Private Doctors' Perspective towards "Patient First" in TB Diagnostic Cascade, Hisar, India.

TB diagnosis has been simplified in India following advances in available diagnostic tools. This facilitates private doctors' "patient first" approach toward early diagnosis; however, costs remain high. India's NTEP established a TB diagnostic network, which is free for patients and incentivizes private doctors to participate. Drawing from this context led to the design and implementation of the One-Stop TB Diagnostic Solution model, which was conducted in the Hisar district, Haryana, allowing specimens from presumptive TB patients from private doctors to be collected and tested as per NTEPs diagnostic algorithm. A subset of data pertaining to private doctors was analyzed for the project period. Qualitative data were also collected by interviewing doctors using a snowball method to capture doctors' perception about the model. Out of 1159 specimens collected from 60 facilities, MTB was detected in 32% and rifampicin resistance was detected in 7% specimens. All specimens went through the diagnostic algorithm. Thirty doctors interviewed were satisfied with the services offered and were appreciative of the program that implements this "patient centric" model. Results from implementation indicate the need to strengthen private diagnostics through a certification process to ensure provision of quality TB diagnostic services.

Solvent directed morphogenesis of a peptidic-benzimidazolium dipodal receptor: ratiometric detection and catalytic degradation of ochratoxin A.

Ochratoxin A (OTA) is the most abundant and harmful toxin found in agriculture and processed food. The environment and human health are both harmed by this mycotoxin. As a result, in various scenarios, selective detection and biodegradation of ochratoxin A are essential. The current study reveals the morphogenesis of a peptidic-benzimidazolium dipodal receptor (SS4) and its application as a catalytic and sensing unit for the detection and degradation of OTA in an aqueous medium. Initially, a facile and scalable method was executed to synthesize SS4, and solvent-directed morphogenesis were examined under SEM analysis. Consequently, molecular recognition properties of self-assembled architectures were explored using UV-visible absorption, fluorescence spectroscopy, and atomic force microscopy (AFM). The designed probe showed a ratiometric response for OTA and served as a catalytic unit for the degradation of OTA at a short interval of 25 min. The biodegradation pathway for OTA was accomplished using LC-MS analysis. Furthermore, the reliability of the developed method was checked by determining the spiked concentrations of the OTA in cereals and wine samples. The results obtained are in good agreement with the % recovery and RSD values. The present work provides a robust, selective, and sensitive method of detection and degradation for OTA.

Comprehensive assessment of invalid and indeterminate results in Truenat MTB-RIF testing across sites under the national TB elimination program of India.

Introduction: Truenat MTB-RIF assay (Truenat), a nucleic acid amplification test (NAAT), is a real-time polymerase chain reaction (RT-PCR) chip-based assay that can detect Mycobacterium tuberculosis (Mtb) and rifampicin (RIF) drug resistance using portable, battery-operated devices. The National TB Elimination Program (NTEP) in India introduced this novel tool at the district and subdistrict level in 2020. This study aimed to assess the level and causes of inconclusive results (invalid results, errors, and indeterminate results) in MTB and RIF testing at NTEP sites and the root causes of these in the programmatic setting. Methods: Truenat testing data from 1,690 functional Truenat sites under the NTEP from April to June 2021 were analyzed to assess the rates of errors, invalid MTB results, and indeterminate RIF results. Following this analysis, 12 Truenat sites were selected based on site performance in Truenat testing, diversity of climatic conditions, and geographical terrain. These sites were visited to assess the root causes of their high and low rates of inconclusive results using a structured checklist. Results: A total of 327,649 Truenat tests performed for MTB and RIF testing were analyzed. The rate of invalid MTB results was 5.2% [95% confidence interval (CI): 5.11-5.26; n = 16,998] and the rate of errors was 2.5% (95% CI: 2.46-2.57; n = 8,240) in Truenat MTB chip testing. For Mtb-positive samples tested using the Truenat RIF chip for detection of RIF resistance (n = 40,926), the rate of indeterminate results was 15.3% (95% CI: 14.97-15.67; n = 6,267) and the rate of errors was 1.6% (95% CI: 1.53-1.78; n = 675). There was a 40.1% retesting gap for Mtb testing and a 78.2% gap for inconclusive RR results. Among the inconclusive results retested, 27.9% (95% CI: 27.23-28.66; n = 4,222) were Mtb-positive, and 9.2% (95% CI: 7.84-10.76; n = 139) were detected as RR. Conclusion: The main causes affecting Truenat testing performance include suboptimal adherence to standard operating procedures (SOPs), inadequate training, improper storage of testing kits, inadequate sputum quality, lack of quality control, and delays in the rectification of machine issues. Root cause analysis identified that strengthening of training, external quality control, and supervision could improve the rate of inconclusive results. Ensuring hands-on training of technicians for Truenat testing and retesting of samples with inconclusive results are major recommendations while planning for Truenat scale-up. The recommendations from the study were consolidated into technical guidance documents and videos and disseminated to laboratory staff working at the tiered network of TB laboratories under the NTEP in order to improve Truenat MTB-RIF testing performance.

Experience of "One Stop TB Diagnostic Solution" Model in Engaging a Private Laboratory for End-to-End Diagnostic Services in the National TB Elimination Program in Hisar, India.

The complete diagnostic evaluation of tuberculosis based on its drug-resistance profile is critical for appropriate treatment decisions. The TB diagnostic landscape in India has been transformed with the scaling-up of WHO-recommended diagnostics, but challenges remain with specimen transportation, completing diagnostic assessment, turnaround time (TAT), and maintaining laboratories. Private laboratories have demonstrated efficiencies for specimen collection, transportation, and the timely testing and issue of results. A one-stop TB diagnostic model was designed to assess the feasibility of providing end-to-end diagnostic services in the Hisar district of Haryana state, India. A NTEP-certified private laboratory was engaged to provide the services, complementing the existing public sector diagnostic services. A total of 10,164 specimens were collected between May 2022 and January 2023 and these were followed for the complete diagnostic assessment of Drug-Susceptible TB (DS-TB) and Drug-Resistant TB (DR-TB) and the time taken for issuing results. A total of 2152 (21%) patients were detected with TB, 1996 (93%) Rifampicin-Sensitive and 134 (6%) with Rifampicin-Resistant TB. Nearly 99% of the patients completed the evaluation of DS-TB and DR-TB within the recommended TAT. The One-Stop TB/DR-TB Diagnostic Solution model has demonstrated that diagnostic efficiencies could be enhanced through the strategic purchase of private laboratory services.

Characteristics of patients who use yoga for pain management in Indian yoga and naturopathy settings: a retrospective review of electronic medical records.

Objectives: The aim of this study is to identify the characteristics of patients who underwent yoga therapy for pain in yoga and naturopathy clinical settings in India. Methods: Electronic medical records of patients who received yoga therapy for pain in three inpatient yoga and naturopathy hospitals were reviewed retrospectively from January 2021 to September 2022. Demographic characteristics and details on pain condition, socioeconomic status, comorbidities, ancillary therapies received, and insurance status were collected. In addition, we prospectively collected data on adherence to yoga practice through a telephonic interview. Results: A total of 984 patients were identified from a pool of 3,164 patients who received yoga therapy for pain for an average of 9.48 (1.13) days. Patients aged between 8 and 80 underwent therapy for varying pain conditions and diseases that include pain in the extremities, pain due to infection, trauma, degenerative diseases, autoimmune diseases, and spine and neurological diseases. The majority of the patients were females (66.3%), from middle class families (74.8%), and who did not have any insurance coverage (93.8%). Most of the patients were under naturopathy treatment (99.8%), followed by ayurveda (56%), and physiotherapy (49.3%), along with yoga therapy. All patients reported a significant reduction in pain post-integrated yoga therapy (p < 0.001). Adherence to yoga was significantly associated with underlying pain conditions, the presence of comorbidities, the types of therapies used, and socioeconomic status (p < 0.001). Conclusion: This study highlights the real-time application of yoga in pain management in Indian yoga and naturopathy settings, as well as implications for future research.

