Management of Tracheo Bronchial Foreign Bodies in Children – A Retrospective Study of series of 50 cases

Abstract             This retrospective study of series of 50 cases of inhaled foreign bodies in pediatric patients in one year, deals with which the cases presented and the types of foreign body removed. Diagnostic flexible bronchoscopy aid in the diagnosis of unsuspected foreign body aspiration, or with doubtful history of foreign body aspiration without physical or X-ray signs and can proceed with definitive treatment in the same preparation without delay. Tracheotomy is indicated for foreign body that cannot be removed through glottis. A team work of anesthetist, endoscopist, and assistants are essential to ensure the safety of procedure with no compromise on availability of instruments.  Key words Tracheo Bronchial · Foreign Bodies · Children · Management

Anthropogenic Impacts on Aquatic Insects in Six Streams of South Western Ghats

Diversity patterns of aquatic insects among sampling sites lying with!ç the unprotected and protected areas of Western Ghats were studied. This study primarily emphasizes whether anthropogenic influence is the prime cause for the presence of aquatic insects especialIy of pollution-sensitive organisms belonging to the orders Ephemeroptera, Plecoptera and Trichoptera, or to factors such as the physico-chemical features of the water, or sampling methods. Six streams were sampled quantitatively, of which three streams (Abbifalls, Monkey falls and SiIver Cascade) were within protected areas and the remaining three streams (Kumbakarai, Shenbagadevi and Manimutharu falls) were in unprotected areas. A total of 3,209 individual aquatic insects belonging to 25 genera, 18 families and 7 orders were collected. The highest species richness and abundance was observed in Monkey falls followed by Kumbakkarai falls. Large çumbers of more habitat-sensitive organisms such as Ecdyonurus sp., Epeorus sp., Thalerosphyrus sp., Euthraulus sp., and Nathanella sp., were found in Monkey falls. Though the species assemblage was somewhat different, pollution-sensitive taxa were also observed in Kumbakkarai falls. Shenbagadevi and Manimutharu falls had a lower diversity of aquatic insects. The likely causes of these differences are discussed

Spatio-Temporal Dynamics of Caddisflies in Streams of Southern Western Ghats

The dynamics of physico-chemical factors and their effects on caddisfly communities were examined in 29 streams of southern Western Ghats. Monthly samples were collected from the Thadaganachiamman stream of Sirumalai Hills, Tamil Nadu from May 2006 to April 2007. Southwest and northeast monsoons favored the existence of caddisfly population in streams. A total of 20 caddisfly taxa were collected from 29 streams of southern Western Ghats. Hydropsyche (Trichoptera: Hydropsychidae) were more widely distributed throughout sampling sites than were the other taxa. Canonical correspondence analysis showed that elevation was a major variable and pH, stream order, and stream substrates were minor variables affecting taxa richness. These results suggested that habitat heterogeneity and seasonal changes were stronger predictors of caddisfly assemblages than large-scale patterns in landscape diversity

Mycobacterial antigen driven activation of CD14++ CD16-monocytes is a predictor of tuberculosis-associated immune reconstitution inflammatory syndrome

Paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an aberrant inflammatory response occurring in a subset of TB-HIV co-infected patients initiating anti-retroviral therapy (ART). Here, we examined monocyte activation by prospectively quantitating pro-inflammatory plasma markers and monocyte subsets in TB-HIV co-infected patients from a South Indian cohort at baseline and following ART initiation at the time of IRIS, or at equivalent time points in non-IRIS controls. Pro-inflammatory biomarkers of innate and myeloid cell activation were increased in plasma of IRIS patients pre-ART and at the time of IRIS; this association was confirmed in a second cohort in South Africa. Increased expression of these markers correlated with elevated antigen load as measured by higher sputum culture grade and shorter duration of anti-TB therapy. Phenotypic analysis revealed the frequency of CD14++CD16− monocytes was an independent predictor of TB-IRIS, and was closely associated with plasma levels of CRP, TNF, IL-6 and tissue factor during IRIS. In addition, production of inflammatory cytokines by monocytes was higher in IRIS patients compared to controls pre-ART. These data point to a major role of mycobacterial antigen load and myeloid cell hyperactivation in the pathogenesis of TB-IRIS, and implicate monocytes and monocyte-derived cytokines as potential targets for TB-IRIS prevention or treatment

Paradoxical tuberculosis immune reconstitution inflammatory syndrome (TB-IRIS) in HIV patients with culture confirmed pulmonary tuberculosis in India and the potential role of IL-6 in prediction

Background: The incidence, manifestations, outcome and clinical predictors of paradoxical TB-IRIS in patients with HIV and culture confirmed pulmonary tuberculosis (PTB) in India have not been studied prospectively. Methods: HIV+ patients with culture confirmed PTB started on anti-tuberculosis therapy (ATT) were followed prospectively after anti-retroviral therapy (ART) initiation. Established criteria for IRIS diagnosis were used including decline in plasma HIV RNA at IRIS event. Pre-ART plasma levels of interleukin (IL)-6 and C-reactive protein (CRP) were measured. Univariate and multivariate logistic regression models were used to evaluate associations between baseline variables and IRIS. Results: Of 57 patients enrolled, 48 had complete follow up data. Median ATT-ART interval was 28 days (interquartile range, IQR 14–47). IRIS events occurred in 26 patients (54.2%) at a median of 11 days (IQR: 7–16) after ART initiation. Corticosteroids were required for treatment of most IRIS events that resolved within a median of 13 days (IQR: 9–23). Two patients died due to CNS TB-IRIS. Lower CD4+ T-cell counts, higher plasma HIV RNA levels, lower CD4/CD8 ratio, lower hemoglobin, shorter ATT to ART interval, extra-pulmonary or miliary TB and higher plasma IL-6 and CRP levels at baseline were associated with paradoxical TB-IRIS in the univariate analysis. Shorter ATT to ART interval, lower hemoglobin and higher IL-6 and CRP levels remained significant in the multivariate analysis. Conclusion: Paradoxical TB–IRIS frequently complicates HIV-TB therapy in India. IL-6 and CRP may assist in predicting IRIS events and serve as potential targets for immune interventions

