Phenotypic and genotypic characteristics of drug resistance in Mycobacterium tuberculosis isolates from pediatric population of Chennai, India

PURPOSE

Multidrug-resistant TB (MDR-TB) has been reported in almost all parts of the world. Childhood TB is accorded low priority by national TB control programs. Probable reasons include diagnostic difficulties, limited resources, misplaced faith in BCG and lack of data on treatment. Good data on the burden of all forms of TB among children in India are not available.

OBJECTIVE

To study the drug sensitivity pattern of tuberculosis in children aged from 3 months to 18 years and the outcome of drug-resistant tuberculosis by BACTEC culture system and PCR-based DNA sequencing technique.

MATERIALS AND METHODS

This is a retrospective study. One hundred and fifty-nine clinical specimens were processed for Ziehl-Neelsen stain, Mycobacterial culture by BACTEC method, phenotypic DST for first-line drugs for Mycobacterium tuberculosis (M. tuberculosis) isolates and PCR-based DNA sequencing was performed for the M. tuberculosis isolates targeting rpoB, katG, inhA, oxyR-ahpC, rpsL, rrs and pncA.

RESULTS AND CONCLUSION

Out of the 159 Mycobacterial cultures performed during the study period, 17 clinical specimens (10.7%) were culture positive for M. tuberculosis. Among the 17 M. tuberculosis isolates, 2 were multidrug-resistant TB. PCR-based DNA sequencing revealed the presence of many novel mutations targeting katG, inhA, oxyR-ahpC and pncA and the most commonly reported mutation Ser531Leu in the rpoB gene. This study underlines the urgent need to take efforts to develop methods for rapid detection and drug susceptibility of tubercle bacilli in the pediatric population.

The safety of peri-articular local anaesthetic injection for patients undergoing total knee replacement with autologous blood transfusion: a randomised trial

Intra-operative, peri-articular injection of local anaesthesia is an increasingly popular way of controlling pain following total knee replacement. At the same time, the problems associated with allogenic blood transfusion have led to interest in alternative methods for managing blood loss after total knee replacement, including the use of auto-transfusion of fluid from the patient's surgical drain. It is safe to combine peri-articular infiltration with auto-transfusion from the drain. We performed a randomised clinical trial to compare the concentration of local anaesthetic in the blood and in the fluid collected in the knee drain in patients having either a peri-articular injection or a femoral nerve block. Clinically relevant concentrations of local anaesthetic were found in the fluid from the drains of patients having peri-articular injections (4.92 μg/ml (sd 3.151)). However, none of the patients having femoral nerve blockade had detectable levels. None of the patients in either group had clinically relevant concentrations of local anaesthetic in their blood after re-transfusion. The evidence from this study suggests that it is safe to use peri-articular injection in combination with auto-transfusion of blood from peri-articular drains during knee replacement surgery.

An interesting case of Leigh-like syndrome

A 12-year-old female child with motor developmental delay presented with persistent vomiting, recurrent falls and unsteadiness in dark since 2 years of age. There was decline in scholastic performance, bulbar symptoms and aggravation of symptoms during intercurrent illness. Clinically, she had frontal and parietal lobar dysfunction, dysarthria, optic atrophy and LMN VII, IX, X, XII cranial nerve involvement. There was generalized hypotonia, distal muscle wasting, weakness, cerebellar signs and impaired vibration/position sense in distal extremities. Biochemical investigations revealed elevated serum/cerebrospinal fluid (CSF) lactate and CSF lactate pyruvate ratio. Neuroimaging demonstrated bilateral symmetrical T2 hyperintensities in basal ganglia, subcortical white matter, cerebellar hemispheres and posterior aspect of spinal cord. As certain atypical features like bilateral symmetrical T2 hyperintensities in subcortical white matter were also seen, metachromatic leukodystrophy was considered in differential diagnosis but ruled out by nerve biopsy. This case is reported for the presence of atypical neuroimaging features that are rarely found in Leigh's disease.

Profile of EBV associated infectious mononucleosis

During a 5 year period, 33 children (22 males) were diagnosed to have infectious mononucleosis (M:F::2:1; age 9 mo-15 y). The common clinical features observed were fever (100%), lymphadenopathy (84%) hepatosplenomegaly (81%), tonsillar enlargement (45%), neck swelling (30%), upper respiratory symptoms (21%), epitrochlear node enlargement (20%), vomiting and diarrhea (1%). Ten children had complications; upper airway obstruction and hemophagocytic lymphohistocytosis occurred in four each and septic shock in two. EBV associated infectious mononucleosis in hospitalized children was found to affect mainly preschool children and had a favorable prognosis.