A high-performance Calix@ZnO based bifunctional nanomaterial for selective detection and degradation of toxic azinphos methyl in environmental samples.

One of the key tenets of sustainable agriculture and food safety is the removal of toxic pesticides from the environment. However, developing reliable, affordable, and efficient methods for detecting and degrading pesticides into non-toxic degradable products remains an immediate matter of concern. Herein, we attempt to develop a strategy for the detection as well as degradation of highly toxic phosphorodithioate pesticide, Azinphos methyl (AZM), using hybrid zinc oxide nanoparticles (ZnO NPs). Considering the non-selectivity of bare ZnO and receptor R1, we have fabricated the heterocalixarene-based Calix (R1) over zinc oxide (ZnO) surface in situ via the sol-gel process. The synthesized heterocaliaxrene-modified ZnO (R1@ZnO) NPs show an excellent affinity for the selective and sensitive detection of AZM with a tremendously low limit of detection (68 mg L-1) and no interference from other pesticides. Degradation of AZM was fully supported by fluorescence spectroscopy, scanning electron microscopy (SEM), 1H NMR titrations, FTIR spectroscopy, cyclic voltammetry, and mass spectroscopy, which unequivocally confirmed the formation of non-toxic products. According to our findings, R1@ZnO NPs are sustainable nanomaterials that can be employed for environmental remediation since they operate in an aqueous medium.

Cellulose-reinforced poly(ethylene-co-vinyl acetate)-supported Ag nanoparticles with excellent catalytic properties: synthesis of thioamides using the Willgerodt-Kindler reaction.

Cellulose, a bio-derived polymer, is widely used in food packaging, dye removal, coatings, and solid-supported catalysis. Heterogeneous catalysts play a critical role in environmental remediation. In this context, the demand for green and cost-effective catalysts has rapidly increased. In this study, cellulose was extracted from rice straw, and a highly active solid-supported catalytic model was developed. First, cellulose was conjugated with poly(ethylene-co-vinyl acetate) (PEVA), and then Ag nanoparticles (AgNPs) were inserted into the cellulose-PEVA composite. The process involved the reduction of AgNPs in the presence of sodium borohydride. The fabricated hybrid catalyst was characterized using Fourier-transform infrared spectroscopy, scanning electron microscopy, energy dispersive X-ray, and powder X-ray diffraction. Thereafter, the obtained hybrid was used as a catalyst for the Willgerodt-Kindler reaction of aromatic aldehydes, amines, and S8 to synthesize thioamides with excellent yields. The developed catalytic system exhibited high stability and recyclability. Moreover, the mechanical properties of the hybrid catalyst were evaluated using tensile strength and impact tests. RGB analysis of digital images was also performed to investigate the primary components of the catalyst.

Backbone extension via peptidomimetics at N-terminal; self-assembled nanofibrous cluster and application to selective progesterone detection in an aqueous medium.

Despite the adequacy of the endogenous steroid (progesterone) levels in biological functioning, elevated levels of progesterone hormone have several physiological effects that are amplified due to its direct and indirect uptake from the environment, food products, and medical therapy. So, it is much needed to evaluate the progesterone levels in environmental samples as well as for biological fluids. In this work, we focused on the development of the nano sensing probe for the selective detection of progesterone among the library of steroid hormones belonging to the class of female sex hormones. Herein, functionalization of dipeptide is carried out at N-terminal to produce N-functionalized dipeptide (SS3), and simultaneously, its self-assembly properties are explored. Furthermore, HR-TEM imaging was also performed to examine the morphology of the self-assembled architectures before and after the addition of the steroid hormone. To investigate the binding mechanism of the sensing probe, Fluorescence spectroscopy, Circular Dichroism (CD), MD-Simulation, and DFT studies were performed and studied in detail. Moreover, to check the potency of the real-time application of the developed nanoprobe, we have successfully determined the spiked concentration of progesterone levels in pharmaceutical and biological fluid samples with functional percentage recovery. Also, the stability and other competitive binding studies of the probe with the coexisting substances are performed to check the rationality of the sensing probe at physiological conditions.

