A prospective study of non-tuberculous mycobacterial disease among tuberculosis suspects at a tertiary care centre in north India

Background & objectives: The burden of non-tuberculous mycobacterial (NTM) disease is increasing worldwide. The disease shares clinicoradiological features with tuberculosis (TB), Nocardia and several fungal diseases, and its diagnosis is frequently delayed. The present study was performed to determine the frequency of NTM disease among TB suspects in a tertiary care centre in north India. Methods: In this prospective study, mycobacterial culture isolates from pulmonary and extrapulmonary specimens among TB suspects were tested with immunochromatographic assay (ICA). All ICA-negative isolates were considered as NTM suspects and further subjected to 16S-23S rRNA internal transcribed spacer gene sequencing for confirmation and species identification. Patients with active disease were treated with drug regimen as per the identified NTM species. Follow up of patients was done to determine clinical, radiological and microbiological outcomes. Results: Of the 5409 TB suspects, 42 (0.77%) were diagnosed with NTM disease. Patients with active disease consenting for treatment were treated and followed up. Thirty four patients had NTM pulmonary disease (NTM-PD) and the remaining eight had extrapulmonary NTM (EP-NTM) disease. Mycobacterium intracellulare and M. abscessus, respectively, were most frequently isolated from NTM-PD and EP-NTM patients. Fifteen NTM-PD and seven EP-NTM patients successfully completed the treatment. Ten patients died due to unrelated causes, five were lost to follow up and another four declined the treatment. Interpretation & conclusions: Our study showed that the frequency of NTM disease was low among TB suspects at a large tertiary care centre in north India and this finding was similar to other Indian studies. More studies need to be done in other parts of the country to know the geographical variation in NTM disease, if any.

Principles of Quality Controlled Endoscopic Submucosal Dissection with Appropriate Dissection Level and High Quality Resected Specimen

Endoscopic submucosal dissection (ESD) has enabled en bloc resection of early stage gastrointestinal tumors with negligible risk of lymph node metastasis, regardless of tumor size, location, and shape. However, ESD is a relatively difficult technique compared with conventional endoscopic mucosal resection, requiring a longer procedure time and potentially causing more complications. For safe and reproducible procedure of ESD, the appropriate dissection of the ramified vascular network in the level of middle submucosal layer is required to reach the avascular stratum just above the muscle layer. The horizontal approach to maintain the appropriate depth for dissection beneath the vascular network enables treatment of difficult cases with large vessels and severe fibrosis. The most important aspect of ESD is the precise evaluation of curability. This approach can also secure the quality of the resected specimen with enough depth of the submucosal layer.

A study of cross-sectional data on the aging of physique and strength / 体力科学

Stature, body weight, grip strength, back strength and Sargent jump of city dwellers, covering an age range from children to elderly subjects, were measured in order to study the development and aging of physical fitness.<BR>From these cross-sectional data, growth and aging curves were obtained.<BR>Stature appeared to decrease gradually in adulthood but a secular increasing trend was included in the data, so that in fact hardly any change is notable except in late adulthood.<BR>Body weight seemed to increase to some degree in middle adulthood after secular trends had been removed from the data.<BR>The data for back strength showed more rapid decrease in adulthood, infering that the strength of back muscles decreases in adulthood, though there have been insufficient reports on secular trends of muscle strength. Leg power decreased gradually in a similar way after development during adolescence. Grip strength seemed to change little or increase only slightly in middle adulthood, and to decrease later.<BR>Cross-sectional data contain more secular trends than age-related changes in physique during adulthood. The present data may show roughly some growth patterns at certain ages when the rate of growth and development is high and aging patterns at ages when the decrease in fitness is marked. However, details on personal growth and aging patterns should be studied by the longitudinal method.

Application of continuous measurements of systolic blood pressure and heart rate during exercise / 体力科学

Human systolic blood pressure and heart rate were measured continuously. This was accomplished by an indirect noninvasive method employed while the subject was involved in exercise. The characteristics of the measurements, and the factors which produced those characteristics were investigated. Then, an index L composed of all of the significant factors was sat up in order to compute L-Scores. L-Score was later statistically considered as a significant indicator of evaluation of a subject's training level.<BR>On the other hand, BP-HR Scores of each subject were obtained from BP-HR Scoring Chart. The Scoring Chart was drawn in order to serve as a scoring table for estimating subjects' training levels according to a formula which represented the characteristics of increments above resting blood pressure and heart rate. Highly significant correlation between L-Scores and BP-HR Scores, 0.94 at P<0.01, was observed.<BR>The study concluded that synthetic investigations of multi factors such as computing L-Scores were more efficient than a singular investigation of individual factors in order to examine a human cardiovascular function from measurements of blood pressure and heart rate during exercise. For simplification of the measurements and computations, application of BP-HR Scores was considered as an effective method.