Using timeliness metrics for household contact tracing and TB preventive therapy in the private sector, India.

Although screening of household contacts (HHCs) of TB patients and provision of TB preventive therapy (TPT) is a key intervention to end the TB epidemic, their implementation globally is dismal. We assessed whether introducing a '7-1-7' timeliness metric was workable for implementing HHC screening among index patients with pulmonary TB diagnosed by private providers in Chennai, India, between November 2022 and March 2023.This was an explanatory mixed-methods study (quantitative-cohort and qualitative-descriptive).There were 263 index patients with 556 HHCs. In 90% of index patients, HHCs were line-listed within 7 days of anti-TB treatment initiation. Screening outcomes were ascertained in 48% of HHCs within 1 day of line-listing. Start of anti-TB treatment, TPT or a decision to receive neither was achieved in 57% of HHC within 7 days of screening. Overall, 24% of screened HHCs in the '7-1-7' period started TPT compared with 16% in a historical control (P < 0.01). Barriers to achieving '7-1-7' included HHC reluctance for evaluation or TPT, refusal of private providers to prescribe TPT and reliance on facility-based screening of HHCs instead of home visits by health workers for screening.Introduction of a timeliness metric is a workable intervention that adds structure to HHC screening and timely management..

How we do it: 'tonsil swabs please' - an alternative use in open neck surgery.

BACKGROUND: Thyroid and parathyroid surgery often involves the use of heated instruments for dissection. Whilst these are beneficial, accidental thermal damage to the exposed skin edges can occur, resulting in an unsatisfactory cosmetic outcome. Tonsil swabs can be used in head and neck surgery intra-operatively to control bleeding. This paper describes an alternative use for them in protecting wound edges during the procedure. METHOD: Damp tonsil swabs are sutured onto the wound edges after the initial skin incision. They remain present for the duration of the surgery and are removed at the time of skin closure. RESULTS: The tonsil swabs provide protection and help avoid accidental injury to the skin. No complications with this technique have been experienced. CONCLUSION: This paper describes a simple, effective and practical technique for protecting the skin during neck procedures using resources readily available in a standard ENT operating theatre.

Moringa oleifera (Lam.): a natural remedy for ageing?

Effect of Moringa oleifera, an age-old ingredient of Indian ayurvedic and traditional medicine, was tested for its effect on age related antioxidant activity in Wistar albino rats of three age groups (6, 12 and 18 months old). Aqueous extract of M. oleifera leaves (MOAE) was administered orally at a dosage of 200 mg/kg body weight for a period of 30 days. MOAE treatment showed significant reduction in lipid peroxidation and lipofuscin pigmentation along with elevated serotonin and antioxidant enzymes in the brains of treated groups of aged rats. LC-MS-MS analysis revealed blood brain barrier permeable secondary metabolites viz., 9,9-bianthracene, 4-Methoxycinnamic acid, Cinnamic acid, (E)-p-coumaric acid pyrogallol and ostruthin from the extract. 9,9-bianthracene and ostruthin showed better binding affinity to Keap-1 and SERT in silico. The present result suggests the protective efficacy of M oleifera against age related oxidative stress in brain.

Effect of supplementation of a dairy-originated probiotic bacterium, Propionibacterium freudenreichii subsp. freudenreichii, on the cecal microbiome of turkeys challenged with multidrug-resistant Salmonella Heidelberg.

