Randomized Clinical Trial of High-Dose Rifampicin With or Without Levofloxacin Versus Standard of Care for Pediatric Tuberculous Meningitis: The TBM-KIDS Trial

Background. Pediatric tuberculous meningitis (TBM) commonly causes death or disability. In adults, high-dose rifampicin may reduce mortality. The role of fluoroquinolones remains unclear. There have been no antimicrobial treatment trials for pediatric TBM. Methods. TBM-KIDS was a phase 2 open-label randomized trial among children with TBM in India and Malawi. Participants received isoniazid and pyrazinamide plus: (i) high-dose rifampicin (30 mg/kg) and ethambutol (R30HZE, arm 1); (ii) high-dose rifampicin and levofloxacin (R30HZL, arm 2); or (iii) standard-dose rifampicin and ethambutol (R15HZE, arm 3) for 8 weeks, followed by 10 months of standard treatment. Functional and neurocognitive outcomes were measured longitudinally using Modified Rankin Scale (MRS) and Mullen Scales of Early Learning (MSEL). Results. Of 2487 children prescreened, 79 were screened and 37 enrolled. Median age was 72 months; 49%, 43%, and 8% had stage I, II, and III disease, respectively. Grade 3 or higher adverse events occurred in 58%, 55%, and 36% of children in arms 1, 2, and 3, with 1 death (arm 1) and 6 early treatment discontinuations (4 in arm 1, 1 each in arms 2 and 3). By week 8, all children recovered to MRS score of 0 or 1. Average MSEL scores were significantly better in arm 1 than arm 3 in fine motor, receptive language, and expressive language domains (P < .01). Conclusions. In a pediatric TBM trial, functional outcomes were excellent overall. The trend toward higher frequency of adverse events but better neurocognitive outcomes in children receiving high-dose rifampicin requires confirmation in a larger trial. Clinical Trials Registration. NCT02958709

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Not AvailableAn investigation was undertaken to standardise the in vitro culture establishment in pomegranate cultivars Bhagwa and Super Bhagwa by using different combinations and concentrations of growth regulators. Among different treatments tested, it was observed that The explants of pomegranate cv. Bhagwa inoculated on MS media supplemented with different combinations and concentrations of plant growth regulators had performed well over the explants cv. Super Bhagwa in terms of number of sprouts explant-1 (2.34), shoot length (2.41cm), percent callus induction (1.81%) and culture establishment index (140.42). The culturing of nodal explants of pomegranate cultivars on MS media supplemented with 1mgL-1 of BAP and 0.5 mgL-1 of NAA (T2) had recorded the less number of days for bud initiation (10.45d), maximum percent (86.83%) of culture establishment, number of sprouts (4.49), leaves (7.83), shoot length (4.05cm) explant-1 and culture establishment index (390.52) over other treatments and the control treatment showed no culture establishment.Not Availabl

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Not AvailableSuccess of a commercially viable protocol for mass multiplication of plants using tissue culture begins with effective elimination of microbial contamination by pre-treatment and surface sterilization methods. In the present study, nodal explants of pomegranate cv. Bhagwa and Super Bhagwa were established using different durations and concentrations of anti-microbial agents followed by inoculation in the culture media for initiation. Among different treatments tested, it was observed that in both the cultivars explants pre-treated with Carbendazim 0.2% + (Metalaxyl-M + Mancozeb) 0.2% + 8 HQ 200ppm for 1 h followed by surface sterilization in laminar airflow chamber with Mercuric chloride (HgCl2)@ 0.1% for 6 min. was proved to be effective method in culture establishment, with maximum survival percentage (57.13% and 67.41% respectively). Among the cultivars Bhagwa showed the maximum survival percentage (33.67% and 36.43%, respectively) when treated with Carbendazim 0.2% + (Metalaxyl-M + Mancozeb) 0.2% + 8 HQ 200ppm for 1 h followed by surface sterilization with Mercuric chloride (HgCl2) @ 0.1% for 6 min with minimum mortality of the explants.Not Availabl