Evaluation of "Indigenous Absorbed ELISA Kit" for the Estimation of Seroprevalence of Mycobacterium avium Subspecies paratuberculosis Antibodies in Human Beings in North India

In present pilot study aimed to estimate, presence of Mycobacterium avium subspecies paratuberculosis (MAP) antibodies in the human serum samples originating from North India using "Indigenous absorbed ELISA kit" (ELISA kit). The phase I, "ELISA kit" was optimized using protoplasmic antigen from native isolate of MAP "Indian Bison type" recovered from the biopsies of Crohn's disease patients. The phase II, sensitivity and specificity of the kit were estimated as 40.0 and 83.3%, respectively, when evaluated in 40 human serum samples (5 Crohn's disease and 22 ulcerative colitis patients and 13 healthy human subjects) with defined MAP status with respect to stool culture. Seroprevalence of MAP antibodies was higher in CD patients (80.0%) as compared to ulcerative colitis patients (4.5%) and normal human subjects (15.3%). The phase III, seroprevalence of MAP antibodies was estimated as 23.4%, on the basis of the screening of 452 human serum samples (without history) from different geographical regions of North India. Region-wise, 34.0, 33.3, 32.8, 25.0, 23.0, 17.7, and 12.5% samples were positive from the states of Punjab, Uttarakhand, New Delhi, Himachal Pradesh, Haryana, Uttar Pradesh and Jammu and Kashmir, respectively. Study reported moderately higher presence of MAP antibodies in human population, which necessitates programs to reduce the bioburden of MAP in the environment and in animal population.

A novel unsupervised spike sorting algorithm for intracranial EEG

This paper presents a novel, unsupervised spike classification algorithm for intracranial EEG. The method combines template matching and principal component analysis (PCA) for building a dynamic patient-specific codebook without a priori knowledge of the spike waveforms. The problem of misclassification due to overlapping classes is resolved by identifying similar classes in the codebook using hierarchical clustering. Cluster quality is visually assessed by projecting inter- and intra-clusters onto a 3D plot. Intracranial EEG from 5 patients was utilized to optimize the algorithm. The resulting codebook retains 82.1% of the detected spikes in non-overlapping and disjoint clusters. Initial results suggest a definite role of this method for both rapid review and quantitation of interictal spikes that could enhance both clinical treatment and research studies on epileptic patients.

Annual risk of tuberculosis infection among the tribal children of Jhabua, Madhya Pradesh

A cross sectional tuberculin survey was undertaken to estimate the Annual Risk of Tuberculosis Infection (ARTI) amongst tribal children aged 1-9 years in Jhabua district, Madhya Pradesh, India. Of the 1056 test-read children, 774 (73.3%) had no BCG scar. The prevalence of infection was estimated as 6.3% (95% CI: 4.8-7.7) and ARTI as 1.2% (95% CI: 0.9-1.5). The findings suggest that the tuberculosis situation in the tribal population of Jhabua district is not that different from the situation among the non-tribal population in the country. However, there is a need to further intensify tuberculosis control measures in the area.

Temporal lobe lesions and psychosis in multiple sclerosis

Lesions in the temporal lobe are associated with psychiatric manifestations in multiple sclerosis. The authors describe this case of a young man with multiple sclerosis who presented with first-episode psychosis and had acute lesions in the temporal lobe. He was successfully treated with olanzapine and β-interferon.

Characteristics of reoffending accommodation sites in Europe with clusters of Legionnaires disease, 2003-2007

Between 2003 and 2007, 21% (n=100/477) of accommodation sites linked to clusters of two or more cases of Legionnaires’ disease that were investigated by the European Surveillance Scheme for Travel-Associated Legionnaires’ Disease (EWGLINET) went on to be associated with at least one further case, despite reporting that satisfactory control measures had been implemented at the time the cluster was first detected. This paper examines these sites (termed reoffenders) in order to determine whether they share any characteristics that may have contributed to the reoffence. All investigations conducted at cluster sites between 2003 and 2007 were included in the analysis, giving a total of 615 investigations conducted at 477 sites. Every country that investigated more than three cluster sites had to deal with at least one reoffence, and one site reoffended five times. The cases involved in the cluster that stayed elsewhere during their incubation periods could be used to help assess the probability of exposure, and therefore the risk, posed by particular cluster sites. A more extensive investigation and control regime may be needed in some instances to better control the risk of Legionnaires’ disease at an accommodation site.

Travel-associated Legionnaires disease in Europe in 2008

In 2008, the European Surveillance Scheme for Travel Associated Legionnaires Disease (EWGLINET) received reports of 866 cases of travel-associated Legionnaires disease, 42 of whom were reported to have died. 824 of the cases were classified as confirmed and 42 were presumptive. As in previous years, a very low proportion of clinical isolates were obtained (63 cases, 7.3%). Males outnumbered females by 2.8:1 in the 2008 dataset and had a median age of 60 years compared with women, whose median age was 63 years. Travel outside Europe was reported for 12% of the cases. The scheme identified 108 new clusters in 2008. Sixteen were located in countries outside EWGLINET and 38 (35.2%) involved only one case from each reporting country, and would not ordinarily have been detected by national surveillance schemes alone. The largest cluster (six cases) was associated with travel to Spain. The 108 clusters were associated with 144 environmental investigations, 35 of which were at re-offending sites, (sites which had previously been investigated and where additional cases had subsequently occurred). At 61 (42.1%) of the sites Legionella species were detected. The names of 12 sites were published on the EWGLINET website.

