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

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic