Programmatic implications of a sub-national TB prevalence survey in India.

Subnational TB estimates are crucial for making informed decisions to tailor TB control activities to local TB epidemiology.A cross-sectional survey was conducted among 143,005 individuals in Tamil Nadu, India. Participants were screened for symptoms and underwent chest X-ray (CXR). Participants with symptoms of TB and/or abnormal CXR were tested for TB using Xpert, smear, and liquid culture.The prevalence of microbiologically confirmed pulmonary TB (MCPTB) was 212 (95% CI 184-239) per 100,000 population. The prevalence-to-notification ratio (P:N) in the state was 2.05 (95% CI 1.8-2.29). Low body mass index and diabetes together had a population attributable fraction of 54.15 (95% CI 45.68-61.97). Approximately 39% of the TB cases were asymptomatic and were identified only by CXR screening. In the general population, only 26.9% sought care at a health facility among those with symptoms suggestive of TB.The programme needs to prioritise screening with CXR to potentially detect cases earlier and curtail the transmission and upscale molecular tests in the selected population to increase the yield of case finding. Innovative health education strategies must be devised to address health-seeking behaviour..

Traffic coordination by reducing jamming attackers in VANET using probabilistic Manhattan Grid Topology for automobile applications.

In recent years Intelligent Transportation System (ITS) has been growing interest in the development of vehicular communication technology. The traffic in India shows considerable fluctuations owing to the static and dynamic characteristics of road vehicles in VANET (Vehicular Adhoc Network). These vehicles take up a convenient side lane position on the road, disregarding lane discipline. They utilize the opposing lane to overtake slower-moving vehicles, even when there are oncoming vehicles approaching. The primary objective of this study is to minimize injuries resulting from vehicle interactions in mixed traffic conditions on undivided roads. This is achieved through the implementation of the Modified Manhattan grid topology, which primarily serves to guide drivers in the correct path when navigating undivided roads. Furthermore, the Fuzzy C-Means algorithm (FCM) is applied to detect potential jamming attackers, while the Modified Fisheye State Routing (MFSR) Algorithm is employed to minimize the amount of information exchanged among vehicles. Subsequently, the Particle Swarm Optimization (PSO) algorithm is developed to enhance the accuracy of determining the coordinates of jamming attackers within individual clusters. The effectiveness of the outcomes is affirmed through the utilization of the Fuzzy C-Means algorithm, showcasing a notable 30% reduction in the number of attackers, along with the attainment of a 70% accuracy rate in this research endeavor.

Temporomandibular Joint Replacement Using Stock Alloplastic Graft in the Treatment of Ankylosis: A Case Report.

INTRODUCTION: This paper aims to assess the suitability and effectiveness of temporomandibular joint replacement (TMJR) devices to treat a case of re-ankylosis and association of tuberculosis (TB) with reduced mouth opening. Traditional protocols for the treatment of temporomandibular joint (TMJ) ankylosis have preferred autologous grafts for reconstruction. Usage of TMJR devices have been reserved for very specific conditions. CASE DESCRIPTION: We present a case of a patient previously treated for ankylosis using a sternoclavicular graft, who came with a chief complaint of progressive decrease in mouth opening. She also gave a history of pulmonary TB a year back. Investigations revealed no active TB. Images and clinical presentation were consistent with bilateral ankylosis. The treatment plan consisted of resection of ankylotic mass on the left side and removal of the failed graft and reconstruction with Biomet stock TMJR prosthesis on the left side. DISCUSSION: Stock device has proven to be reliable option in planned TMJR procedures. Osteoarticular TB should be ruled out in patients with a history and features of TB. CONCLUSION: Stock TMJR devices are an effective and viable option for the treatment of re-ankylosis. This ensures almost immediate possibility of physiotherapy and long-term results including maintenance of mouth opening and function. Osteoarticular TB can cause trismus and painful joints which may be misdiagnosed. Any patient with reduced mouth opening with a history of TB should be investigated for possible extrapulmonary TB.

Comprehensive characterization of raw and alkali (NaOH) treated natural fibers from Symphirema involucratum stem.

The present study investigated the effect of alkali treatment on the enhancement of Physico-chemical, tensile, thermal and surface properties of Symphirema involucratum stem fiber (SISF). The investigation of chemical constituents of optimally alkalized SISF revealed that ideal increment of cellulose content (68.69 wt%) and desired modification of other chemical components was accomplished through 60 min immersion period. An increase in the crystallinity index to 33.33% and small crystallite size to 3.21 nm was noted by X-ray diffraction analysis. Moreover, the treated fiber was found suitable for light-weight applications since physical analysis acknowledges that the density of the fiber augmented to 1424 kg/m3after surface treatment that reduces total weight percentage. The enhancements in tensile strength (471.2 ± 19.8 MPa), tensile modulus (5.82 ± 0.77 GPa) and thermal stability (371 °C) were noted that ensures the treated fiber has good mechanical and thermal properties required for composite preparation. These findings validated that the optimally surface-modified SISF is a suitable material for lightweight composite structures, for the time being.

A Modification of the Classical Dautrey's Procedure - A Case Report.

Rationale: The rationale was to establish a permanent surgical solution for nonreducing dislocations of the temporomandibular joint (TMJ). Patient Concerns: The patient presents with a long-standing history of chronic subluxation of the TMJ bilaterally, with the need to forcibly manipulate and reduce the dislocated jaw. Diagnosis: Chronic recurrent dislocation of the TMJ. Treatment: A modified Dautrey's procedure was performed on the right side, with the osteotomized segment being transferred medially and inferiorly. Outcome: After 5 years of follow-up, there was no incidence of recurrent dislocation. Take-away Lesson: This modification is a viable option in both unilateral and bilateral reducing and nonreducing dislocations.

A Novel Modification of the Sagittal Split Osteotomy as an Access Osteotomy.

Pathologies present in the central zone of the mandible are difficult to access, primarily because of the presence of the inferior alveolar nerve (IAN) and the need to remove a large corticocancellous component to reach the area of interest. Many times, this bony window is replaced as a free graft and there is complete resorption in the long term or even rejection of the graft causing a bony defect which can weaken the mandible. Furthermore, the damage to the IAN is profound. To try and avoid these comorbidities the traditional sagittal split osteotomy was modified to access a central osteoma impinging on the IAN and the successful removal of the same without any comorbidities such as paraesthesia or loss of bone structure. We believe that this modification can be used for other scenarios such as benign cysts and difficult presentations of impacted teeth.

Physicochemical properties of cookies enriched with xylooligosaccharides.

The growing commercial importance of xylooligosaccharides is based on their beneficial health properties, particularly their ability to stimulate the growth and activity of intestinal bacteria such as Bifidobacterium and Lactobacillus species. Xylooligosaccharides are less sweet, acid, and heat stable, with low recommended levels of intake compared to other oligosaccharides. In view of the consumer demand for foods with low sugar, low fat, and high fiber contents, they are suitable for incorporation into bakery products. In this study, we have developed wheat-based cookies incorporated with xylooligosaccharides at 5%, 10%, and 15% levels. The nutritive value and physicochemical properties of the cookies changed with xylooligosaccharides incorporation; both crude fiber and dietary fiber contents increased by 14% and 35%, respectively, in the enriched cookies. The moisture levels increased with increase in the percentage of xylooligosaccharides incorporated. Cookies with 5% xylooligosaccharides were found most acceptable, although the color was slightly darker compared to the control, while cookies with 10% and 15% xylooligosaccharides were softer and darker and therefore less acceptable. Enrichment with xylooligosaccharides at 5% provided a product stable for 21 days at room temperature (25 ± 2℃). The storage stability of cookies with higher levels of xylooligosaccharides was less than the 5% xylooligosaccharides cookies and control. The retention of the prebiotic xylooligosaccharides in the products was relatively high (74%).

Groundwater nitrate contamination and use of Cl/Br ratio for source appointment.

Source appointment for groundwater nitrate contamination is critical in prioritizing effective strategy for its mitigation. Here, we assessed the use of Cl/Br ratio and statistical correlation of hydro-chemical parameters to identify the nitrate source to the groundwater. A total of 228 samples from 19 domestic wells distributed throughout the study area were collected during June 2011-May 2012 and analyzed for various physicochemical parameters. Study area was divided into three spatial zones based on demographic features, viz., northern, southern, and central part. Nitrate concentration in 57 % of samples exceeded the prescribed safe limit for drinking stipulated by the World Health Organization (WHO) and Bureau of Indian standards (BIS). The central part of the study area showed elevated nitrate concentration ranging from below detection limit (BDL) to 263.5 mg/l as NO3 (-) and demonstrated high attenuation within the immediate vicinity thereby restricting diffusion of the nitrate to the adjacent parts. Resolution of correlation matrix as statistical indicator for nitrate contamination was poor. Seventy-seven percent of samples with high nitrate concentration (>45 mg/l as NO3 (-)) showed strong association with high Cl/Br mass ratio (350-900), indicating mixing of sewage and septic tank effluents with groundwater as a primary source for the nitrate in the studied area. Nitrate level during monsoon (BDL, 229.9 mg/l as NO3 (-)), post-monsoon (BDL, 263.5 mg/l as NO3 (-)), and pre-monsoon (0.5-223.1 mg/l as NO3 (-)) indicated additional contribution of surface leaching to groundwater.

Ameloblastic carcinoma: A case series.

Ameloblastic carcinoma is a rare odontogenic tumor exhibiting not only features of ameloblastoma, but also features of carcinoma. Clinical dissemination of this lesion is more aggressive and rapid than that of ameloblastoma and it can metastasize to the lung or regional lymph node. Histologically, there are features of both ameloblastoma and carcinoma. <50 cases have been reported until 2011. We report a series of six cases with our treatment modalities.

Interleukin 1 (IL-1)- and IL-23-mediated expansion of filarial antigen-specific Th17 and Th22 cells in filarial lymphedema.

Lymphatic filarial disease is known to be associated with elevated Th1 responses and normal or diminished Th2 responses to parasite-specific antigens. The roles of Th17 cells and the recently described Th22 cells have not been examined in detail in either filarial infection itself or in filarial disease (e.g., lymphedema and elephantiasis). To explore the roles of Th17 and Th22 cells and their subsets, we examined the frequencies of these cells in individuals with filarial lymphedema (chronic pathology [CP]), in clinically asymptomatic infected (INF) individuals, and in uninfected (UN) individuals ex vivo and in response to parasite and nonparasite antigens. Those with disease (CP) had significantly expanded frequencies of Th17 and Th22 cells, compared with either INF or UN individuals, at baseline (ex vivo) and in response to parasite antigens. This antigen-driven expansion of Th17 and Th22 cells was dependent on interleukin 1 (IL-1), IL-23, and, to lesser extent, transforming growth factor ß (TGF-ß), as blockade of any of these cytokines resulted in significantly diminished frequencies of Th17 and Th22 cells. Our findings, therefore, suggest that filarial parasite-driven expansion of Th17 and Th22 cells is associated with the pathogenesis of filarial infections and disease.

Parasite-antigen driven expansion of IL-5(-) and IL-5(+) Th2 human subpopulations in lymphatic filariasis and their differential dependence on IL-10 and TGFß.

BACKGROUND: Two different Th2 subsets have been defined recently on the basis of IL-5 expression - an IL-5(+)Th2 subset and an IL-5(-)Th2 subset in the setting of allergy. However, the role of these newly described CD4(+) T cells subpopulations has not been explored in other contexts. METHODS: To study the role of the Th2 subpopulation in a chronic, tissue invasive parasitic infection (lymphatic filariasis), we examined the frequency of IL-5(+)IL-4(+)IL-13(+) CD4(+) T cells and IL-5(-)IL-4 IL-13(+) CD4(+) T cells in asymptomatic, infected individuals (INF) and compared them to frequencies (Fo) in filarial-uninfected (UN) individuals and to those with filarial lymphedema (CP). RESULTS: INF individuals exhibited a significant increase in the spontaneously expressed and antigen-induced Fo of both Th2 subpopulations compared to the UN and CP. Interestingly, there was a positive correlation between the Fo of IL-5(+)Th2 cells and the absolute eosinophil and neutrophil counts; in addition there was a positive correlation between the frequency of the CD4(+)IL-5(-)Th2 subpopulation and the levels of parasite antigen - specific IgE and IgG4 in INF individuals. Moreover, blockade of IL-10 and/or TGFß demonstrated that each of these 2 regulatory cytokines exert opposite effects on the different Th2 subsets. Finally, in those INF individuals cured of infection by anti-filarial therapy, there was a significantly decreased Fo of both Th2 subsets. CONCLUSIONS: Our findings suggest that both IL-5(+) and IL-5(-)Th2 cells play an important role in the regulation of immune responses in filarial infection and that these two Th2 subpopulations may be regulated by different cytokine-receptor mediated processes.

Management of symphysis fracture in a 3-year-old child with prefabricated acrylic splint and circum-mandibular wiring.

Pediatric mandibular fractures are often the sequelae of facial skeletal injuries in patients with trauma and frequently require hospitalization. Due to the retrusive mid-face position relative to the calvarial prominence, facial fractures are rare in children younger than 5 years of age. Although rare, they most often occur as a result of motor vehicle accidents. The purpose of this report is to describe the management of a mandibular symphysis fracture in a 3-year-old boy with displacement between the primary mandibular left central and lateral incisors. The fracture was reduced and the fractured segment was stabilized under general anesthesia with a prefabricated acrylic splint with circum-mandibular wiring. Children have greater osteogenic potential and faster healing rates than adults; therefore, anatomic reduction in children is best accomplished earlier.

The need for early detection of neck nodal metastasis in squamous cell carcinoma of oral cavity.

In the Indian subcontinent, the incidence of squamous cell carcinoma of the oral cavity has been constantly increasing despite the improvement in the awareness about squamous cell carcinoma. The patients generally report to us in the period in which the tumor would have undergone metastasis. This article highlights about the grading, staging, and decision-making regarding the surgical management of squamous cell carcinoma of the oral cavity. The article also stresses upon the early detection of the lesion by the practitioner for a definitive successful surgical treatment of the patient.

Versatility of a single upper border miniplate to treat mandibular angle fractures: A clinical study.

CONTEXT: Mandibular fractures are among the most common of facial fractures. Fractures of the mandibular angle are associated with the highest incidence of postsurgical infection of all mandibular fractures. The treatment of facial fractures has traditionally involved reestablishment of a functional dental occlusion with various types of intermaxillary fixation. Treatment modalities range from simple maxillo-mandibular fixation to rigid internal fixation of the bone fragments. AIMS: The aim of this study was to determine the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle with access via an intraoral route. MATERIALS AND METHODS: Cases of unfavorable fractures of the mandibular angle were selected for the study of intraoral surgical management of mandibular angle fractures using a single 2.0-mm noncompression miniplate. STATISTICAL ANALYSIS AND RESULTS: An observational study was carried out on treatment of fractures of the angle of the mandible, and the findings were recorded and presented. CONCLUSIONS: We studied the versatility of the single noncompression miniplate to treat the fractures of the mandibular angle and found no complications associated with superior border miniplate fixation of mandibular angle fractures.

The prevalence of tuberculosis in different economic strata: a community survey from South India.

A cross-sectional socio-economic survey to assess the standard of living index (SLI) of a rural population in South India was undertaken along with a tuberculosis (TB) prevalence survey during 2004-2006. Of 32,780 households, the SLI was low, medium and high in 22%, 36% and 42%, and TB prevalence was 343, 169 and 92 per 100,000 population, respectively, a significant decrease in trend (P < 0.001); 57% of the TB patients had a low SLI and the prevalence of TB was higher amongst the landless (P < 0.001), those living below the poverty line (P < 0.01) and in katcha houses (P < 0.001), suggesting that TB disproportionately affects those with a low SLI.

Relationship of ARTI to incidence and prevalence of tuberculosis in a district of south India.

OBJECTIVE: To validate the currently used empirical relationship between annual risk of tuberculous infection (ARTI) and incidence and prevalence of smear-positive cases. SETTING: Two disease surveys to estimate the prevalence and incidence of tuberculosis (TB) among adults in Tiruvallur district, south India, and a tuberculin survey to estimate the ARTI among children. RESULTS: The incidence of TB was estimated to be 82 and prevalence 210 per 100,000 population and ARTI 1.6%. We estimated that 1% ARTI corresponded to 51 new and 131 prevalent cases. CONCLUSION: The currently used empirical relationship between ARTI and incidence can be used by programme managers as an effective monitoring tool.

Shifting the focus of tuberculosis research in India.

India has a long and distinguished tradition of research in the field of tuberculosis (TB). Pioneering studies from India demonstrated the efficacy and safety of domiciliary treatment, the necessity of direct observation of treatment, the feasibility of case detection through sputum smear microscopy in primary health care institutions, and the effectiveness of intermittent short-course chemotherapy. These findings laid the foundation of directly observed treatment, short course (DOTS), which has been adopted by nearly 150 countries worldwide. Today, India has the second-largest and the fastest-growing DOTS programme in the world. A strong component of programme evaluation and operational research is needed to sustain and expand DOTS in the context of a suboptimal primary health care system, a large and unregulated private health care system, and the dual threats of HIV and multidrug-resistant TB (MDR-TB). Therefore, the focus of TB research in India has shifted to the following operational research areas: evaluating models to involve the private health sector; assessing the role of incentives in increasing treatment compliance; examining gender differentials in the access to TB services; assessing risk factors for delay in diagnosis; evaluating diagnosis, treatment and prevention of TB among HIV-infected persons; monitoring MDR-TB; estimating cost-effectiveness of the DOTS programme; monitoring the quality of smear microscopy services; and measuring the current burden of TB. Research for developing newer diagnostic tools, drugs and vaccines remains a long-term priority. Greater networking is needed among national researchers, programme managers and policy-makers to translate the findings of research into policies and programmes to make TB control in India more effective and efficient.

Trends in the prevalence and incidence of tuberculosis in south India.

OBJECTIVE: To study trends in the prevalence and incidence of tuberculosis in south India. METHODS: In 1968-1970, about 100,000 subjects were surveyed for tuberculosis and followed thereafter for 15 years, mainly by repeat survey once every 2.5 years. New entrants were inducted at every repeat survey. Radiographic examination of subjects aged 5 years or more and sputum smear and culture examinations of those with an abnormal shadow were undertaken; tuberculin tests were done initially on all, and at 4, 10 and 15 years in selected samples of those aged 1-9 years. RESULTS: The prevalence of culture-positive tuberculosis decreased by 1.4% per annum to 694/100,000, while that of smear-positive tuberculosis showed no significant decrease from 457/100,000. The annual incidence of culture-positive tuberculosis decreased by 4.3%/annum to 189/100,000 and that of smear-positive tuberculosis decreased by 2.3%/annum to 113/100,000. Decreases in incidence occurred exclusively in those with abnormal radiographic findings suggestive of tuberculosis at the start of the period. The annual risk of tuberculosis infection (ARTI) was initially 2%, and showed no sign of decline over the period. CONCLUSION: The prevalence of tuberculosis and ARTI showed little or no decrease over the 15-year period. A significant decrease in incidence occurred, but exclusively in those with abnormal radiograph suggestive of tuberculosis at the start of the period.

Serial evaluation of serum neopterin in HIV seronegative patients treated for tuberculosis.

OBJECTIVE: To delineate the course of serum neopterin (s-neo) concentrations in patients with pulmonary tuberculosis who are on anti-tuberculosis therapy. DESIGN: S-neo concentrations were measured by high performance liquid chromatography (HPLC) in 39 patients treated for pulmonary tuberculosis at pretreatment, at one month and at end of treatment. It was also measured in 11 relapse cases and their matched controls at the above time points and at the time of relapse. The results were correlated with bacteriological and radiological findings. RESULTS: All patients had elevated levels of s-neo at pretreatment which had declined at 1 month and were near normal at the end of treatment. The decline was more significant in patients with moderate lesions, suggesting that immune activation is maximum in this group of patients. The mean decrease was 37% at one month and 66% at the end of treatment. The corresponding decreases were 11% and 56% in patients with limited lesions and 11% and 45% in those with extensive lesions. It continued to fall after completion of therapy in patients who did not relapse, whereas an increase after completion of therapy was associated with bacteriologically proven relapse. CONCLUSIONS: The measurement of s-neo concentration could be of help in evaluating response to therapy. This study provides a rational basis for the association between s-neo concentration and relapse.