TB disease patterns by HIV and diabetes status.

BACKGROUND: TB is commonly categorised as pulmonary (PTB) or extrapulmonary TB (EPTB). Knowledge of TB disease patterns (PTB and/or EPTB) and determining risk factors remains limited.METHODS: This was a prospective cohort study using point-of-care ultrasound (POCUS) in Indian patients with presumed TB. Clinical and imaging data were used to develop refined case definitions for PTB, concurrent PTB and EPTB (PTB + EPTB) and EPTB without PTB (EPTB). These groups were analysed by HIV (HIV+/-) and diabetes mellitus (DM+/-) status.RESULTS: Of 172 HIV-/DM- patients with TB, 48% had PTB, 23% PTB + EPTB and 29% had EPTB, totalling 52% with any EPTB (PTB + EPTB or EPTB). In HIV+/DM- patients with TB (n = 35), 6% had PTB, 40% had PTB + EPTB and 54% had EPTB, accounting for 94% with EPTB. In HIV-/DM+ patients with TB (n = 61), 61% had PTB, 28% had PTB + EPTB and 11% had EPTB, representing 39% with EPTB.CONCLUSION: Refined case definitions revealed high proportions of EPTB even without HIV or DM. HIV further altered the TB disease pattern towards EPTB and DM towards PTB. Therefore, the dichotomy between PTB or EPTB does not represent the actual spectrum of TB disease. EPTB should receive higher priority in research and clinical practice.

Acute demyelinating encephalomyelitis after anti-venom therapy in Russell's viper bite.

INTRODUCTION: Russell's viper is a commonly encountered venomous snake in India. Morbidity and mortality following envenomation and the treatment thereof are frequent. We report a rarely seen complication after a treated Russell's viper bite. CASE REPORT: A 36-year-old male farmer received 30 vials polyvalent anti-snake venom after a viper bite to his right leg. Improvement in initial hematemesis and circulatory shock was followed by acute renal failure managed with regular hemodialysis. He displayed no abnormalities on neurological examination at admission. Fourth day onwards his neurologic status started deteriorating with development of behavioral abnormalities, hemi-spatial neglect of left upper limb, paralysis of left facial nerve, left upper limb, and right lower limb. Acute disseminated encephalomyelitis was confirmed on magnetic resonance imaging (MRI) of brain with typical spectroscopic characteristics. High dose methyl prednisolone was administered and a rapid recovery followed. CONCLUSION: Russell's viper bite followed by treatment with antivenom may be complicated by the development of immune complex mediated demyelination and development of acute disseminated encephalomyelitis. MRI spectroscopy helps in early identification of demyelination and in a definite diagnosis. Treatment with corticosteroids was associated with resolution of symptoms in this case.

Mother's knowledge about pre-school child's oral health.

Children under the age of 5 years generally spend most of their time with their parents and guardians, especially mothers, even when they attend pre-schools or nurseries. It has been found that young children's oral health maintenance and outcomes are influenced by their parent's knowledge and beliefs. This study was done to assess the mother's knowledge about the oral health of their pre-school children in Moradabad, India. Mothers of children aged 1-4 years, attending the hospital for vaccination or regular checkups in the pediatric division of government hospitals, were invited to participate in the study. A 20-item questionnaire covering socio-demographic characteristics, dietary practices, oral hygiene practices and importance of deciduous teeth, was distributed to their mothers, during their visit to the hospital. Responses of the mothers were recorded on a Likert Scale. The sample comprised 406 mothers, with the mean age of children being 3.8 years. Three hundred (73.8%) mothers had a good knowledge about diet and dietary practices, while only 110 (27.1%) and 103 (25.4%) mothers were found to have a good knowledge about the importance of oral hygiene practices and importance of deciduous teeth, respectively. Mothers with higher educational qualification and information gained through dentist had a better knowledge about child's oral health. Oral hygiene habits and dietary habits are established during pre-school days and the parents, especially mothers, function as role models for their children.

Coherent optical detection of highly excited Rydberg states using electromagnetically induced transparency.

We demonstrate coherent optical detection of highly excited Rydberg states (up to n=124) using electromagnetically induced transparency (EIT), providing a direct nondestructive probe of Rydberg energy levels. We show that the EIT spectra allow direct optical detection of electric field transients in the gas phase, and we extend measurements of the fine structure splitting of the nd series up to n=96. Coherent coupling of Rydberg states via EIT could also be used for cross-phase modulation and photon entanglement.

Cryptococcal meningitis in acquired immunodeficiency syndrome.

