Histoid Leprosy: Are We Still Harbouring Potential Community Menace? A Case Series from North-East India

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Histoid leprosy is considered an uncommon multibacillary form of leprosy characterized by presence of histoid lepromas which present as erythematous round or oval shaped glistening nodules. Most commonly this form of leprosy is seen in patients on irregular therapy with MDT. In this series we report a total of three cases with their clinical, histopathological and dermoscopic findings.

CYTOMORPHOLOGY PATTERN ON FNAC AND AFB POSITIVITY IN CASES OF TUBERCULAR LYMPHADENITIS IN A TERTIARY CARE CENTRE OF CENTRAL INDIA

Background- One of the most typical diagnoses at OPDs in a developing nation like India is tuberculous lymphadenitis. Anti-tubercular therapy, however, cannot be started based solely on clinical suspicion. Along with culture, cytomorphology with acid fast staining is an effective tool for diagnosing these cases. The purpose of the study was to examine the usefulness, limits, and relationships between Ziehl-Neelsen staining in tuberculous lymphadenitis and various cytomorphological presentations using fine needle aspiration cytology. At a tertiary care facility, the study was Materials and Methods- carried out over the course of a year with a total of 146 cases. Patients who had lymphadenopathy that was clinically suspected were chosen. There were 36.3% cases of tuberculous Resultlymphadenitis out of which 66.04% cases were overall AFB positive. The most frequent cytological finding was epithelioid cell granulomas with lymphocytes, and cases with granulomas and necrosis had the highest levels of AFB positivity. Most patients first showed up in their third or fourth decade of life. Solitary lymphadenopathy, as opposed to matted lymph nodes as reported by others, was the most frequent presentation and the cervical area was the most frequently involved site. Fine needle as Conclusion- piration cytology is a highly sensitive method for diagnosing tuberculous lymphadenitis that is inexpensive, safe, and dependable. By adding acid fast staining and culture procedures to cytomorphology, the diagnostic index can be raised even higher. However, FNAC combined with methods like ELISA and PCR would improve the current landscape of diagnostic and therapeutic options.

Rapid detection of aflatoxin B_1 in Chinese herbal medicines by indirect and direct competitive enzyme-linked immunosorbent assays: a comparative analysis / 中国中药杂志

The indirect competitive enzyme-linked immunosorbent assay(ic-ELISA) and direct competitive enzyme-linked immunosorbent assay(dc-ELISA) were performed for the rapid detection of aflatoxin B_1(AFB_1) in Astragali Radix, Zingiberis Rhizoma Recens, Jujubae Fructus, and Nelumbinis Semen with self-made antigens and antibodies. Different extraction methods were investigated to reduce the matrix effects of different medicinal parts in Chinese herbal medicines. The sensitivity of dc-ELISA method was improved by optimizing the molar ratio of AFB_1 to horseradish peroxidase(HRP). In this study, the sensitivity(IC_(50)) of ic-ELISA and dc-ELISA was 0.046 and 0.023 ng·mL~(-1), with the limit of detection(LOD) of 0.007 and 0.004 ng·mL~(-1), respectively. The detection time was 3 h and 50 min for ic-ELISA and dc-ELISA, respectively. The recovery rates were within the range of 62.96%-104.4%, with RSDs of less than 10%. Confirmed by LC-MS/MS, three positive samples of Nelumbinis Semen were detected from 53 samples. Two ELISA methods established in this study were accurate, rapid and sensitive, and can be used for rapid screening of AFB_1 in Chinese herbal medicines such as Astragali Radix, Zingiberis Rhizoma Recens, Jujubae Fructus, and Nelumbinis Semen. In addition, the advantages and limitations of the two methods were compared and discussed, which can provide a reference for the testing institutions to choose the proper method.

miRNA-mediated regulation of auxin signaling pathway during plant development and stress responses

Auxin is one of the most important plant growth hormones, playing a crucial role in development as well as instress responses. Auxin biosynthesis and signaling pathway comprises a series of events including auxinperception by the receptor, activation, and function of auxin response factors and control by auxin repressors.All these factors are regulated by several different microRNAs during leaf, flower and fruit development,anther development, nodulation, lateral and adventitious root development, potato tuber development as wellas during heat stress, submergence, boron toxicity, aluminium stress responses, etc., as depicted in the availableliterature. In this review a thorough study on miRNA-mediated regulation of auxin biosynthesis and signalinghas been done in various plant species. The data gathered can be utilized to point out the particular miRNAmediated regulation module which can be utilized to modulate the expression of the miRNA and therebymodulation of the auxin pathway. Information in this review would be beneficial to utilize the miRNAexpression to generate the protocol for engineering plants with altered auxin signaling pathway to obtain betteryield and improved stress tolerance.

