Direct and early detection of Mycobacterium tuberculosis complex and rifampicin resistance from sputum smears

SETTING

Four district DOTS centres in Sikkim, India.

OBJECTIVE

Direct and early detection of Mycobacterium tuberculosis complex and rifampicin (RMP) susceptibility using the INNO-LiPA Rif.TB assay.

DESIGN

DNA was extracted from 44 inactivated acid-fast bacilli-positive sputum slides using the Gen Elute bacterial genomic DNA kit. Eluted DNA were ethanol precipitated. The LiPA kit detected RMP susceptibility by detection of mutation in the 81 base pair (bp) rpoB gene. Culture of sputum from the same person was used for drug susceptibility testing for RMP using the proportion method.

RESULTS

Amplification of 88.6% (39 slides) was achieved from DNA extracted using kits (66.7% for 1+, 81.8% for 2+ and 100% for 3+ slides). Hybridisation using the LiPA kit was applied to 31 amplified products. There was a concordance of 96.8% (24 RMP-resistant and 6 RMP-susceptible samples) and discordance of 3.2% (one sample resistant using the proportion method and susceptible on LiPA) between LiPA and the proportion method.

CONCLUSION

LiPA proved useful on DNA extracted from smear-positive slides. Appropriate treatment regimen could be decided early. Slide smear preparation could replace sputum transport in cetylpyridinium chloride, reducing biohazard and thereby controlling the transmission of multidrug-resistant tuberculosis in the community.

Haemoglobinopathies - major associating determinants in prevalence of anaemia among adolescent girl students of Assam, India

Prevalence of anaemia among adolescent girl students of Assam, a north-eastern state of India, was evaluated along with its associating determinants. The present study revealed that anaemia is a major public health problem among adolescent girl students of Assam. The overall prevalence of anaemia among adolescent girl students of Assam is as high as 71.5%. Non-nutritional factors such as infection due to helminths was substantially low (24.71%). Ascaris lumbricoides was the most frequent infection (10.6%), followed by Trichuris trichiura (6.2%), and hookworm infestations (3.9%). Polyparasitic infection (A. lumbricoides, T. trichiura and hookworm) was observed in 0.5% of the study subjects. While coinfection due to A. lumbricoides and T. trichiura was 2.3%, A. lumbricoides and hookworm was 1.1% and T. trichiura and hookworm was 0.9%. Serum ferritin level in a subgroup of samples was in the lower normal range. Malaria parasite was not detected in any of the slides. We have observed a gene frequency of 0.188 for βE-globin gene among the adolescent girl students of Assam. The gene frequency for βE-globin gene ranged from 0.071 to 0.266. Statistically significant difference (F=3.471; P=0.001) of mean haemoglobin level was observed in different types of haemoglobin variants. Multiple regression analysis, in a sub-set of samples having information on Hb levels (g/dl), helminthic infestation (A. lumbricoides, T. trichuria and hookworm), haemoglobin type, revealed haemoglobin type (Hb E) was the important determinant of anaemia among adolescent girl students in the present study.

Subcutaneous nocardial abscess in a post-renal transplant patient

A case of nocardiosis in a post-renal transplant patient is being reported for the first time from Eastern India. The patient had multiple abscesses on the right thigh and chest. Direct examination of the aspirated pus by Gram stain and modified Ziehl Neelsen stain revealed gram-positive beaded, partially acid-fast, branching filaments. Culture of the pus yielded Nocardia asteroides. The patient responded to surgical drainage and sulphamethoxazole therapy.

Emergence of sporotrichosis in Manipur

A retrospective analysis of all cases of sporotrichosis was conducted to examine the pattern and frequency of sporotrichosis cases in Manipur over a period of six year from July 1999 to June 2005. Seventy-three (73) cases of sporotrichosis were detected of which 30 were confirmed by culture and 43 were diagnosed by aspiration cytology only. Most of the patients belonged to the age group of 21 to 40 years (n = 23; 31.5%). There were 39 females (53.4%) and 34 males (46.5%). Commonest site of infection was upper limbs (n = 39; 53.4%) followed by lower limbs (n = 17; 23.2%). Commonest type of infection was lymphocutaneous form (n = 46; 63.1%) followed by fixed cutaneous form (n = 27; 36.9%). Among these 73 cases, 2 male patients (2.7%) were found to be HIV positive. In our experience, collection of material by aspiration of pus or infected tissue was found to be a better method compared to scraping or exudate. This study revealed Manipur as a new endemic area for sporotrichosis.