A dairy-originated probiotic bacterium, Propionibacterium freudenreichii subsp. freudenreichii B3523 (PF) was found to be effective in reducing multidrug-resistant Salmonella Heidelberg (MDR SH) colonization in turkey poults (2-week-old) and growing (7-week-old) and finishing (12-week-old) turkeys. In this study, we explored the potential for microbiome modulation in the cecum of turkeys of different age groups due to PF supplementation in conjunction with MDR SH challenge. One-day-old commercial turkey poults were allocated to 3 treatment groups: negative control (N; turkeys without PF supplementation or SH challenge), SH control (S; turkeys challenged with SH without PF supplementation), and test group (P; turkeys supplemented with PF and challenged with SH). Turkeys were supplemented with 1010 CFU PF in 5-gallon (18.9 L) water until 7 or 12 week of age. At the 6th or 11th wk, turkeys were challenged with SH at 106 and 108 CFU/bird by crop gavage, respectively. After 2 and 7 d of challenge (2-d postinoculation [PI] and 7-d PI, respectively), cecal samples were collected and microbiome analysis was conducted using Illumina MiSeq. The experiments were repeated twice with 8 and 10 turkeys/group for 7- and 12-wk studies, respectively. Results indicated that the species richness and abundance (Shannon diversity index) was similar among the treatment groups. However, treatments caused apparent clustering of the samples among each other (P < 0.05). Firmicutes was the predominant phylum in the growing and finishing turkey cecum which was evenly distributed among the treatments except on wk 12 where the relative abundance of Firmicutes was significantly higher in P than in N (P = 0.02). The MDR SH challenge resulted in modulation of microflora such as Streptococcus, Gordonibacter, and Turicibacter (P < 0.05) in the S groups compared with the P and N groups, known to be associated with inflammatory responses in birds and mammals. The supplementation of PF increased the relative abundance of carbohydrate-fermenting and short-chain fatty acid-producing genera in the P group compared with the S group (P < 0.05). Moreover, the results revealed that PF supplementation potentially modulated the beneficial microbiota in the P group, which could mitigate SH carriage in turkeys.

Emerging multidrug resistance isolates of hospital-acquired bacterial meningitis in a tertiary care centre in North India.

Purpose. Acute bacterial meningitis continues to be a potentially life threatening condition. Hospital-acquired meningitis is rapidly increasing and adding an immense burden to the health system due to the emergence of multidrug resistance isolates. The purpose of this study is to find the antibiotic susceptibility pattern of the bacteria detected from hospital- and community-acquired meningitis.Methodology. A total of 400 Cerebrospinal fluid (CSF) samples from the suspected meningitis cases were collected and processed for cell count, biochemical examination, Gram staining, latex agglutination and culture. Bacteria grown on blood, chocolate and Mac-conkey agar were identified by matrix-assisted laser desorption/ionization-time of flight. Antibiotic susceptibility tests were performed as per Clinical and Laboratory Standard Institute guidelines.Results. Of the isolates, most prevalent Gram negative organisms in hospital-acquired bacterial meningitis were Escherichia coli 13 (27.08 %), Acinetobacter baumannii 12 (25 %), Klebsiella pneumoniae 5 (10.42 %), Pseudomonas aeruginosa 4 (8.33 %) and Gram positive organisms were Staphylococcus aureus 4 (8.33 %), Enterococcus faecium 3 (6.25 %) and CONS 2 (4.16 %). Streptococcus pneumoniae 3 (6.25 %) was the predominant organism in community-acquired bacterial meningitis. All the Gram negative isolates were multidrug resistance. Only colistin and imipenem were effective antibiotics against them. Likewise Gram positive organisms were susceptible to most of the antibiotics tested. However, E. faecium was only susceptible to Vanco+Teicoplanin.Conclusion. In hospital-acquired bacterial meningitis, multidrug resistance Gram negative bacteria are a huge challenge for the treatment of patients. Hence, antimicrobial stewardship should be followed to counteract with the emerging multidrug resistance isolates.

Taxane-based Induction Chemotherapy Plus Concurrent Chemoradiotherapy in Nasopharyngeal Carcinoma: Prospective Results from a Non-endemic Cohort.