Bronchoscopic Analysis in Sputum Smear Negative Pulmonary Tuberculosis Patients A Hospital based Study

Introduction: India has the highest burden of TB cases inthe world, majority of them are pulmonary tuberculosis.The method of choice for diagnosis of PTB is microscopicexamination of AFB by sputum smear. However, 30 to 50%of patients with pulmonary tuberculosis can have negativesputum report or may not produce sputum. Flexible fibreopticbronchoscopy can provide excellent material for diagnosis forpatients with suspected sputum smear negative pulmonarytuberculosis. Study aimed to evaluate the role of fiberoptic bronchoscopy in sputum smear negative pulmonorytuberculosis.Material and methods: Forty suspected cases of pulmonaryTB with clinical and radiological evidence of tb and sputumsmear negative on 2 occasions were selected for thisprospective nonrandomised observational study. Detailedexamination of the bronchial tree was done and specimensincluding bronchial aspirate and lavage was collected andsend for investigations. Post bronchoscopy sputum (PBS) wasalso collected and sent for smear microscopy.Results: In our study of 40 patients, tuberculosis wasconfirmed in 13 (32.50%) by smear examination of AFB inBroncho alveolar fluid and by post bronchoscopy sputumsmear examination in 3/40 (7.5%) cases. A definitive diagnosisof tuberculosis was possible in 23 (57.5%) of the 40 patientsby AFB culture by BACTEC MGIT960.Conclusion: Fibreoptic bronchoscopy with post bronchoscopysputum,BAL and BAL AFB culture is a useful tool fordiagnosis and can thereby prompt treatment of sputum smearnegative pulmonary tuberculosis patients.

Features and Outcome of Hepatobiliary Tuberculosis among Filipino Children: Report of a Six-year Experience

Background@#The features and outcome of hepatobiliary tuberculosis (HBTB) have not been extensively reported in children.@*Objective@#To describe the clinical, biochemical, radiologic, microbiologic and histologic features and outcome of children diagnosed with HBTB. @*Methods@#Data of HBTB patients aged 0-18 years were collected by review of medical records and as they were admitted. Cases were classified as bacteriologically-confirmed (positive AFB smear, TB culture or PCR of bile/liver tissue) or clinically-diagnosed (clinical, histologic and/or radiologic evidence). @*Results@#A total of 36 patients were included (mean age: 13yrs; 64% males): three bacteriologically-confirmed and 33 clinically-diagnosed. Most common signs/symptoms were weight loss (69%), fever (67%), hepatomegaly (61%) and jaundice (53%). Of the total, 68% had hypoalbuminemia, 50% increased transaminases and 47% prolonged prothrombin time. Fifteen (42%) patients were AFB positive on various microbiologic specimens. Most common imaging finding was hepatic calcification (64%). Of 11 patients with liver biopsy, seven (64%) had chronic/ granulomatous inflammation. All 36 were managed medically. Eight were lost to follow up, six died, and 22 (61%) are alive, nine with complete resolution of liver disease. @*Conclusion@#Hepatobiliary tuberculosis presents with non-specific clinical and biochemical findings. Several investigations are necessary to confirm the diagnosis. Overall response to anti-TB treatment is satisfactory with possible resolution of liver disease.

