Initial drug resistance pattern among Pulmonary Tuberculosis patients.

Background: Drug resistant tuberculosis (DRTB) is an emerging problem that adversely affects treatment outcomes and public health in the developing world. Objective: To determine the initial drug resistance pattern among pulmonary tuberculosis patients registered under the Revised National Tuberculosis Control Programme. Study Design: A cross-sectional study design. Setting: Two urban Directly Observed Treatment Supervised (DOTS) centres in Lucknow District of Uttar Pradesh. Methods: The present study consisted of newly diagnosed sputum smear-positive for acid-fast bacilli (AFB) cases at the time of registration under the tuberculosis control programme. All sputum smear positive cases were subjected to culture and drug-susceptibility testing by 1% proportion method on Lowenstein-Jensen (LJ) medium. Results: A total of 185 newly diagnosed sputum smear positive for AFB in pulmonary tuberculosis patients were subjected to culture and drug sensitivity test. Among 185 isolates, 170 (91.4%) isolates were culture positive. Of these 170 isolates, 169 (99.4%) were M. tuberculosis and one (0.5%) was Mycobacterium other than tuberculosis (MOTT). Out of 99.4% M. tuberculosis positive isolates, 21.3% were resistant to at least one drug. Resistance pattern of 21.3% strains of M. tuberculosis showing resistance to single, double, triple, and quadruple drugs were 5.9%, 10.7%, 2.4% and 2.4% respectively. Multi-drug resistance (MDR) was observed in 4.7% isolates. Conclusion: The present study highlights the high rate of drug resistance pattern among the new sputum smear positive pulmonary tuberculosis patients and also high MDR tuberculosis. Routine surveillance of drug resistance profile of patients provides useful information for adopting new strategies of effective treatment within National Tuberculosis Control Programmes in order to combat the threat of MDR-TB in the general population.

Hepsin immunohistochemical expression in prostate cancer in relation to Gleason's grade and serum prostate specific antigen.

Background: Hepsin (HPN), a type II trans-membrane serine protease, has been reported to be one of the most up regulated genes in prostate cancer. The aim of the present study was to find out immuno-histochemistry based phenotypic expression of HPN in formalin fixed paraffin embedded sections of prostate cancer compared with that in benign prostatic hyperplasia, in a prospective clinical setting, to know the differential status of HPN expression in benign and malignant prostatic disease. Materials and Methods: Tissue biopsies of histologically proven cases of prostatic cancers (48), benign prostatic hyperplasia (42), benign prostatic hyperplasia with prostatic intraepithelial neoplasia (7) and 4 cases of benign prostatic hyperplasia with prostatitis, were subjected to immunohistochemical staining with HPN antibody by strepavidin biotin method. Results: Hepsin expression was 100% in prostate carcinoma, 11.9% (5/42) in benign prostatic hyperplasia, 57.14% (4/7) in benign prostatic hyperplasia with prostatic intraepithelial neoplasia (PIN), and none in benign prostatic hyperplasia with prostatitis. Hepsin staining showe higher expression in high grade tumor in comparison to low grade tumor. Conclusions: Positive immunohistochemical expression of hepsin in cent percent cases of prostate cancer cases is intriguing, underscoring the significance of hepsin gene expression in prostate cancer.

Lipid peroxidation and antioxidants in different stages of cervical cancer: Prognostic significance.

Background: Free radical Injury is associated with cancer, but how the extent of oxidative stress correlates with the FIGO (International Federation of Gynecology and Obstetrics) stage in Carcinoma Cervix (Ca Cx), and its significance as a prognostic marker, is not clear and needs an in-depth study. Aim: To correlate the blood levels of Lipid Peroxidation (LPO), Reduced Glutathione (GSH), Superoxide Dismutase (SOD), and Vitamin A and E levels with the clinical stage in Ca Cx. Settings and Design: This is a Prospective Case Control Study. Materials and Methods: LPO, SOD, reduced GSH were estimated by Bio Chemical Assays and Vitamins by High Performance Liquid Chromatography (HPLC). Statistical Analysis: The cases and controls were compared using One Way ANOVA and different stages over different time periods were individually compared by Repeated Measure Analysis of Variance. Results: The results indicated a statistically significant increase of LPO vis-a-vis the FIGO stage of Ca Cx and control, while the antioxidant status as depicted by GSH and SOD decreased. Vitamin A and E levels were significantly lower in cancer cases as compared to the control. Conclusion: Increased LPO and reduced antioxidant levels may be taken as associated predictive markers, thus suggesting that Ca Cx cases should get nutritive supplements to contain the blood LPO level and maintain a positive balance of antioxidants for a better outcome in terms of delayed recurrence and better Quality of Life (QOL).

Predictors of outcome in fulminant hepatic failure in children.

OBJECTIVE: To identify the predictors of outcome in fulminant hepatic failure (FHF) in children. STUDY DESIGN: Prospective cohort study. METHODS: 41 children with FHF were studied. Patient characteristics and findings on examination at the time of hospitalization were noted. Serum biochemistry and screening for hepatotropic viruses (A, B and C) were done in each patient. Patients were treated using a predefined protocol and followed up till death or discharge. Univariate and multivariate analysis was done to find the predictors of outcome. RESULTS: Hepatitis B was the commonest cause of FHF (11 children; 26.9%). Markers for hepatitis A and C viruses were present in one and two patients, respectively. Serology was negative in 27 children (65.9%), of whom two had history of ingestion of hepatotoxins (antitubercular drugs). The overall mortality was 61%. Irrespective of etiology, the following factors were associated with poor outcome on univariate analysis: presence of gastrointestinal (GI) hemorrhage, serum bilirubin more than 10 mg/dL, age 6 years or less, coma of grade 3 or more, presence of infection, prolongation of prothrombin time > 8 s over control, prothrombin concentration < 50%, hypoglycemia (blood glucose < 45 mg/dL), hyponatremia (serum sodium < 125 mEq/L) and hyperkalemia (serum potassium > 5.5 mEq/L). On multiple logistic regression analysis, presence of GI hemorrhage (p = 0.005), degree of coma (p = 0.02) and serum bilirubin level (p = 0.025) were identified as independent predictors of mortality.

Correlative study of histopathology and bacteriology in patients of tubercular lymphadenitis.

Histopathology as well as bacteriology of lymph node specimen are useful diagnostic tools for tuberculous lymphadenitis. In the present study, a total of 71 cases of lymphadenitis were selected for histopathological and bacteriological studies. Only 46 patients had caseating type and 4 had non-caseating type of tuberculous lymphadenitis while 21 patients revealed non-specific chronic lymphadenitis on histopathological examination. Only 6 lymph node smears were positive for acid fast bacilli (AFB), 19 cases were positive for mycobacterial culture growth. Thus, it is not necessary that the cases which are histopathologically positive will be positive for culture as well. Therefore, both bacteriology and histopathology are complimentary diagnostic tools for tuberculous lymphadenitis.

Renal failure in symptomatic perinatal asphyxia.

The study included seven term newborns developing acute renal failure due to symptomatic perinatal asphyxia in early neonatal period. Its diagnosis was based on clinical and biochemical indices. Urinary output, serum and urinary sodium, potassium and creatinine, and blood urea nitrogen were evaluated in all of them. All the patients had oliguria not responding to fluid challenge and/or diuretic therapy, high serum K, FeNa of greater than 2.5% and RFI of greater than 3 indicative of intrinsic renal disease. The condition was associated with a very high mortality.