Production & characterization of monoclonal antibodies to Mycobacterium tuberculosis

BACKGROUND & OBJECTIVES

Monoclonal antibodies (MAbs) against Mycobacterium tuberculosis H37Rv culture filtrate (CF) were raised by immunizing BALB/c mice and characterization was done. Attempts have been directed towards identifying mycobacterial antigens in biological fluids by employing polyclonal and monoclonal antibodies specific for M. tuberculosis. Immunohistologic studies, using MAbs for the localization of whole or fragmented bacilli in the biopsy specimens were also carried out.

METHODS

Intrasplenic IS and intraperitoneal i.p. routes of immunization, were compared. The MAbs were characterized for their isotype, binding specificity, nature of binding epitope, reactivity in immunoassays etc.

RESULTS

IS and i.p. routes of immunization, were compared and i.p. was found superior. Ten MAbs designated TRC 1-10 were produced. Of these, 7 MAbs, TRC 1-7 reacted with the 30/31 kDa doublet (antigen 85 complex), TRC 8 with 12 kDa in addition to 30/31 kDa and TRC 9 and 10 with the 24 and 12 kDa antigens respectively. Six MAbs were classified as broadly cross reactive and 2 showed limited cross reactivity. TRC 8 and 10 showed species specificity. Employing TRC 8 in sandwich ELISA, antigen was detected in sera from 17 of 25 pulmonary tuberculosis patients and 3 of 20 controls. TRC 8 was found to be useful in detecting antigens specifically in M. tuberculosis and M. leprae infected tissues, by immunoperoxidase staining.

INTERPRETATION & CONCLUSION

TRC 8 was found to be restricted in its reactivity to M. tuberculosis complex and M. leprae. TRC 8 may prove useful in immuno-diagnosis of tuberculosis.

Pathological prognostic factors in breast carcinoma

OBJECTIVE

Pathological prognostic factors in breast cancer are now widely used to predict biological behavior of cancer and to plan its effective management. In this paper, we attempt to evaluate the reports from our histopathology laboratory spanning over a period of 4 years, to assess completeness in recording these factors. It will enable us to improve and standardize reporting on breast cancer.

METHODS

The pathology reports of primary carcinoma of the breast diagnosed in our laboratory from 1st January 1994 to 31st December 1997 (4 year period) were reviewed for details on tumor size, histological type and grade, presence or absence of tumor emboli in vascular channels, proximity of the tumor to resection margins and lymph node status.

RESULTS

Tumor size was not recorded in 1 case each in 1994, 1995 and 1996 and 2 cases in 1997. Histological type was mentioned in all cases in 1995 and 1997. It was not mentioned in 1 case in 1994 and 3 cases in 1996. Out of 77 cases with axillary clearance, the total number of lymph nodes was recorded in 83% of cases. The number of lymph nodes with metastasis was recorded in 71% of cases.

CONCLUSION

Our histopathology laboratory receives the majority of surgical biopsies carried out in the Sultanate of Oman. During our study period we received a total of 45354 biopsies. From 1993 onwards, pathological prognostic factors of breast carcinoma were incorporated in our pathology reports following the publication of major and leading articles regarding the same. This study shows an improvement in the quality of reports after introducing this concept in 1994. This study clearly reveals the necessity for written protocols to be established, to standardize and improve the quality of reporting.

Pattern of breast neoplasms in Oman

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The pattern of malignant lymphoma in Oman

The pattern of malignant lymphoma (ML) in the Middle East has not been well documented and constitutes a lacuna in the epidemiology of this disease. This preliminary report describes a retrospective study of 46 native Omanis who, at the Sultan Qaboos University Hospital and the Royal Hospital, Sultanate of Oman, were diagnosed in 1990 as having ML. Of the 46 patients with ML, 16 (35%) were found to have Hodgkin's disease (HD) and 30 (65%) had non-Hodgkin's lymphomas (NHL). Among the HD, mixed cellularity (MC) appeared in 9 cases (56%). Among the NHL, 25 (83%) showed a diffuse pattern and 5 (17%) were follicular. Twenty-one (70%) of the NHL were of high-grade type, of which 5 (17%) were Burkitt-like lymphomas. Immunological study of the NHL biopsies revealed 24 (80%) of the B cell type, 2 (7%) of the T-cell type, 1 (3%) of the null cell type and 3 (10%) could not be classified because of scanty material or unsatisfactory fixation. We present in this study the pattern of ML in Oman, which was found to be different from those reported from the West, Far East and Saudi Arabia, with some resemblance to the pattern from tropical Africa.