Investigation of aflatoxins and toxigenic fungi contamination during post-harvest processing of Polygalae Radix / 中草药

Objective: To investigate aflatoxins contamination B1, B2, G1, G2 (AFB1, ATB2, AFG1, AFG2), toxigenic fungi species and potential contamination sources of Polygalae Radix during post-harvest processing, and analyze the main ways of aflatoxins contamination. Methods: Twenty-one Polygalae Radix samples were collected from multiple steps during the post-harvest processing in this study. Aflatoxin levels in these samples were determined by immunoaffinity column and HPLC coupled with post-column photochemical derivatization. Dilution-plate method was applied for the fungi isolation followed by strain identification based on morphological characterization and molecular approaches. Results: Aflatoxins were detected in 15 samples, but none of them exceeded the limit set by Chinese Pharmacopoeia. The fungal counts increased significantly from newly harvested samples to post-sweating, and the counts further increased to the maximum (2 × 108 CFU/g) after xylem-removing, then decreased after drying. In contrast, fungal counts of samples dried directly after harvesting did not change much throughout the processing. There was a significant positive correlation between fungal counts and water activity (Aw). A total of 209 fungal belonged to five genera were identified from the samples, and Penicillium was the predominant genus. Cladosporium and Fusarium were increased after sweating, and then Aspergillus increased after xylem-removing and drying. One A. parasiticus strain was confirmed to be able to produce AFB1, AFB2, AFG1, and AFG2. Conclusion: Aflatoxins contamination happened in both field production and post-harvest processing of Polygalae Radix. Especially, the contamination of Penicillium spp. should be paid more attention.

The incidence detection of tuberculosis in patients with infertility and abnormal uterine bleed: a study in North Indian population

Background: Tuberculosis (TB) remains a major global health problem, responsible for ill health among millions of people each year. TB ranks as the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV). The latest estimates included in this report are that there were 9.0 million new TB cases in 2013 and 1.5 million TB deaths (1.1 million among HIV-negative people and 0.4 million among HIV-positive people). In India the incidence of genital tuberculosis is nearly about 18%. And in female genital tract it is estimated that 18% in India suffer from genital TB.Methods: The study was carried-out during November 2014 to March 2016 at Maharishi Markandeshwar deemed to be University, MMIMSR Mullana (Ambala).  A total of 100 females of reproductive age attending the Gynaecology Outpatient were finally recruited on the basis of inclusion and exclusion criteria.Results: In our study majority i.e. 39 (39.0%) patient were found in the group of 20-29 years of age followed by 38 (38.0%) patients in the group of 30-39 years of age. Only 23 (23.0%) were found in the group of 40-49 years of age. In our study majority i.e. 54 (54.0%) patients were from Haryana followed by 44 (44.0%) patients were from Uttar Pradesh and only 2 (2.0%) patients were from Punjab. Out of 100 patients majority i.e. 76 (76.0%) patients had negative TB with either of investigation and only 24 (24.0%) patients had positive TB with either of investigation.Conclusions: Female genital tuberculosis affects the females of reproductive age group. The disease manifests itself as pelvic inflammatory disease in its acute form with menstrual irregularities and later infertility, and is almost always secondary to a primary lesion elsewhere.

Prevalence of female genital tract tuberculosis in suspected cases attending Gynecology OPD at tertiary centre by various diagnostic methods and comparative analysis

Background: The genital tract tuberculosis is one of the most common causes of tubal factor infertility. This study was conducted to compare the results of different diagnostic methods used in screening for female genital tuberculosis in suspected cases attending Gynecology OPD at RMC, Ajmer.Methods: This prospective study was conducted in department of obstetrics and gynecology, J. L. N. Medical College, Ajmer, Rajasthan, for studying incidence of genital tuberculosis by various diagnostic methods (viz. AFB smear examination, AFB Lowenstein Jensen culture method, TB-PCR and CBNAAT).Results: Prevalence of genital TB was 5.5% in study population of 200 selected women meting the inclusion criteria. 72% women were in between 20-30 years age group. Oligomenorrhoea (24%) was found to be significant symptom with P value of <0.05. TBPCR and CBNAAT were found to be statistically significant with P value of <0.001 for diagnosing FGTTB.Conclusions: We concluded that genital tuberculosis is paucibacillary disease, TBPCR and CBNAAT appears to be rapid and sensitive diagnostic modality.