AIMS: To report the outcomes of induction chemotherapy (ICT) followed by chemoradiotherapy (CTRT) for a large cohort of locoregionally advanced nasopharyngeal cancer (LA-NPC) from a non-endemic region. MATERIALS AND METHODS: Between January 2008 and July 2015, 201 patients with histologically proven, non-metastatic NPC were treated with ICT followed by CTRT at our institute. All the patients received two to three cycles of a taxane-based ICT regimen. Radiotherapy was delivered using an intensity-modulated radiotherapy (IMRT) technique in all patients. RESULTS: After a median follow-up of 37 months (range: 7-110 months), the 3-year disease-free survival (DFS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS) and overall survival of the entire cohort was 72, 85, 83 and 87.4%, respectively. On multivariate analysis, histology was an independent predictor of DFS, LRFS and overall survival, with keratinising squamous cell carcinoma histologies predicting a worse outcome. The nodal stage was an independent predictor of DFS, DMFS and overall survival. Age, gender, ethnicity, tumour stage and response to ICT did not significantly affect any of the outcomes. Grade 2 or worse subcutaneous fibrosis was seen in 19% of patients at last follow-up and grade 2 or worse xerostomia was seen in 24% of patients. Thirty-nine per cent of patients developed clinical hypothyroidism at last follow-up. CONCLUSION: ICT followed by concurrent CTRT in the IMRT era provides excellent locoregional control, distant control and overall survival rates in patients with LA-NPC. However, distant failure continues to be a problem and may require further systemic intensification.

Cryopreservation of Encapsulated Axillary Buds of Clitoria ternatea (L.).

BACKGROUND: Clitoria ternatea is a brain revitalizing legume, with immense pharmacological value including antimicrobial, antioxidant and anticancer. The lack of a commercial cultivation has led to its' over collection from the wild to meet the demand of herbal pharmaceutical sector and the species is now rare in the wild. Hence, the plant needs to be conserved. Cryopreservation of the species would supplement the conventional conservation strategies in the field or seed bank. OBJECTIVE: The objective of the study was to evolve an efficient and simple protocol for the cryopreservation of Clitoria ternatea using an encapsulation-dehydration technique. MATERIALS AND METHODS: An in vitro culture system via axillary shoot proliferation was developed using nodal segments in MS medium and optimization of the levels of cytokinins and auxins. Calcium alginate encapsulated axillary buds were subjected to 0-5 h of dehydration, to determine the optimum drying time and moisture content for effective cryopreservation. RESULTS: The beads dehydrated for 4 h to 20.1 % moisture content had 60 % survival after freezing in LN, of which 65 % regrew. Based on RAPD analysis, the plants regrowing after cryostorage were genetically stable. CONCLUSION: A simple and efficient cryopreservation protocol has been established for C. ternatea using an encapsulation-dehydration technique, and this could be effectively utilized for germplasm conservation of this species.

Neonatal mice possess two phenotypically and functionally distinct lung-migratory CD103+ dendritic cell populations following respiratory infection.

The CD103+ subset of lung-migratory dendritic cells (DCs) plays an important role in the generation of CD8+ T cell responses following respiratory infection. Here, we demonstrate that the dependence on CD103+ DCs for stimulation of RSV-specific T cells is both epitope and age-dependent. CD103+ DCs in neonatal mice develop two phenotypically and functionally distinct populations following respiratory infection. Neonatal CD103+ DCs expressing low levels of CD103 (CD103lo DCs) and other lineage and maturation markers including costimulatory molecules are phenotypically immature and functionally limited. CD103lo DCs sorted from infected neonates were unable to stimulate cells of the KdM282-90 specificity, which are potently stimulated by CD103hi DCs sorted from the same animals. These data suggest that the delayed maturation of CD103+ DCs in the neonate limits the KdM282-90-specific response and explain the distinct CD8+ T cell response hierarchy displayed in neonatal mice that differs from the hierarchy seen in adult mice. These findings have implications for the development of early-life vaccines, where the promotion of responses with less age bias may prove advantageous. Alternately, specific approaches may be used to enhance the maturation and function of the CD103lo DC population in neonates to promote more adult-like T cell responses.

Predictors of unfavourable treatment outcome in patients with multidrug-resistant tuberculosis in India.

