Mycobacterium tuberculosis strain lineage in mixed tribal population across India and Andaman Nicobar Island

In India, the tribal population constitutes almost 8.6% of the nation's total population. Despite their large presence, there are only a few reports available on Mycobacterium tuberculosis (M. tb) strain prevalence in Indian tribal communities considering the mobile nature of this population and also the influence of the mainstream populations they coexist within many areas for their livelihood. This study attempts to provide critical information pertaining to the TB strain diversity, its public health implications, and distribution among the tribal population in eleven Indian states and Andaman & Nicobar (A&N) Island. The study employed a population-based molecular approach. Clinical isolates were received from 66 villages (10 states and Island) and these villages were selected by implying situation analysis. A total of 78 M. tb clinical isolates were received from 10 different states and A&N Island. Among these, 16 different strains were observed by spoligotyping technique. The major M. tb strains spoligotype belong to the Beijing, CAS1_DELHI, and EAI5 family of M. tb strains followed by EAI1_SOM, EAI6_BGD1, LAM3, LAM6, LAM9, T1, T2, U strains. Drug-susceptibility testing (DST) results showed almost 15.4% of clinical isolates found to be resistant to isoniazid (INH) or rifampicin (RMP) + INH. Predominant multidrug-resistant (MDR-TB) isolates seem to be Beijing strain. Beijing, CAS1_DELHI, EAI3_IND, and EAI5 were the principal strains infecting mixed tribal populations across India. Despite the small sample size, this study has demonstrated higher diversity among the TB strains with significant MDR-TB findings. Prevalence of Beijing MDR-TB strains in Central, Southern, Eastern India and A&N Island indicates the transmission of the TB strains.

Prevalence of pulmonary tuberculosis among the tribal populations in India

Importance

There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a high degree of heterogeneity.

Objective

To estimate the prevalence of TB among the tribal populations in India.

Design, participants, setting

A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old.

Main outcome and measures

Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening.

Results

A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 [95% CI: 496–754] in the central zone and least 153 [95% CI: 24–281] in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 [95% CI: 504–1101] and Jammu and Kashmir the lowest 127 [95% CI: 0–310] per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m², h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever.

Conclusion and relevance

The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs.

Medical attribution of common mental disorders in a rural Indian population

Common mental disorders (CMD) refer to anxiety and depressive disorders causing significant disability and are commonly encountered in communities. Early diagnosis and treatment of these disorders can be improved if the population has a better understanding of them. This study aimed to explore the medical attribution of CMD among a rural community in South India using case vignettes. While most respondents agreed that there was a problem, they showed a preference for lay help over medical treatment. Improving awareness among rural communities of the usefulness of medical help for CMD might facilitate early diagnosis and treatment for these disorders.

Genotyping of methicillin-resistant Staphylococcus aureus strains from two hospitals in Bangalore, South India

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen in India, and up to 70% methicillin resistance has been reported from hospitals in various parts of India. Hospitals use phenotyping for the most part, and molecular genotyping is not done. Here we report on the genotyping of 82 single-patient isolates from two hospitals in Bangalore, South India, for the first time. Most of the strains possessed type III or IIIA staphylococcal cassette chromosome (SCCmec) cassettes, and we did not detect strains with type I, IA, or II cassettes. Most isolates also contained the type III cassette chromosome recombinase (ccr) AB region. Multilocus sequence typing (MLST) and staphylococcal protein A (spa) typing of a selected number of isolates have been carried out. Although most isolates that were chosen for MLST and spa typing had the same patterns, they were quite diverse in their pulsed-field gel electrophoresis (PFGE) patterns. PFGE, MLST, and spa typing of the Indian strains revealed that they are related to the previously described Hungarian and Brazilian clones.

PREVALENCE OF ANTIBODIES TO HEPATITIS C VIRUS IN HOSPITALIZED POPULATION SUBSETS

Prevalence of antibodies to hepatitis C virus (anti-HCV antibody) was ascertained in different subsets of hospitalized patients. Anti-HCV antibody testing was done using a third generation test The anti-HCV positivity in the sera of 308 tuberculosis patients, who had been given streptomycin, was 12.3 per cent It was 7.1 percent among 84 cardiac patients undergoing invasive cardiac procedures, 15.6 per cent in 77 patients on haemodialysis and 41.2 per cent patients with surgical jaundice. It is surmised that hospitalization, particularly parenteral therapy and invasive procedures during hospitalization, puts patients at higher risk of contracting HCV infecticn.

