 × 10 4 fibers/g, and in small cell carcinoma was 7.54 × 10 4 fibers/g. Mean fiber burden in bronchoscopic endobronchial biopsy tissue was 10.69 × 10 4 fibers/g, while in CT-guided biopsy was 8.60× 10 4fibers/g.

CONCLUSION

Maximum number of fibers was found in adenocarcinoma.

Blood pressure lowering, fibrinolysis enhancing and antioxidant activities of cardamom (Elettaria cardamomum)

Elettaria cardamomum (L.) Maton. (Small cardamom) fruit powder was evaluated for its antihypertensive potential and its effect on some of the cardiovascular risk factors in individuals with stage 1 hypertension. Twenty, newly diagnosed individuals with primary hypertension of stage 1 were administered 3 g of cardamom powder in two divided doses for 12 weeks. Blood pressure was recorded initially and at 4 weeks interval for 3 months. Blood samples were also collected initially and at 4 weeks interval for estimation of lipid profile, fibrinogen and fibrinolysis. Total antioxidant status, however, was assessed initially and at the end of the study. Administration of 3 g cardamom powder significantly (p<0.001) decreased systolic, diastolic and mean blood pressure and significantly (p<0.05) increased fibrinolytic activity at the end of 12th week. Total antioxidant status was also significantly (p<0.05) increased by 90% at the end of 3 months. However, fibrinogen and lipid levels were not significantly altered. All study subjects experienced a feeling of well being without any side-effects. Thus, the present study demonstrates that small cardamom effectively reduces blood pressure, enhances fibrinolysis and improves antioxidant status, without significantly altering blood lipids and fibrinogen levels in stage 1 hypertensive individuals.

Complete radiological clearance in bilateral loculated pyopneumothorax managed conservatively

We are reporting a case of bilateral loculated pyopneumothorax in a 30-year-old male patient, who was treated conservatively with antibiotics alone, and had complete radiological clearance.

East Central South African genotype as the causative agent in reemergence of Chikungunya outbreak in India

Chikungunya fever is an important arboviral infection prevalent throughout Africa and Southeast Asia. Recently, in 2006, it has reemerged in many parts of India, affecting more than a million persons. A detail serological, virological, and molecular investigation of this unprecedented outbreak was carried out by collecting and studying 540 samples from all the affected regions of India during this epidemic. An in-depth investigation revealed the presence of anti-Chikungunya antibodies in 68% of the samples and genomic RNA in 49% of them. In addition 32 Chikungunya viruses were isolated from 45 representative polymerase chain reaction-positive samples. The nucleotide sequences of partial E1 gene of 25 representative Chikungunya viruses were deciphered. The sequence analysis indicated that all the isolates of this epidemic belonged to the new Indian Ocean island clade of East Central South (ECS) African genotype. This study conclusively proved the genotype shift from Asian to ECS African as the major factor in the reemergence of Chikungunya in an unprecedented outbreak in India after a gap of 32 years.

MRI detection of a female pelvic arteriovenous fistula after hysterectomy: treatment with superselective coil embolisation

We present a rare case of acquired pelvic arteriovenous fistula of the uterine vessels in a woman with a remote history of hysterectomy who presented with chronic pelvic and left limb pain. It was successfully treated by coil embolisation of the left uterine artery. The MRI and angiographic features are described, together with the current management and a review of literature.

Quality of ground water used for irrigation in Ujjain district of Madhya Pradesh, India

The ground water samples collected from different tehsils of Ujjain district were analysed in the laboratory for electrical conductivity (EC), pH, cations (Na+, K+, Ca2+ and Mg2+) and anions (CO3(2-)), HCO3-, Cl- and SO4(2-)). The water samples were categorized as per criterion developed by Central Soil Salinity Research Institute, Karnal, Haryana, India. Out of 712 samples, 105, 144, 150, 84, 68, 111 and 50 samples belong to Ujjain, Mahidpur, Khachrod, Tarana, Barnagar, Nagda and Ghatia tehsils of the district respectively. 80% samples indicated good water quality at the district as a whole, whereas 14% were found saline (marginally saline (B1)-9%, saline (B2)-4%, high SAR saline (B3)-1%) and 6% as alkali (marginally alkali (C1)-5%, and alkali (C2)-1%) categories. In general, these waters were of Ca-Na-Mg type with the dominance of Cl followed by HCO3 and CO3 in case of good quality waters. The poor water quality belonged to categories of B1, B2, B3, C1 and C2, which were either having accumulation of salts (high EC) or high sodium adsorption ratio (SAR) and residual sodium carbonate (RSC). High significant negative correlation coefficient between pH and SO4-- was observed. The sodium (Na+) content showed significant positive correlation coefficient with EC. Similarly, HCO3- showed a significant positive correlation with RSC content. The ground water quality map of the district was generated using ERDAS-IMAGINE 8.7 Software showing different categories.