Cryogenics and its application with reference to spice grinding: a review

Cryogenics is the study of very low temperature and its application on different materials including biological products. Cryogenics has numerous applications in space science, electronics, automobiles, the manufacturing industry, sports and musical instruments, biological science and agriculture, etc. Cryogenic freezing finds pivotal application in food, that is, spices and condiments. Although there is a wide range of cryogens to produce the desired low temperature, generally liquid nitrogen (LN₂) is used in food grinding. The application of low temperature shows a promising pathway to produce higher quality end product with higher flavor and volatile oil retention. Cryogenic grinders generally consist of precoolers and grinder with the cryogen distribution system. In such grinding systems, cryogens subject the raw material up to or lower than glass transition temperature before it is ground, thus eliminating much of the material and quality hassles of traditional grinding. At present, the capital investment including cryogen and handling costs escalate the final cost of the product. Thus, for large-scale production, a proper design to optimize and make it feasible is the need of the hour and understanding the behavior of different food materials at these low temperature conditions. This article reviews the scenario and application of cryogenics in different sectors, especially to spice grinding.

1-(2-Carb-oxy-eth-yl)-5-ethyl-2-methyl-pyridinium chloride

In the crystal structure of the title salt, C₁₁H₁₆NO₂⁺·Cl⁻, the cations and anions are linked by O—H⋯Cl hydrogen bonds. The structure is further stabilized by weak C—H⋯Cl hydrogen bonds.

Dengue viral infection in children: a perspective

Dengue is a vector-borne viral infection of global importance. Several pathogenetic mechanisms such as immune enhancement and selection pressure have been proposed and febrile, critical and recovery phases have been identified. A new classification proposed by WHO has recently been introduced where definitions have been changed to 'probable dengue', 'dengue with warning signs' and 'severe dengue'. The majority of dengue viral infections are self-limiting, but complications have high morbidity and mortality. The diagnosis of dengue viral infection is essentially clinical, although confirmation requires laboratory tests including serology, NS1 antigen detection, PCR and viral cultures. There are no specific anti-dengue drugs and treatment is basically supportive and consists of early recognition of complications and appropriate fluid therapy. A number of candidate vaccines are under development.

Rheological and nutritional quality of selected dehulled legumes blended rice extrudates

Rheological and nutritional quality of ready-to-eat rice (Oryza sativa ) -legume viz. black gram (Vigna mungo), green gram (Vigna radiata), lentil (Lens culinaris) and peas (Pisum sativum) based extrudates were studied using low cost collet extruder. Extrudates were prepared keeping constant feed rate (25 kg/h) and moisture content (14% wb) at 0, 5, 10 and 15% legume incorporation levels. Rheological properties of porridge made of extrudate flour were evaluated using Rapid Visco Analyser (RVA). Maximum and minimum peak viscosity for rice extrudates alone and rice extrudates blended with 15% peas were 697 cp and 523 cp, respectively. There was a decreasing trend in degree of gelatinization with increase in legume incorporation level. Other RVA rheological parameters like trough break down and final viscosity were in the range of 266-226 cp, 431-297 cp and 452-375 cp respectively. Maximum values of protein, fat, fibre and ash contents were found in rice extrudates at 15% legumes blend levels. There was an increasing trend in nutrient contents with legume content in rice extrudates. Degree of gelatinization for rice alone extrudate was 29.4% and showed a decrease in gelatinization with increase in legumes extrudate and was minimum (22.4%) for rice blended with 15% dehulled green gram. Sensory evaluation scores for all extrudates showed the most acceptable range of 6 to 8. Thus, legume blend level (up to 15%) of dehulled legumes fetched good scores and showed promising trend for the production of low cost expanded extrudates and its instant flour.