Aflatoxins and fumonisins in feed from a broiler operation system from São Paulo state, Brazil / Aflatoxinas e fumonisinas em rações de um sistema de produção de frangos de corte no estado de São Paulo, Brasil

ABSTRACT: The aim of the present study was to assess the occurrence of aflatoxins (AFs) and fumonisins (FBs) in feed ingredients (corn and soybean meal) and finishing feed in a broiler operation system, as well was to evaluate their effect on the productivity of 20 batches of broilers produced and the histology status of broilers' liver after slaughter. Corn samples presented the highest frequencies of AFs and FBs, at mean levels of 29.1 and 2,100µg/kg, respectively. Soybean samples presented mean levels of 1.5 and 70µg/kg for AFs and FBs, respectively. Batches of broilers receiving feed containing FB levels higher than 1,000µg/kg had lower weight gain and higher mortality rates, while those fed rations with AFs equal or above the limit of quantification (LOQ) of the analytical method presented higher scores of histological changes in the liver. A dilution effect was observed for AFs and FBs from ingredients, especially corn, to feed during manufacture, whilst not enough to prevent losses in productivity. Results of this trial highlighted the need for strict control of mycotoxins in corn intended for broilers.

RESUMO: O objetivo do presente trabalho foi verificar a ocorrência de aflatoxinas (AFs) e fumonisinas (FBs) em ingredientes (milho e farelo de soja) e na ração de abate sobre a produtividade de uma empresa integradora de frangos de corte, bem como avaliar seus efeitos sobre produtividade de 20 lotes de frangos produzidos pela empresa e a histologia dos fígados dos frangos após o abate. As amostras de milho apresentaram as maiores frequências de AFs e FBs, em concentrações médias de 29,1 e 2.100µg/kg, respectivamente. As amostras de farelo de soja apresentaram níveis médios de 1,5 e 70µg/kg para AFs e FBs, respectivamente. Os lotes de aves que receberam ração contendo níveis de FBs maiores que 1,000µg/kg apresentaram menor ganho de peso e maior percentual de mortalidade, enquanto que as que receberam ração com AFs iguais ou superiores ao limite de quantificação (LQ) do método analítico apresentaram maior grau de alteração histopatológica no fígado. Houve efeito de diluição de AFs e FBs dos ingredientes, especialmente o milho, à ração no processo de fabricação, porém não suficiente para evitar perdas na produtividade. Os resultados do estudo reforçam a necessidade do controle estrito de micotoxinas no milho destinado à alimentação de frangos de corte.

Prospective study of tubercular co-infection in HIV infected patients in VIMSAR, Burla, Sambalpur, Odisha, India

Background: Puerperium is of 6 weeks after delivery, when body reverts back to its original non pregnant state. This period holds its own set of medical issues with frequent occurrence of gynaecological complaints like hematoma, bleeding, painful discharge and many medical issues like pyrexia, mastalgia, coagulation disorders and depression. The management of all these problems is further complicated by consideration of lactation which prohibits use of many drugs. There are many studies available in international communities that analysed women in puerperium but the data from Indian subpopulation where most deliveries are conducted in government funded institutes is lacking. The current study was an observational single center study carried out at gynaecology department along with medicine and surgery department of a tertiary care hospital associated with a medical teaching institute for defining the epidemiological parameters of the puerperal maladies.Methods: 150 randomly selected pregnant subjects with otherwise uncomplicated pregnancies, both booked at our institute or referred at the time of delivery between January to July 2016 were included in the study. Both normal vaginal or assisted deliveries were considered irrespective of booking status. Patient not willing for consent, and patients reporting beyond 2 weeks of delivery were excluded. All patients were observed while in hospital and weekly thereafter till 6th week and detailed gynaecological, medical and psychiatric evaluation was carried out by a multidisciplinary team. Detailed evaluation of cause was carried out in all cases of pyrexia, pain or other objective symptoms and analysis of depression was done. All data were collected and analysed by spss 22.0 at the end of 6 weeks.Results: Of the 150 patients studied, 40% had caesarean delivery while 60% had normal vaginal delivery with or without episiotomy. The most common complications noted during puerperium were wound discharge (10.67%), perineal pain (10%), fever (15%) and Mastalgia & Mastitis (13%). Depression was diagnosed in 6% of the studied cases. Cause of fever was mastitis/breast abscess in 30%, Urinary tract infection in 24%, Malaria in 7% and puerperal sepsis in 12% cases, in rest of the cases the cause of fever could not be found. The puerperal complication rate was more in LSCS 22.95% as compared with vaginal deliveries 14.6%.Conclusions: Puerperium remains an important aspect of pregnancy where the nature of complications differs totally from those seen during antenatal period. Our study suggests that most important complications in puerperium are purulent discharge, perineal pain and pyrexia. Depression is a frequent occurrence in post-partum period and its early identification can benefit both maternal and child health. Fever in puerperium is fairly common Perineal infection, Breast infection, Urinary tract infection and Malaria being common causes. A vigilant multidisciplinary approach is required to optimally manage all these complications.