ENTERIC FEVER - CULTURE AND SENSITIVITY PATTERN AND TREATMENT OUTCOME

One hundred cases of enteric fever in the age group of 6 months to 12 years were analysed with respect to culture sensitivity pattern and treatment outcome. Patients were divided into 5 treatment groups - chloramphenicol, amoxycillin, trimethoprim-sulfamethoxazole + furazolidine, gentamicin + cephalexin and ciprofloxacin. Out of 91 culture positive cases, 100% were sensitive to ciprofloxacin followed by gentamicin (84.9%), cephalexin (83.6%), furazolidine (36.6%), trimethoprim-sulfamethoxazole (34.1%), chloramphenicol (34.0%) and amoxycillin (23.8%). In 60 cases resistant to chloramphenicol, resistance to other drugs varied from 20 to 88.3%. The treatment response was 100% to ciprofloxacin, 72.7% to chloramphenicol, 50% to gentamicin + cephalexin, 38.5% to trimethoprim-sulfamethoxazole + furazolidine and 12.5% to amoxycillin. Out of 48 cases who did not respond to initial regimen, 33 were treated successfully with ciprofloxacin and remaining with other drug regimens. Time taken for defervescence was shortest with gentamicin + cephalexin (4.6±2.0 days) followed by ciprofloxacin (6.1±2.5 days) and chloramphenicol (6.4±3.5 days). There were 3 deaths in this study.

Human leucocyte antigen and insulin dependent diabetes mellitus

HLA typing was done in 25 cases of insulin dependent diabetes mellitus (IDDM) and compared with 60 healthy controls. There was a significantly increased frequency of HLA B-8, HLA B-12 and HLA DR-3 in IDDMO. The odds ratio (relative risk) of developing IDDM for HLA B-8 was 4.42 (p less than 0.10), for HLA B-12 was 3.56 (p less than 0.10) and for HLA DR3 9.75 (p less than 0.001). There was no correlation of HLA specificity with complications of diabetes.

Spectrum of seronegative spondarthritides (SSA) with special reference to HLA profiles

The present study describes the profile of seronegative spondarthritides (SSA) in young servicemen. SSA was diagnosed in 63 patients from a prospective study on spondyloarthropathy. The SSA group consisted of ankylosing spondylitis (AS, 40 patients), Reiter's syndrome (RS, 6) and SSA undifferentiated (SSA-U, 17). The chief clinical and radiological features of the group were due to sacro-iliitis/spondylitis, peripheral arthritis and enthesopathy. Except for RS, extra-articular features were sparse. Mucosal lesions were not evident. Radiologically, sacro-iliitis varied from 24% in SSA-U to 100% in AS, and was disproportionately less when compared to its clinical extent. Dominant lower limb arthritis (poly and oligo) was seen in AS (40%), SSA-U (88.2%) and RS (100%). HLA A and B were typed in patients and controls. HLA AI had a significant negative association (p less than 0.05) with AS and the SSA group, and its relative risk (R) was consistently low (0.2-0.3). HLA B27 was present in 65.7%, 73%, 67%, 41% and 9% of the SSA group, AS, RS, SSA-U and controls respectively (p less than 0.05). Significant R values of A and B loci antigens in disease groups are presented. When compared with available Indian literature, this study highlights the variability and overlap in the disease. Disease markers currently available have limitations in defining the various subsets of SSA.

Chronic inflammatory polyarthritides in a select population of young men. A prospective study

Twenty young servicemen suffering from chronic inflammatory polyarthritides (CIP) were studied. While rheumatoid arthritis (RA) was the final diagnosis in 15 patients, the arthritis remained 'unclassifiable' in the rest. An acute onset of asymmetric deforming arthritis, dominant in the lower limbs, was the usual pattern. Sacroiliitis and enthesopathy were uncommon. Extra-articular features were sparse and sub-cutaneous nodules absent. Rheumatoid factor was present in 86.7% of RA patients. Radiologic erosions were evident in 73.3% RA patients. Arthritis robustus variant of RA was diagnosed in 4 patients. HLA B27 was present in 45.5% of RA patients in this atypical setting. An overlap of RA and seronegative spondarthritides was considered probable in 3 patients.

