ABSTRACT
Background: The aim was to determine utility of Cartridge based nucleic acid amplification test (CBNAAT) in diagnosis of mycobacterium tuberculosis in children with neurotuberculosis diagnosed on the basis of clinical evaluation, CSF findings and neuroimaging.Methods: A prospective randomized controlled trial was conducted in Pediatric Department of RNT Medical College, Udaipur, Rajasthan, India from July 2017 to June 2018. Total 110 children of age group of 6 months to 18 years with the diagnosis of tubercular meningoencephalitis (TBME) on the basis of clinical evaluation, CSF examination and neuroimaging were included in the study.Results: A total 110 children were enrolled. Maximum number of cases admitted with TBME were among 1-5 years of age group (60.91%). CSF and gastric aspirate were examined by CBNAAT for MTB. 5 (4.55%) children had CBNAAT positivity in CSF. Gastric aspirate was positive among 16 (14.55%) children. None of the patient had CBNAAT positive result both in CSF and gastric aspirate.Conclusions: TBME is a major health problem in children below 5 years. Gene Xpert assay has the potential to significantly improve and escalate the diagnosis of smear-negative body fluid specimens. CBNAAT for mycobacterium tuberculosis was positive in 5 (4.55%) children from CSF and 16 (14.55%) from gastric aspirate. Negative CBNAAT should not prevent any patient with suspected features of TBME from starting anti tubercular treatment (ATT) as sensitivity of this test remains low. Final judgement to start ATT should be based on clinical, biochemical and radiological profile especially in CNS tuberculosis.
ABSTRACT
Background: Diagnosis of celiac disease in children suffering from severe acute malnutrition without duodenal biopsy or HLA typing is a dilemma. The objective of this study was to study the response to gluten free diet in sero-positive Celiac Disease children suffering from severe acute malnutrition in age group 1-5 years.Methods: This prospective, observational, hospital-based study was conducted at MTC of tertiary care medical college hospital of southern Rajasthan from Dec. 2017 to Nov. 2018. Total 110 children with SAM were enrolled and screened for celiac disease on the basis of tissue tTg-IgA/IgG serology. Seropositive cases were kept on gluten free diet for short period of time and observed for the resolution of symptoms and improvement in growth, monitored by anthropometry on discharge and follow up visit.Results: Mean weight gain (gm/kg/day) on follow up was 3.87'3.49 in seropositive and 1.88'3.79 in seronegative cases (P-value<0.05). Mean weight gain was 6.43'3.28gm/kg/day in only tTg-IgA positive and 3.04'2.95 gm/kg/day in only tTg-IgG positive cases (P-value-<0.05). The mean weight gain in strictly gluten free adherent sero-positive cases was 4.89'2.97 gm/kg/day while in gluten free non-adherent patients it was -0.49'1.70 (P-value <0.001). Mean weight gain in probable (tTg-Ig-A <10 times ULN) and presumptive (tTg-IgA >10 times ULN) Celiac disease were 3.44'3.73 and 5.44'3.78, respectively without statically significant difference (P-value >0.05).Conclusions: In situations where facility of duodenal biopsy and or HLA DQ2/DQ8 typing is not available, resolution of symptoms and improvement in growth on gluten free diet confirms the diagnosis of celiac disease.
ABSTRACT
ABSTRACTThe present investigation was aimed to detect the specific polypeptide(s) appeared during the sequential stages of differentiation. Among different explants, only nodal explants showed good results for callusing. Depending on the fresh and dry weight, best callus growth was observed on MS medium supplemented with NAA (2.5 mg/L) inDioscorea alata and 2, 4-D (2.0 mg/L) inD. deltoidea, respectively. This callus was used for the regeneration. Roots differentiation was observed on MS medium + NAA (2.0 mg/L) + IBA (0.5 mg/L) and shoots on MS medium + BAP (2.0 mg/L) + NAA (0.5 mg/L) in D. alata while in D. deltoidea, roots on RT medium + IAA (1.0 mg/L) and shoots on RT medium + BAP (1.0 mg/L) + NAA (0.5 mg/L). Continuous decrease was seen in the total soluble protein during the differentiation inD. alatawhereas inD. deltoidea, the protein content decreased upto initiation stage. Four root specific polypeptides (MW 25.56, 24.35, 19.13 and 18.2 kDa) and three shoot specific polypeptides (MW 53.7, 25.12 and 19.13 kDa) were synthesized during the differentiation inD. alata. Similarly, two root specific (MW 33.9 and 31.69 kDa) and one shoot specific (MW 16.98 kDa) polypeptide band were appeared during differentiation in D. deltoidea.
ABSTRACT
Increase in the mortality and morbidity in pleural infection is a concern worldwide due to increasing resistant Gram negative pathogens like Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella species. Rise of pneumonia due to K. pneumoniae, is more likely observed in alcoholics, diabetics, hospitalized and patients receiving mechanical ventilation. In the present study, we discuss a case of a 59 year old male patient with pulmonary effusion infected with extended spectrum beta-lactamases (ESBL) producing K. pneumoniae with co-morbidities of uncontrolled Type II diabetes mellitus (DM), hypertension and coronary artery disease (CAD), treated with a newer antibiotic adjuvant entity: Elores (ceftriaxone/sulbactam/disodium edetate) and recovered well.
ABSTRACT
Background: Cigarette smoking is the most commonly encountered risk factor for COPD, and causes COPD by its noxious particles and or gases. Cigarette smoke contains some neurotoxin substances that might be important in the pathogenesis of peripheral neuropathy. Objective: To determine whether the effect of the duration of smoking leads to development of peripheral neuropathy in different groups of the COPD patients as measured by nerve conduction studies of upper extremities Material and Methods: The nerve conduction test, of the median and ulnar nerves of the upper extremities, was performed on the subjects (study and control group), who were assessed for their anthropometric measurements, history regarding pack years, the pulmonary function tests, SpO2 levels. Results: Significant difference was found between smoking history in pack years and in the values of Nerve Conduction Velocity of the nerves of upper extremities in different groups of COPD patients, which was found to be statistically significant at p<0.001. Conclusion: A decrease in nerve conduction velocity was observed in the nerves of upper extremities as duration of smoking in pack years increased in the different groups of COPD patients.
ABSTRACT
Background: TNF – α, a cytokine of a generalized intravascular inflammatory reaction, has been also shown to cause microvascular protein leakage and hypertrygliceridemia which are associated with pre-eclampsia. Increased serum uric acid is also associated with hypertension. Aims & Objective: To study the relationship between Tumour Necrosis Factor – alpha (TNF – α) with uric acid and to access the role of TNF – α as a determinant of Pre-eclampsia in women. Material and Methods: 100 patients with pre-eclampsia were studied out of which 50 were mild and 50 were severe pre-eclamptics. They were compared with 50 healthy subjects. Subjects were of similar gestational age, body mass index (BMI) and parity matched. They were all primigravidas at third trimester of pregnancy. Results: All studied subjects belonged to age group 28-40 years. The difference in mean age of healthy subjects and pre-eclamptics was non-significant (P=0.8). BMI values were ranged from 18-43 kg/m2. No significant difference was observed between healthy pregnant women and pre-eclamptics. Serum TNF – α co-related significantly with Mean Arterial Pressure (MAP) and Uric acid levels. The association of TNF – α with uric acid was considerably significant compared to its association with other variables. The result showed that TNF – α is a strong determinant of pre-eclampsia. Conclusion: A co-relation exists between TNF – α and uric acid. The observed co-relation indicates that monitoring TNF – α and uric acid levels in Pre-eclamptic women might serve to help prevent the development of pre-eclampsia in pregnant women.