Temperature affects the results of the glutaraldehyde test in the diagnosis of pulmonary tuberculosis

SETTING

Subjects attending the District Tuberculosis Clinic and a Teaching Hospital in Jodhpur were studied at the Desert Medicine Research Centre, Jodhpur.

OBJECTIVES

To confirm the effect of temperature on the results of the blood glutaraldehyde test (GT) and to examine the sensitivity and specificity of the restandardised test procedure.

DESIGN

Blood glutaraldehyde gelification time (BGGT) was compared, in the same blood samples, at 19, 22 and 25 degrees C and after storage at 1) room temperature and at 2) 2-8 degrees C for 3-5 h, using the paired t-test. After restandardisation of the procedure, the GT was carried out on 88 sputum culture-positive cases with pulmonary tuberculosis (PTB) and 182 controls. The technician was blinded to patient information.

RESULTS

BGGT significantly varied with the temperature of the water bath and the temperature at which blood samples were stored before testing. When the test was carried out in the water bath at 22 degrees C after storing blood for 3-5 h at 2-8 degrees C, as per the restandardised procedure, the specificity of GT was 96.2% (95 %CI 93.36-98.95) and the sensitivity was 84.1% (95%CI 76.45-91.73).

CONCLUSION

Restandardised GT is a reliable, simple, easy, rapid, inexpensive and user-friendly test for diagnosis of PTB which does not require sophisticated laboratory equipment.

Potential utility of BCG test in excluding tuberculosis in adults

In developing countries, many sputum-negative suspects of pulmonary tuberculosis (PTB) are given antituberculous medication just because tuberculosis (TB) could not be excluded in them. Many studies have shown that BCG test is nearly 100% sensitive, except in those with severe malnutrition, steroid therapy and other causes of immunosuppression. The aim of the present study was to find out the proportion of PTB suspects in whom BCG test may be useful in excluding diagnosis of TB. The study was carried out on adult subjects attending District Tuberculosis Clinic (DTC), Pali, Rajasthan, India. Out of 104 subjects studied, all 18 sputum-positive subjects showed a positive BCG test indicating 100% sensitivity of the test. The result of BCG test was negative in 16.28% of 86 sputum-negative suspects of TB. The BCG test did not show any adverse reactions among these cases except for adenitis of axillary or cervical lymph nodes in 6.7% subjects. The study raises the possibility that BCG test may be useful in excluding diagnosis of tuberculosis in a proportion of adult sputum negative-suspects of PTB in developing countries like India. More studies are needed in this direction.

A study of an epidemic of acute respiratory disease in Jaipur town

AIM

To detect an association between the sudden epidemic with respiratory symptoms, and fogging with dichlorovos in Jaipur town and to find out probable mechanism of causation of the epidemic.

SUBJECTS AND METHODS

In this community based study of the epidemic, house to house survey of households selected using systematic random sampling was carried out. The incidence in the exposed and unexposed population, the relative risk and attributable risk were calculated.

RESULTS

The incidence of cases was high (58.9%) in subjects present on roads at the time of fogging as compared to in those who were inside rooms of the houses (5.4%) and in those who were not in the locality at that time (1.8%) [Relative Risk (RR)=32.7 and Attributable Risk (AR)=96.9%].

CONCLUSION

High RR and AR in the present epidemic indicate strong association between fogging and occurrence of symptoms. In absence of signs and symptoms of organophosphorus poisoning it suggests that this could have been due to an inappropriate solvent or defective functioning of fog generator, leading to generation of an unusual dark fog, that might have irritated eyes and respiratory tract of exposed residents.

Drug resistance in tuberculosis patients in Jodhpur district

Drug resistant tuberculosis is a serious problem in control of tuberculosis. To assess this problem in Jodhpur district, Sputum samples of symptomatic quarry workers and cases of pulmonary tuberculosis attending District Tuberculosis Clinic (DTC) Jodhpur were tested for culture of Mycobacterium tuberculosis complex (MTB) and their sensitivity to antituberculous drugs, using proportion method. Primary drug resistance to isoniazid was observed in 16.67%, to streptomycin in 16.67%, to ethambutol in 6.67% and to rifampicin in 6.67%. Acquired resistance to isoniazid was 61.76%, to streptomycin was 51.52%, to rifampicin was also 70.59%, and to ethambutol was 39.39%. Proportion of Multi-drug resistant (MDR) TB defined as resistant to at least isoniazid and and rifampicin, was 3.3% in new cases (primary drug resistance) and 38.2% in old cases (acquired drug resistance), the later may be due to inadequate treatment, the the history of which was present in most cases. Adequate treatment of such cases with effective regimens is of vital importance to prevent the spread of MDR TB.

