Mycobacterium bovis induced human tuberculosis in India: Current status, challenges & opportunities

Tuberculosis (TB) caused by Mycobacterium tuberculosis is a leading cause of human deaths due to any infectious disease worldwide. However, infection of Mycobacterium bovis, primarily an animal pathogen, also leads to the development of ‘human tuberculosis’. Infected animals have been considered the major source of M. bovis infection and humans get exposed to M. bovis through close contact with infected animals or consumption of contaminated milk, unpasteurized dairy products and improperly cooked contaminated meat. The information on the global distribution of bovine TB (bTB) is limited, but the disease has been reported from all the livestock-producing middle- and low-income countries of the world. In recent years, there is a renewed interest for the control of bTB to minimize human infection worldwide. In India, while the sporadic presence of M. bovis has been reported in domestic animals, animal-derived food products and human beings from different geographical regions of the country, the information on the national prevalence of bTB and transmission dynamics of zoonotic TB is, however, not available. The present article reviewed published information on the status of M. bovis-induced zoonotic TB to highlight the key challenges and opportunities for intervention to minimize the risk of M. bovis infection in humans and secure optimum animal productivity in India.

Lateral arthroplasty along with buccal fat pad inter-positioning in the management of Sawhney type III temporomandibular joint ankylosis

OBJECTIVES@#The objective of this study was to highlight the role of lateral arthroplasty along with interposition of the buccal fat pad (BFP) in the management of Sawhney type III temporomandibular joint (TMJ) ankylosis.@*MATERIALS AND METHODS@#Ten patients with TMJ ankylosis (7 unilateral and 3 bilateral, total of 13 joints) were treated with lateral arthroplasty and BFP interposition. The bony bridge of the ankylotic mass on the lateral aspect was resected, leaving a distance of 1.5 to 2.0 cm from the base of the skull to the neck of the condyle. The condyle was left intact. Coronoidectomy was performed on the ipsilateral side via the same approach in all cases. The inter-incisal opening was measured at that time, and if it was less than 35 mm, contralateral coronoidectomy was performed by using the intra-oral approach. After satisfactory inter-incisal mouth opening (≥35 mm) was achieved, the TMJ surgical site was revisited, and BFP was retrieved and used to cover the lateral aspect of the medially placed condyle.@*RESULTS@#With lateral arthroplasty, the medially displaced condyle can be left in-situ to maintain the mandibular ramal height and function and to act as a growth center in children. Interposition of the BFP prevents reformation of the lateral bony bridge that was removed.@*CONCLUSION@#Lateral arthroplasty along with interpositioning of the BFP is a novel technique for managing Sawhney type III ankylosis that achieves management goals while avoiding complex and advanced reconstructive surgical procedures.

Lateral arthroplasty along with buccal fat pad inter-positioning in the management of Sawhney type III temporomandibular joint ankylosis

OBJECTIVES: The objective of this study was to highlight the role of lateral arthroplasty along with interposition of the buccal fat pad (BFP) in the management of Sawhney type III temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: Ten patients with TMJ ankylosis (7 unilateral and 3 bilateral, total of 13 joints) were treated with lateral arthroplasty and BFP interposition. The bony bridge of the ankylotic mass on the lateral aspect was resected, leaving a distance of 1.5 to 2.0 cm from the base of the skull to the neck of the condyle. The condyle was left intact. Coronoidectomy was performed on the ipsilateral side via the same approach in all cases. The inter-incisal opening was measured at that time, and if it was less than 35 mm, contralateral coronoidectomy was performed by using the intra-oral approach. After satisfactory inter-incisal mouth opening (≥35 mm) was achieved, the TMJ surgical site was revisited, and BFP was retrieved and used to cover the lateral aspect of the medially placed condyle. RESULTS: With lateral arthroplasty, the medially displaced condyle can be left in-situ to maintain the mandibular ramal height and function and to act as a growth center in children. Interposition of the BFP prevents reformation of the lateral bony bridge that was removed. CONCLUSION: Lateral arthroplasty along with interpositioning of the BFP is a novel technique for managing Sawhney type III ankylosis that achieves management goals while avoiding complex and advanced reconstructive surgical procedures.

