The rK39 strip test is non-predictor of clinical status for kala-azar

<p>Abstract</p> <p>Background</p> <p>The rK39 strip test is reported to be simple, sensitive, specific, non-invasive and economical test. Since this method is supposed to be patient friendly, it may easily be accepted for sero-epidemiological surveys. An attempt was made to evaluate the role of rK39 strip test in pre and post treatment phases of Kala azar, as a diagnostic and prognostic marker, in addition to other laboratory investigations, in order to evaluate its role in sero-epidemiological surveys.</p> <p>Findings</p> <p>A total of 210 cases were selected for the study. One hundred clinically and parasitologically confirmed cases were corroborated with other hematological profiles. The formol-gel test was included along with well matched control group comprising of normal endemic controls (50), non-endemic normals (20) and other febrile cases (40). All groups were tested by rK39 strip test. Fifty Kala azar cases were followed up after completion of successful treatment. They were subjected to rK39 strip test after 0, 90 and 180 days of completion of successful treatment.</p> <p>The rK39 showed sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 98% (95% CI 91.7-100), 100%, 100%, 90% (95% CI 66-100) and 98% (95% CI 92.6-100) respectively. All the 50 cured followed up cases showed positive result by rK39 strip test even after 180 days of completion of successful treatment.</p> <p>Conclusion</p> <p>The test seems an ideal qualitative test for the diagnosis of kala-azar. But for sero-epidemiological studies the test may be used with other parameters. Alternatively a quantitative ELISA using rK39 antigen may be used.</p

A numerical study on the influence of tunnel excavation on pile foundation

Tunnel construction in cities faces many geotechnical challenges, and the effect on pile foundation is possibly one of the most complex ones. Most tall buildings in big cities mostly have pile foundations, and any tunneling nearby might significantly influence those existing foundations. In the present study, a 3-dimensional Finite Element (FE) analysis has been carried out to investigate tunneling effects on pile foundations. The investigation is done for a single pile with multiple stages of tunnel excavation where the pile foundations are assumed to reach below the base of the excavation of tunneling. A tentative rate of excavation was also included in this investigation and found that a faster rate of excavation results in better performance of foundations affected by tunneling. The study also extended to see the effect of tunneling on pile groups. Attempts were made to compare the results with some of the previously published literature

The epidemiology of Leishmania donovani infection in high transmission foci in India.

OBJECTIVE: Visceral Leishmaniasis (VL) is highly prevalent in Bihar, India. India and its neighbours aim at eliminating VL, but several knowledge gaps in the epidemiology of VL may hamper that effort. The prevalence of asymptomatic infections with Leishmania donovani and their role in transmission dynamics are not well understood. We report data from a sero-survey in Bihar. METHODS: Demographic and immunological surveys were carried out in July and November 2006, respectively in 16 highly VL endemic foci in Muzaffarpur district in Bihar. Household and individual information was gathered and capillary blood samples were collected on filter papers. Direct agglutination test (DAT) was used to determine infected individuals (cut-off titre 1:1600). DAT results were tabulated against individual and household variables. A multivariate generalized estimating equation (GEE) model was used to study the prevalence of serologically positive individuals taking into account the clustering at household and cluster levels. RESULTS: Of study subjects 18% were DAT positive, and this proportion increased with age. Women had a significantly lower prevalence than men >14 years old. Owning domestic animals (cows, buffaloes or goats) was associated with a higher risk of being DAT positive [OR 1.16 (95% CI 1.01-1.32)], but socio-economic status was not. CONCLUSIONS: Prevalence of leishmanial antibodies was high in these communities, but variable. Demographic factors (i.e. marriage) may explain the lower DAT positivity in women >14 years of age. Within these homogeneously poor communities, socio-economic status was not linked to L. donovani infection risk at the individual level, but ownership of domestic animals was

Diarrhea, CD4 counts and enteric infections in a hospital - based cohort of HIV-infected patients around Varanasi, India

Background: As most of the studies in HIV patients with diarrhea were cross sectional, focusing on the etiological agents, we are reporting data on the rate of diarrhea, associations between diarrhea and CD4 counts and variation in frequency of identifying a pathogen with consistency of diarrhea and duration in a prospective hospital based study. Methods: Stool specimens were obtained between Jan 2001 and April 2003 from HIV infected adults with diarrhea presenting to Infectious Disease clinic, Banaras Hindu University, Varanasi. In all patients with diarrhea, specimens were examined by microscopy and cultures to identify pathogens. Results: During the study, 630 person years of observations with diarrhea were analyzed. 140 stool samples were collected representing 43% of episodes of reported diarrhea. Positivity of finding a pathogen from watery stools and formed stools were 40%&amp;24% respectively (p &lt; 0.01) probably due to associated inflammation is more in watery diarrhea. Patients having chronic diarrhea are 2.25 (95%CI 1.52-2.81) times at more risk of developing other opportunistic infections compared to those who don't have. However this is not true with the acute diarrhea where risk of harboring the opportunistic infections remain same. Conclusion: Diarrhea was most strongly associated with low CD4 counts. Over two-thirds of diarrheal episodes were undiagnosed, suggesting that unidentified agents or primary HIV enteropathy are important causes of diarrhea in this population. There is a strong negative association between duration of diarrhea and CD4 levels

Phase 4 Pharmacovigilance Trial of Paromomycin Injection for the Treatment of Visceral Leishmaniasis in India

Background. A phase 3 study demonstrated the safety and efficacy of paromomycin (paromomycin IM injection) for treatment of VL in an inpatient setting. Methods. This phase 4 study was conducted to assess the safety and efficacy of paromomycin in children and adults in an outpatient setting in Bihar, India. Results. This study enrolled 506 adult and pediatric patients. Of the 494 patients in the intent-to-treat (ITT) population, 98% received a full course of treatment. The overall study completion rate was 94% (462/494) for the ITT population and 96% (461/479) for the efficacy-evaluable (EE) population. Initial clinical cure was 99.6%, and final clinical cure 6 months after treatment was 94.2%. Grade 3 or 4 adverse events occurred in 5% of patients; events with a frequency of ≥1% were increases in alanine aminotransferase and aspartate aminotransferase. Conclusions. This study confirms the safety and efficacy of paromomycin to treat VL in an outpatient setting

Cost-Effectiveness Analysis of Combination Therapies for Visceral Leishmaniasis in the Indian Subcontinent

Visceral leishmaniasis (VL) is a serious health problem in the Indian subcontinent affecting the rural poor. It has a significant economic impact on concerned households. The development of drug resistance is a major problem and threatens control efforts under the VL elimination initiative. With an unprecedented choice of antileishmanial drugs (but no newer compound in clinical development), policies that protect these drugs against the emergence of resistance are required. A possible strategy that has been successfully used for malaria and tuberculosis is the use of combination therapies. This study is the first comprehensive assessment of the cost-effectiveness of all possible mono- and combination therapies for the treatment of visceral leishmaniasis in the Indian subcontinent. The analysis was done from the societal perspective, including both health provider and household costs. The present work shows that combination treatments are a cost-effective alternative to current monotherapy for VL. Given their expected impact on emergence of drug resistance, the use of combination therapy should be considered in the context of the VL elimination programme in the Indian subcontinent

Control Barrier Functions in UGVs for Kinematic Obstacle Avoidance: A Collision Cone Approach

In this paper, we propose a new class of Control Barrier Functions (CBFs) for Unmanned Ground Vehicles (UGVs) that help avoid collisions with kinematic (non-zero velocity) obstacles. While the current forms of CBFs have been successful in guaranteeing safety/collision avoidance with static obstacles, extensions for the dynamic case with torque/acceleration-controlled unicycle and bicycle models have seen limited success. Moreover, with these nonholonomic UGV models, applications of existing CBFs have been conservative in terms of control, i.e., steering/thrust control has not been possible under certain common scenarios. Drawing inspiration from the classical use of collision cones for obstacle avoidance in path planning, we introduce its novel CBF formulation with theoretical guarantees on safety for both the unicycle and bicycle models. The main idea is to ensure that the velocity of the obstacle w.r.t. the vehicle is always pointing away from the vehicle. Accordingly, we construct a constraint that ensures that the velocity vector always avoids a cone of vectors pointing at the vehicle. The efficacy of this new control methodology is experimentally verified on the Copernicus mobile robot. We further extend it to the bicycle model and demonstrate collision avoidance under various scenarios in the CARLA simulator.Comment: Submitted to 2023 IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS). 8 pages, 8 figures, For supplement video follow https://youtu.be/4qWYaWEPduM. The first and second authors have contributed equall