Variations in Plasma IL-2 and IL-10 in Relationship with Plasmodium Parasite Density

Study Background: Plasma IL-2 and IL-10 are cytokines for immuno regulation and immuno modulation in infectious diseases. IL10 inhibit synthesis of IFN gamma, IL-2, IL-3, TNF. Plasmodium infection is associated with reproduction of cytokines for innate and acquired immunity. Aim and Objective: This work was designed to determine variations in plasma IL-2 and IL-10 in relationship with plasmodium parasite density. Materials and Methods: Out of one hundred and sixteen (116) initially recruited only fifty Plasmodium infected female and male (female =25; male =25) aged 4-70 years free of M. tuberculosis and seronegative to HBsAg, HCV and HIV were recruited for the work.. Fifty age matched Plasmodium non-infected subjects were studied as control (female =25; male =25). Only subjects who were free of M. tuberculosis and seronegative to HIV, HCV, HBsAg test and AFB negative were recruited for the work. Plasma IL-2, IL-10, HIV, HBsAg and HCV were determined in the patients and the control subject immunochemically by ELISA while Identification of Plasmodium spp was determined in the blood of the patients and the control subject using WHO standard technique for the laboratory diagnosis of plasmodium infection in malaria endemic area. Results: A frequency of : 12.0%(14) Anti-HCV seropositive, 6.9%(8) Anti-HIV seropositive, 19.8%(23) HBsAg seropositive, 13.8% (16) AFB positive patients and 4.3%(5) indeterminate results was obtained from the 116 Plasmodium infected patients initially recruited. There was a significantly Higher plasma value of IL-10 in plasmodium infected patients with parasite density of 500-999 and ≥1000 than the control subjects with p<0.05. There was also a significantly lower mean plasma value of IL-10 in plasmodium infected patients with parasite density of 50-499 than those patients with parasite density 500-999 and ≥1000 with p<0.05. Conclusion: Plasmodium parasitemia and increase in parasite density has been found to significantly increase the plasma value of IL-10 with no significant change in the plasma value of IL-2. There was also an evidence of HIV, HCV, HBV and M. tuberculosis co-infection with Plasmodium spp .

To Compare the Competency of Prognostic Markers- ESR, CRP against ZN Staining in Determining Pulmonary Tuberculosis Cases

Background: Tuberculosis (TB) is a highly prevalent chronic infectious disease caused by Mycobacterium tuberculosis an aerobic intracellular binding bacterium (bacillus). Active TB disease can be fatal if left untreated. The disease today is considered curable and preventable. This retrospective study was undertaken to compare and analyzed the relationship between acute phase reactant proteins CRP (quantitative) and ESR in sputum smear positive for AFB patients and to evaluate their diagnostic and prognostic significance. Methods: The present prospective study was carried on a randomly selected study group comprising of 180 cases of pulmonary TB patients who were sputum smear positive for AFB and 25 normal healthy (sputum smear negative for AFB) individual were taken as control. The cases of  PTB group was further categorized on the basis of recommendation of RNTCP grading system of AFB in Sputum ZN staining into four subgroups AFB – 3+, AFB – 2+, AFB –1+ and scanty. The control groups were negative for the Acid Fast bacilli in sputum. Results: In our study showed that the maximum patients seen in grade III (36.11%) followed by grade II (31.66%), grade I (19.44%) and 12.77% scanty according to RNTCP grading system of ZN staining of sputum for acid fast bacilli.  The   distribution of mean values of CRP, ESR in different grades of ZN staining of sputum in AFB positive patients as well as controls. CRP mean value was 55.4, 40.8 & 22.9 in grade III, grade II & grade I respectively and ESR was 48.1, 38.8 & 23 respectively in different grading significantly higher (p vol < 0.0001) in group II there were no serious adverse reactions in either group. Conclusions: Our study concluded that during the compression of values of CRP and ESR along with the grading of sputum AFB positive patients, the CRP raised more significantly as compare to ESR; with markedly raised values in all the grades of sputum AFB positive patients.