OBJECTIVE: To study the clinical course and outcome of cryptococcal meningitis (CM) in patients with acquired immunodeficiency syndrome (AIDS). METHOD: Patients infected with human immunodeficiency virus (HIV) and symptoms suggestive of meningitis were evaluated with detailed history, clinical examination and investigations. Diagnosis of CM was based on positive India ink preparation or positive fungal culture of CSF. All patients were treated with amphotericin those showing response were put on oral fluconazole. RESULT: A total of 431 patients with HIV infection were admitted to this centre during the study period, of these 15 were diagnosed to have CM. Majority of the patients had a subacute presentation with signs of meningeal irritation seen in only seven patients. India ink preparation and positive fungal culture on cerebrospinal fluid (CSF) established diagnosis in all cases. All patients were treated with amphotericin B and fluconazole. Complete response was noticed in seven patients, two patients were lost to follow-up and six patients died during the course of therapy. Raised intracranial tension (ICT) and disseminated disease were associated with poor prognosis. CONCLUSION: CM is a common opportunistic fungal infection in patients with AIDS. A high index of clinical suspicion and routine mycological surveillance is required to diagnose this infection. Majority of patients respond to therapy except those who have disseminated infection, altered sensorium and features of raised ICT at presentation.

Haematological characteristics and bone fluoride content in Bufo melanostictus from an aluminium industrial site.

Fluoride concentration in bones and differential haemotological characteristics (RBC, haemoglobin, haematocrit, mean corpusclar haemoglobin and mean corpuscular volume) were measured in amphibians, Bufo melanostictus, collected from fluoride-contaminated and -uncontaminated areas. The average haemoglobin content, total RBC count and haematocrit (%) in blood samples were found to be significantly reduced, while mean corpuscular concentration and volume were significantly elevated in individuals from the contaminated area in comparison to those from the uncontaminated area. Fluoride concentration was approximately 11 times greater in the bones of toads from the contaminated area.

Infrequent alteration of the c-myc gene in human glial tumours associated with increased numbers of c-myc positive cells.

Twenty five human glial tumours of different grades of malignancy were examined by Southern blotting and polymerase chain reaction (PCR) for alterations (rearrangements, amplification and deletions) in the c-myc gene. Number of c-myc positive cells per thousand cells were also counted in all the tumours after immunohistochemical staining for c-myc protein was done on fixed sections of the tumours. No tumours exhibited any amplification of the gene, as found by Southern blotting. One astrocytoma and one mixed glioma showed some rearrangements in the 3' end of the gene, as detected by Southern blotting and hydridization. These two tumours had higher number of c-myc positive cells than in other tumours of the same histopathological groups. Deletion in the first promoter region, as determined by PCR, was seen in only one astrocytoma. However, the number of c-myc positive cells in that tumour did not show any deviation from that found in other astrocytomas. In light of present literature, it is speculated that the 3' rearrangements may be the cause of increased number of c-myc immunopositive cells in those tumours by disrupting the 3' end of the gene leading to increased c-myc mRNA stability. Such a mechanism may play a part in small subset of glial and possibly other tumours.

Encephalopathy in patients with extrahepatic obstruction after lienorenal shunts.

Thirty patients with portal hypertension resulting from extrahepatic portal vein obstruction were studied. Evidence of postshunt encephalopathy was sought using neurological and psychometric tests and visual evoked potentials. Eleven patients were studied before and after lienorenal shunt operations and 19 at varying intervals, from 6 to 123 (median 26) months, after the same procedure. All the shunts were patent and none of the patients developed clinical or subclinical encephalopathy. In patients with extrahepatic portal vein obstruction, a lienorenal shunt does not appear to be associated with postshunt encephalopathy.

Cladosporiosis (cerebral phaeohyphomycosis) of brain--a case report.

A case of cerebral cladosporiosis caused by Cladosporium trichoides (bantianum) now known as Xylohypha bantiana is described and illustrated. Predisposing debilitating diseases were not detectable. The Cladosporiosis diagnosis was based on visualisation of hyphal element in direct Gram's stain, direct KOH preparate of pus from brain abscess and on repeated successful cultivation of Cladosporium trichoides from specimen and by histopathology. Following surgery and anti-fungal chemotherapy the patient was cured.

Imbalances in T cell subpopulations in human gliomas.

The quantitation of cells bearing CD3, CD4, CD8, and B cell phenotypic markers, as well as an estimation of serum immunoglobulin (Ig)G, IgA, and IgM, was carried out in a group of 39 glioma patients with different grades of malignancy. The findings were compared with those obtained from 21 normal healthy control subjects. The analysis revealed a significant decrease both in the absolute numbers and in the percentages of circulating CD3+ (p less than 0.001) and CD4+ (p less than 0.001) cells, while the CD8+ and Pan B+ cells remained within the normal range irrespective of the type and grade of tumor. The CD4+:CD8+ ratio was significantly decreased in all categories of patients. The CD4 lymphopenia was also evident in 10 patients who had no history of previous immunosuppressive drug therapy (steroids and anticonvulsants) until the commencement of the study. The Ig levels were within the normal range in patients with malignant astrocytoma and glioblastoma multiforme, whereas a three- and fourfold increase in the IgM level was observed in patients with astrocytoma. It is suggested that T cell lymphopenia in glioma patients could mainly be due to a selective depletion of CD4+ cells and that it occurs principally as a reaction to the tumor.