Assessment of Knowledge and Practices of Referring Private Practitioners Regarding Revised National Tuberculosis Control Programme in Nagpur City - A Cross Sectional Study

Objectives: To assess knowledge, diagnostic and treatment practices of the referring private practitioners of Nagpur city regarding Revised National Tuberculosis Control Programme (RNTCP). Methods: The study involved interview of 103 Private Practitioners (PPs) of Nagpur city. Knowledge of private practitioners was assessed based on questions related to diagnosis, categorization, treatment regimens & follow up. Practices of private practitioners were assessed based on which investigations and treatment regimen they advise & whether they offer supervised treatment. Their willingness to get involved in the programme was also recorded. Results: Only 49 (47.6%) private practitioners knew sputum smear examination as primary tool of diagnosis of TB. Only half, 52 (50.5%) of the private practitioners knew number of categories of tuberculosis correctly and 64 (62.1%) private practitioners did know how to categorize TB patients. Chest X-ray and Mantoux test (38.5%) was mainly used by the PPs for TB diagnosis. 42.7% of PPs were prescribing treatment for TB and among them only 8 were prescribing as per RNTCP guidelines and just one provided treatment under direct observation. Different combination of HRZE and HRZES was prescribed for variable period ranges from 2-8 months. And only 12 (11.6%) private practitioners expressed their willingness to get involved in RNTCP for TB control. Conclusion: There is lack of adequate knowledge, diagnostic and treatment practice among PPs as per RNTCP guidelines and further encouragement is required for their participation in the programme

Effect of HIV-1 infection on T-Cell-based and skin test detection of tuberculosis infection

RATIONALE: Two forms of the IFN-gamma release assay (IFNGRA) to detect tuberculosis infection are available, but neither has been evaluated in comparable HIV-infected and uninfected persons in a high tuberculosis incidence environment. OBJECTIVE: To compare the ability of the T-SPOT.TB (Oxford Immunotec, Abingdon, UK), QuantiFERON-TB Gold (Cellestis, Melbourne, Australia), and Mantoux tests to identify latent tuberculosis in HIV-infected and uninfected persons. METHODS: A cross-sectional study of 160 healthy adults without active tuberculosis attending a voluntary counseling and testing center for HIV infection in Khayelitsha, a deprived urban South African community with an HIV antenatal seroprevalence of 33% and a tuberculosis incidence of 1,612 per 100,000. MEASUREMENTS AND MAIN RESULTS: One hundred and sixty (74 HIV(+) and 86 HIV(-)) persons were enrolled. A lower proportion of Mantoux results was positive in HIV-infected subjects compared with HIV-uninfected subjects (p < 0.01). By contrast, the proportion of positive IFNGRAs was not significantly different in HIV-infected persons for the T-SPOT.TB test (52 vs. 59%; p = 0.41) or the QuantiFERON-TB Gold test (43 and 46%; p = 0.89). Fair agreement between the Mantoux test (5- and 10-mm cutoffs) and the IFNGRA was seen in HIV-infected people (kappa = 0.52-0.6). By contrast, poor agreement between the Mantoux and QuantiFERON-TB Gold tests was observed in the HIV-uninfected group (kappa = 0.07-0.30, depending on the Mantoux cutoff). The pattern was similar for T-SPOT.TB (kappa = 0.18-0.24). Interpretation: IFNGRA sensitivity appears relatively unimpaired by moderately advanced HIV infection. However, agreement between the tests and with the Mantoux test varied from poor to fair. This highlights the need for prospective studies to determine which test may predict the subsequent risk of tuberculosis

Latent Tuberculosis Infection among Healthcare Students and Postgraduates in a Mediterranean Italian Area: What Correlation with Work Exposure?

Background: Tuberculosis screening is part of the standard protocol for evaluating the risk of infection in healthcare workers. The aim of this study was to evaluate the prevalence of latent tuberculosis infection (LTBI) among students attending various healthcare profession degree courses and postgraduate medical courses at the School of Medicine of the University of Palermo, Italy, and assess the possible professional origin of infection. Methods: In total, 2946 students (2082 undergraduates and 864 postgraduates) took part in a screening program for LTBI between January 2014 to April 2019 using the tuberculin skin test (TST). Students with a positive TST result underwent a Quantiferon-TB test (QFT). Results: Among the 2082 undergraduates, 23 (1.1%) had a positiveTST;theresultwasconfirmedwithQFTfor13(0.62%)ofthem. Amongthe864postgraduate students,24(2.78%)hadapositiveTSTandonly18(2.08%)showedapositiveQTF.Latenttuberculosis infectionsweresignificantlymorefrequentamongpostgraduatesthanundergraduates(2.08% &gt; 0.62%, p &lt; 0.0001). There was a higher number of subjects previously vaccinated for TB (18.87% &gt; 0.24%, p &lt; 0.0001), and of vaccinated subjects found positive for TST and QTF (66.67% &gt; 7.69%, p = 0.001) in the postgraduate group. Conclusion: Latent TB is relatively low among medical school students in our geographic area. Nevertheless, this infectious disease must be regarded as a re-emerging biohazard for which preventive strategies are required to limit the risk of infection, especially among exposed workers

Etiology of severe childhood pneumonia in the Gambia, West Africa, determined by conventional and molecular microbiological analyses of lung and pleural aspirate samples.