Clinical profile of childhood Tuberculosis in a Tertiary Care Rural Hospital and comparision of efficacy of daily vs intermittent chemotherapy

Introduction: Tuberculosis (TB) remains a major public health problem, despite noteworthy socioeconomic development and advances in medical science. It is a curable disease but still millions of people suffer every year and a number of them die from this infectious disease, resulting in devastating social and economic impact. We report the disease course, clinical profile and factors associated with treatment outcome in a tertiary facility of Waghodia. Materials and methods: The study was carried out in the Department of Pediatrics at Dhiraj Hospital, Piparia. Recruitment took place from February 2014 to February 2015. The clinical profile of 71 patients was studied and patients were followed up to 6 months to evaluate the treatment outcome. Results: There was preponderance of males (60.56%, n=43) in study population as compared to females (39.44%, n=28). Most of the patients were belonging to age group of <6 years (32.4%, n=23) and >10 years (38.0%, n=27). Among 6 to 10 years, 21 (29.6%) patients were included in study. Most common form of TB was extra-pulmonary TB (60.56%, n=43) followed by pulmonary TB (39.43%, n=28). Non-specific symptoms like fever (82.5%, n=66) was the commonest presenting symptoms. Other symptoms included cough (33.8%, n=24), altered sensorium (19.71%, n=14), swelling (15.5%, n=11). From all the patient with follow up (n=50), 44 (88.0%) were cured. Conclusion: Diagnosis of paediatric tuberculosis still continues to be a challenge. In the study TB was more common in extra-pulmonary than pulmonary forms in our setting. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations. Aashish Sethi, Prasad Muley. Clinical profile of childhood Tuberculosis in a Tertiary Care Rural Hospital and comparison of efficacy of daily vs. intermittent chemotherapy. IAIM, 2018; 5(5): 69-78. Page 70 Presence of paediatric TB is an indication of prevalence of TB in that community. Extra pulmonary tuberculosis is more common in pediatric population and comparison of daily vs. intermittent treatment shows similar efficacy

Yield of AFB by direct sputum smear examination with bronchial washings and post bronchoscopy sputum smear examination

Background and objectives: The objective of the present study is to evaluate the yield of AFB by direct sputum smear examination with Bronchial Washings and Post Bronchoscopy sputum smear examination. Materials and methods: This prospective study was conducted on 100 patients with suspected pulmonary TB October 2015 – September 2017 at S.V.S Medical College, Mahabubnagar. Results: Out of 100 clinically suspected, sputum smear negative cases, 38 cases were diagnosed as active pulmonary tuberculosis. Bronchial washings for AFB smear was positive in 32/100 (32%) of cases and post bronchoscopic sputum smear was positive in 16/100 (16%) of cases. Both bronchial washings and post bronchoscopic sputum smear for AFB was positive in 10 (10%) of cases. 4/16 additional cases are diagnosed by post bronchoscopic sputum smear over the bronchial washings. Total yield of bronchoscopy in the diagnosis of sputum negative Pulmonary Tuberculosis was A.N.V. Koteshwar Rao, L. Bhaskar, K. Vamshi, Pradyut Waghray. Yield of AFB by direct sputum smear examination with bronchial washings and post bronchoscopy sputum smear examination. IAIM, 2017; 4(11): 113-116. Page 114 38.00% of which bronchial washing smear samples are superior in the diagnosis and is contributed to 32% . Conclusion: It has shown that additional yield of 38% more than direct sputum smear examination, which helps to initiate early treatment of tuberculosis.

