Delay in DOTS for new pulmonary tuberculosis patient from rural area of Wardha District, India

Vast majority of active tuberculosis patients seeks treatment, do so promptly, still many patients spend a great deal of time and money “shopping for health” and too often they do not receive either accurate diagnosis or effective treatment, despite spending considerable resources. Objective: To find out the time taken to, for diagnosis of tuberculosis and to put patient on DOTS from the onset of symptoms and pattern of health seeking behavior of new pulmonary tuberculosis patients. A cross-sectional rapid assessment using qualitative (FGD) and quantitative (Interview) methods conducted at DOTS center of tertiary care hospital from rural Wardha. Participants: 53 pulmonary tuberculosis patients already on DOTS, in intensive phase. Main outcome measure: Delay in initiation of DOTS & health seeking behavior Results: Median total delay for starting DOTS was 111 days, (range: 10 to 321 days). Patient delay was more than provider delay. Patients delay was more in patients above 60 years, illiterate, per-capita income below 650 Rupees and HIV TB co-infection. Pattern of health seeking behavior was complex. Family physician was the preferred health care provider. Patient visited on an average four providers and spent around 1450 rupees (only direct cost) before DOTS begin. Time taken from the onset of symptoms and start of DOT is a cause of concern for the tuberculosis control program. Early case detection is important rather than mere achieving target of 70% new case detection. Program manager needs to implement locally relevant & focused strategies for early case detection to improve the treatment success, especially in rural area of India

Aggressive Posterior Retinopathy of Prematurity (APROP): LASER as the Primary Modality of Treatment

Purpose: To study the success rate of LASER as a primary modality of treatment in aggressive posterior retinopathy of prematurity (APROP) cases. Methods: This is a prospective case series of 56 eyes of 28 preterm babies (males = 21) with APROP who underwent laser therapy. Babies were divided into groups on the basis of gestational age (GA), birth weight (BW), and postmenstrual age (PMA) at which treatment was performed. GA (in weeks): <28 (n = 7), 28–30 (n = 11), >30 (n = 10). BW (in grams): <1000 (n = 8), 1000–1200 (n = 10), >1200 (n = 10). PMA (in weeks): < 32 (n = 6), 32–34 (n = 18), >34 (n = 4). Success was calculated as complete regression of disease without need for any other modality of treatment such as anti-vascular endothelial growth factor (anti-VEGF) or pars plana vitrectomy. Results: The overall success rate was 94.64% (53/56). Two babies who needed additional modality of treatment were <28 weeks of GA (one eye) and 28–30 weeks (two eyes). One baby (one eye) was <1000 gm and the other (two eyes) was >1200 gm, while PMA at which additional treatment was needed was 30 weeks in one baby (one eye) and 33 weeks in the other (two eyes). Conclusion: In this era of anti-VEGF treatment, even in cases of APROP, LASER should still be considered as a primary modality of treatment, as it is a one-time treatment without the concern of systemic side effects and recurrent/persistent avascular zones

Primary renal echinococcosis

Echinococcosis is a parasitic infection caused by the larval stage of a cestode Echinococcus granulosus and is endemic in sheep farming regions of developing countries. It manifests as hydatid cyst and most commonly is found in liver followed by lungs. Renal hydatid cyst is rare and amounts for 2% of all cases. There are no specific clinical manifestations, and hence diagnosis of renal hydatid disease is missed out easily without imaging. We report a case of 50-year-old female who had 6 months history of lower abdominal pain with hematuria, found to have right renal hydatid cyst on imaging which was treated with right nephrectomy with pre- and post-operative albendazole treatment

Effects of oxidizing and reducing agents on ovine pulmonary artery responses to nitric oxide donors, sodium nitroprusside and 3-morpholino-sydnonimine

964-970Nitrovasodilators-sodium nitroprusside (SNP; 10-9-10-4 M) and 3-morpholino-sydnonimine (SIN-1; 10-9-10-4 M) produced concentration-dependent relaxation of the fourth generation sheep pulmonary artery, preconstricted with 5-hydroxytryptamine (1 µM). Oxidizing agents [oxidized glutathione (GSSG, 1 mM) and CuSO4 (5 and 20 µM)] and reducing agents [dithiothreitol (DTT, 0.1 mM), ascorbic acid (1 mM) and reduced glutathione (GSH, 1 mM)] caused opposite effects on nitric oxide (NO)-induced vasodilation in the artery. Ascorbic acid and GSH potentiated the NO responses, while GSSG and CuSO4 inhibited relaxation caused by the nitrovasodilators. DTT, however, reduced the relaxant potency and efficacy of SNP and SIN-1. Pretreatment of the pulmonary artery strips with DTT (0.1 mM) inhibited SNP (10 µM)-induced Na+-K+-ATPase activity, while ascorbic acid (1 mM) and GSH (1 mM) had no effect either on basal or SNP (10 µM)-stimulated 86Rb uptake, an index of Na+-K+-ATPase activity, in ovine pulmonary artery. The results suggest that reducing agents like ascorbic acid may have beneficial effect in improving the vascular function under oxidative stress

