Scrofula Revisited: An Update on the Diagnosis and Management of Tuberculosis of Superficial Lymphnodes

Lymphnode tuberculosis is a disease of great antiquity. It is the commonest form of extra-pulmonary tuberculosis, and is probably the commonest cause of chronic lymphadenitis in children. Even after the advent of effective chemotherapy for tuberculosis, it still poses considerable problems in diagnosis and management. The disease usually presents as a painless lymphadenopathy of the superficial lymphnodes of insidious onset, which may proceed to abscess and sinus formation if neglected. Cervical nodes are most commonly affected, but multiple node involvement is common. Differential diagnosis include other infections, neoplasia, congenital conditions in the head and neck and rarely, drug reactions. Diagnosis, whenever feasible, should be made on the basis of histological evidence after lymphnode biopsy. Diagnosis, made on clinical grounds has poor specificity and will result in a great degree of over diagnosis. Recently, the role of fine needle aspiration cytology as an initial screening procedure has been recognized. The Tuberculosis Research Centre carried out the first clinical trial which established the efficacy of short course chemotherapy in the treatment of childhood lymphnode tuberculosis. In 168 children with biopsy confirmed lymphnode tuberculosis treated with an intermittent six month regimen, the cure rate after five years was 95%. The Revised National Tuberculosis Control Programme recommends that patients with lymphnode tuberculosis (Category 3) should be treated with rifampicin and isoniazid three times a week for six months, with pyrazinamide for the first two months

Current trends in chemotherapy of tuberculosis

After treptomycin, which heralded the era of antibacterial chemotherapy for tuberculosis (TB), many important advances have made available treatment regimens that are almost 100 per cent curative. Randomised clinical trials by the Tuberculosis Research Centre, in Chennai and British Medical Research Council in East Africa and in the Far East have helped to establish many of the principles of antituberculosis chemotherapy. With successes have also come fresh challenges. Mycobacterium tuberculosis becomes rapidly resistant to the drugs used against it and in the last decade, the HIV epidemic has had an adverse impact on the global epidemiology of tuberculosis, with many countries in Sub-Saharan Africa experiencing a 2-3 fold increase in their TB burden. While the currently recommended treatment regimens are very effective, they have failed to control the burden of TB in the developing countries due to less than satisfactory implementation of the control programmes. Faced with the dual threat of multidrug resistant TB and the HIV/facilitated increase in TB, the WHO has instituted a Global TB Control Programme based on the directly observed treatment shortcourse (DOTS) strategy. Much of the principles of this strategy have come out of research in India. As part of this strategy, the Government of India is implementing a Revised National Tuberculosis Control Programme (RNTCP). Under the RNTCP standardized treatment regimens are prescribed for different treatment categories. Already more than 80 per cent of the population is covered by this Programme and full coverage is slated for 2005. Meanwhile, fresh research is ongoing to shorten treatment duration, a measure that should greatly aid TB control

Integrated fuzzy and phase shift controller for output step voltage control in multilevel inverter with reduced switch count

A modified multilevel inverter with a configurable level generation is proposed in this paper. The MLI is composed of a modified boost converter at the front end followed by a level generation circuit and a H-bridge configuration. The front-end converter is biased with a PV source with a Hybrid boost resonant converter. The switches are triggered out of phase through a MPP tracker which uses Fractional INC MPPT. The secondary side of the circuit is composed of a derived voltage doubler along with the voltage regulator. The output of the doubler is regulated through a level converter which integrates a fuzzy controller and a phase shift controller. The modified multilevel inverter uses a low-voltage PV source as input and generates a variable-step multilevel output voltage with lower harmonic distortion and it is suitable for low-power PV applications

Efficient Optimization for Rank-based Loss Functions

The accuracy of information retrieval systems is often measured using complex loss functions such as the average precision (AP) or the normalized discounted cumulative gain (NDCG). Given a set of positive and negative samples, the parameters of a retrieval system can be estimated by minimizing these loss functions. However, the non-differentiability and non-decomposability of these loss functions does not allow for simple gradient based optimization algorithms. This issue is generally circumvented by either optimizing a structured hinge-loss upper bound to the loss function or by using asymptotic methods like the direct-loss minimization framework. Yet, the high computational complexity of loss-augmented inference, which is necessary for both the frameworks, prohibits its use in large training data sets. To alleviate this deficiency, we present a novel quicksort flavored algorithm for a large class of non-decomposable loss functions. We provide a complete characterization of the loss functions that are amenable to our algorithm, and show that it includes both AP and NDCG based loss functions. Furthermore, we prove that no comparison based algorithm can improve upon the computational complexity of our approach asymptotically. We demonstrate the effectiveness of our approach in the context of optimizing the structured hinge loss upper bound of AP and NDCG loss for learning models for a variety of vision tasks. We show that our approach provides significantly better results than simpler decomposable loss functions, while requiring a comparable training time.Comment: 15 pages, 2 figure