Evaluation of a serologic test for the diagnosis of tuberculosis

The ICT TB test, a new, simple, serologic diagnostic test for tuberculosis (TB), was performed on serum samples from individuals seen at an urban teaching hospital and a local health department clinic. The study population included cases of TB, disease with mycobacteria other than tuberculosis (MOTT), non-mycobacterial pulmonary disease, and healthy controls. In contrast to prior studies, we found the ICT TB test had little value in detection of new cases of TB (overall sensitivity was 20%). It had very low sensitivity (4%) in the first month of disease. The sensitivity improved in patients tested at least 3 months after clinical presentation, but still remained fairly low. The test was also positive in 30% cases of disease caused by MOTT demonstrating cross-reactivity. It was negative in all human immunodeficiency virus (HIV) positive cases of TB or MOTT. The overall specificity was 89%. At least part of the discrepancy between our results and those of previous investigators may be attributable to differences in the respective study populations, including incidence of HIV disease and duration of tuberculosis illness prior to testing.

A study of forced vital capacity and its predictors among the sand stone quarry workers

The study assesses the relationship of selected demographic, anthropometric, radiological, work-history and smoking-history related variables with Forced Vital Capacity (FVC) in a sample of 168 sand stone quarry workers in a desert environment. Except the variables related to smoking behaviour, all are found significantly associated with FVC. The predictors of FVC screened through the multiple regression analysis were age, weight, height, profusion of opacities in chest X-ray and duration of work. Mean FVC was found significantly lower as compared to the healthy adult population. On an average FVC% was 90% of predicted (Percentage deviation of 10%). A clear increasing trend in FVC% along age/duration of work was observed among the young workers, which may be due to building of muscles in this job. Percentage deviation of 20% or more in FVC was significantly associated with presence of radiological opacities suggestive of silicosis (odds Ratio = 3.3). The diagnostic utility of the same is also assessed.

An approach to evaluate a possible bias in Indian well-to-do standard weight values and its implications for interpretations of survey results

The results of different Nutrition surveys carried out in India during 1976-1980 by the National Nutrition Monitoring Bureau (NNMB), Hyderabad, clearly indicated that, among preschool age children, girls often fared better compared to boys with regard to body weight. In these surveys, Hyderabad well-to-do standards have been in use, but it is well documented that, generally, in India girls often have higher morbidity and mortality compared to boys. In view of the above, it is hypothesized that the values quoted for girls in Hyderabad standard weight values are possibly on the low side. A novel approach was developed and the above hypothesis was tested with the help of lower percentiles. Analysis suggests that there exists a bias and the values quoted for girls in Hyderabad well-to-do standard are certainly on the lower side. Hence, as recommended by WHO, there is a need to adopt NCHS standard values in assessment of the nutritional status of preschool children instead of local standards.

Increased risk of tuberculosis in opium addicts

In rural areas of desert of western Rajasthan crude opium is consumed with a social sanction by a notable proportion (7.1%) of adult males. It is believed that prevalence of opium addiction is high in TB cases as they may use it to suppress cough. Prevalence of opium addiction among TB cases from rural desert (16.1%) was compared with that in general population (7.1%) and the difference was found significant (X2 = 11.6, p > 0.001). The difference became a little more prominent after age adjustment. A case control analysis of matched pairs showed significant association between opium addiction and pulmonary tuberculosis (Odd's ratio = 2.61 and attributable risk = 0.099). Results were consistent in different age and ethnic groups. In cases with opium addiction, the addiction always preceded the pulmonary tuberculosis.

