Predominance of Mycobacterium fortuitum-chelonae complex in Ghatampur field area, endemic for leprosy

Non-tuberculous mycobacteria (NTM) are commonly found in the environment. As exposure to environmental mycobacteria has been reported to immunomodulatory in this study, the presence of environmental mycobacteria was investigated in soil, drinking water and drainage sample in Ghatampur, India, which is known for high endemicity for leprosy. Soil, drinking water from the hand pumps/wells and also drainage water collected in pools was collected in clean containers and cultured for environmental mycobacteria. Samples were processed according to the protocol established earlier. 69 soil, 62 drinking water and 31 drainage water samples were analysed from soil and water collected from 48 villages of this field area. After decontamination, cultures were set upon Lowenstein Jensen (LJ) medium. Mycobacteria were identified using biochemical tests and molecular techniques such as PCR-RFLP targeting hsp65 kD and rpoB region as well as 16S ribosomal sequencing in case of isolates showing variable biochemical features. NTM (non-tubercular mycobacteria) were isolated from 47.82% of soil samples, 20.69% of drinking water samples and 19.35% of the drainage water samples, overall mycobacteria could be isolated 52/162 of samples (32.09%). Among these mycobacteria, M. fortuitum-chelonae complex was predominant in this area; other species isolated were M. phlei, M. vaccae, M. terrae and M. flavescens. Relevance of exposure to these mycobacteria on endemicity needs to be studied by immunological and epidemiological parameters.

Dipolar interactions and their influence on the critical single domain grain size of Ni in layered Ni/Al(2)O(3) composites

Pulsed laser deposition has been used to fabricate Ni/Al(2)O(3) multilayer composites in which Ni nanoparticles with diameters in the range of 3-60 nm are embedded as layers in an insulating Al(2)O(3) host. At fixed temperatures, the coercive fields plotted as a function of particle size show well-defined peaks, which define a critical size that delineates a crossover from coherently rotating single domain to multiple domain behavior. We observe a shift in peak position to higher grain size as temperature increases and describe this shift with theory that takes into account the decreasing influence of dipolar magnetic interactions from thermally induced random orientations of neighboring grains.

Acute myeloid leukemia with non-specific cutaneous manifestation

Acute myeloid leukemia is not uncommon in upper Assam. Primary skin manifestation in AML though very rare, may be found. The skin manifestation may be the first presentation in AML. Here such a case has been discussed which presented with primarily skin manifestation, subsequently diagnosed as AML. Therefore routine investigations are mandatory in all patients before going for a sophisticated investigation so that the diagnosis is not missed.

Serological evidence of Neospora caninum infection in mithun (Bos frontalis) from India

Studies conducted on mithuns maintained at National Research Centre on mithun, Indian Council of Agricultural Research (ICAR), Nagaland, India and mithuns found in free-ranging condition of Nagaland revealed that the overall prevalence of antibodies to Neospora caninum in mithun was 10% (95% CI=5-15) when detected by a commercially available competitive enzyme-linked immunosorbent assay test. Highest (prevalence rate=16, 95% CI=8-24) seroprevalence was found in mithuns above 3 years of age and lowest (prevalence rate=2, 95% CI=0-6) in mithuns of 2-12 months old. No statistically significant difference was observed between male (prevalence rate=7, 95% CI=0-14) and female (prevalence rate=12, 95% CI=6-18) seroprevalences. The seroprevalence was found to be higher (prevalence rate=20, 95% CI=9-31) in mithuns found in free-ranging condition in comparison to mithuns kept in semi-intensive system (prevalence rate=5, 95% CI=1-9). This is probably the first report on serological evidence of N. caninum infection in mithun. The possible role of sylvatic fauna in the epidemiology of N. caninum infection mithun is also discussed in brief.

External validation of established risk adjustment models for procedural complications after percutaneous coronary intervention

BACKGROUND

Workable risk models for patients undergoing percutaneous coronary intervention (PCI) are needed urgently.