Prevalence of pulmonary tuberculosis amongst the Baigas--a primitive tribe of Madhya Pradesh, Central India

BACKGROUND

A community-based cross-sectional tuberculosis (TB) disease prevalence survey was undertaken amongst the Baiga primitive tribal community of Baiga Chak in central India.

MATERIAL AND METHODS

A population of 2,359 was covered under the study. Sputum samples were collected from chest symptomatics and examined for smear microscopy and culture.

RESULTS

Overall prevalence of PTB was 146 (95% C.I: 0-318) per 100,000 population.

CONCLUSION

The findings suggest that TB is not a major public health problem amongst this tribal group. However, there is still the need to maintain and further strengthen TB control measures on a sustained and long term basis in the area.

Penetrating neck injury by an arrow: a paradigm of age old assault

Penetrating neck injuries by traditional weapons are rare entity in the modern era of sophisticated weapons. We report an unusual case of penetrating neck injury by a metallic arrow entering anterior neck in zone II and its tip coming out of neck posteriorly causing difficulty for patient to lie down as well as posing challenge to intubate. Arrows are low velocity projectile and from a close proximity they can cause penetrating trauma similar to a low powered handgun. Management of the case was discussed.

Prevalence of pulmonary tuberculosis among the Bharia, a primitive tribe of Madhya Pradesh, central India

A cross-sectional survey was undertaken to estimate the prevalence of pulmonary tuberculosis (TB) among the primitive Bharia tribe of Madhya Pradesh, India. Virtually the entire community in Patalkot valley of Chhindwara District was covered. Individuals aged > or =15 years were questioned about chest symptoms relating to TB. Sputum samples were collected and examined by smear microscopy and culture. The overall prevalence of pulmonary TB was found to be 432 per 100 000 population-not dissimilar to that seen in the wider population in India. There is, however, an urgent need to strengthen TB services in the area to improve access for this group.

Transpubic urethroplasty for complex posterior urethral strictures: a single center experience

AIM

To review our experience and outcome of transpubic urethroplasty for complex posterior urethral strictures.

PATIENTS AND METHODS

19 patients, mean age 17.8 (6-35) years, were treated with transpubic urethroplasty over the last 6 years. All had traumatic etiology (15 due to road traffic accidents and 4 due to falls from height). Mean stricture length was 4.4 (3.0-6.0) cm. All had a history of some intervention earlier. Three had rectourethral fistula, and 2 sinus tract in perineum which was connected to the periurethral cavity. One had a long fistulous tract connected through the anus to the anterior abdominal wall. One patient each had urethrocutaneous fistula, periurethral cavity and osteomyelitis of the pubic bone.

RESULTS

16 of 19 (84.2%) patients had excellent outcomes with no evidence of stricture. Three had acceptable outcomes with some evidence of stricture. The mean operative time was 3.2 (2.5-4.0) h and average blood loss was 650 (500-900) ml. The mean hospital stay was 7.6 (6-12) days and average follow-up was 30 (7-66) months. Two patients developed mild wound infection. One patient each developed epididymoorchitis, perineal hematoma, fecal fistula and urine leak. One patient failed to void, and one patient developed erectile dysfunction.

CONCLUSION

Transpubic urethroplasty is an excellent approach for patients with complex posterior urethral strictures.

Electrical impedance plethysmography technique in estimating pulmonary function status

An attempt has been made to study the appropriateness of electrical impedance plethysmography (EIP) in detecting pulmonary health status. A feasibility study was conducted on normal, obstructive and restrictive subjects aged between 20 and 60 years. Quantitative assessment of pulmonary function was made by way of both EIP and pulmonary function tests (PFT). Amongst the various EIP parameters, a statistically significant difference was observed for the respiratory band power, between normal (129.7) and obstructive (35.8) subjects, indicating that this EIP variable can be used to distinguish between the two pulmonary function states. A significant positive correlation was observed between a spirometry parameter, peak expiratory flow rate (PEFR), and an EIP parameter, respiratory amplitude (r = 0.372, p < 0.05), thereby indicating that EIP information by way of respiratory amplitude is comparable to that provided by PEFR. Hence, both respiratory amplitude and respiratory band power were seen to provide useful information on pulmonary health status.

Prevalence of sexually transmitted disease syndromes in tribal population of central India

BACKGROUND

A syndromic approach has been advocated for identification and management of sexually transmitted diseases (STDs) in countries where diagnostic laboratory tests are not consistently available. A community-based cross-sectional study was conducted to discover the prevalence of STD syndromes in tribal population of central India.

METHODS

All married men and women in the age group of 15-49 years from selected villages were enumerated by house-to-house visit. Individuals were interviewed using pre-coded, pre-tested questionnaires about STD syndromes of urethral discharge, vaginal discharge, dysurea, genital ulcer, inguinal swelling, scrotal swelling and lower abdominal pain.

RESULTS

Of the 2568 individuals interviewed, 326 (12.7%) had at least one STD syndrome. The prevalence was almost double in women (17.6%) than in men (8.4%). The highest prevalence (16.2%) was observed in the age group 30-34 years followed by 35-39 years (14.7%). The commonest syndrome in women was vaginal discharge (16.0%) while in men the commonest syndrome was dysurea (1.8%).

CONCLUSION

The low level of STD syndromes among tribal populations offers an opportunity to prevent a potential epidemic in this disadvantaged community. As no baseline data are available, the findings form the basis for future work in this area.