A Comparative Study Of Propofol-Ketamine And Propofol-Fentanyl For Total Intravenous Anaesthesia For Short Surgical Cases In Paediatric Patients

Aims and objective :To compare combinations of Propofol-Ketamine and Propofol-Fentanyl for total intravenous anesthesia in short surgical cases in pediatric patients. The study also compared recovery characteristics and the incidence of side effects / complications in the groups. Methodology: The patients were randomly divided into two groups depending upon the drug combination used for Total Intravenous Anaesthesia. Group I : 30 patients were given i.v. Ketamine followed by Propofol. Group II: 30 patients were given i.v. Fentanyl followed by Propofol Recovery characteristics were compared and the incidence of side effects and complications in two groups were noted. Results: The pulse rate and blood pressure remained near to preinduction value in group I, while in group II these values decreased. After induction RR increased in group I but decreased in group II at 1,3%5 min after induction.None of the patients in both groups were observed to have nausea, vomiting and respiratory depression. . A significant no. of the patients in group II were observed to have either pain on injection site or restlessness. Conclusion: Propofol-Ketamine and Propofol-Fentanyl combinations provide satisfactory surgical conditions for minor surgical procedures in paediatric patients, but the Propofol-Ketamine combination gives better hemodynamic stability and less restlessness during induction and maintenance of anaesthesia.

Whole cell & culture filtrate proteins from prevalent genotypes of Mycobacterium tuberculosis provoke better antibody & T cell response than laboratory strain H37Rv.

Background & objectives: The immune responses to different antigens of Mycobacterium tuberculosis H37Rv vary from patient to patient with tuberculosis (TB). Therefore, significant difference might be documented between the H37Rv with long histories of passages and recent clinical isolates of M. tuberculosis. In the present study, immune response of TB patients and healthy controls against 39 clinical M. tuberculosis isolates was correlated with laboratory strain H37Rv. Methods: The antibody response was studied coating whole cell extracts and culture filtrate proteins of M. tuberculosis isolates and laboratory strain H37Rv by enzyme linked immunosorbent assay (ELISA). Lymphoproliferation was studied by incorporation of tritiated thymidine and cytokines (IFN-γ and IL-4) by using commercially available kits. Results: Sero-reactivity to whole cell extract (WCE) of 11 clinical isolates was higher with pooled serum and individual's serum from tuberculosis patients showed significant reactivity (P<0.05) to ten of these isolates using ELISA. Of the WCE of 39 clinical isolates, 10 were found to be potent inducer of lymphoproliferation as well as cytokine secretion (P<0.05) in peripheral blood mononuclear cells from PPD+ healthy controls. Six culture filtrate proteins (CFPs) from these selected clinical isolates were also better inducers of antibody and T-cell response. Interpretation & conclusion: Overall, our results revealed that the clinical isolates belonging to prevalent genotypes; CAS1_Del (ST-26), East African-Indian (ST-11) and Beijing family (ST-1) induced better antibody and T cell responses compared to H37Rv laboratory strain. Further studies need to be done to purify and identify the dominant protein (s) using whole cell extract and culture filtrates from these immunologically relevant clinical M. tuberculosis isolates, which will be worthwhile to find out pathogenic factors, potential diagnostic markers and protective molecules for tuberculosis.

Polymerase chain reaction confirmed Mycoplasma pneumoniae arthritis: a case report.

We report here a case of polyarthritis caused by Mycoplasma pneumoniae in a 30 years old male who initially triggered suspicion of tuberculosis. Synovial fluid subjected to AFB smear, culture and PCR for Mycobacterium tuberculosis along with culture for aerobic and anaerobic bacteria by standard methods were negative. Synovial fluid was found to be positive by PCR for M. pneumoniae amplifying 543 bp fragment of P1 gene, however it could not be grown in culture. Specific IgG immunoglobulins to M. pneumoniae were also detected in synovial fluid as well as serum by ELISA which were further confirmed by IgG immunoblotting showing response to M. pneumoniae proteins specially immunodominant protein P1. The finding that both M. pneumoniae DNA and specific antibodies to M. pneumoniae are present in synovial fluid of the patient suggests that M. pneumoniae play an important role in arthritis. To the best of our knowledge, this is the first PCR confirmed M. pneumoniae infection in synovial fluid from a case of polyarthritis.