The pattern of rheumatoid arthritis in the Indian population: a prospective study

Evaluation of polyarthritis in 110 patients in civilian and armed force life revealed 89 with rheumatoid arthritis (RA). In the Indian population, RA seems milder and confined to the joints. A substantial number of male patients appeared to share features with spondylarthritis, often in HLA-B27 positive individuals.

Epidemic infection by a gentamicin-resistant Staphylococcus aureus in three hospitals

A Staphylococcus aureus strain, resistant to aminoglycosides, including gentamicin and tobramycin, and to penicillin, lincomycin, and other antibiotics, caused an outbreak of hospital infection in a surgical ward which spread to the intensive-therapy unit and to two other hospitals. 21 patients were colonised and 9 of these had overt clinical infection. Administration of antibiotics to which the staphylococcus was resistant was associated with colonisation. The use of gentamicin, tobramycin, and lincomycin in these hospitals has increased as has the occurrence of bacterial resistance to these agents. An antibiotic policy to control their use is essential to preserve their value in life-threatening infections by bacteria resistant to other agents.

Interaction of Rubber and Carbon Tetrachloride

Carbon tetrachloride has been used for studies on the solution properties of natural rubber. It has been tacitly assumed that no chemical reaction between the two takes place; but carbon tetrachloride has been found to show a negative heat of mixing with natural rubber. There is absorption of heat (0.37–1.36 cal./g.) with benzene, dichloroethylene and toluene, while there is evolution of heat (2–3 cal./g.) with carbon tetrachloride and chloroform. There is considerable evolution of heat on mixing cellulose triacetate with tetrachloroethane and the solvent is found to be completely bound with the polymer. It appears therefore that similar combination between rubber and carbon tetrachloride may occur, when these are brought together. An indication of chemical interaction of carbon tetrachloride and rubber has been found in an examination of the spectra of carbon tetrachloride solutions of natural rubber. Chemical analysis of rubber, aged in solution at the laboratory temperature, showed that chlorine was incorporated into the rubber. In the present investigation a progressive detailed study of the system of deproteinized rubber-carbon tetrachloride has been carried out from the instant the two are brought in contact till either a homogeneous solution (in darkness only) or a gel is obtained (visible radiations).

Chlorination of Natural Rubber Solutions by Means of Phenyl Iododichloride

The loss of unsaturation attending the chlorination of carbon tetrachloride solutions of unmasticated pale crepe and deproteinized rubbers by means of phenyl iododichloride was followed by quantitative ozonization of the chlorinated products, ranging in chlorine contents from 2.3 to 73.6 per cent. It is concluded from such studies that the reaction proceeds mainly by the additive reaction of the chlorine radicals produced by the thermal decomposition of phenyl iododichloride. The hydrogen chloride found in the preparation of these chlorinated products was determined. It has a value below 1 per cent up to about 15 per cent chlorine content and thereafter it increases. However, this value generally does not exceed 4 per cent. This indicates the occurrence of only a slight amount of substitutive reaction by chlorine. Cyclization also takes place, probably following an additive reaction of the chlorine radicals. The main difference between the deproteinized rubber and pale crepe rubber reactions is confined to the very early stages, wherein the nonrubber components have a directive influence in bringing about a slightly earlier onset of cyclization. It is also concluded that atmospheric oxygen has a negligible effect on the reaction.

Chlorination of Natural Rubber in Solution with Gaseous Chlorine

The chlorination of rubber solutions by gaseous chlorine was followed by isolating the partially chlorinated products and preparing their ozonides. The ozonides were hydrolyzed, and the acids and aldehydes formed on hydrolysis were determined. By a comparison with the amounts of acids and aldehydes obtained from ozonides of unreacted rubber, the amount of residual isoprenic double bonds present was found. The loss of double bonds attending the introduction of chlorine atoms into the molecule of rubber indicates four definite stages in chlorination : (1) initial substitutive attack by chlorine, with concomitant cyclization, resulting in a loss of one double bond between two isoprenic units, (2) substitution, (3) additive reaction, and (4) essentially substitution. Chlorination of aged rubber solutions differs from the above in that the cyclization reaction (stage 1) seems to be absent.