Histology and histochemistry of the intermoult integument in the ghost crab Ocypoda platytarsis (Milne-Edwards) (Crustacea: Brachyura)

The histological and histochemical aspects of the integument have been described and discussed during the intermoult period of Ocypoda platytarsis. Histological observations revealed that the cuticle comprises of four layers namely epicuticle, exocuticle, endocuticle and membranous layers. Various types of cells in the subepidermal tissue have also been elucidated.

The primary structure of rat ribosomal protein S3

The amino acid sequence of rat ribosomal protein S3, which has been reported to form part of the binding site for initiation factors, was deduced from the sequence of nucleotides in a recombinant cDNA. Ribosomal protein S3 contains 243 amino acids and has a molecular weight of 26,643. Rat S3 and Xenopus laevis ribosomal protein S1 are homologous: There are 62 identities in 63 consecutive residues in the carboxyl-terminal amino acid acid sequence of rat S3 and in a partial sequence of Xenopus S1. Hybridization of rat S3 cDNA to digests of nuclear DNA suggests that there are 8-10 copies of the S3 gene. The mRNA for the protein is about 950 nucleotides in length.

The primary structure of rat ribosomal protein L21

The covalent structure of rat ribosomal protein L21 was deduced from the sequence of nucleotides in a recombinant cDNA and confirmed from the NH2-terminal amino acid sequence of the protein. Ribosomal protein L21 contains 159 amino acids (the NH2-terminal methionine is removed after translation of the mRNA) and has a molecular weight of 18,322. Hybridization of the cDNA to digests of nuclear DNA suggests that there are 16-23 copies of the L21 gene. The mRNA for the protein is about 680 nucleotides in length.

The primary structure of rat ribosomal protein S4

The amino acid sequence of the rat 40 S ribosomal subunit protein S4 was deduced from the sequence of nucleotides in a recombinant cDNA and confirmed from the NH2-terminal amino-acid sequence of the protein. Ribosomal protein S4 has 282 amino acids (the NH2-terminal methionine is removed after translation of the mRNA) and has a molecular weight of 31,841. Hybridization of the cDNA to digests of nuclear DNA suggests that there are 7-11 copies of the S4 gene. The mRNA for the protein is about 1 kb in length. Rat S4 is homologous to Saccharomyces cerevisiae YS6. The protein contains a possible internal duplication of 11 residues.

The primary structure of rat ribosomal protein L18

The amino acid sequence of rat ribosomal protein L18 was deduced from the sequence of nucleotides in a recombinant cDNA and confirmed from the amino-terminal amino acid sequence of the protein. Ribosomal protein L18 contains 187 amino acids (the amino-terminal methionine is removed after translation of the mRNA) and has a molecular weight of 21,530. Hybridization of the cDNA to digests of nuclear DNA suggests that there are 10-14 copies of the L18 gene. Rat ribosomal protein L18 is homologous to Xenopus laevis L14; the extent of the identity of the amino acid sequences is 87% and for the nucleotides in the coding region of the DNA it is 76%.

Renal involvement in leprosy

Renal involvement in 13 non-lepromatous and 17 lepromatous leprosy patients were assessed by routine urinalysis, detailed biochemical analysis of blood and urine and by renal histopathological studies and compared with 10 normal healthy controls. The presence of RBC and pus cells were detected in the urinary deposit of only one lepromatous leprosy patient in reactional phase. A reversal of albumin/globulin ratio was observed in 17.6% of non-lepromatous and 15.3% of lepromatous patients. 24 hours urinary excretion of sodium, potassium, chloride and aminonitrogen of the patients were within the normal range. Forth seven percent of the non-lepromatous and 46% of the lepromatous patients had proteinuria. Even though the mean serum creatinine values of the patients showed no difference from that of the normals, the creatinine clearance was low in 82.3% of the non-lepromatous and in all of the lepromatous patients. Serum phosphorus, serum uric acid, urinary phosphate excretion and the renal tubular reabsorption of phosphorus of the patients were normal. Twenty one percutaneous renal biopsy specimens showed nonspecific pathological changes such as nephritis of various varieties in 71.4% of the specimens. Among the lepromatous group renal involvement was observed in 5 out of 9 cases (55.6%) and in the non-lepromatous group 10 out of 12 cases (83.3%). No acid fast bacilli, amyloid and granuloma were seen in any of the renal tissues studied. There was no definite correlation between the type of renal pathology and biochemical changes. None of the patient showed any clinical evidence of renal involvement.