Efficacy of cartridge based nucleic acid amplification test to diagnose tubercular pleural effusion

Background: Tuberculosis (TB) remains a major health concern worldwide. Extra pulmonary tuberculosis (EPTB) in India accounts up to 20% of all tuberculosis cases. EPTB often remains undetected and untreated due to variable clinical presentation and lack of diagnostic means. Early detection of TB and drug resistance is important in the management of TB. The aim of present study was to assess the role of cartridge based nucleic acid amplification test in rapid diagnosis of tubercular pleural effusion.Methods: The study screened 211 symptomatic patients. The patients with clinical and radiological presentations suggestive of pleural effusion were analyzed using light’s criteria to make a diagnosis of tubercular pleural effusion; these patients submitted pleural fluid sample for smear microscopy after concentration for presence of acid fast bacilli under light emitting diode based fluorescent microscopy (LED-FM), and for cartridge based nucleic acid amplification test (CBNAAT) using GX4 GeneXpert MTB/Rif test system. The results were statistically analyzed.Results: Out of patients who had pleural effusion without any pulmonary tuberculosis, pleural fluid biochemistry analyses using light’s criteria detected 20 tubercular pleural effusions (11 male and 9 female). Seven patients had history of extrapulmonary tuberculosis in past, all of them received treatment with effective treatment compliance in past. Pleural fluid microscopic examination for detection of acid-fast bacilli was not able to detect acid-fast bacilli in any of these 20 patients diagnosed with tubercular pleural effusion. CBNAAT could authentically detect M. tuberculosis in 5/20 patients diagnosed with tubercular pleural effusion. There was no impact of gender, previous history of tuberculosis, history of anti-tuberculosis treatment (ATT) intake, or compliance to ATT on CBNAAT status in this study.Conclusions: CBNAAT has the potential to significantly authenticate tubercular etiology in some of smear-negative pleural fluid specimens with rapid test results. It has an added advantage to assess the rifampicin drug sensitivity. All this contribute hugely in diagnosis and management of tubercular pleural effusion

A concurrent parallel study to compare the efficacy and safety of oral iron chelators, defrasirox and defriprone in patients of beta thalassaemia major

Background: This study was planned to evaluate all the cases of β thalassaemia major, already receiving one of the oral iron chelators for a comparison among the efficacy, safety and economy of deferasirox and deferiprone to establish the better option in an Indian scenario.Methods: We identified two groups of patients: 38 treated with deferasirox and 35 treated with deferiprone. Laboratory parameters such as serum ferritin, creatinine, SGPT, Hb, CBC and urine were recorded at the time of inclusion and at 1, 3 and 6 months after the inclusion. The primary outcome variable was serum Ferritin level at the start and at the end of study. Serum ferritin level was carried out by microparticle enzyme linked immunoassay.Results: Before the study, the mean hemoglobin level was 7.32±1.50mg/dL ranged from 4 to 10.8 in deferasirox group and 7.54±1.15mg/dL ranged from 5.5 to 8.8 in deferiprone group. At the time of inclusion, study population was characterized by a mean serum ferritin value of 4735.11±450.01 SE in deferasirox and 4315.97±340.75 SE in deferiprone group. After one month the mean serum ferritin increases to 4578.66±371.96 in deferasirox and 4388.82±316.16 in deferiprone group. After three month the mean serum ferritin reduces to 4295.60±377.37 in deferasirox and 3988.88±349.84 in Deferiprone group.Conclusions: Thus, we conclude that deferasirox and deferiprone are well tolerated, have few adverse effects and almost have a comparable effect in lowering of the patient's serum ferritin level. Deferiprone is more cost effective but needs a strict control on compliance owing to requirement in three divided doses per day

A study on pattern of initial and acquired drug resistance for isoniazid and rifampicin in A.F.B. positive sputum smears of pulmonary tuberculosis patients at a Medical College in North Eastern Uttar Pradesh, India

Background: Despite availability of good quality anti-tubercular drugs and its administration through Directly Observed Therapy Short Course (DOTS) strategy of Revised National Tuberculosis Control Programme (RNTCP), tuberculosis remains a major cause of morbidity and mortality in India. The emergence of drug resistance necessitates the timely detection of susceptibility of anti-TB drugs. This can help in appropriate modification in treatment strategies.Methods: A total of 50 patients of pulmonary TB with AFB positive sputum smears attending the OPD of TB and Chest department of B.R.D. Medical College, Gorakhpur were included. Patients were grouped based on history into new (cat-I) and previously treated patients (cat-II). Cat-II patients were further subdivided into defaulter, treatment failure and relapse groups. The culture and DST of AFB positive sputum smears of these patients was done in VersaTREK™®. At the end of study, patients were grouped according to age, sex, category and drug sensitivity pattern for Isoniazid (INH) and Rifampicin (RIF) viz mono resistance (resistance to either INH or RIF) or multi drug resistance (M.D.R.) and the resultant data were analysed.Results: Of the total 50 patients included in this study, 18 (36%) patients were sensitive to both the drugs INH and RIF, of which 11 (22%) were of cat-I and 7 (14%) of category-II. Twenty-two (44%) patients were resistant to INH only of which 8 (16%) were of cat-I and 14 (28%) of cat-II. One (2%) case of cat-I showed resistance to RIF only, while M.D.R. type of resistance is seen in 1 (2%) patient of cat-I and 8 (16%) patients of cat-II. Pattern of resistance to both INH and RIF together (i.e. M.D.R. type) showed significant difference between cat-I and cat-II.Conclusions: Most of the patients showing resistance to INH, RIF or both INH and RIF (M.D.R.) belonged to category-II (previously treated) patients