Non-wheat pasta based on pearl millet flour containing barley and whey protein concentrate

Non-wheat pasta was prepared with pearl millet supplemented with 10-30 % barley flour, 5-15 % whey protein concentrate, 2.5-4 % carboxy methyl cellulose and 27-33 % water using response surface methodology (RSM) following central composite rotatable design (CCRD). Results showed that barley flour and whey protein concentrate (WPC) had significant (p ≤ 0.05) positive effect on lightness and negative effect on stickiness of pasta, thus improved the overall acceptability (OAA). Carboxymethyl cellulose (CMC) improved the textural attributes i.e. increased firmness and decreased stickiness significantly (P ≤ 0.05) and caused a significant (P ≤ 0.05) reduction in solids losses in gruel. Based upon the experiments, the optimized level of ingredients were barley flour 13.80 g 100 g(-1) pearl millet flour (PMF), WPC 12.27 g 100 g(-1) PMF, CMC 3.45 g 100 g(-1) PMF and water 27.6 mL 100 g(-1) ingredients premix with 88 % desirability. The developed pasta had protein 16.47 g, calcium 98.53 mg, iron 5.43 mg, phosphorus 315.5 mg and β-glucan 0.33 g 100 g(-1) pasta (db).

Retarding the progression of chronic kidney disease with renin angiotensin system blockade

We assessed the effect of renin angiotensin system blockade (RASB) in chronic kidney disease (CKD) of diverse etiology. Two hundred and sixty-five consecutive CKD patients attending our renal clinic, with estimated glomerular filtration rate (eGFR) of 20-70 ml/min/1.73m(2) at baseline and a minimal follow-up of 1 year, were studied retrospectively. We devised a scoring system to quantify RASB, wherein the maximum dose of an agent recommended for control of hypertension was scored as 1. The renal endpoints studied were the rate of change in eGFR (ΔeGFR) and decline of eGFR>50%. The mean age was 48 ± 11.2 years and 69% were male. The mean duration of follow-up was 4 ± 2.7 years. The rate of ΔeGFR was -1.5 ± 5.0 ml/min/1.73 m(2) per year in patients who received RASB (N=168) and -6.0 ± 5.4 in those who did not (N=97) (P<0.001). The incidence of decline of eGFR >50% was 11.3% with RASB and 24.7% without (P=0.003). In a subgroup of patients who received RASB, the incidence of decline of eGFR >50% was 17.8% in the low-dose RASB group (N=84, RASB score 0.63 ± 0.38) and 4.8% in the high-dose group (N=84, RASB score 2.5 ± 0.7) (P=0.001). RASB was associated with significantly better renoprotection in CKD of diverse etiology, even in nonproteinuric diseases. This effect appeared to be dose-dependent, with higher supramaximal doses exhibiting better renoprotection than the lower conventional doses. Our results make a strong case for use of aggressive RASB in all CKD patients to postpone end-stage renal disease.

Two cases of Pompe's disease: case report and review of literature

Glycogen storage disease type II (also called Pompe's disease or acid maltase deficiency) is an autosomal recessive metabolic disorder which causes an accumulation of glycogen in the lysosomes due to deficiency of the lysosomal acid alpha-glucosidase enzyme. It is the only glycogen storage disease with a defect in lysosomal metabolism, and the first glycogen storage disease to be identified in 1932. The build-up of glycogen causes progressive muscle weakness (myopathy) throughout the body and affects various body tissues, particularly in the heart, skeletal muscles, liver, and nervous system. We are presenting two cases of infantile form of Pompe's disease with secondary hypertrophic cardiomyopathy (CMP). The first case was a 1-year-old female child who presented with Ross Class III heart failure (HF) of 3 months duration. Echocardiography (ECHO) showed concentric left ventricular (LV) hypertrophy, with the posterobasal segment more hypertrophic than the inter-ventricular septum and moderate pericardial effusion. The second case was a 2-month-old male child who presented with Ross Class II HF. His ECHO showed eccentric hypertrophy of the posterobasal left ventricle, with thickening of the mitral valve leaflets and the chordae with Grade I mitral regurgitation (MR). Both children were diagnosed to have Pompe's disease by blood alpha-glucosidase assay.

Control of Clinical Pathogens by the Haemolymph of Paratelphusa hydrodromous, a Freshwater Crab

In the present study, effort has been made to find the antimicrobial activity of haemolymph collected from freshwater crab, Paratelphusa hydrodromous. The haemolymph collected was tested for antimicrobial assay by disc diffusion method against clinical pathogens. Five bacterial species, namely, Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and five fungal strains, namely and Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Rhizopus sp., and Mucor sp., were selected for the study. The result shows a strong response of haemolymph against the clinical pathogens which confirms the immune mechanism of the freshwater crab.