Annual risk of tuberculous infection in the northern zone of India

OBJECTIVE: To estimate the annual risk of infection with tubercle bacilli in the northern zone of India. METHODS: A community-based cross-sectional tuberculin survey was conducted among children aged 1-9 years who lived in a sample of villages and urban blocks of six selected districts in a defined north zone of India. A two-stage cluster sampling method was used to select rural and urban clusters. A total of 48 624 children in 598 clusters were subjected to tuberculin testing with one tuberculin unit (1 TU) of PPD RT23 stabilized with Tween 80. The maximum transverse diameter of induration was measured about 72 hours after the test. FINDINGS: Among the 48 624 test-read children, 22 064 (45.4%) had a bacille Calmette-Guérin (BCG) scar. On the basis of the frequency distribution of tuberculin reaction size among 25 816 children without a BCG scar, the prevalence of infection with tubercle bacilli was estimated as 10.3%. The annual risk of infection was computed as 1.9%. The proportion of infected children was significantly higher in urban than rural areas. CONCLUSION: The high rate of tuberculous infection in the north zone of India suggests the need for further intensification of tuberculosis control efforts on a sustained and long-term basis

Effects of immunomodulatory drugs on depressive symptoms: A mega-analysis of randomized, placebo-controlled clinical trials in inflammatory disorders

Activation of the innate immune system is commonly associated with depression. Immunomodulatory drugs may have efficacy for depressive symptoms that are co-morbidly associated with inflammatory disorders. We report a large-scale re-analysis by standardized procedures (mega-analysis) of patient-level data combined from 18 randomized clinical trials conducted by Janssen or GlaxoSmithKline for one of nine disorders (N = 10,743 participants). Core depressive symptoms (low mood, anhedonia) were measured by the Short Form Survey (SF-36) or the Hospital Anxiety and Depression Scale (HADS), and participants were stratified into high (N = 1921) versus low-depressive strata based on baseline ratings. Placebo-controlled change from baseline after 4\u201316 weeks of treatment was estimated by the standardized mean difference (SMD) over all trials and for each subgroup of trials targeting one of 7 mechanisms (IL-6, TNF-\u3b1, IL-12/23, CD20, COX2, BL\u3b3S, p38/MAPK14). Patients in the high depressive stratum showed modest but significant effects on core depressive symptoms (SMD = 0.29, 95% CI [0.12\u20130.45]) and related SF-36 measures of mental health and vitality. Anti-IL-6 antibodies (SMD = 0.8, 95% CI [0.20\u20131.41]) and an anti-IL-12/23 antibody (SMD = 0.48, 95% CI [0.26\u20130.70]) had larger effects on depressive symptoms than other drug classes. Adjustments for physical health outcome marginally attenuated the average treatment effect on depressive symptoms (SMD = 0.20, 95% CI: 0.06\u20130.35), but more strongly attenuated effects on mental health and vitality. Effects of anti-IL-12/23 remained significant and anti-IL-6 antibodies became a trend after controlling for physical response to treatment. Novel immune-therapeutics can produce antidepressant effects in depressed patients with primary inflammatory disorders that are not entirely explained by treatment-related changes in physical health

Human health risk assessment for aluminium, aluminium oxide, and aluminium hydroxide.

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