Setting: India has one of the highest global rates of multidrug-resistant tuberculosis (MDR-TB), which is associated with poor treatment outcomes. A better understanding of the risk factors for unfavourable outcomes is needed. Objectives: To describe 1) the demographic and clinical characteristics of MDR-TB patients registered in three states of India during 2009-2011, 2) treatment outcomes, and 3) factors associated with unfavourable outcomes. Design: A retrospective cohort study involving a record review of registered MDR-TB patients. Results: Of 788 patients, 68% were male, 70% were aged 15-44 years, 90% had failed previous anti-tuberculosis treatment or were retreatment smear-positive, 60% had a body mass index < 18.5 kg/m2 and 72% had additional resistance to streptomycin and/or ethambutol. The median time from sputum collection to the start of MDR-TB treatment was 128 days (IQR 103-173). Unfavourable outcomes occurred in 40% of the patients, mostly from death or loss to follow-up. Factors significantly associated with unfavourable outcomes included male sex, age ⩾ 45 years, being underweight and infection with the human immunodeficiency virus. Adverse drug reactions were reported in 24% of patients, with gastrointestinal disturbance, psychiatric morbidity and ototoxicity the most common. Conclusion: Long delays from sputum collection to treatment initiation using conventional methods, along with poor treatment outcomes, suggest the need to scale up rapid diagnostic tests and shorter regimens for MDR-TB.

Contexte : L'Inde a l'un des taux les plus élevés au monde de tuberculose multirésistante (TB-MDR), qui est associée à des résultats médiocres du traitement. Une meilleure compréhension des facteurs de risque de résultats défavorables est requise.Objectifs : Décrire : 1) les caractéristiques démographiques et cliniques des patients TB-MDR enregistrés dans trois états d'Inde de 2009 à 2011, 2) les résultats du traitement, et 3) les facteurs associés à des résultats défavorables.Schéma : Une étude de cohorte rétrospective impliquant une revue des dossiers des patients TB-MDR enregistrés.Résultats : Il y a eu 788 patients, dont 68% d'hommes, 70% âgés de 15­44 ans, 90% ayant eu un échec de leur traitement anti-tuberculose précédent ou ayant un frottis positif en retraitement, 60% ayant un index de masse corporelle < 18,5 kg/m2 et 72% ayant en plus une résistance à la streptomycine et/ou à l'éthambutol. Le délai médian entre le recueil de crachats et la mise en route du traitement de la TB-MDR a été de 128 jours (IQR 103­173). Les résultats ont été défavorables pour 40% des patients, en majorité des décès ou des pertes de vue. Les facteurs significativement associés à un résultat défavorable ont inclus le sexe masculin, l'âge ⩾ 45 ans, la maigreur et le fait d'être positif pour le virus de l'immunodéficience humaine. Des effets secondaires des médicaments ont été notés dans 24% des cas, avec des troubles gastro-intestinaux, des problèmes psychiatriques et une ototoxicité comme symptômes les plus fréquents.Conclusion : De longs délais entre le recueil de crachats et la mise en route du traitement basé sur des méthodes conventionnelles et des résultats médiocres du traitement signalent la nécessité d'intensifier la mise en œuvre des tests de diagnostic rapide et des protocoles de traitement court de la TB-MDR.

Marco de referencia: La tasa de tuberculosis multirresistente (TB-MDR) en la India es una de las tasas más altas en el mundo y se asocia con desenlaces terapéuticos desfavorables. Es preciso lograr un mejor conocimiento de los factores de riesgo que determinan la ineficacia del tratamiento.Objetivos: 1) Describir las características demográficas y clínicas de los pacientes con TB-MDR registrados en tres estados de la India del 2009 al 2011; 2) analizar los desenlaces terapéuticos; y 3) describir los factores asociados con los resultados desfavorables del tratamiento.Método: Un estudio retrospectivo de cohortes a partir del análisis de las historias clínicas de los pacientes registrados con diagnóstico de TB-MDR.Resultados: Se incluyeron en el estudio 788 pacientes; el 68% era de sexo masculino, en el 70% la edad estaba comprendida entre 15 años y 44 años, el 90% tenía antecedente de fracaso de un tratamiento antituberculoso o estaba en retratamiento con baciloscopia positiva, el índice de masa corporal era inferior a 18,5 en el 60% de los casos y el 72% presentaba resistencia adicional a estreptomicina, etambutol o ambos. La mediana del lapso entre la recogida de la muestra de esputo y el comienzo del tratamiento de la TB-MDR fue 128 días (intervalo intercuartil 103­173). Se observaron desenlaces desfavorables en 40% de los pacientes y consistieron en su mayoría en defunciones o pérdidas durante el seguimiento. Los factores que se asociaron de manera significativa con estos desenlaces fueron el sexo masculino, la edad ⩾ 45 años, el bajo peso y la serología positiva frente del virus de la inmunodeficiencia humana. Se notificaron reacciones adversas a los medicamentos en el 24% de los casos, de las cuales las más frecuentes fueron los trastornos gastrointestinales, las afecciones psiquiátricas y la ototoxicidad.Conclusión: La observación de plazos prolongados entre la recogida de las muestras de esputo y la iniciación del tratamiento cuando se utilizan los medios diagnósticos corrientes y de desenlaces terapéuticos desfavorables destaca la necesidad de ampliar la escala de aplicación de las pruebas rápidas de diagnóstico y la administración de pautas más cortas de tratamiento de la TB-MDR.

