A clinical prediction rule to identify patients with tuberculosis at high risk for HIV co-infection

Background & Objective: Many patients presenting with tuberculosis (TB) have underlying human immunodeficiency virus (HIV) co-infection. Routine HIV testing, however, is not a component of the national TB control programme in India. We sought to derive and validate a clinical prediction rule, based on clinical and laboratory parameters, to identify patients at high risk for HIV co-infection among those treated for active TB. Methods: Case records of adult patients with active TB treated between 1997 and 2003 at the All India Institute of Medical Sciences hospital, New Delhi were retrospectively reviewed. The data set was randomly split into a training set and a testing set. First a clinical prediction rule was derived by multivariable logistic regression on the training set and was subsequently validated on the testing set. Results: The study group comprised 1074 patients [training set 711 (66%), HIV co-infected 66 (9%); testing set 363 (34%), HIV co-infected 30 (8%)]. In the training set, male gender [odds ratio (95% CI) 5.31(1.52- 18.61)], axillary lymphadenopathy [9.71 (3.24-29.10)], anaemia [7.56 (2.48-23.05)], hypoalbuminaemia [3.67(1.31-10.26)], and reduced triceps skinfold thickness [2.91(0.95-8.89)] were independently associated with HIV co-infection. In the testing set, presence of any two of these five features was 94 per cent (95% CI 84-100%) sensitive and 54 per cent (49-60%) specific for predicting HIV co-infection; negative predictive value was 99 per cent (98-100%). Area under the receiver-operating characteristic curve was 0.93 (0.86-1.0) in the testing set. Interpretation & Conclusion: A simple clinical prediction rule based on clinical and laboratory parameters could be used to identify a subgroup of patients, among those treated for active TB in a hospital setting, for targeted HIV testing

Prevalence of extensively drug-resistant tuberculosis among patients with multidrug-resistant tuberculosis: a retrospective hospital-based study

Background & Objective: Extensively drug-resistant tuberculosis (XDR-TB) is a difficult-to-treat form of multidrug-resistant tuberculosis (MDR-TB). High rates of XDR-TB have been reported from India. We sought to ascertain the prevalence of XDR-TB among patients with MDR-TB treated at a tertiary care centre in New Delhi, India. Methods: Case records of patients treated for MDR-TB at the All India Institute of Medical Sciences hospital, New Delhi, between 1997 and 2003 were retrospectively reviewed. All patients underwent a pretreatment drug-susceptibility testing (DST) to first- as well as second-line drugs. XDR-TB was defined as TB caused by bacilli showing resistance to rifampicin and isoniazid in addition to any fluoroquinolone and to at least one of the three following injectable drugs: capreomycin, kanamycin, and amikacin. Results: A total of 211 laboratory-confirmed cases of MDR-TB were reviewed. The mean age of the patients was 33 ± 12 yr. Fifty one (24%) patients were females. All patients were sero-negative for human immunodeficiency virus infection. Five of the 211 MDR-TB patients had XDR-TB. The prevalence of XDR-TB was 2.4 per cent among MDR-TB patients. Interpretation & Conclusion: Our results showed that XDR-TB was rare among patients with MDR-TB treated between 1997 and 2003 at our centre. Unreported selection bias might have been responsible for the high prevalence of XDR-TB reported in previous hospital-based studies from India

Pattern & correlates of neurocognitive dysfunction in Asian Indian adults with severe obstructive sleep apnoea

Background & Objectives: No published data are available on neurocognitive dysfunction in Asian Indians with obstructive sleep apnoea (OSA). We therefore, studied the pattern and correlates of neurocognitive dysfunction in Indian adults with severe OSA. Methods: Fifty patients aged 25-65 yr with severe OSA (apnoea-hypopnoea index>30) and 25 age, sex, and education level-matched normal controls were studied. Both groups were administered a standardized battery of neurocognitive tests. Results: Patients with severe OSA had significantly impaired performance on tests of alertness, working memory, response inhibition, problem solving, and executive function. However, the difference in executive function between the groups disappeared after adjusting for delayed information processing. The test scores did not correlate with apnoea-hypopnoea index, arousal index, or Epworth sleepiness score. However, the percentage of time spent at <90 per cent oxygen saturation had a weak correlation with the number of stroop errors (Spearman's rho=0.64; P=0.033), number of trials required (rho=0.05; P=0.02), and perseverative errors on Wisconsin card sorting test (rho=0.36; P=0.02). Interpretation & Conclusions: Our results suggested that delayed information processing rather than impaired abstract thinking was probably the cause of impaired performance on composite tests of neurocognitive function in patients with severe OSA