Paraoxonase Mimic by a Nanoreactor Aggregate Containing Benzimidazolium Calix and l-Histidine: Demonstration of the Acetylcholine Esterase Activity.

An anion-mediated preorganization approach was used to design and synthesize the benzimidazolium-based calix compound R1⋅2 ClO4 - . X-ray crystallography analysis revealed that the hydrogen-bonding interactions between the benzimidazolium cations and N,N-dimethylformamide (DMF) helped R1⋅2 ClO4 - encapsulate DMF molecule(s). A nanoreactor, with R1⋅2 ClO4 - and l-histidine (l-His) as the components, was fabricated by using a neutralization method. The nanoreactor could detoxify paraoxon in 30 min. l-His played a vital role in this process. Paraoxonase is a well-known enzyme used for pesticide degradation. The Ellman's reagent was used to determine the percentage inhibition of the acetylcholinesterase (AChE) activity in the presence of the nanoreactor. The results indicated that the nanoreactor inhibited AChE inhibition.

Rhodamine-based fluorescent probe for sequential detection of Al3+ ions and adenosine monophosphate in water.

Organic nanoparticles (N1) were prepared by dispersing thiophene-conjugated rhodamine derivative 1 in a buffer solution (10 mM TRIS, pH 7.4, containing 1% DMSO, v/v). N1 selectively recognized Al3+ ions through the "OFF-ON" switching mechanism of the spirolactam ring in rhodamine. The resulting N1·Al3+ complex recognized the biologically important molecule adenosine monophosphate (AMP) through a cation displacement process with a detection limit of 2 nM. N1 was capable of determining the concentration of Al3+ ions in environmental and biological samples. Portable test strips of N1 were prepared for the recognition of Al3+ ions and AMP for practical uses. Furthermore, it was demonstrated that the N1·Al3+ complex facilitated real-time monitoring of AMP concentration in the hydrolysis of ATP and ADP.

Can a commercially available EPID dosimetry system detect small daily patient setup errors for cranial IMRT/SRS?

PURPOSE: The purpose of this study was to determine if the Sun Nuclear PerFRACTION electronic portal imager device dosimetry software would be able to detect setup errors in a clinical setting and would be able to correctly identify the direction in which the setup error was introduced. METHODS AND MATERIALS: A 7-field intensity modulated radiation therapy (IMRT) treatment plan for a centrally located tumor was developed for 1 phantom and 5 canine cadaver heads. Systematic setup errors were introduced by manually moving the treatment couch by 1, 3, and 5 mm in each translational direction to assess stereotactic radiation surgery (SRS), IMRT, and 3-dimensional (3D) treatment tolerances after the initial alignment was performed. An angular setup error of 5° yaw was also assessed. The delivered treatment fluence was automatically imported in the PerFRACTION software and compared with the baseline fluence. RESULTS: In the canine phantom, a 5-mm shift was undetected by gamma analysis, and up to a 2-cm shift had to be introduced for the gamma pass rate of 3%/3 mm to fall below a 95% pass rate criterion. The same 5-mm shift using 3% difference caused the pass rates for 2 fields to drop below the 95% tolerance. For each respective translational shift, the affected beam angles were consistent across the cadaver heads and correlated with the direction of translational shift. The best field pass rate, worst field pass rate, and average pass rate across all 7 fields was analyzed to develop clinical guidance on parameter settings for SRS, IMRT, and 3D tolerances. CONCLUSIONS: PerFRACTION 2-dimensional mode successfully detected setup errors outside the systematic error tolerance for SRS, IMRT, and 3D when an appropriate analysis metric and pass/fail criteria was implemented. Our data confirm that percent difference may be more sensitive in detecting plan failure than gamma analysis.

Rapid detection of extensively drug-resistant (XDR-TB) strains from multidrug-resistant tuberculosis (MDR-TB) cases isolated from smear-negative pulmonary samples in an Intermediate Reference Laboratory in India.

BACKGROUND: Direct sputum smear microscopy is commonly used for diagnosing tuberculosis (TB). The objectives of the study were first, to determine the recovery of Mycobacterium tuberculosis in smear-negative sputum samples through liquid culture (using MGIT 960) and solid culture (using LJ slant) and second, to screen multidrug-resistant isolates through line probe assay and further third, to identify XDR isolates through MGIT second-line DST from these positive MDR cultures in Delhi region. METHODS: In this study, the sample size was 717 (sputum smear AFB negative and culture positive for M. tuberculosis complex by both solid and liquid culture methods) MDRTB suspects who were enrolled from January 2014 to December 2014 at the Intermediate Reference Laboratory in New Delhi Tuberculosis Centre, New Delhi. Rapid line probe assay was performed on all culture-positive samples, which were direct smear-negative specimens, and LPA-confirmed MDR samples were tested on MGIT 960 second-line DST for identification of XDR strains. RESULTS: An overall increase in the culture positivity (9.4%) among these smear-negative cases shows a good sign of recovery from M. tuberculosis infection in these samples. 717 (9.4%) positive cultures (MGIT+LJ) were subjected to line probe assay. Out of these 717 cultures, 9 (1.2%) were confirmed as NTM, 50 (7%) were MDR, 4 (0.6%) were mono-rifampicin resistant and 654 (91.2%) cultures were sensitive to both drugs Rif and Inh, respectively. Out of these 54 (50 MDR +4 mono-RIF resistant) cultures as screened by LPA, 1 (1.8%) was XDR, 10 (18.6%) were mono-ofloxacin resistant and 1 (1.8%) was mono-Kanamycin resistant. Sensitivity to both drugs KAN and OFX was seen in 42 (77.8%) cultures. CONCLUSIONS: Since the bacterial load in direct smear-negative suspected MDR samples is less, it is important to recover mycobacteria by rapid liquid culture method in such samples. Initial screening for MDRTB is to be done in such cases by performing rapid molecular genotypic drug susceptibility test such as LPA. Baseline second-line DST is also done to rule out the XDR cases among them for rapid and better management of XDRTB patients.

Disease progression and antiretroviral therapy in newly seropositive HIV subjects in a tertiary care hospital in North India.

INTRODUCTION: In developing countries the standard methods used to monitor HIV disease progression and therapy response are clinical assessment, CD4+ T lymphocyte count measurement, and plasma viral load (PVL) quantification. These tests require expensive equipment and skilled technicians, so monitoring HIV in resource-limited countries remains challenging as few laboratories can offer these tests free of cost. METHODOLOGY: Newly diagnosed HIV seropositive subjects (n = 130) were categorized into three study groups: CD4 counts < 200 cells/µl (group A, 43 subjects); 200-500 cells/µl (group B, 44 subjects); and > 500 cells/µl (group C, 43 subjects). At recruitment, PVL estimation was performed for group A subjects only, who were then initiated on highly active antiretroviral therapy (HAART) and were followed up after six months for evaluation of response to HAART by measuring the CD4 counts and PVL. Groups B and C were followed up after six months to monitor disease progression by measuring only CD4 counts. RESULTS: Among group A subjects, a rise in the median CD4 counts after six months of HAART was observed. At baseline, PVL ranged from 2636 to > 750,000 copies/ml with a median PVL at baseline of 165,000 copies/ml. At follow-up, 90% of the study subjects had undetectable levels of viraemia. Among group B and C subjects, a fall in the CD4 counts at follow-up was observed. CONCLUSIONS: CD4 count is a powerful tool to determine response to antiretroviral therapy (ART) and monitor disease progression in HIV/AIDS. PVL is important to assess response to ART, especially in immunovirologic discordant responses.

Utility of Serum Neopterin and Serum IL-2 Receptor Levels to Predict Absolute CD4 T Lymphocyte Count in HIV Infected Cases.