Role of microscopic spread beyond gross disease as an adverse prognostic factor in oral squamous cell carcinoma.

INTRODUCTION: Despite meticulous surgery and proper adjuvant treatment, outcome of oral squamous cell carcinoma remains unpredictable. This shows that there may be other factors which should be considered while prognosticating these patients. Many a times there is spread of disease beyond the gross margin which can alter the margin status. We hypothesized that microscopic spread beyond gross disease may portend a poor prognosis. METHOD: This is a retrospective study of prospectively collected data of 1025 treatment naïve oral squamous cell carcinoma patients. All patients underwent surgery from January 2012 to October 2013, this was followed by appropriate adjuvant treatment. Demographic and histopathological details were noted from the electronic medical records. RESULTS: Microscopic spread beyond gross disease (MSGD) is associated with higher incidence of nodal positivity (p < 0.046), peri-neural invasion (p < 0.001), thicker tumours (p < 0.024) and poor differentiation (p < 0.060). The overall survival in patients with MSGD was 32.45 months vs. 37.5 months in patients without MSGD (p < 0.002). CONCLUSION: Tumours with MSGD tend to have a higher incidence of nodal metastasis, PNI and thicker tumours. Presence of MSGD was associated with lower overall survival as compared to those without.

Angiopoietins as biomarkers of disease severity and bacterial burden in pulmonary tuberculosis.

BACKGROUND: Circulating angiogenic factors of the vascular endothelial growth factor family are important biomarkers of disease severity in pulmonary tuberculosis (PTB). However, the role of angiopoietins, which are also involved in angiogenesis, in PTB is not known. OBJECTIVE AND DESIGN: To examine the association of circulating angiopoietins with TB disease or latent tuberculous infection (LTBI), we examined the systemic levels of angiopoietin (Ang) 1, Ang 2 and Tie-2 receptor in individuals with PTB (n = 44), LTBI (n = 44) or no tuberculous infection (NTBI) (n = 44). RESULTS: Circulating levels of Ang-1, Ang-2 and Tie-2 were significantly higher in PTB than in individuals with LTBI or NTBI. Moreover, Ang-1, Ang-2 and Tie-2 levels were significantly higher in PTB with bilateral disease. The levels of these factors also exhibited a significant positive relationship with bacterial burdens in PTB. Receiver operating characteristics curve analysis revealed Ang-2 as a marker distinguishing PTB from LTBI or NTBI. Finally, the circulating levels of Ang-1, Ang-2 and Tie-2 were significantly reduced following anti-tuberculosis chemotherapy. CONCLUSIONS: Our data demonstrate that PTB is associated with elevated levels of circulating angiopoietins, possibly reflecting endothelial dysfunction. In addition, Ang-2 could prove useful as a biomarker to monitor disease severity, bacterial burden and therapeutic responses.

Pulmonary Mycobacterium kansasii disease in immunocompetent host: Treatment outcomes with short-course chemotherapy.

Mycobacterium kansasii, most virulent of all atypical mycobacteria, causes pulmonary disease identical to the disease caused by Mycobacterium tuberculosis. Early identification of the species and prompt initiation of treatment for M. kansasii is necessary to prevent morbidity and mortality due to this disease. This case series highlights the similarity in the clinical presentation of both M. tuberculosis and M. kansasii and response to direct observation of short-course chemotherapy with rifampicin, in the management of pulmonary M. kansasii disease. Larger studies are required to evaluate the long-term effect of short-course chemotherapy, especially use of moxifloxacin, in the management of pulmonary M. kansasii disease.