Clinical Profile of Childhood Tuberculosis in a Tertiary Care Rural Hospital

Introduction: Tuberculosis (TB) remains a major public health problem, despite noteworthy socioeconomic development and advances in medical science. It is a curable disease but still millions of people suffer every year and a number of them die from this infectious disease, resulting in devastating social and economic impact. TB treatment requires several months of swallowing a combination of 3 to 4 drugs every day. Patients often forget to take their medicines or stop taking them when they start to feel better. The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy was launched. Studies of paediatric TB are scantily available both in global and national context. Reliable data on the treatment of paediatric TB and its follow up are not available. Hence, a study of paediatric TB is designed to evaluate the clinical profile of childhood tuberculosis and following up the treatment outcome upto 6 months Materials and methods: The study was carried out in the Department of Pediatrics at Dhiraj Hospital, Piparia. Recruitment took place from February 2014 to February 2015. The clinical profile of 71 patients was studied. Results: There was preponderance of males (60.56%, n=43) in study population as compared to females (39.44%, n=28). Most of the patients were belonging to age group of <6 years (32.4%, n=23) and >10 years (38.0%, n=27). Among 6 to 10 years, 21 (29.6%) patients were included in study. Most common form of TB was extra-pulmonary TB (60.56%, n=43) followed by pulmonary TB (39.43%, n=28). Non-specific symptoms like fever (82.5%, n=66) was the commonest presenting symptoms. Other symptoms included cough (33.8%, n=24), altered sensorium (19.71%, n=14), swelling (15.5%, Muley P, Odedara T, Memon R, Sethi A, Gandhi D. Clinical Profile of Childhood Tuberculosis in a Tertiary Care Rural Hospital. IAIM, 2017; 4(6): 109-124. Page 110 n=11). From all, the patient with follow up (n=50), 44 (88.0%) were cured, 3 (6.0%) patients expired during the course of treatment, 3(6.0%) patient showed no improvement. Conclusion: Diagnosis of paediatric tuberculosis still continues to be a challenge. In the study TB was more common in extra-pulmonary than pulmonary forms in our setting. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations. Presence of paediatric TB is an indication of prevalence of TB in that community. As the source of transmission of TB to children is usually an adult, control of tuberculosis in adult is necessary to decrease the prevalence of TB in children. DOTS is an effective strategy for treatment of TB.

Interpretation of Mantoux test in children

Tuberculosis is the most common infectious cause of death worldwide. Young children especially infants usually are more susceptible to tuberculous infection. Disease usually develops within 1 year of infection. The present study has been conducted upon 41 children in whom Mantoux test was positive (n=41). These children were coming to our outpatient department, in a Teaching Hospital, Nizamabad, Telangana State with mild fever, cough, night sweats, anorexia, and loss of weight. The age group selected for this study was 1 to 12 year, and the period of study was from August, 2013 to December, 2015. Among the 41 children under study 13 children were 1 to 4 year and 28 were 5 to 12 year. Among the total 41 cases of Mantoux positive, 16 (39%) were found to be suffering from tuberculous disease and anti tuberculous drugs were started. In these cases 7 were 1 to 4 year (n=13), and 9 were 5 to 12 year (n=28). After 3 months follow up, all the children who were on ATT became free from their symptoms. It shows association between mantoux positivity and tuberculosis is more in children between 1 and 4 year than children between the age of 5 and 12 year. Most of the other children needed antipyretics, other symptomatic drugs and antibiotics only. But in 3 cases symptoms were not relieved either with antibiotics or with trial ATT. The factors for deciding tuberculosis are history of contact, clinical picture, CBP, ESR, chest- x- ray, Mantoux test, sputum for AFB, antibiotic trial, follow up, trial ATT. All these factors are put together and then only we will decide whether to start ATT or not.

In vitro ability of beer fermentation residue and yeast-based products to bind aflatoxin B1

This study aimed to verify the in vitro ability of beer fermentation residue (BFR) containing Saccharomyces cerevisiae cells and five commercial products that differed in the viability and integrity of S. cerevisiae cells to remove aflatoxin B1 (AFB1) from a citrate-phosphate buffer solution (CPBS). BFR was collected at a microbrewery and prepared by drying and milling. The commercial yeast-based products were as follows: inactive intact yeast cells from beer alcoholic fermentation, inactive intact yeast cells from sugarcane alcoholic fermentation, hydrolyzed yeast cells, yeast cell walls and active yeast cells. Adsorption assays were performed in CPBS spiked with 1.0 μg AFB1/mL at pH 3.0 and 6.0 for a contact time of 60 min at room temperature. Analysis of AFB1 in the samples was performed by high performance liquid chromatography. AFB1 adsorption by the products ranged from 45.5% to 69.4% at pH 3.0 and from 24.0% to 63.8% at pH 6.0. The higher percentages (p < 0.05) of AFB1 binding at both pH values were achieved with products containing hydrolyzed yeast cells or yeast cell walls rather than intact cells. The AFB1 binding percentages of BFR were 55.0 ± 5.0% at pH 3.0 and 49.2 ± 4.5% at pH 6.0, which was not significantly different (p > 0.05) from commercial products containing inactive intact yeast cells. The results of this trial indicate that the yeast-based products tested, especially the BFR, have potential applications in animal feeds as a suitable biological method for reducing the adverse effects of aflatoxins.