Acute pancreatitis: a lesser-known complication of aluminum phosphide poisoning

There have been no case reports on aluminum phosphide-induced pancreatitis in the literature available. In this report, we present the case of a young man who developed acute pancreatitis and probably acute myocarditis following ingestion of aluminum phosphide pellets in the absence of the usual risk factors and after exclusion of other possible causes of pancreatitis. In the absence of re-challenge, we put forth the probable causative association of pancreatitis with aluminum phosphide or phosphine gas, its active pesticidal component.

Avoidance of allergens by the patients with bronchial asthma

OBJECTIVES

Association between environmental allergens and bronchial asthma is well established. A great number of substances found in the environment can precipitate or aggravate respiratory symptoms in asthmatics. Avoiding allergens is recognized as an integral part of management. Through various educational interventions the patients can be taught various measures to avoid these allergens. The present study was undertaken to evaluate the impact of 'self care manual' an educational intervention on the avoidance of various environmental allergens.

METHODS

The total enrolled patients were 523 of which 260 were included in the study group to whom 'self care manual' was given and 263 in the control group with no access to self care manual. A fourteen items interview schedule consisting of three parts was administered. The first two subparts were in the form of checklist to know the various allergens which were inducing symptoms in the patients and weather they could avoid these triggers. The third part which was open ended was administered to know their ways of avoiding these triggers. All the patients were followed up at 2 weeks, 6 months and at 1 year.

RESULT

Mean age of the subjects in both the groups was 36.72 +/- 11.52 years and 34.33 +/- 12.86 years respectively. Both the groups were comparable on majority of the socio-demographic variables. The number of patients whose symptoms were aggravated by a particular triggering factor reduced significantly on each successive visit in the study group. Almost all the patients started avoiding their triggers in follow-ups in the study group. In control group this change was only for few triggers. More and more patients started using inhalers on exposure to dust or triggering weather conditions. They started slowing down for exercises and diverted their attentions against triggering emotional situations.

CONCLUSION

Patient education should be an essential component in the overall management of bronchial asthma. Control of asthma symptoms is better achieved with avoidance of allergens. This can be accomplished by emphasizing these facts particularly with the use of self care manuals.

Pediatric and adolescent strangulation deaths

The incidence of pediatric and adolescent deaths due to unnatural means is increasing. Fatal strangulation constitutes a significant group of violent deaths. The characteristics of pediatric and adolescent involvement has been rarely studied. In the present study, a cohort of 28 cases of pediatric and adolescent strangulation deaths was analyzed. The data for the study were collected from inquest papers, post-mortem reports and other departmental records for the period 1993-2004 (12 years). Female victims were more than male with male, female ratio of 3:4. Ligature strangulation was three times more frequent than manual strangulation. Ninety three percent were homicidal and the remaining 7% accidental. Fracture of neck structures was found in 25% of the cases and other associated injuries on different body parts were observed in more than half of the cases. Clothing and personal belongings were the most common ligature materials and in the majority of cases the exact reason for strangulation was not known at the time of postmortem.

Sodium stibogluconate-sensitive visceral leishmaniasis in the non-endemic hilly region of Uttarakhand, India

Although visceral leishmaniasis (VL) is endemic in various parts of India, mainly Bihar, West Bengal and Orissa, and neighbouring countries such as Nepal and Bangladesh, it is rarely reported from the hilly areas of India. We report on nine male VL cases from the non-endemic Garhwal region of Uttarakhand who were treated successfully with sodium stibogluconate. We conclude that sodium stibogluconate-sensitive VL is emerging in this region and that urgent and effective vector control measures may be warranted to prevent the disease from becoming a major health problem and to ensure that resistance to sodium stibogluconate does not emerge.