Models for crop parameters due to normal load of tractor and number of passes

Multiple passage of power machinery system particularly heavy machines with high wheel loads creates sub-soil compaction which results into increasing in soil bulk density & penetration resistance and reduction in water infiltration, crop germination, growth as well as yield. This study was conducted to determine the different crop growth and crop yield models could be developed to predict growth as well as yield of crop considering normal load and number of passes of tractor. A 36-plot experiment consisting of 12 treatments with three replications were set up using a randomized block design in a uniform field of Division of Agricultural Engineering, IARI, New Delhi during the period of 2007-08. Prediction models were developed between compaction parameters (normal loads and number of passes) and crop parameters like (a) plant height, (b) number of plants per meter, and (c) yield. In, other models a relation between crop yield and sub-soil bulk density and penetration resistance were established and their sensitivity analysis was done for developed models. The best fit model for plant height and number of plants per meter row was quadratic. However, the best fit model between yield vs soil bulk density and yield vs penetration resistance was exponential and quadratic, respectively. The developed model is not more sensitive for number of plants per meter row and yield vs soil bulk density. However, model was more sensitive to plant height model and yield vs soil penetration resistance is more sensitive

Prevalence of hypertension and its association with anthropometric parameters in adult population of Raipur city, Chhattisgarh, India

Background: Obesity is now an important emerging public health problem in India. It is one of the major risk factor for hypertension. Overweight persons have two to six fold increase in the risk of developing hypertension. This study was carried out with objective to find out prevalence of Hypertension and assess its association with four obesity-related indices- body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR).Methods: A cross-sectional community-based study was done among 640 study subjects of age group 25-59 years during July 2015 to June 2016. Multi stage random sampling method was used. Data collection was done using WHO STEPS instrument V 3.1. Privacy and confidentiality of data was maintained. Data was entered in the Microsoft excel, collected data was checked for its completeness and correctness before data analysis with the help of PSPP software.Results: Prevalence of hypertension among study subjects was found to be 22.19% (142 out of 640).With respect to body mass index, waist circumference, waist hip ratio and waist height ratio, 4.38%, 64.35%, 85.33%, 76.2% were found to be obese respectively. Hypertension was strongly associated with BMI (p<0.001), waist circumference (p<0.001), waist hip ratio (p<0.05), waist height ratio (p<0.05). Out of the four anthropometric variables waist hip ratio (WHR) was most strongly associated with hypertension (β=420.236, p=0.007).Conclusions: The study shows a rising burden of hypertension among study population. As WHR is the best indicator for measuring obesity, so measurement of WHR should be made compulsory in healthy life style clinics along with other parameters

Making of a unique birth control vaccine against hCG with additional potential of therapy of advanced stage cancers and prevention of obesity and insulin resistance

Reviewed is the work which led to the development of a unique vaccine that prevents pregnancy in sexually active women without impairment of ovulation and block of their making normally their sex steroid hormones. Being given that hCG is not expressed by non-pregnant females, immunization with the vaccine is devoid of any crossreaction with any tissue of the body. It is totally reversible and women regained fertility on decline of antibodies. A recombinant vaccine has been developed which is highly immunogenic in mice. It is undergoing extensive toxicology under GLP conditions in rodents and a primate species, the marmosets, before resumption of clinical trials. Ectopic expression of hCG or its subunits takes place in a variety of cancers, particularly at advanced stage with adverse survival and poor prognosis. Anti-hCG antibodies exercise therapeutic action against such cancers as indicated by in vitro culture and in vivo studies in nude mice. Transgenic hCG β mice put on weight and manifest insulin resistance. Immunization of these mice with the recombinant hCG β-LTB vaccine prevents obesity and insulin resistance.Fil: Talwar, G. P.. Talwar Research Foundation; IndiaFil: Rulli, Susana Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); ArgentinaFil: Vyas, Hemant. Harvard Medical School; Estados UnidosFil: Purswani, Shilpi. Talwar Research Foundation; IndiaFil: Kabeer, Rafi Shiraz. Talwar Research Foundation; IndiaFil: Chopra, Prem. Sir Ganga Ram Hospital; IndiaFil: Singh, Priyanka . Talwar Research Foundation; IndiaFil: Atrey, Nishu. Talwar Research Foundation; IndiaFil: Nand, Kripa. Talwar Research Foundation; IndiaFil: Gupta, Jagdish C.. Talwar Research Foundation; Indi

Variations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis.

BACKGROUND: COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic. METHODS: Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income. FINDINGS: Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88-2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69-19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status. INTERPRETATION: The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries. FUNDING: Funding for this study was provided by the Canadian Institutes of Health Research and the International Development Research Centre

Household, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study

Introduction. Switchingfrom polluting (e.g. wood, crop waste, coal)to clean (e.g. gas, electricity) cooking fuels can reduce household air pollution exposures and climate-forcing emissions.While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. Methods.We examined longitudinal survey data from 24 172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology study.We assessed household-level primary cooking fuel switching during a median of 10 years offollow up (∼2005–2015).We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. Results. One-half of study households(12 369)reported changing their primary cookingfuels between baseline andfollow up surveys. Of these, 61% (7582) switchedfrom polluting (wood, dung, agricultural waste, charcoal, coal, kerosene)to clean (gas, electricity)fuels, 26% (3109)switched between different polluting fuels, 10% (1164)switched from clean to polluting fuels and 3% (522)switched between different clean fuels