Rifampicin-induced renal toxicity during retreatment of patients with pulmonary tuberculosis

Rifampicin is a crucial component of treatment regimens for tuberculosis and has been in use since the early 1970’s. It is usually considered safe. Rarely life-threatening complications like acute renal failure or acute thrombocytopaenia may manifest during treatment with rifampicin. In our experience at the Tuberculosis Research Centre of treating more than 8000 pulmonary and extrapulmonary tuberculosis patients with rifampicin-containing regimens over the last 30 years, we are reporting 3 cases of probably rifampicininduced acute renal failure. Despite extreme therapeutic safety of this drug the clinician must be aware of this rare complication, which if detected early is completely reversible

A study on Olfactory dysfunction in various subtypes of Parkinsonism.

Impairment of olfaction in Parkinson’s disease (PD) was first recognized in the 1970s, but it is mainly in the past decade that insights into its pathogenic basis and specificity have occurred. Various degrees of olfactory dysfunction occur in some other Parkinsonian syndromes, but a marked reduction in the sense of smell remains a highly characteristic feature of PD. The early or pre clinical detection of Parkinson’s disease is increasingly recognized as an area in which olfactory testing may be of value. Research findings have confirmed a role for olfactory testing in the differential diagnosis movement disorders, and suggest that this approach is currently underused in clinical practice. Validated test batteries are now available that may prove to be of practical use in the differential diagnosis of Parkinsonian syndromes and indeterminate tremors. Since the pioneering work of Valentin (1848), who determined the lowest concentration of an odorous gas that a subject could perceive, a plethora of nominally distinct olfactory tests has been developed, including tests of sensitivity(e.g., odor detection and recognition thresholds),discrimination, identification, memory and suprathreshold intensity. Katerina Markopoulou [et al.], Doty [et al.] &Stern et al have extensively studied olfactory functions in various types of parkinsonian patients and they have found out the usefulness of doing olfactory function tests in he diagnosis of various subtypes of parkinsonism. Doty [et al.] have developed the olfactory function test kit, the University of Pennsylvania Smell Identification Test (UPSIT) in 1988 and have researched in detail about the olfactory impairment in various neurodegenerative diseases like parkinsonism, various types of dementia and hereditary ataxias. Significant olfactory impairment is present even in early stages of idiopathic parkinsonism 1) Odour identification and odour discrimination are both impaired and odour threshold is elevated in idiopathic parkinsonism. 2) Olfactory impairment is severe in later stages of Idiopathic parkinsonism. 3) The severity of olfactory impairment is not dependent on the duration of illness but dependant on the disease stage. 4) In doubtful early clinical presentation of parkinsonism, presence of significant olfactory impairment suggests the possibility of Idiopathic parkinsonism. 5) Dopa therapy does not alter the presence or severity of olfactory impairment in various subtypes of parkinsonism. 6) In Familial parkinsonism, olfactory functions are impaired. 7) In Multi system atrophy, olfactory functions are impaired mildly in late stages of illness. In Progressive supranuclear palsy, Vascular parkinsonism, Spinocerebellar ataxia presenting with parkinsonism, olfactory functions are not impaired. 8) Olfactory function tests can be used as an easy bedside supplementary clinical tool in the diagnosis of various subtypes of parkinsonism

Stock assessment and exploitation status of Lethrinus nebulosus (Lacepede, 1802) exploited off Thoothukudi coast, Tamil Nadu, India

825-828Lethrinus nebulosus (Lacepede, 1802), although a commercially important fish species, has not been studied (population studies) in Thoothukudi coast of Tamil Nadu, India. Research on recruitment pattern, virtual population analysis and exploitation status of L. nebulosus off Thoothukudi coast was conducted from July 2011 to June 2012. During the study period, 4590 specimens of L. nebulosus were collected for studying the above said parameters by using FiSAT software. Recruitment pattern of the species expressed continuously with one peak each in April and August. The fishing pressure occurred more in the length group of 43 cm onwards. The results revealed that the total annual catch of 7566.28 tonnes was obtained from 52210 boat days. The maximum catch per unit was during December and January. The maximum sustainable yield (MSY) was estimated at 12203.68 tonnes. The discrepancy between MSY and annual catch was 4664.399. The present fishing effort may be increased to 61.29% to achieve MSY with 19310 boat days. It was revealed that L. nebulosus is underexploited in this region

Persistng alveolitis in miliary tuberculosis despite treatment with short-course chemotherapy

Bronchoalveolar lavages in two patients with miliary tuberculosis have shown lymphocytic alveolitis. A 6-month regimen with an initial intensive 2- month phase resulted in remarkable clinical and radiographic improvement in both. However, bronchoalveolar lavage following treatment has shown that there was a persistence of lymphocytic alveolitis, though with reduced intensity. The significance of the persisting alveolitis, despite treatment, is not known at present. There is also a suggestion that compartment-alisation of lymphocytes may occur in miliary tuberculosis of the lung