Frequency of polymorphic variants in corticotropin releasing hormone receptor 1, glucocorticoid induced 1 and Fc fragment of IgE receptor II genes in healthy and asthmatic Tamilian population

Background: Asthma is a chronic airway inflammatory disease characterized by increased hyper-responsiveness and recurrent episodes of reversible obstructions. Asthma pharmacogenomic studies report significant association of single nucleotide polymorphisms (SNPs) in genes corticotropin releasing hormone receptor 1 (CRHR1), Fc fragment of IgE receptor II (FCER2) and glucocorticoid induced 1 (GLCCI1) with inhaled corticosteroid (ICS) response. The present study was aimed to establish the allelic and genotypic frequencies of polymorphisms rs242941, rs28364072 & rs37972 in CRHR1, FCER2 and GLCCI1 genes, respectively in Tamilian healthy population and asthma patients and to compare with established frequencies of global populations.Methods: The study groups consisted of healthy volunteers and persistent asthma patients who were drug naïve or without ICS treatment in the last ≥2 months, attending JIPMER hospital (n=111 and 78, respectively). SNP genotyping was done using PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) and real time-PCR methods.Results: Allelic and genotypic frequencies for all the studied variants found to be in hardy-weinberg equilibrium with minor allele frequencies (MAF) of rs 242941, rs 28364072 and rs 37972 at 0.51, 0.33 and 0.38, respectively, in healthy population. No significant difference in gene frequencies was obtained between healthy control and asthma patient groups. Significant difference in allele frequencies was observed between Tamilian healthy and specific global populations. West African frequency was found to be significantly different for all 3 SNPs (p<0.0001).Conclusions: MAF of rs 242941, rs 28364072 and rs 37972 were 0.51, 0.33 and 0.38, respectively in Tamilian population which were significantly different from various global populations. The frequency distribution found helps to further with ICS response association studies in larger cohorts of asthma patients

A prospective study of risk factor profile &amp; incidence of deep venous thrombosis among medically-ill hospitalized patients at a tertiary care hospital in Northern India

Background &amp; Objective: Hospitalization for medical-illness is associated with an increased risk of deep venous thrombosis (DVT). However, there are no published data from India addressing at this issue. We sought to study the risk factor profile and the incidence of DVT among hospitalized medically-ill patients, a tertiary care hospital in northern India. Methods: All adults admitted to the medical wards and intensive care unit with level 1 or 2 mobility over a period of two years (July 2006 to July 2008) at the All India Institute of Medical Sciences hospital, New Delhi, were prospectively studied. Patients having DVT at admission or an anticipated hospital stay less than 48 h were excluded. The presence of clinical risk factors for DVT was recorded and laboratory evaluation was done for hypercoagulable state. A routine surveillance venous compression Doppler ultrasonography was performed 12 ± 8 days after hospital admission. Results: Of the 163 patients, 77 (47%) had more than one risk factor for DVT. Five (3%) patients developed DVT; none of them had symptomatic DVT. None of these patients received anticoagulation prior to the development of DVT. The mean age of those who developed DVT was 40 ± 13 (25-50) yr; two of five were male. The incidence rate of DVT was 2.7 per 1000 person-days of hospital stay [95% confidence interval (CI): 0.87 to 6.27]. None of the factors was found to be significantly associated with the risk of DVT. Interpretation &amp; Conclusion: In our setting, although many hospitalized medically-ill patients had risk factors for DVT, the absolute risk of DVT was low compared to the western population but clearly elevated compared to non hospitalized patients. Large studies from India are required to confirm our findings

Proton magnetic resonance spectroscopy of brain in obstructive sleep apnoea in North Indian Asian subjects

Background &amp; Objectives: Repeated apnoeic/hypoapnoeic episodes during sleep may produce cerebral damage in patients with obstructive sleep apnoea (OSA). The aim of this study was to determine the absolute concentration of cerebral metabolites in apnoeic and non-apnoeic subjects from different regions of the brain to monitor the regional variation of cerebral metabolites. Methods: Absolute concentration of cerebral metabolites was determined by using early morning proton magnetic resonance spectroscopy (1H MRS) in 18 apnoeic patients with OSA (apnoeics) having apnoea/hypopnoea index (AHI) &gt; 5/h, while 32 were non-apnoeic subjects with AHI &lt; 5/h. Results: The absolute concentration of tNAA [(N-acetylaspartate (NAA)+N-acetylaspartylglutamate (NAAG)] was observed to be statistically significantly lower (P&lt;0.05) in apnoeics in the left temporal and left frontal gray regions compared to non-apnoeics. The Glx (glutamine, Gln + glutamate, Glu) resonance showed higher concentration (but not statistically significant) in the left temporal and left frontal regions of the brain in apnoeics compared to non-apnoeics. The absolute concentration of myo-inositol (mI) was significantly high (P&lt;0.03) in apnoeics in the occipital region compared to non-apnoeics. Interpretation &amp; Conclusions: Reduction in the absolute concentration of tNAA in apnoeics is suggestive of neuronal damage, probably caused by repeated apnoeic episodes in these patients. NAA showed negative correlation with AHI in the left frontal region, while Cho and mI were positively correlated in the occipital region and Glx showed positive correlation in the left temporal region of the brain. Overall, our results demonstrate that the variation in metabolites concentrations is not uniform across various regions of the brain studied in patients with OSA. Further studies with a large cohort of patients to substantiate these observations are required

Synthesis, spectral characterization and DNA/Protein binding studies on Cobalt (II) complex containing Mixed ligand Ethylenediamine with 2-Hydroxy-1-Naphthaldehyde

New cobalt (II) complex has been synthesized and characterized by elemental analysis, UV-Vis, FT-IR and thermal analysis. Binding of this Co (II) complex with calf thymus DNA was investigated by UV-Visible absorption, fluorescence spectroscopy techniques. The intrinsic binding constants&nbsp;Kb&nbsp;of complex with CT-DNA obtained from UV-Vis absorption studies were 4.43 × 105M-1. Further, the&nbsp;in vitro&nbsp;cytotoxic effect of the complexes examined on cancerous cell line, such as human breast cancer cells (MCF-7).&nbsp

HIV-TB co-infection: Epidemiology, Diagnosis &amp; Management

HIV/AIDS pandemic has caused a resurgence of TB, resulting in increased morbidity and mortality worldwide. HIV and Mycobacterium tuberculosis have a synergistic interaction; each accentuates progression of the other. Clinical presentation of TB in early HIV infection resembles that observed in immunocompetent persons. In late HIV infection, however, TB is often atypical in presentation, frequently causing extrapulmonary disease. These factors coupled with low sputum smear-positivity, often result in a delayed diagnosis. HIV-infected patients respond well to the standard 6-month antituberculosis treatment regimens, although mortality is high. Antituberculosis treatment is complicated by frequent drug-interactions with highly active antiretroviral therapy (HAART) and adverse drug reactions are more common among HIV-infected patients. Guidelines for the management of patients co-infected with HIV and TB are still evolving. Timely institution of antituberculosis treatment using the directly observed treatment, short-course (DOTS) strategy and HAART markedly improves the outcome of HIV-infected patients with TB

Determinants of hospital mortality of HIV infected patients from north India

A majority of the HIV infected population lives in developing nations. Most patients require hospitalisation for management of opportunistic infections (OIs) sometime during the course of their illness. Locally endemic infections and underlying malnutrition tend to influence the manifestations and course of the disease. However, there is paucity of data on pattern of disease and determinants of immediate outcome of such patients from Indian subcontinent

An elderly man with multiorgan involvement – a diagnostic challenge

The diagnostic considerations in acute onset illness with multiorgan involvement typically include infectious diseases and at times, systemic vasculitides. We report an elderly man that presented with transient heart block, renal failure, and bicytopenia. Following a short-lasting initial clinical improvement, he developed a nasal mass, cutaneous nodules, and pericardial effusion in quick succession and succumbed to his illness. We made a final diagnosis of extranodal peripheral T-cell non-Hodgkin’s lymphoma. This patient highlights the importance of considering aggressive lymphoma as a differential in patients presenting with unexplained multiorgan involvement