Factors associated with sputum culture conversion in multidrug-resistant pulmonary tuberculosis.

INTRODUCTION: Sputum culture conversion in pulmonary multidrug-resistant tuberculosis (MDR-TB) is important to make treatment-related decisions and prevent transmission of disease. OBJECTIVE: To identify factors associated with sputum culture conversion, and to determine time to culture conversion and the impact of culture conversion on successful treatment outcomes in MDR-/rifampicin (RMP) resistant TB. METHOD: Retrospective analysis of data from treatment cards and registers of MDR-/RMP-resistant patients initiated on treatment under India's Revised National TB Control Programme in Delhi, West Bengal and Kerala from January 2009 to December 2011. Proportions were calculated and logistic regression analysis was performed. RESULTS: Of 836 patients, 787 were analysed, 651 (83%) of whom experienced culture conversion: respectively 57%, 73% and 79% culture converted by month 3, 4 and 6 of treatment. The median time to culture conversion was 91.3 days. Patients with body mass index (BMI) 16 kg/m2 (OR 0.403, P = 0.001) and 1618 kg/m2 (OR 0.519, P = 0.039) were less likely to have culture conversion. High rates of culture conversion were observed in patients with successful treatment outcomes compared to those without treatment success (462/469, 99% vs. 183/311, 59%; P 0.0001). CONCLUSION: Low BMI is associated with poor sputum culture conversion in MDR-/RMP-resistant TB patients. Lack of culture conversion can impact successful treatment outcomes.

Carbon dioxide emission from bamboo culms.

Bamboos are one of the fastest growing plants on Earth, and are widely considered to have high ability to capture and sequester atmospheric carbon, and consequently to mitigate climate change. We tested this hypothesis by measuring carbon dioxide (CO2 ) emissions from bamboo culms and comparing them with their biomass sequestration potential. We analysed diurnal effluxes from Bambusa vulgaris culm surface and gas mixtures inside hollow sections of various bamboos using gas chromatography. Corresponding variations in gas pressure inside the bamboo section and culm surface temperature were measured. SEM micrographs of rhizome and bud portions of bamboo culms were also recorded. We found very high CO2 effluxes from culm surface, nodes and buds of bamboos. Positive gas pressure and very high concentrations of CO2 were observed inside hollow sections of bamboos. The CO2 effluxes observed from bamboos were very high compared to their carbon sequestration potential. Our measurements suggest that bamboos are net emitters of CO2 during their lifespan.

Squamous cell carcinoma of the upper aerodigestive tract in exclusive smokers, chewers, and those with no habits.

BACKGROUND: Tobacco consumption is the major risk factor for developing head and neck squamous cell cancer (SCC). The site of development of HNSCC may depend on the way the tobacco is consumed. While laryngeal cancers are more common among smokers, oral cancers are more common among tobacco chewers. Since the use of smokeless tobacco is increasing, it is important to know whether this difference is restricted only to site wise distribution or it has other clinical and pathological implications. PATIENTS AND METHODS: We analyzed a prospectively collected dataset of HNSCC patients other than nasopharyngeal cancers attending our outpatient department at a single unit of the head and neck services at Tata Memorial Hospital, Mumbai, India, between January 2010 and September 2011. There were 747 eligible patients and were divided into three groups: Those with chewing as the only habit (chewers), those with smoking as the only habit (smokers), and those with no habits. Patients with regular use of alcohol were excluded from the study. The clinical and pathological parameters were analyzed. RESULTS: Of the 747 patients, the tobacco chewers formed 69.3% followed by smokers (19.5%) and patients with no habits (11.1%). Majority of smokers were men (98%). Site distribution revealed patients with chewing as the only habit had oral cancers (most commonly gingivobuccal complex cancers) as the most common site and those with smoking as the only habit had larynx as the most common site. In patients with no habits, oral tongue was found to be the most common site. No statistically significant pathological differences were observed in between these groups in patients who underwent surgery (n = 366) at the initial modality of treatment. CONCLUSIONS: There is a direct relationship between the form of tobacco use and site of appearance of HNSCC. However, there are no differences in clinical or pathological parameters between HNSCC caused by tobacco chewing or tobacco smoking.