Efficacy of Fluorescence Microscopy in the Diagnosis of Tuberculosis in Guyana.

Background: Tuberculosis is one of the potentially serious human diseases and is still one of the major causes of mortality. It ranks as the second most leading cause of death from a single infectious agent, after the human immunodeficiency virus (HIV). Objective: The aim of the study was to evaluate the efficacy of Fluorescence microscopy (FM) technique to determine sensitivity in detecting TB between HIV positive and HIV negative patients in a poor resource country. Methods: The study was a cross sectional and blind assessment on 50 suspected cases of TB among HIV positive and HIV negative patients using FM method against Zeihl Neelsen (ZN) staining method. Culture results were considered as gold standard. Results: Of the total 50 specimens examined by ZN, FM and culture method 32%, 40% and 38% were found positive by ZN, FM and culture respectively. FM was sensitive to ZN on several aspects. The difference in their case detection rates were statistically significant (2 = 35.3, p<0.001). In detecting overall patients for TB, FM method showed sensitivity of 90.0% (95% CI 68.3-98.5) over ZN method 75.0% (95% CI 50.9-91.3) with a kappa value of 0.83 (p≤0.05). FM method showed excellent sensitivity, sensitivity, PPV and NPV all with 100% (95% CI 48.0-100) among HIV-TB patients and an excellent kappa value of 1 (p≤0.05) Conclusion: This study presented greater sensitivity of FM method over conventional ZN staining method in detecting TB among HIV positive patients. Fluorescence microscopy can be widely used even in peripheral laboratories where culture facilities are not available.

Factors Affecting Discordance between Sputum Smear and Culture Conversion Rates In Newly Diagnosed Pulmonary Tuberculosis: A Retrospective Study in Developing Country.

Aims: To assess the performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs among newly diagnosed smear positive pulmonary TB patients. Study Design: This study was conducted prospectively among newly diagnosed smear positive pulmonary TB patients. Place and Duration of Study: Queen Savang Vadhana Memorial Hospital and Chonburi Regional Hospital, Chonburi province, Thailand during April 2010 and July 2012. Methodology: Sputum AFB smear, culture and drug susceptibility test were performed at the time of diagnosis, the second and the fifth month of treatment. Baseline characteristic, clinical and laboratory parameters, treatment regimens and adverse events were recorded. Descriptive statistics and multiple logistic regression analysis were applied as appropriate. The performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs was done using culture as the gold standard. Results: Of 297 eligible pulmonary TB cases, majorities were male (72.4%) with median age of 39 years, illiterate to low educated (52.6%) and earning low income (77.5%). Cough was the most common symptom (91.2%) and cavity was present in 31.1%. At the second month, 17.0% of patients had discordance between sputum AFB smear and culture. High bacilli load (adjusted OR=2.38, CI=1.09-5.18), and hearing alteration (adjusted OR=10.98, CI=1.79-67.28) were significant predictors. Hypoalbuminemia was significantly more severe in patients with false positive AFB smear (P=.04). Sensitivity and specificity for AFB smear were 44.7% and 89.6% at the second month and 57.1% and 97.5% at the fifth month, respectively. MDR-TB was diagnosed in 1.0% and success rate was 77.1%. Conclusions: Baseline AFB smear ≥ 2+ and hypoalbuminemia as well as adverse events during intensive phase are strongly recommended as the criteria to prioritize culture and DST for new smear positive pulmonary TB patients with positive AFB smear at the second and the third month of treatment in developing countries.