Clinico-pathological profile, radiological presentation and drug susceptibility pattern of new smear positive (category I) pulmonary tuberculosis: a single centre experience in Delhi, India

Background:Aim of current study was to determine the clinical characteristics, radiological, laboratory features and anti-tubercular drug sensitivity in new smear positive (category I) pulmonary tuberculosis cases in a tertiary care dedicated TB OPD, Delhi. Methods:The study was a cross-sectional observational study and consists of 100 cases of new smear positive pulmonary tuberculosis cases (category I) irrespective of age and sex. The sputum were collected, stained with Ziehl-Nielsen (Z-N) staining and ultimately inoculated on Lowenstein-Jensen (L-J) media for six weeks. All sputum smear positive cases were subjected to culture and drug-susceptibility testing by 1% proportion method on Lowenstein-Jensen (LJ) medium. The Drug-Susceptibility Testing (DST) for isoniazid (INH), rifampicin (R-cin), ethambutol (EMB) and streptomycin (SM) were performed.Results:The age & sex distribution of 100 patients showed that majority of the patients (79%) belonged to 2nd, 3rd and 4th decades & 60 % were males and 40% were female with male to female ratio 3:2 respectively. Cough (83%), fever (77%) and weight loss (76%) were the most common presenting clinical features. The chest X-ray of 100 smear positive patients showed that 53% of patients had evidence of 35% unilateral and 18%  bilateral consolidation and 46% had cavitary lesions on chest X-ray (PA view) with 37% and 9% of patients having unilateral and bilateral cavities respectively. Of these 82 culture positives, 56.1% (n=46) were susceptible to all first-line anti-tubercular drugs, while 43.9% (n=36) were resistant to mostly one or other anti-tubercular drugs (INH, R-cin, SM or EMB).  Conclusion: We stressed the importance of early diagnosis of new cases by clinico-pathological features, identifying of drug resistance trends in anti-tubercular treatment naïve patients, in order to assess the efficacy of current interventions. Overall, these findings emphasize the importance of early diagnosis of drug resistance pattern of M. tuberculosis isolates to anti-tubercular in category I patients as well as its association with HIV across the country to timely modify and strengthen the national programs in order to prevent the emergence of MDR-TB strains and avert the threat of XDR-TB.

Role of living conditions and socioenvironmental factors on chronotype in adolescents

An individual's chronotype, defined as the preference for rest and activity at different times of the day, is linked to several physiological and psychological outcomes. Research on environmental determinants of chronotype has focussed mostly on geographic location, whereas other socioenvironmental determinants have been neglected. We aimed to investigate the association between other previously unrecognized socioenvironmental factors and chronotypes in adolescents. We analysed data of 1916 Bengali adolescents (aged between 13-14 years, 47% girls). Chronotype was determined by the reduced morningness-eveningness questionnaire (rMEQ), and socioenvironmental factors were identified through a structured questionnaire. Associations were analysed using multinomial logistic regression models. Our findings demonstrated that living in urban areas, the presence of a smoker at home, and higher parental education were associated with a higher evening activity (eveningness), while the use of biomass cooking media (compared to liquefied petroleum gas) and assisting parents in farming were associated with higher morningness in adolescents. This is the first study to identify the association between previously unrecognized socioenvironmental factors and chronotypes delineating the interaction between environment and sleep in adolescents and might help the parents to understand the importance of a proper sleep-activity rhythm of their kids through a comprehensive understanding of their surrounding environment and other factors

Role of offending out-door aero-allergen and CD14 C(-159)T polymorphism in development and severity of asthma in a Kolkata patient population

Objective: Present study involved identification of offending out-door aero-allergens and associated genetic pathway in nasso-bronchial asthma among Kolkata population.Methods: Skin-prick test was done among 950 asthmatic patients against 11 common aero-allergens and total serum IgE concentration was measured. PCR-RFLP was done in patients and non-asthmatic control (n=220 in each) to characterize functional polymorphism, C(-159)T, of CD14, a positional candidate gene for allergy. Association of genetic polymorphisms was made with clinico-pathological conditions.Results: We identified Cocos nucifera as the most common aero-allergen sensitizer among atopic patients in Kolkata. Patients with childhood-onset asthma were significantly more sensitive towards aero-allergens and had significantly higher serum IgE level than those of adult-onset (p< 0.0001). No significant difference was found in distribution of SNP genotypes of CD14 among case and control (p=0.178). However among patients, frequency of C allele is significantly higher in childhood-onset group thanthat of adult-onset and concordantly in former CC genotype was associated with significant higher level of serum IgE than CT and TT.Conclusion: In Kolkata, pollen is a common out-door aero-allergen and Cocos nucifera is predominant among pollens. Childhood- onset and adult-onset of asthma showed significant difference in allergen sensitivity as well as genetic background with respect to CD14 polymorphism.Keywords: Asthma, aero-allergen, skin prick test, total IgE, CD14 gene polymorphis

Increasing burden of COPD in rural India: an example why India warrants primary healthcare reforms

Battle against COPD: time to reinforce the primary healthcare units of rural areas of India to combat lung diseases http://ow.ly/ZAwg

Chronotype assessment of the Bengalese adolescents: an observational study using a Bengali version of the reduced Morningness-Eveningness Questionnaire (rMEQ)

Chronotype or morningness orientation is an interpersonal characteristic that influence human physiology and psychology and less is known about the chronotype of the Bengalese adolescents in India. We aimed to study the chronotype of this population by using a translated version of a previously established questionnaire. 471 Bengali-speaking adolescents (13–14 years) (boys = 268, girls = 203) of West Bengal, India were included in this study and their chronotype was assessed using an interviewer-administered Bengali version of the reduced Morningness–eveningness Questionnaire (rMEQ). The reliability of the translated instrument was assessed using Cronbach’s α. Chi-squared test was used to observe the chronotype distribution between the boys and girls. rMEQ scores of all the participants ranged between 5 and 25 with a median value of 17 (25–75th percentile: 15–20). Cronbach’s α was 0.751. Using cut off scores, we found 47% of our study participants were of morning chronotype, whereas the intermediate and evening types were of 50% and 3%, respectively. Chi-squared test demonstrated a significantly higher morningness among boys than the girls. The study describes the morningness orientation pattern of the Bengalese adolescents that may have some defined influence on their physiological and psychological characteristics including health and disease.This study was partially supported by the unrestricted internal research grant of the Allergy & Asthma Research Centre, Kolkat

Atorvastatin induced thrombocytopenia: A case report and review of literature

A 65-year-old hypertensive male, with co-existing benign prostatic hyperplasia for last 5 years was on tab telmisartan 40 mg and tab tamsulosin 0.4 mg, both once daily. He was found dyslipidemic on a routine investigation and was put on tab atorvastatin 10 mg once daily. The patient developed a petechial rash and bleeding from gums within a week of starting atorvastatin, and his platelet count dropped to 15,000/cmm. Atorvastatin was suspected to be the offender as no other causes of thrombocytopenia could be implicated. Atorvastatin was discontinued and intravenous steroid and platelet transfusion given. Platelet count improved gradually and became normal after 10 days. Causality assessment as per the Naranjo algorithm revealed a "probable association" with atorvastatin therapy