Drug resistance detection and mutation patterns of multidrug resistant tuberculosis strains from children in Delhi

A total of 312 sputum samples from pediatric patients presumptive of multidrug resistant tuberculosis were tested for the detection of drug resistance using the GenoTypeMTBDRplus assay. A total of 193 [61.8%] patients were smear positive and 119 [38.1%] were smear negative by Ziehl-Neelsen staining. Line probe assay [LPA] was performed for 208 samples/cultures [193 smear positive samples and 15 cultures from smear negative samples]. Valid results were obtained from 198 tests. Of these, 125/198 [63.1%] were sensitive to both rifampicin [RIF] and isoniazid [INH]. 73/198 [36.9%] were resistant to at least INH/RIF, out of which 49 [24.7%] were resistant to both INH and RIF [multidrug resistant]. Children with tuberculosis are often infected by someone close to them, so strengthening of contact tracing in the program may help in early diagnosis to identify additional cases within the household. There is a need to evaluate newer diagnostic assays which have a high sensitivity in the case of smear negative samples, additional samples other than sputum among young children not able to expectorate, and also to fill the gap between estimated and reported cases under the program

Frequency of multi-drug resistance and mutations in Mycobacterium A tuberculosis isolates from Punjab state of India

Data regarding prevalence of multi-drug resistant tuberculosis [MDR-TB] and associated common mutations is scarce from Punjab region. The study was designed to determine rate of MDR-TB among presumptive MDR-TB from Punjab and mutation patterns using GenoType MTBDRplus assay. Total of 812 consecutive sputum samples were received from January 2012 to July 2013, from 14 districts of Punjab at the National Reference Laboratory at New Delhi for diagnosis of MDR-TB as hand holding activity. Presumptive MDR-TB patients were identified on basis of criterion B defined by the programme. Smear positive and negatives patients were found to be 636/798 [79.7%] and 162/ 798 [20.3%] respectively. Total of 606 GenoType MTBDRplus tests were conducted and mutations in rpoB, kat G and inhA genes analyzed. Total of 94/606 [15.5%], 43/606 [7.1%] and 40/606 [6.6%] were found to be RIF and INH resistant, mono-RIF resistant and 40/606 [6.6%] mono-INH resistant respectively

Commonest known mutation for RIF in rpoB gene and INH in kat G gene was S531L [80/ 137; 58.4%] and S315T1 [119/134; 88.8%] respectively. Mutations in inhA were found in 21/134 ]15.7%] strains. Average turn-around time [TAT] for dispatch of result toPunjab was 4.6 days. Prevalence of RIF resistance in Punjab was found to be 22.6%. Common mutations for RIF and INH were similar to that in other regions of country. GenoType MTBDRplus was found to be useful assay for rapid detection of MDR-TB, responsible for determining better management of MDR-TB patients under the programme

Predominance of Beijing genotype in extensively drug resistant Mycobacterium tuberculosis isolates from a tertiary care hospital in New Delhi, India

Out of a total of 311 Mycobacterium tuberculosis isolates from sputum specimens subjected to first- and second-line drug-susceptibility testing [DST] at a hospital serving as a referral center for chronic tuberculosis [TB] cases in New Delhi, 232/311 [74.6%] isolates were found to be resistant to isoniazid and rifampicin. Among multidrug-resistant [MDR] isolates, 119/232 [51.3%] were resistant to four first-line drugs [streptomycin, isoniazid, rifampicin and ethambutol]. Mono-resistance to isoniazid was observed in 18 [5.7%] isolates, while none of the isolates tested showed mono-resistance to rifampicin. 50/232 [21.5%] isolates met the definition of extensively drug resistant [XDR] TB, i.e., additional resistance to a fluoroquinolone and at least one of the three injectable second-line drugs: kanamycin, capreomycin, or amikacin. Spoligotyping of the XDR-TB isolates revealed 14 patterns; 39/50 [78%] isolates being grouped in three clusters vs. 11/50 [22%] isolates being unique. SIT1/Beijing represented the largest cluster [n = 21, 42%], followed by SIT26/CAS1-Delhi [n = 10, 20%] and SIT 53/T1 [n = 8 isolates; 16%]. This study corroborates recent observations from North India suggesting that both Beijing and CAS1-Delhi lineages constitute the bulk of XDR-TB isolates that are disseminating rapidly across a large geographical region in and around the capital city of India

Bipartite clavicular attachment of the sternocleidomastoid muscle: a case report / 대한해부학회지

Morphological variations of the sternocleidomastoid (SCM) muscle assume relevance during attempted surgical interventions in the cervical region. The present study reports bipartite clavicular attachment of the SCM in the neck of an adult male cadaver during performance of a routine anatomy demonstration. The anomaly was unilaterally observed on the left side of the neck. The clavicular head of the muscle exhibited two bellies, one medial and one lateral. While the medial belly was fused with the sternal head, the lateral belly appeared to blend with the medial. Cranially, the SCM attached to the mastoid process and superior nuchal line. We have attempted to elucidate the embryological basis of the above muscular variant. Additionally, we discuss its clinical relevance, highlighting the utility of the SCM in various reconstructive procedures. We assert that detailed anatomical knowledge of such SCM variants is of utility not only to the gross anatomist, but also for neck and orthopaedic surgeons and anaesthetists. Moreover, radiologists require familiarity with such aberrations to decipher magnetic resonance imaging scans of the cervical region.

Unilateral anomalous arterial pattern of human upper limb: Anatomical description and clinical implications

A unilateral case of variations in the brachial and antebrachial arterial branching pattern of a human upper limb is reported. A high bifurcation of brachial artery along with superficial course of ulnar artery was observed. Additionally, the profunda brachii and common interosseous artery originated from the radial artery instead of brachial and ulnar arteries respectively. An atypical branching pattern of arteries in an upper limb could pose a challenging problem to vascular surgeons while performing reconstructive procedures

Humero - bicipito - articularis: a rare accessory muscle of the arm

Anomalies related to the musculature of the upper limb are extremely important for plastic and orthopedic surgeons in their clinical practice. The present study reports the presence of a rare accessory muscle in the flexor compartment of the arm with its morphological description and also highlights its clinical relevance. We encountered a rare accessory muscle in the region of upper arm of an adult male Indian cadaver in the Anatomy department. The anatomical details of this accessory muscle were studied in detail and appropriate photograph was taken. An accessory muscle in the flexor compartment of the right upper arm was observed. The muscle originated from the proximal part of the humeral shaft and displayed insertion into the lateral border of the short head of biceps brachii It's fibers also blended with the fibrous capsule of the shoulder joint. The plethora of muscular variations in this important anatomic area is of utmost significance to the surgeon performing reconstructive and explorative procedures