OBJECTIVE

To validate two proposed risk adjustment models (Mayo Clinic Risk Score (MC), USA and North West Quality Improvement Programme (NWQIP), UK models) for in-hospital PCI complications on an independent dataset of relatively high risk patients undergoing PCI.

SETTING

Tertiary centre in northern England.

METHODS

Between September 2002 and August 2006, 5034 consecutive PCI procedures (validation set) were performed on a patient group characterised by a high incidence of acute myocardial infarction (MI; 16.1%) and cardiogenic shock (1.7%). Two external models-the NWQIP model and the MC model-were externally validated.

MAIN OUTCOME MEASURE

Major adverse cardiovascular and cerebrovascular events: in-hospital mortality, Q-wave MI, emergency coronary artery bypass grafting and cerebrovascular accidents.

RESULTS

An overall in-hospital complication rate of 2% was observed. Multivariate regression analysis identified risk factors for in-hospital complications that were similar to the risk factors identified by the two external models. When fitted to the dataset, both external models had an area under the receiver operating characteristic curve >or=0.85 (c index (95% CI), NWQIP 0.86 (0.82 to 0.9); MC 0.87(0.84 to 0.9)), indicating overall excellent model discrimination and calibration (Hosmer-Lemeshow test, p>0.05). The NWQIP model was accurate in predicting in-hospital complications in different patient subgroups.

CONCLUSIONS

Both models were externally validated. Both predictive models yield comparable results that provide excellent model discrimination and calibration when applied to patient groups in a different geographic population other than that in which the original model was developed.

A benchtop system to assess cortical neural interface micromechanics

A benchtop brain tissue-microelectrode insertion model system was developed to aid in improving the design of cortical neural interfaces. The model partially mimics the in vivo environment via the use of human cadaver brain specimens (nspecimen = 6), or agar gel exposed to physiologically relevant mechanical oscillations. 150 lpm diameter stainless-steel microelectrode wires (TS = 600 MPa) implanted 3.0 cm within fixed human primary auditory cortex (ntrial > 10) experienced 133 +/- 8 and 64 +/- 4 mN of peak and steady axial forces. When subjected to a 3 Hz, 3-mm vertical oscillation, dynamic force amplitudes (ntrial > 10) of 148 +/- 10 mN were measured. The model system allows the study and comparison of static and dynamic forces and their mechanical influences on proposed implanted microelectrode structures.

Study of proinflammatory responses induced by Yersinia pestis in human monocytes using cDNA arrays

Yersinia pestis, the causative agent of plague, is known to develop strategies to overcome the host immune mechanisms and survive in the host. The molecular changes induced by Y. pestis in the host are not well delineated. Here, we examined the early events triggered after the intracellular infection of Y. pestis in human monocytes and lymphocytes by analyzing the host transcriptional profiles using cDNA arrays. We found that sets of genes that, especially at early time periods, were highly upregulated in monocytes alone when compared with a mixed culture of lymphocytes and monocytes. Gene expression responses revealed genes coding for cytokines, chemokines, transcription factors, inflammatory and apoptosis-related genes. Protein levels were measured, and real-time polymerase chain reaction was used to validate the microarray results. Our data suggest that intracellular infection of human monocytes with Y. pestis results in a strong inflammatory response at early time periods and a downregulation of genes such as thromobomodulin, which may play a role in coagulation, resulting in disseminated intravascular coagulation, a primary cause of death in plague infected hosts. We provide evidence that genomic analysis can provide a solid foundation to mechanistic insights to explain some of the symptoms induced by Y. pestis.

Molecular typing of Mycobacterium tuberculosis isolates from different parts of India based on IS6110 element polymorphism using RFLP analysis

BACKGROUND & OBJECTIVE

IS 6110 based typing remains the internationally accepted standard and continues to provide new insights into the epidemiology of Mycobacterium tuberculosis. The aim of the study was to characterize M. tuberculosis isolates obtained from different parts of India based on IS6110 element polymorphism using restriction fragment length polymorphism (RFLP) analysis.

