A retrospective analysis of drug resistance in M. tuberculosis and role of CBNAAT, LPA and culture in diagnosis

Background: Nucleic acid detection has potentially revolutionized diagnosis of tuberculosis and has established as a screening test of choice. However, conclusions on its role in diagnosing extrapulmonary infection and discordance between drug susceptibility reported through culture, Xpert MTB/ RIF, line probe assay require further review. Objectives were to compare positivity rate of Xpert MTB/RIF ULTRA across various sample types; compare drug susceptibility percentage of Mycobacterium tuberculosis (M. tb) across three platforms i.e., culture, Xpert MTB/RIF and LPAMethods: A retrospective analysis of results of samples was undertaken for a period of one year for Xpert MTB/RIF ultra and three years for LPA and susceptibility through MGIT.Results: Xpert MTB/ RIF Ultra showed overall positivity of 26%, with 10% rifampicin resistance; genitourinary sample positivity was 4%. First line LPA recorded 26% Rif resistance and very few Rifampicin indeterminates. Second line LPA revealed 5.4% aminoglycoside resistance and 26% fluoroquinolone resistance. Through MGIT Rif resistance was 18.2%, multidrug resistance 17.5%, isoniazid monoresistance 6.6%, FQ resistance 18.6%, MDR with FQ resistance 18.6%, amikacin resistance 4% and streptomycin resistance 18%.Conclusions: Xpert MTB/ RIF should be used as a test of choice for detection; Rifampicin resistance should be confirmed with LPA. However, for GUN, pleural fluid and GIT tissue samples; an additional culture should be attempted on the primary sample to improve detection rates. Drug resistance detected through LPA should be phenotyped especially for fluoroquinolones. Moxifloxacin and amikacin could be empirical antibiotics of choice over ofloxacin and Kanamycin due to lower resistance percentage recorded for them

Prevalence of human papillomavirus types in cervical lesions from women in rural Western India

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Brain status recognition using FPGA)

Human brain, the most complex and confusingcontrol system controls the entire human body and its activities justby sending electric impulses to relevant body parts. While doingthat, it processes data such as sensory information,awareness, thinking etc. The six brainwaves viz.; Infrared, Delta,Theta, Alpha, Beta, & Gamma are generated by brain are in the rangeof 0.5 Hz to 30 Hz. The main objective of this proposed projectis to acquire and process the human brain waves. Filteringand amplifying of brain signals are big issues while processingbrain waves, since the brain signals have very low amplitude andare in the low frequency. We aim to identify the brain state such asawake, normal alert consciousness, physically and mentally relaxed,awake but drowsy, deep (dreamless) sleep, loss of bodily awareness,reduced consciousness, deep meditation, dreams, light sleep, REMsleep, heightened perception etc in real time. To carry out real timeprocessing of digital signals and to maximize the efficiency,processing on a powerful signal processor viz., FPGA is selected.It supports programming for a specific task without hardware restrictions besides being faster than its embedded counterparts which are not powerful enough forreal time processing. So in this paper, we propose a system forthe brain wave capturing, filtering and classification usingartificial intelligence in MATLAB IDE. The developed programwill be converted to HDL using HDL coder of MATLAB andthen it would be dumped in FPGA for testing the functionality ofproposed system

A case of Hepatitis E in a blood donor

The threat of hepatitis E is being felt in blood banks in recent times. The disease is usually self-limiting, but may progress to a fulminant fatal form. We report a unique case of a hepatitis E virus (HEV)-positive asymptomatic blood donor who later developed jaundice and informed the blood bank. A blood donor passed all eligibility criteria tests and donated blood. After 20 days, the blood bank was informed by the donor that he had developed vomiting and jaundice 1 day postdonation. He was investigated by a local laboratory 1 day postdonation for liver profile, which was high. There had been a major outbreak in his community of similar symptoms during the same period. HEV IgM antibody by enzyme-linked immunosorbent assay was positive. Silent infections may be lurking in apparently healthy donors. Donors need to be encouraged to revert in case of any significant developments after donation and maintain open channels of communication

A case report of osteogenic sarcoma with leprosy

This is a rare case report of osteosarcoma with lepromatous leprosy. A 15 year old male patient presented with swelling around the right knee joint. Imaging and biopsy were consistent with osteosarcoma. After his first cycle of adjuvant chemotherapy (ACT), the patient developed fever, erythematous nodules, perichondritis of ear lobe, and thickened nerves. His slit-skin smear examination showed acid-fast bacilli in clumps, and a diagnosis of multibacillary leprosy was made. He was treated with anti-leprosy medications with steroids, and once his condition stabilized, his ACT was continued. On follow-up, his skin lesions completely recovered

Scalp flora in Indian patients undergoing craniotomy for brain tumors – Implications for pre-surgical site preparation and surgical site infection

Introduction Causation of surgical site infection (SSI) following craniotomy is multifactorial. Most preventive strategies (including site preparation and antibiotic prophylaxis) revolve around reducing preoperative contamination of the local site. There is little evidence, however, linking site contamination with postoperative infections. This is important given the preference for performing non-shaved cranial surgery. We undertook a prospective study to document the scalp flora in neurosurgical patients in an Indian setting and to assess possible association with SSI. Materials and Methods A prospective study recruited 45 patients undergoing non-shaved clean craniotomies for various brain tumors. Standard perioperative procedures and antibiotic policy were employed. Prior to and immediately following the pre-surgical scrubbing, we collected swabs and evaluated their growth qualitatively. SSI was documented adhering to CDC guidelines. The association of swab-positivity with various parameters (including SSI) was evaluated. Results Pre-scrub positivity was seen in 18 of 44 patients, three of them developed subsequent SSI. Most were known skin contaminants. Five patients had swab positivity after scrubbing, though none of these developed any SSI. Four of these five had pre-scrub positivity. In three the same organisms persisted (two being Staphylococcus aureus), and one had different growth post-scrub, whereas one patient developed new growth (contaminant mycelial fungus) in the post-scrub swab. We did not find any association between swab positivity and SSI. Swab positivity was also not related to hair-length or hygiene. Conclusion Scalp flora in Indian patients is similar to that described. Pre-surgical preparation does not always eliminate this contamination (especially staphylococcus). However, this does not necessarily translate into increased SSI. Moreover, the results also provide objective evidence to support the performance of non-shaved cranial surgery without an undue risk of SSI

Concurrent evaluation of visual, cytological and HPV testing as screening methods for the early detection of cervical neoplasia in Mumbai, India.

OBJECTIVE: Naked eye visual inspection with acetic acid (VIA), magnified VIA (VIAM), visual inspection with Lugol's iodine (VILI), cytology and human papillomavirus (HPV) testing were evaluated as screening methods for the detection of high-grade squamous intraepithelial lesions (HSIL) of the uterine cervix in a cross-sectional study in Mumbai, India. METHODS: Cytology, HPV testing, VIA, VIAM and VILI were carried out concurrently for 4039 women aged 30-65 years. All women were investigated with colposcopy and biopsies were taken from 939 women who had colposcopic abnormalities. The reference standard for final disease status was histology or negative colposcopy. The presence of HSIL was confirmed in 57 women (1.4%). The test characteristics for each method were calculated using standard formulae. RESULTS: The sensitivities of cytology, HPV testing, VIA, VIAM and VILI were 57.4%, 62.0%, 59.7%, 64.9%, and 75.4%, respectively (differences were not statistically significant). The specificities were 98.6%, 93.5%, 88.4%, 86.3%, and 84.3%, respectively. Adding a visual test to cytology or HPV testing in parallel combination resulted in a substantial increase in sensitivity, with a moderate decrease in specificity. The parallel combination of VILI and HPV testing resulted in a sensitivity of 92.0% and a specificity of 79.9%. CONCLUSION: As a single test, cytology had the best balance of sensitivity and specificity. Visual tests are promising in low-resource settings, such as India. The use of both VIA and VILI may be considered where good quality cytology or HPV testing are not feasible. The sensitivity of cytology and HPV testing increased significantly when combined with VIA or VILI

Prevalence and predictors of colposcopic-histopathologically confirmed cervical intraepithelial neoplasia in HIV-infected women in India.

BACKGROUND: Prevalence estimates of cervical intraepithelial neoplasia (CIN) among HIV-infected women in India have been based on cervical cytology, which may have underestimated true disease burden. We sought to better establish prevalence estimates and evaluate risk factors of CIN among HIV-infected women in Pune, India using colposcopy and histopathology as diagnostic tools. METHODOLOGY: Previously unscreened, non-pregnant HIV-infected women underwent cervical cancer screening evaluation including standardized diagnostic colposcopy by a gynecologist. Histopathologic confirmation was conducted among consenting women with clinical suspicion of CIN. The prevalence of CIN was evaluated by a composite diagnosis based on colposcopy and histopathology results. Multivariable ordinal logistic regression analysis was conducted to determine independent predictors of increasing severity of CIN. RESULTS: The median age of the n = 303 enrolled HIV-infected women was 30 years (interquartile range, 27-34). A majority of the participants were widowed or separated (187/303, 61.7%), more than one-third (114/302, 37.7%) were not educated beyond primary school, and nearly two-thirds (196/301, 64.7%) had a family per capita income of <1,000 Indian Rupees ( approximately US$22) per month. Cervical high-risk HPV-DNA was detected in 41.7% (124/297) of participants. The composite colposcopic-histopathologic diagnoses revealed no evidence of CIN in 220 out of 303 (72.6%) women, CIN1 in 33/303 (10.9%), CIN2 in 31/303 (10.2%), CIN3 in 18/303 (5.9%) and 1 (0.3%) woman was diagnosed with ICC. Thus, over a quarter of the participants [83/303: 27.7% (95% CI: 22.7-33.1)] had > or =CIN1 lesions and a sixth [50/303: 16.5% (95% CI: 12.2-21.9)] had evidence of advanced (> or =CIN2) neoplastic disease. The independent predictors of increasing severity of CIN as revealed by a proportional odds model using multivariable ordinal logistic regression included (i) currently receiving antiretroviral therapy [adjusted odds ratios (aOR): 2.24 (1.17, 4.26), p = 0.01] and (ii) presence of cervical high-risk HPV-DNA [aOR: 1.93 (1.13, 3.28), p = 0.02]. CONCLUSIONS: HIV-infected women in Pune, India have a substantial burden of cervical precancerous lesions, which may progress to invasive cervical cancer unless appropriately detected and treated. Increased attention should focus on recognizing and addressing this entirely preventable cancer among HIV-infected women, especially in the context of increasing longevity due to antiretroviral therapy