A prospective study was carried out to evaluate the efficacy of serum neopterin and soluble IL-2 receptor (sIL-2R) concentrations in comparison to CD4 count to study the progression of HIV disease and monitor response to ART in HIV cases. One hundred newly diagnosed HIV seropositive subjects were recruited. CD4 counts were determined by FACS system. Serum neopterin and sIL-2R levels were measured using enzyme immunoassay. In our study, levels of neopterin and sIL-2R were significantly higher in subjects with CD4 <200 cells/ µ L (with S. neopterin levels of >25.1 nmol/L and sIL-2R levels of >47.1 pM as cutoff values for CD4 <200 cells/ µ L) compared to those in subjects with CD4 >200 cells/ µ L at baseline which indicate that these markers can be utilized for initiation of ART in HIV cases. The levels of these markers decreased significantly after initiation of ART. In patients with CD4 >200 cells/ µ L, these markers are helpful in predicting disease progression.

Resistance-associated mutations in HIV-1 among patients failing first-line antiretroviral therapy.

Thirty-five HIV-1 infected patients showing clinical and/or immunological failure to first line antiretroviral therapy (ART) according to WHO criteria were recruited from the ART center of Lok Nayak Hospital, New Delhi to detect the presence of resistance-mutations in reverse transcriptase (RT) and protease (PR) region of pol gene of HIV-1. Plasma viral load (PVL) was estimated. HIV-1 pol gene region encoding complete protease and reverse transcriptase (codons; 1-232 to 1-242) was reverse transcribed, followed by nested PCR. The PCR product was sequenced and analyzed. Plasma samples from 94.3% of patients with PVL >log(10) 3.0 c/mL could be amplified and analyzed. Virologic failure was detected in 65.7% of patients according to WHO criteria (PVL >log(10) 4.0). All patients were found to be infected with subtype C. One or more resistance-mutations were observed among 90.9% of study sequences. Nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations were seen among all patients, with M184V and thymidine analogue mutations (TAM) being most frequently detected (75.6% and 72.7%, respectively). Nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance-mutations were detected in 63.6% of sequences, of which Y181C/I (47.6%), K103N (33.3%) and G190S (28.6%) are the most common. None of the sequences showed major protease inhibitors (PIs) resistance mutation. High prevalence of NRTI and NNRTI drug resistance mutations among the study participants warrants the use of genotypic resistance testing to prevent accumulation of resistance mutations, which would limit future treatment options.

Hepatitis B infection in microbiology laboratory workers: prevalence, vaccination, and immunity status.

The risk of contracting HBV by health care workers (HCW) is four-times greater than that of general adult population. Studies have demonstrated that vaccine-induced protection persists at least 11 years. High risk groups such as HCWs should be monitored and receive a booster vaccination if their anti-HBsAb levels decrease below 10 mIU/mL. In view of the above this study was undertaken to assess the HBV vaccination of the HCWs and their immunological response. Seventy-two HCWs of the Department of Microbiology, Maulana Azad Medical College, New Delhi, India, were recruited and blood sample was drawn for serological tests (HBSAg, anti-HCV, anti-HBsAb, anti-HBeAb, and anti-HBcAb). Anti-HBs titers of >10 mIU/mL were considered protective. Thirty-four (47.3%) of the participants were completely vaccinated with three doses. 25 (73.5%) of the participants with complete vaccination had protective anti-HBsAb levels as against 8 (53.3%) of those with incomplete vaccination and 9 (39.1%) of those who were not vaccinated at all. One of our participants was acutely infected while 29 participants were susceptible to infection at the time of the study. All HCWs should receive three doses of the vaccine and be monitored for their immune status after every five years. Boosters should be administered to those who become susceptible.

Staphylococcus aureus phage types and their correlation to antibiotic resistance.