Skin involvement and ipsilateral nodal metastasis as a predictor of contralateral nodal metastasis in buccal mucosa cancers.

CONTEXT: In view of low incidence of contralateral nodal metastasis and increase in the morbidity, the opposite neck is not routinely addressed. However, contralateral nodal metastasis is seen frequently in a certain group of patients. Identifying those factors associated with higher chances of contralateral nodal metastasis may help in optimizing the treatment. AIMS: The aim of this study was to identify prognostic factors associated with contralateral nodal metastasis in cases of buccal mucosa cancers. SETTINGS AND DESIGN: A retrospective audit of 125 patients with squamous cell carcinoma of buccal mucosa at a tertiary cancer center. SUBJECTS AND METHODS: Those cases in which lesions were reaching or crossing midline were included in this study. All cases underwent surgery as primary modality of treatment and had bilateral neck dissection. STATISTICAL ANALYSIS USED: Chi-square test is used for evaluating the variables predicting contralateral nodal metastasis. Finally, a multivariate analysis was performed using binomial logistic regression to identify those variables that were independently associated with the risk of contralateral nodal metastasis. RESULTS: Among 125 patients, 53 cases were node negative. Ipsilateral nodal metastasis was seen in 44/125 (35.2%) patients, 26/125 (20.8%) had bilateral neck node metastasis, and 2/125 (1.6%) had isolated contralateral nodal metastasis. Among these 28 patients with contralateral nodal metastasis, 26 patients had ipsilateral nodal metastasis. Ipsilateral nodal metastasis and skin involvement were independently predictive of contralateral nodal metastasis. CONCLUSIONS: Contralateral nodal metastasis in the absence of ipsilateral nodal metastasis is very rare and frozen section of ipsilateral neck dissection specimen can be an important pointer for addressing contralateral neck.

Genetic variant in the BCL11A (rs1427407), but not HBS1-MYB (rs6934903) loci associate with fetal hemoglobin levels in Indian sickle cell disease patients.

India along with Nigeria and DRC contribute to 57% of the world sickle cell anemia population. The annual number of newborns in India with SCA was estimated at 44,000 in 2010. Even with this high prevalence there is minimal information about genetic factors that influence the disease course in Indian patients. The current study was conducted on 240 patients with SCD and 60 with sickle cell trait, to determine the association of genetic variants at the BCL11A (rs1427407) and HBS1-MYB (rs6934903) loci with fetal hemoglobin levels (HbF). Both these loci have been implicated with influencing HbF levels, a powerful modulator of the clinical and hematologic features of SCD. Our results indicate the BCL11A rs1427407 G>T variant to be significantly associated with HbF levels {19.12±6.61 (GG), 20.27±6.92 (GT) and 24.83±2.92 (TT) respectively} contributing to ~23% of the trait variance. Interestingly no association of the HBS1L-MYB rs6934903 with the HbF levels was seen. The present study indicates the BCL11A (rs1427407) but not HMIP (rs6934903) to be associated with elevated HbF levels in Indian patient. Further interrogation of additional variants at both the loci; as also a GWAS which may help uncover new loci controlling HbF levels.

Setting priorities for a research agenda to combat drug-resistant tuberculosis in children.

SETTING: Numerous knowledge gaps hamper the prevention and treatment of childhood drug-resistant tuberculosis (TB). Identifying research priorities is vital to inform and develop strategies to address this neglected problem. OBJECTIVE: To systematically identify and rank research priorities in childhood drug-resistant TB. DESIGN: Adapting the Child Health and Nutrition Research Initiative (CHNRI) methodology, we compiled 53 research questions in four research areas, then classified the questions into three research types. We invited experts in childhood drug-resistant TB to score these questions through an online survey. RESULTS: A total of 81 respondents participated in the survey. The top-ranked research question was to identify the best combination of existing diagnostic tools for early diagnosis. Highly ranked treatment-related questions centred on the reasons for and interventions to improve treatment outcomes, adverse effects of drugs and optimal treatment duration. The prevalence of drug-resistant TB was the highest-ranked question in the epidemiology area. The development type questions that ranked highest focused on interventions for optimal diagnosis, treatment and modalities for treatment delivery. CONCLUSION: This is the first effort to identify and rank research priorities for childhood drug-resistant TB. The result is a resource to guide research to improve prevention and treatment of drug-resistant TB in children.

Contexte : De nombreuses lacunes en matière de connaissances entravent la prévention et le traitement de la tuberculose (TB) pharmacorésistante. L'identification des priorités de recherche est vitale pour informer et développer des stratégies afin de répondre à ce problème négligé.Objectif : Tenter d'identifier systématiquement et de classer par ordre les priorités en matière de recherche sur la TB pharmacorésistante de l'enfant.Schéma: Ayant adapté la méthode de Child Health and Nutrition Research Initiative (CHNRI) (Initiative de recherche en santé et en nutrition de l'enfant), nous avons compilé 53 questions de recherche dans quatre domaines, puis les avons classées en trois types de recherche différents. Nous avons invité des experts en TB pharmacorésistante de l'enfant à classer ces questions grâce à une enquête en ligne.Résultats : Un total de 81 personnes ont participé à l'enquête. La question de recherche qui a été classée première était l'identification des meilleures associations d'outils de diagnostic existants pour permettre un diagnostic précoce. Les questions considérées comme prioritaires en matière de traitement étaient centrées sur des interventions visant à améliorer les résultats du traitement, à réduire les effets secondaires des médicaments et à déterminer la durée idéale du traitement. La prévalence de la TB pharmacorésistante était la priorité dans le domaine de l'épidémiologie. Les questions relatives au développement ont été considérées comme hautement prioritaires et se sont focalisées sur des interventions d'amélioration du diagnostic, du traitement et des modalités de délivrance du traitement.Conclusion : Cette enquête est la première qui vise à identifier et à hiérarchiser les priorités de recherche relatives à la TB pharmacorésistante de l'enfant. Son résultat constitue une ressource pour guider la recherche afin d'améliorer la prévention et le traitement de la TB pharmacorésistante de l'enfant.

Marco de referencia: Numerosas lagunas de conocimiento obstaculizan la prevención y el tratamiento de la tuberculosis drogorresistente (TB-DR) en niños. Es esencial identificar cuales son las áreas prioritarias de investigación para informar y desarrollar estrategias para hacer frente a este problema descuidado.Objetivo: Identificar sistemáticamente las prioridades de investigación en la TB-DR en niños, y construir una clasificación jerárquica de ellas.Diseño: Se adaptó la metodología de la Iniciativa de Investigación en Salud y Nutrición Infantil (CHNRI). Recopilamos 53 preguntas de investigación en cuatro áreas de investigación y luego las clasificamos entre tres tipos de investigación. Invitamos a expertos en TB-DR en niños a que asignen puntajes a cada una de estas preguntas usando una encuesta en línea.Resultados: Un total de 81 individuos participaron en la encuesta. La pregunta de investigación con el puntaje más alto fue de identificar la mejor combinación de existentes herramientas de diagnosis para llegar a un diagnóstico precoz. Preguntas con altos puntajes relacionadas al tratamiento se centraron en entender las razones y las intervenciones para mejorar los resultados del tratamiento, los efectos adversos de los fármacos y la duración óptima del tratamiento. La prevalencia de la TB-DR fue la pregunta con el más alto puntaje en el área de epidemiología. Las preguntas de tipo desarrollo con puntajes más altos se centraron en las intervenciones para el diagnóstico óptimo, el tratamiento óptimo y las modalidades óptimas de prestación del tratamiento.Conclusión: Este ha sido el primer esfuerzo de identificar y clasificar jerárquicamente las prioridades de investigación en la TB-DR en niños. El resultado es un recurso para orientar la investigación para mejorar la prevención y el tratamiento de la TB-DR en niños.