Correlates of peak expiratory flow rate: a study of sand stone quarry workers in desert

The study assesses the relationship between selected demographic, anthropometeric, radiological, work-history and smoking-history related variables with Peak Expiratory Flow Rate (PEFR) in a sample of 286 sand stone quarry workers from a desert region. Age, height, profusion of radiological opacities, age at beginning of work, duration of work and duration of smoking were found significantly associated with PEFR while duration of exposure to dust, nature of job and number of biries smoked per day failed to establish their significant association. Mean PEFR of these workers was found significantly lower than the same among healthy adults from the study area. The subset of predictors of PEFR only included age, height and profusion of radiological opacities as identified by multiple regression analysis.

Entomological studies in a dengue endemic area, Jalore, Rajasthan

Entomological studies on prevalence of adult and immatures of Aedes aegypti along with associated ecological factors have been conducted in a dengue endemic area of Jalore, Rajasthan from 1992 to 1993. Studies in two areas; reportedly affected and unaffected revealed more adults and higher breeding indices in the affected area as compared to the unaffected one. Mosquitoes harbouring dengue antigen were found only in the affected locality. Presence of dengue antigen in field caught mosquitoes in the affected locality was observed mainly during the months of January to April in both the years. Statistical analysis of data has shown a correlation to be significant between adult house index and breeding index in the affected area while this association was found insignificant in the unaffected locality. Water storage practices of the population due to irregular water supply in the affected area is the possible cause for a higher vector concentration in the locality. Seasonality of occurrence of dengue fever patients in a particular period of the year is associated with a relatively higher vector density and the presence of infected mosquitoes which is due to favourable temperature, relative humidity, water temperature and pH.

Nutritional status of school age children of salt-workers in Rajasthan

Nutritional status of 1044 school age children (6-18 yr) of salt workers in various salt manufacturing sites of Rajasthan, was assessed using anthropometry. Heights and weights of girls were observed to be better than in boys in the menarcheal age groups. Children of the present study showed reduced growth in comparison to National Centre for Health Statistics (NCHS), World Health Organisation (WHO), well-to-do Indian children and Rajasthan reference values of the same age groups. The prevalence of stunted with severe wasting was 4.5 per cent in the children of salt workers. Higher prevalence of severe wasting was observed in girls than the boys (P < 0.01).

Morbidity profile of desert population engaged in salt production in Rajasthan

A total 2120 salt workers were examined in 8 camps organised at different salt sites in Rajasthan. These camps were organised to find out the morbidity conditions among salt workers and to provide preventive and curative treatment for the ailments. The majority of salt workers who attended the camps were males (79.0%) in comparison to females (21.0%). The majority of workers belonged to Scheduled Castes followed by Backward Class and Scheduled Tribes at all sites. The major morbidity disorders observed during these camps were dermatological, respiratory, musculoskeletal, gastro-intestinal and ophthalmological in both the sexes. The prevalence of hypertension was 4.3% among both sexes. The morbidity pattern in male workers was agreeing among Sujangarh and Kuchaman and after that Pokran and Didwana were agreeing with highest rank correlation, whereas in female workers it was agreeing among Nawa and Sujangarh and after that Phalodi and Pokran were agreeing with highest correlation.

Hepato-duodenal fistula

A description of a rare case of hepato-duodenal fistula was demonstrated on barium meal examination and subsequently surgically proved.

II. Effect of Coagulants on the Quality of Rubber

1. Whatever coagulant is used for coagulation, a certain proportion of inorganic components, proteins and resins (1/9, 1/7, 1/5, respectively) of those originally present in latex remains adsorbed on rubber. 2. One-half of the total solids are eliminated with serum during coagulation. 3. The quality of rubber does not vary with a coagulant. 4. The molecules of latex are saclike bodies consisting of an inner core of rubber surrounded by protective films of resins and proteins, and the intervening spaces are filled with serum components. A puncture in the latex sac expels the serum components and brings about a collapse of the protective films which get adsorbed on rubber and these fused sacs float in serum as cream. By further fusion of cream particles a spongy coagulum of rubber is formed. 5. Coagulation is brought about because of profound changes in latex produced by physical and chemical agencies which destroy the stability of the system by elimination of resins, proteins and serum components, by neutralization of the charge on the rubber, and by the disruption of electrical, molecular and cohesive forces that pervade latex.