CONTEXT: Staphylococcus aureus is one of the most devastating human pathogen. The organism has a differential ability to spread and cause outbreak of infections. Characterization of these strains is important to control the spread of infection in the hospitals as well as in the community. AIM: To identify the currently existing phage groups of Staphylococcus aureus, their prevalence and resistance to antibiotics. MATERIALS AND METHODS: Study was undertaken on 252 Staphylococcus aureus strains isolated from clinical samples. Strains were phage typed and their resistance to antibiotics was determined following standard microbiological procedures. STATISTICAL ANALYSIS: Chi square test was used to compare the antibiotic susceptibility between methicillin resistant Staph. aureus (MRSA) and methicillin sensitive S. aureus (MSSA) strains. RESULTS: Prevalence of MRSA and MSSA strains was found to be 29.36% and 70.65% respectively. Of these 17.56% of MRSA and 40.44% of MSSA strains were community acquired. All the MSSA strains belonging to phage type 81 from the community were sensitive to all the antibiotics tested including clindamycin and were resistant to penicillin. Forty five percent strains of phage group III and 39% of non-typable MRSA strains from the hospital were resistant to multiple antibiotics. CONCLUSION: The study revealed that predominant phage group amongst MRSA strains was phage group III and amongst MSSA from the community was phage group NA (phage type 81). MSSA strains isolated from the community differed significantly from hospital strains in their phage type and antibiotic susceptibility. A good correlation was observed between community acquired strains of phage type 81 and sensitivity to gentamycin and clindamycin.

Use of total lymphocyte count to predict absolute CD4 count in HIV-seropositive cases.

We conducted an observational study to assess the use of total lymphocyte counts (TLC) alone and along with hemoglobin (Hb) as a predictor of CD4 count. A total of 103 antiretroviral therapy (ART)-naive HIV-1-infected patients were enrolled and divided in 2 groups (with CD4 count <200 cells/mm(3) and CD4 count ≥200 cells/mm(3)). The TLC and Hb were performed by automatic full digital cell counter. CD4 count was determined by flow cytometry. Among the World Health Organization (WHO) clinical stages 2 and 3, in the cases with CD4 count <200 cells/mm(3), 70.4% cases had TLC ≤1200 cells/mm( 3), whereas 63% cases had TLC ≤1200 cells/mm(3) + Hb ≤12 g/dL. In the cases with CD4 count >200 cells/mm(3), 2% cases had TLC ≤1200 cells/mm(3), whereas adding Hb ≤12 g/dL with TLC ≤1200 cells/mm(3), none of the cases would require initiation of ART. TLC + Hb can be used to treat all HIV-infected patients with WHO stages 2 and 3 who have a TLC <1200 cells/mm(3) + Hb ≤12 g/dL and to limit CD4 counts to patients who are symptomatic but have TLC + Hb values other than TLC <1200 cells/mm(3) + Hb ≤12 g/dL.

Epidemiology of opportunistic infections and its correlation with CD4 T-lymphocyte counts and plasma viral load among HIV-positive patients at a tertiary care hospital in India.

The study was conducted to find the correlation of CD4 counts and plasma viral load (PVL) with opportunistic infections (OIs) in HIV-positive patients. A total of 43 drug-naive patients enrolled in the study. Absolute CD4 counts and PVL were measured. On the basis of symptoms, sputum, stool, and blood samples were obtained for laboratory tests. Oral swabs were obtained from all the patients. Pneumocystis jiroveci pneumonia was found in 45.2% patients (odds ratio [OR] = 12.8 for CD4 counts 4.0 log(10) copies/mL). Pulmonary tuberculosis (TB; OR = 8.0 for PVL >4.0 log(10) copies/mL) and streptococcal pneumonia (detected only with CD4 counts <50 cells/mm( 3) and PVL >4.0 log(10) copies/mL) were seen in 41.9% and 12.9% patients, respectively. Among patients with diarrhea, Giardia lamblia was detected in 31% patients (OR = 3.0 for CD4 counts 4.0 log(10) copies/mL) and Cryptosporidium in 17.2% patients (OR = 1.8 for CD4 counts 4.0 log(10) copies/mL). Shigellosis and Clostridium difficile toxin was present in 13.6% patients and 6.8% patients, respectively.