Molecular analyses of lung aspirates from Gambian children with severe pneumonia detected pathogens more frequently than did culture and showed a predominance of bacteria, principally Streptococcus pneumoniae, >75% being of serotypes covered by current pneumococcal conjugate vaccines. Multiple pathogens were detected frequently, notably Haemophilus influenzae (mostly nontypeable) together with S. pneumoniae

Leptomeningitis in a person with radiologically isolated syndrome and latent tuberculosis. A case report with implications for clinical research

A 39-year-old man, followed with serial MRI of CNS for a radiologically isolate syndrome (RIS, a recently described condition considered a subclinical form of MS), was hospitalized for the occurrence of a leptomeningitis. Routine blood tests and contrast enhanced total body CT scan were unremarkable. Cerebrospinal fluid (CSF) examination showed increase of cells (22 mononuclear cells/mm3), albumin (294 mg/L), immunoglobilins G (161 mg/L) and Link Index (1.9), with 17 oligoclonal bands. Microbiological examinations of CSF (including those for Koch’s Bacillus) were negative. The Mantoux reaction and the QuantiFERON test were positive, featuring a latent tuberculosis (TB). The patient started prophylaxis with rifampicin and isoniazid for four months, until a new MRI showed the disappearance of the leptomeningeal enhancement, and the stability of white matter brain and spinal cord lesions. Two other MRI scans showed a new brain Gd-enhancing lesion nine month after anti-tubercular therapy and, after additional six months, new cerebral and spinal cord areas. This case provides the following suggestions about the effects of TB infection and related therapies on the underlying autoimmune status: the infection, while actively present, did not exacerbate the RIS condition; the worsening nine months after the prophylaxis discontinuation might have been the ‘natural’ evolution of RIS condition. Alternative speculative hypotheses include a remote effect of the infection, of isoniazid (that was reported in some cases to trigger MS), or the result of the clearance of the infection itself. Irrespective of the existence of any interaction between RIS and TB infection, It seems important to collect cases with MS-related diseases and concomitant infections, that may provide clues about disease pathogenesis and treatment

Theories of Technological Progress and the British Textile Industry from Kay to Cartwright

Editada en la Fundación Empresa PúblicaLa industria textil británica continúa en el centro del debate sobre la revolución industrial. Las innovaciones técnicas en el período produjeron una aceleración extraordinaria del crecimiento del output y una considerable reducción de los precios de los tejidos. En este trabajo presentamos un estudio de la comunidad de los inventores responsables de la transformación tecnológica, lo que nos permite alcanzar una serie de conclusiones nuevas sobre el ritmo y dirección de la actividad innovadora durante la revolución industrialThe cotton textile industry remains central to all accounts of the first industrial revolution. Innovations in this period precipitated an extraordinary acceleration in the growth of output and a steep decline in the cost of producing all varieties of cloth. In this paper we outline an explanation through an analysis of the community of inventors responsible for the technological transformation, which enables us to offer some generalizations of the pace and pattern of the inventive activity in this period.Publicad

Lupus Vulgaris in a Maltese patient

Introduction The incidence of cutaneous tuberculosis (TB) in the developed world has fallen, in parallel with the decline of other forms of TB. Nevertheless cases still occur and their diagnosis may be difficult. We report a case of lupus vulgaris in a Maltese patient who went on to have an excellent response to antituberculous chemotherapy.peer-reviewe

Screening vaccine formulations for biological activity using fresh human whole blood.

Understanding the relevant biological activity of any pharmaceutical formulation destined for human use is crucial. For vaccine-based formulations, activity must reflect the expected immune response, while for non-vaccine therapeutic agents, such as monoclonal antibodies, a lack of immune response to the formulation is desired. During early formulation development, various biochemical and biophysical characteristics can be monitored in a high-throughput screening (HTS) format. However, it remains impractical and arguably unethical to screen samples in this way for immunological functionality in animal models. Furthermore, data for immunological functionality lag formulation design by months, making it cumbersome to relate back to formulations in real-time. It is also likely that animal testing may not accurately reflect the response in humans. For a more effective formulation screen, a human whole blood (hWB) approach can be used to assess immunological functionality. The functional activity relates directly to the human immune response to a complete formulation (adjuvant/antigen) and includes adjuvant response, antigen response, adjuvant-modulated antigen response, stability, and potentially safety. The following commentary discusses the hWB approach as a valuable new tool to de-risk manufacture, formulation design, and clinical progression

Preventive medicine center and health care for students of medicine and health professions at the Sapienza University of Rome: a research protocol

This project aims to develop a Center of Preventive Medicine and Health Care for the students of Medicine and Health profession at Sapienza University of Rome. At the beginning of the university career students, both residents and nonresident s, have to face several difficulties such as: starting smoking or the increase in cigarette consumption ; the independent management of their own health (especially for non residents consequently to the distance of the family doctor) ; unhealthy diet; tuberculosis (TB) biological risk during their university training. These aspects , especially if present at the same time, act as a source stress and adversely affect the quality of life and the academic performance. Specific aims of the project will be: implementing an ambulatory of Preventive Medicine; implementing a virtual ambulatory of general medicine; creating a website on the problems mentioned above. Data collected will be computerized to keep an electronic health record (HER) and to use the information for the purposes of scientific research. The Centre will act in close relationship with the Central Administration, with the Headmasters of the Medical Faculties, and in close collaboration with the Center of Occupational Medicine of Sapienza University