Endobronchial ultrasound sonographic characteristics of mediastinal lymph node in evaluation of lung cancer

Endobronchial ultrasound (EBUS) and contrast enhanced computed tomography (CECT) are essential components of lung cancer evaluation. Features of mediastinal lymph nodes on EBUS and CECT can help in predicting metastatic disease. Clinical, radiological and EBUS data of patients with clinico-radiological suspicion of lung cancer and have undergone EBUS with no trans-bronchial needle aspiration (TBNA) or nonyielding EBUS-TBNA were retrospectively collected from medical records. EBUS features of lymph nodes for metastatic disease [Size >1cm, round shape, heterogeneous echo-texture, indistinct margin, coagulation necrosis(CN), absence of central hilar structures (CHS) and grade II-III vascularity] were noted. CECT findings were noted from CECT films and reports to analyse and compare with EBUS findings. Scoring criteria of EBUS sonographic characteristics from previous studies for discriminating benign and malignant lymph-nodes were also assessed for possible prediction. Thirty-one (31) patients [male=18 (58.1%), female=13 (41.9); age (mean±SD) =52.9±15.7 years] with CECT findings suggesting lung cancer were studied. EBUS showed mediastinal lymphadenopathy at 82 lymph node station in 29 patients. Size>1cm, round shape, heterogeneous echo-texture, distinct margin, CN, absence of CHS and grade II-III vascularity at 33 (40%), 28 (34%), 31 (38%), 55 (67%), 3 (4%), 77 (94%) and 6 (7.3%) lymph nodes, respectively. Malignant or benign status assigned to lymph nodes using different scoring criteria were highly discordant. Compared to EBUS, CECT revealed abnormal mediastinal lymph nodes (LN) in significantly less number of patients [21( 67.7%) vs 29 (93.5%), p=0.01] involving less number of lymph node stations (LNS) [(37 vs 82, p<0.001]. Lymphadenopathy frequency at different LNS on EBUS and CECT showed a weak positive but significant correlation (r=0.356; p=0.0426). EBUS characteristics and related scores have limited accuracy in differentiating benign and malignant nodes. CECT underestimates lymph-adenopathy in comparison to EBUS. Larger prospective study of EBUS features with cyto/histo-pathology correlation may elicit its clinical significance and help to create a better and composite scoring criteria

Effectiveness of pneumococcal vaccine in patients with chronic obstructive pulmonary disease (COPD)

Background: Pneumococcal infections are frequent cause chronic obstructive pulmonary disease (COPD) exacerbations and though various guidelines recommend the use of pneumococcal vaccines routinely to COPD patients to prevent exacerbations, the data regarding the effectiveness of this vaccine is limited and contradictory. Aims and objectives was to compare the frequency of exacerbations in patients of COPD before and after administration of pneumococcal vaccine and to find out the frequency of exacerbations in patients of COPD who are vaccinated against those who are not vaccinated as well as to study the effectiveness of pneumococcal vaccine will be analysed in respect to age, sex, Body mass index (BMI), severity of disease and other co-morbidity.Methods: This was a randomized non-placebo controlled trial, conducted from September 2013 to August 2015 including total of 150 patients divided into two groups: cases and controls. The cases were administered PPV23 along with specific medication and were followed up at intervals of 3months. Exacerbations were identified based on ANTHONISEN’S criteria. Number of exacerbations in each follow-up was recorded. The data from both the groups were analysed statistically.Results: After 1 year of follow up, there was significant reduction in mean number of exacerbations (p value <0.0001) in patients with COPD in vaccinated group. PPV23 was more effective in patients with COPD of less than 65 years of age and with severe and/or very severe airflow obstruction and also in patients with lower BMI (≤21kg/m2), females and with co-morbidities.Conclusions: This is an important strategy to prevent the repeated exacerbations in COPD patients particularly in severe and very severe disease groups and we support the recommendation that pneumococcal vaccine should be administered to these patients