Mycobacterial Antigen Driven Activation of CD14++CD162 Monocytes Is a Predictor of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome

Submitted by Nuzia Santos ([email protected]) on 2015-03-17T17:08:53Z No. of bitstreams: 1 2014_157.pdf: 8039547 bytes, checksum: 61886898f8eac99f8b159f84a0aed9a8 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-03-17T17:09:01Z (GMT) No. of bitstreams: 1 2014_157.pdf: 8039547 bytes, checksum: 61886898f8eac99f8b159f84a0aed9a8 (MD5)Approved for entry into archive by Nuzia Santos ([email protected]) on 2015-03-17T17:17:24Z (GMT) No. of bitstreams: 1 2014_157.pdf: 8039547 bytes, checksum: 61886898f8eac99f8b159f84a0aed9a8 (MD5)Made available in DSpace on 2015-03-17T17:17:24Z (GMT). No. of bitstreams: 1 2014_157.pdf: 8039547 bytes, checksum: 61886898f8eac99f8b159f84a0aed9a8 (MD5) Previous issue date: 2014National Institutes of Health. National Institute of Allergy and Infectious Diseases. Laboratory of Parasitic Diseases. Immunobiology Section. Bethesda, MD, United States of AmericaNational Institutes of Health. National Institute of Allergy and Infectious Diseases.Laboratory of Immunoregulation. Clinical and Molecular Retrovirology Section. Bethesda, MD, United States of AmericaNational Institute for Research in Tuberculosis. Chennai, IndiaNational Institutes of Health. National Institute of Allergy and Infectious Diseases.Laboratory of Immunoregulation. Clinical and Molecular Retrovirology Section. Bethesda, MD, United States of AmericaNational Institute for Research in Tuberculosis. Chennai, IndiaNational Institute for Research in Tuberculosis. Chennai, IndiaNational Institute for Research in Tuberculosis. Chennai, IndiaNational Institutes of Health. National Institute of Allergy and Infectious Diseases.Laboratory of Immunoregulation. Clinical and Molecular Retrovirology Section. Bethesda, MD, United States of AmericaNational Institutes of Health. National Institute of Allergy and Infectious Diseases.Laboratory of Immunoregulation. Clinical and Molecular Retrovirology Section. Bethesda, MD, United States of AmericaLaboratório de Imunopatologia, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, BrazilUniversity of Cape Town. Institute of Infectious Disease and Molecular Medicine, and Department of Medicine. Clinical Infectious Diseases Research Initiative. Cape Town, South AfricaUniversity of Cape Town. Institute of Infectious Disease and Molecular Medicine, and Department of Medicine. Clinical Infectious Diseases Research Initiative. Cape Town, South Africa/Imperial College London. Department of Medicine. London, United Kingdom/MRC National Institute for Medical Research. London, United KingdomUniversity of Cape Town. Institute of Infectious Disease and Molecular Medicine, and Department of Medicine. Clinical Infectious Diseases Research Initiative. Cape Town, South Africa/Imperial College London. Department of Medicine. London, United KingdomUniversity of Cape Town. Institute of Infectious Disease and Molecular Medicine, and Department of Medicine. Clinical Infectious Diseases Research Initiative. Cape Town, South AfricaNational Institutes of Health. National Institute of Allergy and Infectious Diseases. Biostatistics Research Branch. Bethesda, MD, United States of AmericaNational Institutes of Health. National Institute of Allergy and Infectious Diseases. T-Lymphocyte Biology Unit, Laboratory of Parasitic Diseases. Bethesda, MD, United States of AmericaNational Institute for Research in Tuberculosis. Chennai, IndiaNational Institutes of Health. National Institute of Allergy and Infectious Diseases. Laboratory of Parasitic Diseases. Immunobiology Section. Bethesda, MD, United States of AmericaNational Institutes of Health. National Institute of Allergy and Infectious Diseases.Laboratory of Immunoregulation. Clinical and Molecular Retrovirology Section. Bethesda, MD, United States of AmericaParadoxical tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) is an aberrant inflammatory response occurring in a subset of TB-HIV co-infected patients initiating anti-retroviral therapy (ART). Here, we examined monocyte activation by prospectively quantitating pro-inflammatory plasma markers and monocyte subsets in TB-HIV co-infected patients from a South Indian cohort at baseline and following ART initiation at the time of IRIS, or at equivalent time points in non-IRIS controls. Pro-inflammatory biomarkers of innate and myeloid cell activation were increased in plasma of IRIS patients pre-ART and at the time of IRIS; this association was confirmed in a second cohort in South Africa. Increased expression of these markers correlated with elevated antigen load as measured by higher sputum culture grade and shorter duration of anti-TB therapy. Phenotypic analysis revealed the frequency of CD14++CD16− monocytes was an independent predictor of TB-IRIS, and was closely associated with plasma levels of CRP, TNF, IL-6 and tissue factor during IRIS. In addition, production of inflammatory cytokines by monocytes was higher in IRIS patients compared to controls pre-ART. These data point to a major role of mycobacterial antigen load and myeloid cell hyperactivation in the pathogenesis of TB-IRIS, and implicate monocytes and monocyte-derived cytokines as potential targets for TB-IRIS prevention or treatment