Research Paper - Effect of redox agents on the response of rat aorta to nitric oxide and sodium nitroprusside

Objective: To study the redox regulation of vascular responses to endogenous nitric oxide (NO) and NO derived from nitrovasodilator sodium nitroprusside (SNP) in isolated rat aorta. Materials and Methods: To determine the influence of reducing [ascorbic acid (1 mM) and reduced glutathione (GSH) (1 mM)] and oxidizing agents [oxidized glutathione (GSSG) (1 mM) and CuSO4 (1 and 5 μM)] on the vasodilation caused by acetylcholine (ACh; 10-11-10-5 M) and SNP (10-9-10-4 M). Isometric tensions were measured in isolated aorta by a force transducer and recorded in a computer, using Chart V4.1.2 software. Results: ACh and SNP produced relaxation of rat aortic rings that was dependent on concentration. The rings were preconstricted with L-phenylephrine (1 μM). It was observed that oxidizing and reducing agents caused opposite effects on vasodilation induced by NO in rat aorta. Ascorbic acid and GSH potentiated the responses to NO, causing a leftward shift in the concentration-response curve of ACh with significant increase in the pD2 and the Emax. GSSG and CuSO4 inhibited relaxation caused by ACh and shifted the concentration-response curve to the right. In concentration-responses induced by SNP, ascorbic acid significantly increased the pD2 and Emax values from 5.85 ± 0.08 to 6.24 ± 0.05 and 80.83 ± 1.37% to 89.26 ± 1.49%, respectively. However, CuSO4 significantly decreased these values from 5.85 ± 0.02 to 4.56 ± 0.10 and 77.18 ± 0.82% to 53.52 ± 1.60%, respectively. Potentiation of NO response by reducing agents may be related to either increased availability of nitroxyl anion (NO-) or reduction in superoxide anion radical (O2·-). The opposite could be true for the oxidizing agents. Conclusion: The findings of this study suggest that reducing agents like ascorbic acid can improve the vascular responses to NO under oxidative stress

Methylene blue induced methemoglobinemia with acute kidney injury in a glucose-6-phosphate dehydrogenase-deficient patient

Our case was treated with methylene blue for symptomatic nitrobenzene poisoning. After which he developed methemoglobinemia with acute kidney injury due to hemolysis and on further testing, he was found to be glucose-6-phosphate dehydrogenase (G6PD) enzyme deficient. Thus, afterward, the patient was treated with only available mode of treatment as repeated blood transfusions and ascorbic acid with dialysis support to which the patient responded. Thus, it is important to evaluate for the G6PD deficiency where methylene blue treatment is planned as an antidote to nitrobenzene compounds poisoning

Phase III Pivotal comparative clinical trial of intranasal (iNCOVACC) and intramuscular COVID 19 vaccine (Covaxin®)

Abstract One of the most preferable characteristics for a COVID-19 vaccine candidate is the ability to reduce transmission and infection of SARS-CoV-2, in addition to disease prevention. Unlike intramuscular vaccines, intranasal COVID-19 vaccines may offer this by generating mucosal immunity. In this open-label, randomised, multicentre, phase 3 clinical trial (CTRI/2022/02/40065; ClinicalTrials.gov: NCT05522335), healthy adults were randomised to receive two doses, 28 days apart, of either intranasal adenoviral vectored SARS-CoV-2 vaccine (BBV154) or licensed intramuscular vaccine, Covaxin®. Between April 16 and June 4, 2022, we enrolled 3160 subjects of whom, 2971 received 2 doses of BBV154 and 161 received Covaxin. On Day 42, 14 days after the second dose, BBV154 induced significant serum neutralization antibody titers against the ancestral (Wuhan) virus, which met the pre-defined superiority criterion for BBV154 over Covaxin®. Further, both vaccines showed cross protection against Omicron BA.5 variant. Salivary IgA titers were found to be higher in BBV154. In addition, extensive evaluation of T cell immunity revealed comparable responses in both cohorts due to prior infection. However, BBV154 showed significantly more ancestral specific IgA-secreting plasmablasts, post vaccination, whereas Covaxin recipients showed significant Omicron specific IgA-secreting plasmablasts only at day 42. Both vaccines were well tolerated. Overall reported solicited reactions were 6.9% and 25.5% and unsolicited reactions were 1.2% and 3.1% in BBV154 and Covaxin® participants respectively