Foot-and-mouth disease in elephants in Kerala state of India during 2013

Foot-and-mouth disease (FMD) is a highly contagious acute vesicular disease of the cloven-hoofed animals including cattle, buffalo, sheep, goats, pigs along with more than 70 wildlife species. During the year 2013, FMD outbreaks were recorded in the southern peninsular India comprising the states of Karnataka, Tamil Nadu, Kerala and Andhra Pradesh. Besides domestic livestock, captive elephants in Kerala were also affected by FMD. The suspected FMD outbreak in six elephants occurred in Neendoor of Kottayam district, Guruvayoor and Thrissur of Thrissur district in Kerala during November - December 2013. The first clinical signs recorded in the elephants were loss of appetite and lameness with mild fever. Frank lesions were grossly evident on the tongue, palate and inner mucous membrane of trunk with exudates from nostrils. There was copious salivation often appeared to be drooling. Severe lameness led to recumbency. Erosive lesions were also noticed in foot-slipper. The foot with blisters turned to open sores making the animals difficult to stand and walk. Clinical samples (foot/oral/tongue/trunk/nasal epithelium) from the FMD-suspected elephants were collected in 50% phosphate buffered saline/glycerol medium (pH-7.5). Supernatants of the homogenized clinical samples were used in a serotype differentiating antigen detection ELISA and samples found negative were further subjected to multiplex PCR. All clinical samples were found positive for FMD virus (FMDV) serotype O in antigen detection ELISA and in mPCR. The VP1 region based phylogenetic analysis indicated the involvement of O/Middle East-South Asia/Ind2001d sub-lineage of FMDV serotype O, which was also responsible for severe disease in domestic livestock in southern states of India during 2013

Diagnosis and treatment of pulmonary tuberculosis in one day : Way forward for END TB Strategy 2015

Background: According to Revised National Tuberculosis Control Program (RNTCP), diagnosis of pulmonary tuberculosis (TB) in India requires examination of two sputum samples collected over 2 days, that is, “spot” and next day “morning” samples. Objective: To assess the feasibility of diagnosing pulmonary TB by examining two spot sputum samples in 1 day and to compare this approach with the current RNTCP protocol. Materials and Method: A total of 375 subjects having cough >2 weeks were enrolled into the study. Three sputum samples were collected from each of the study participant; first spot (S1), second extra-spot (S2) sample 1 h after collection of the first sample, and third morning (M) sample collected next day morning. These specimens were subjected to standard sputum smear microscopy for acid-fast bacilli as per RNTCP guidelines. For 1-day protocol, results of “S1 and S2” samples and for 2-day protocol results of “S1 and M” samples were considered. Results: The number of sputum-positive pulmonary TB cases diagnosed with standard 2-day protocol was 119, whereas the experimental 1-day protocol diagnosed 120 cases (P = 0.7). Comparing with standard 2-day protocol, this new 1-day protocol had sensitivity 98.32%, specificity 100%, positive predictive value 100%, and negative predictive value 99.17%. Conclusion: Single-day method can be adopted as the standard diagnostic approach for pulmonary TB after large-scale multicenter randomized controlled trials

Alternate vaccine strain selection in the wake of emerging foot-and-mouth disease virus serotype A antigenic variants in India

Not Available‘National foot-and-mouth disease (FMD) control programme’ is being implemented in India and therefore predicting vaccine match is a key surveillance task. Recently, a considerable proportion of field viruses (75.6%) showed antigenic drift from the existing serotype A vaccine strain A IND 40/2000 necessitating search for an alternate strain. Here, antigenic relationship (‘r1’ value) of 87 field viruses with each of the 8 candidate strains was estimated by virus neutralization test. A IND 27/2011 strain emerged to be the one with the widest spectrum of antigenic coverage showing ‘r1’ value of more than 0.3 with 81.6% of field strains. It achieved a reasonably high titre of log10 7.5 TCID50/ml in BHK-21 suspension cell which was accompanied by positive charge gaining substitutions (E82–K and E131–K in VP2) thought to have adaptive significance. However, potency trial remains to be conducted before A IND 27/2011 finds a place in the vaccine formulation.Not Availabl

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Not AvailableNational foot-and-mouth disease (FMD) control programme’ is being implemented in India and therefore predicting vaccine match is a key surveillance task. Recently, a considerable proportion of field viruses (75.6%) showed antigenic drift from the existing serotype A vaccine strain A IND 40/2000 necessitating search for an alternate strain. Here, antigenic relationship (‘r1’ value) of 87 field viruses with each of the 8 candidate strains was estimated by virus neutralization test. A IND 27/2011 strain emerged to be the one with the widest spectrum of antigenic coverage showing ‘r1’ value of more than 0.3 with 81.6% of field strains. It achieved a reasonably high titre of log10 7.5 TCID50/ml in BHK-21 suspension cell which was accompanied by positive charge gaining substitutions (E82–K and E131–K in VP2) thought to have adaptive significance. However, potency trial remains to be conducted before A IND 27/2011 finds a place in the vaccine formulation.Not Availabl

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Not AvailableIn this study we describe the adaptive changes fixed on the capsid of several foot-and-mouth disease virus serotype A strains during propagation in cell monolayers. Viruses passaged extensively in three cell lines (BHK-21, LFBK and IB-RS-2) consistently gained positively charged amino acids in the putative heparin-sulfate-binding pocket (VP2 βE-βF loop, VP1 C-terminus and VP3 β-B knob) surrounding the fivefold symmetry axis (VP1 βF-βG loop) and at other discrete sites on the capsid (VP3 βG-βH loop, VP1 C-terminus, VP2 βC strand and VP1 βG-βH loop). A lysine insertion in the VP1 βF-βG loop of two of the BHK-21-adapted viruses supports the biological advantage of positively charged residues acquired in cell culture. The charge transitions occurred irrespective of cell line, suggesting their possible role in ionic interaction with ubiquitous negatively charged cell-surface molecules such as glycosaminoglycans (GAG). This was supported by the ability of the cell-culture-adapted variants to replicate in the integrin-deficient, GAG-positive CHO-K1 cells and their superior fitness in competition assays compared with the lower passage viruses with WT genotypes. Substitutions fixed in the VP1 βG-βH loop (-3, -2 and +2 'RGD' positions) or in the structural element known to be juxtaposed against that loop (VP1 βB-βC loop) suggest their possible role in modulating the efficiency and specificity of interaction of the 'RGD' motif with αv-integrin receptors. The nature and location of the substitutions described in this study could be applied in the rapid cell culture adaptation of viral strains for vaccine production.Not Availabl

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Not AvailableFoot-and-mouth disease (FMD) is endemic in India, where circulation of serotypes O, A and Asia1 is frequent. Here, we provide an epidemiological assessment of the ongoing mass vaccination programs in regard to post-vaccination monitoring and outbreak occurrence. The objective of this study was assessing the contribution of mass vaccination campaigns in reducing the risk of FMD in India from 2008 to 2016 by evaluating sero-monitoring data and modelling the spatiotemporal dynamics of reported outbreaks. Through analyzing antibody titre data from >1 million animals sampled as part of pre- and post-vaccination monitoring, we show that the percent of animals with inferred immunological protection (based on ELISA) was highly variable across states but generally increased through time. In addition, the number of outbreaks in a state was negatively correlated with the percent of animals with inferred protection. We then analyzed the distribution of reported FMD outbreaks across states using a Bayesian space–time model. This approach provides better acuity to disentangle the effect of mass vaccination programs on outbreak occurrence, while accounting for other factors that contribute to spatiotemporal variability in outbreak counts, notably proximity to international borders and inherent spatiotemporal correlations in incidence. This model demonstrated a ∼50% reduction in the risk of outbreaks in states that were part of the vaccination program. In addition, after controlling for spatial autocorrelation in the data, states that had international borders experienced heightened risk of FMD outbreaks. These findings help inform risk-based control strategies for India as the country progresses towards reducing reported clinical disease.Not Availabl