METHODS

RFLP was analyzed among 308 isolates of M. tuberculosis deposited in the Mycobacterial Repository Centre, Agra, from different parts of India. DNAs isolated from these strains were restricted with Pvu II, transferred on to nylon membrane and hybridized with a PCR amplified DIG-labeled 245 bp IS6110 probe.

RESULTS

Based on the copy number, M. tuberculosis isolates were classified into four groups, (i) lacking IS6110 element; (ii) low copy number (1-2); (iii) intermediate copy number (3-5); and (iv) high copy number (6-19). Copy number higher than 19 however was not observed in any of the isolates studied. At the national level, 56 per cent of the isolates showed high copy number of IS6110, 13 per cent showed intermediate copy number, 20 per cent showed low copy number, whereas 11 per cent isolates lacked IS6110 element. At the regional level, there was not much difference in the RFLP profiles of isolates (IS6110 copy numbers/patterns) from different parts of the country.

INTERPRETATION & CONCLUSION

IS6110 DNA based fingerprinting could be a potentially useful tool for investigating the epidemiology of tuberculosis in India.

A comparative profile of the prevalence and age distribution of human papillomavirus type 16/18 infections among three states of India with focus on northeast India

Human papillomavirus (HPV) DNA in cervical scrape samples of married women from Manipur (n= 692) and Sikkim (n= 415) in northeast India was determined and compared with that of women from West Bengal (n= 1112) in eastern India by polymerase chain reaction. HPV prevalence was lower in Manipur (7.4%) than in Sikkim (12.5%), which was closely followed by West Bengal (12.9%). HPV18 was predominant in Manipur (2.03%) and strikingly lower (0.2%) in Sikkim and West Bengal (0.9%), while the reverse was true for HPV16. The proportion of HPV16/18 infections in Manipur (3.3%, 22/672) and Sikkim (3.89%, 14/359) were comparable and significantly lower compared to that in West Bengal (7.8%, 79/1007) among women having normal cervical cytology. Such prevalence was similar among all age groups in Manipur: increased with age for women in Sikkim and dropped with age for those in West Bengal similar to that reported previously. At age < or =30 years, HPV16/18 prevalence in Manipur (3.3%) and Sikkim (2.5%) was comparable but was significantly lower (P < 0.05) in contrast to that in West Bengal (8.8%). Among abnormal cytologic lesions, HPV16/18 infections were significantly higher than in normals (P= 0.000) both in Sikkim (14.3%) and West Bengal (20.9%) and absent in Manipur. Such prevalence was noted among women in Sikkim aged >30 years and equally among those in West Bengal aged < or =30 or >30 years. Thus, women from northeast India, particularly from Manipur, appear less susceptible to HPV16/18 infection and related cervical lesions compared to those from West Bengal, where such proneness was prominently evident at age < or =30 years.

Research priorities for urological care following spinal cord injury: recommendations of an expert panel

OBJECTIVE

A multidisciplinary panel of experts from Canada and the United States was convened by the Ontario Neurotrauma Foundation (ONF) to establish research priorities in the area of urological care following spinal cord injury (SCI).

DESIGN

The panel reviewed a synthesis of published literature in five areas of urology, identified emerging opportunities in the private and public sector, and used a modified Delphi approach to reach consensus on priorities for funding.

RESULTS

The panel recommendations included: clinical trials of the safety and efficacy of M3 receptor specific anti-muscarinic agents for bladder hyperactivity in SCI patients; development and testing of protocols for sacral nerve electrostimulation without sacral afferent neurectomy for management of micturition - including selective stimulation of sacral nerve fibers, high frequency blocking of the pudendal nerve to minimize the risk of urethral sphincter co-contraction and genital nerve stimulation for bladder inhibition and incontinence management; clinical trials of the efficacy and safety of intra-urethral valve catheters; trials of the efficacy of probiotics for bacterial interference i.e. to reduce colonization by uropathogens and manage the dual problems of infection and pathogen resistance to anti-microbials: innovations in the prevention or treatment of stone disease (ureteral, bladder and kidney).

CONCLUSIONS

The recommendations form the strategic priorities of the ONF SCI grants program for Ontario-based investigators and their partnerships with out-of-province collaborators and organizations.

Comparative evaluation of Löwenstein-Jensen proportion method, BacT/ALERT 3D system, and enzymatic pyrazinamidase assay for pyrazinamide susceptibility testing of Mycobacterium tuberculosis

Pyrazinamide (PZA) is an important first-line antituberculosis drug because of its sterilizing activity against semidormant tubercle bacilli. In spite of its very high in vivo activity, its in vitro activity is not apparent unless an acidic environment is available, which makes PZA susceptibility testing difficult by conventional methods. The present study was, therefore, planned to assess the performance of the colorimetric BacT/ALERT 3D system and compare the results with those from conventional tests, i.e., the Löwenstein-Jensen (LJ) proportion method (pH 4.85) and Wayne's pyrazinamidase (PZase) assay, using 107 clinical isolates. The concordance among all of these tests was 89.71% after the first round of testing and reached 92.52% after resolution of the discordant results by retesting. Prolonged incubation of the PZase tube for up to 10 days was found to increase the specificity of the PZase test. The concordances between LJ proportion and BacT/ALERT 3D, LJ proportion and the PZase assay, and BacT/ALERT 3D and the PZase assay were found to be 99.06%, 93.46%, and 92.52%, respectively. Using the LJ results as the gold standard, the sensitivities of BacT/ALERT 3D and the PZase assay were 100 and 82.85%, respectively, while the specificity was 98.61% for both of the tests. The difference between the sensitivities of BacT/ALERT 3D and the PZase assay was significant (P = 0.025). The mean turnaround times for the detection of resistant and susceptible results by BacT/ALERT 3D were 8.04 and 11.32 days, respectively. While the major limitations associated with the PZase assay and the LJ proportion method are lower sensitivity in previously treated patients and a longer time requirement, respectively, the BacT/ALERT 3D system was found to be rapid, highly sensitive, and specific.

Occurrence, virulence characteristics and antimicrobial resistance of Escherichia coli O157 in slaughtered cattle and diarrhoeic calves in West Bengal, India

AIMS

(i) To study the occurrence of Escherichia coli serotype O157 in cattle stool in West Bengal, India, and (ii) the virulence properties and antimicrobial resistance of the E. coli isolates.

METHODS AND RESULTS

Following enrichment in modified EC broth and plating onto HiCrome MS.O157 agar, a total of 14 strains of E. coli serotype O157 was isolated from faecal samples from two (2.04%) slaughtered cattle and six (7.59%) diarrhoeic calves. By multiplex PCR, Shiga toxin genes were detected in all the isolates. The enterohaemolysin phenotype was found in all, but one strain. Among 14 strains, ten were resistant to at least one of the antimicrobial agents tested. Multiple antibiotic resistance was frequent.

CONCLUSIONS

The study showed that occurrence of Shiga toxin-producing and multiple antibiotic-resistant E. coli O157 among cattle population in this region of India is significant.

SIGNIFICANCE AND IMPACT OF THE STUDY

Considering routine human contacts with cattle, a large human population in this region may be at risk for exposure to Shiga toxin-producing E. coli O157.

Pancytopenia in a child associated with hepatitis A infection

Pancytopenia is a very rare condition associated with hepatitis A infection. We managed a 12 year old boy who had hepatitis A infection with anemia. His hemogram and bone marrow examination were suggestive of pancytopenia. Pancytopenia recovered without any specific therapy. There are case reports of severe aplastic anemia with hepatitis A infection that required immunosuppressive therapy. The present case did not require any aggressive therapy and recovered. In a young child with hepatitis A infection and anemia, bone marrow depression should be suspected. The pancytopenia may be transient as exemplified by the present case.