TB diagnostic cascade among patients registered under the Revised National TB Control Programme in Chennai, South India.

OBJECTIVE: To discern and quantify the TB diagnostic cascade among patients registered under the Revised National TB Control Programme, Chennai city, Tamil Nadu, South India. METHODS: This cross-sectional study was conducted in metropolitan Chennai from February 2017 to March 2018. We interviewed TB patients retrospectively on their diagnostic attempt in different health facilities. RESULTS: Of 455 TB patients, only 4.4% received their diagnosis at their first health facility. Of 1250 visits to health facilities, the vast majority (79.4 vs. 20.6%) was in the public rather than the private sector. 56% of patients went to a public facility as the first point of care, of whom 1.6% shifted to private facilities subsequently. The remaining 54.4% shifted between up to five government health facilities. Male patients and those with a higher family income were more likely to shift from private to public. CONCLUSION: Most shifts between diagnostic facilities occurred in the public sector. This necessitates interventions at public health facilities for strengthening and extending services to TB patients at their first point of care.

OBJECTIF: Discerner et quantifier la cascade de diagnostic de la TB chez les patients enregistrés dans le Programme National Révisé de lutte contre la TB, dans la ville de Chennai, dans le Tamil Nadu, dans le sud de l'Inde. MÉTHODES: Cette étude transversale a été menée dans la région métropolitaine de Chennai de février 2017 à mars 2018. Nous avons interviewé rétrospectivement des patients TB sur leur tentative de diagnostic dans différents établissements de santé. RÉSULTATS: Sur 455 patients TB, seuls 4,4% ont reçu leur diagnostic dans le premier établissement de santé visité. Parmi 1250 visites dans les établissements de santé, la grande majorité (79,4 vs 20,6%) était dans le secteur public plutôt que le privé. Parmi les 56% des patients qui sont allés dans un établissement public comme premier point de soins, dont 1,6% sont ensuite passés dans des établissements privés. Les 54.4 restants se sont déplacés entre cinq établissements différents de santé publics. Les patients de sexe masculin et ceux dont le revenu familial était plus élevé étaient plus susceptibles de passer du privé au public. CONCLUSION: La plupart des changements entre les établissements de diagnostic se sont produits dans le secteur public. Cela nécessite des interventions dans les établissements de santé publique pour renforcer et étendre les services aux patients TB à leur premier point de soins.

Molecular mechanism of synthetic pyrethroid and organophosphate resistance in field isolates of Rhipicephalus microplus tick collected from a northern state of India.

The frequently used chemical control method to manage Rhipicephalus microplus is limited by the emergence of resistance populations. Understanding of resistance mechanisms is essential to develop strategy for sustainable management. The present study was focused on working out the molecular mechanisms of resistance against synthetic pyrethroids (SPs) and organophosphates (OPs) in field isolates of R. microplus collected from six districts of Uttar Pradesh, India. Adult immersion test with discriminating concentrations (AIT-DC) was used to determine resistance status of isolates to SPs (deltamethrin, cypermethrin) and OPs (diazinon, coumaphos). All the six isolates were found resistant to SPs with resistance factor (RF) of 2.9-58.6 and to one of the OP compounds, diazinon having RF of 3.5-13.7 but susceptible to coumaphos (RF < 1.4). Three R. microplus genes, viz. para-sodium channel domain II S4-5 linker, carboxylesterase (372 bp) and acetylcholinesterase 2 (1692 bp) were sequenced and compared with respective sequences of reference susceptible IVRI-I, reference OP resistant population (IVRI-III), IVRI-IV and multi-acaricide resistant population (IVRI-V) of R. microplus. A C190A mutation in the domain II S4-5 linker region of sodium channel gene leading to L64I amino acid substitution was detected in all six isolates. The G1120A mutation in the carboxylesterase gene could not be detected in any isolate. Five nucleotide substitutions viz., G138A, G889A, T1090A, C1234T and G1403A were identified in the acetylcholinesterase 2 gene leading to four amino acid substitutions. The findings of the study corroborate the role of mutation in sodium channel and acetylcholinesterase 2 genes in SP and OP resistance in this part of India.

Characterization and establishment of a reference deltamethrin and cypermethrin resistant tick line (IVRI-IV) of Rhipicephalus (Boophilus) microplus.

The problem of ticks and tick borne diseases is a global threat and growing reports of resistance to commonly used insecticides further aggravated the condition and demands for country specific resistance monitoring tools and possible solutions of the problem. Establishment of standard reference is prerequisite for development of monitoring tools. For studying possible role of different mechanisms involved in development of resistance in Rhipicephalus (Boophilus) microplus population and to develop newer drug to manage the problem of resistance, a deltamethrin exposed and selected tick colony, referred to as IVRI-IV, was characterized using reference susceptible IVRI-I tick line as control. The RF values of IVRI-IV ticks against deltamethrin, cypermethrin and diazinon were determined as 194.0, 26.6, 2.86, respectively, against adults. The esterase enzyme ratios of 2.60 and 5.83 was observed using α-naphthyl and ß-naphthyl acetate while glutathione S-transferase (GST) ratio was 3.77. Comparative analysis of IVRI-I and IVRI-IV carboxylesterase gene sequences revealed 13 synonymous and 5 non synonymous mutations, reported for the first time. The C190A mutation in the domain II S4-5 linker region of sodium channel gene leading to leucine to isoleucine (L64I) amino acid substitution was also detected in the IVRI-IV population. In the present study, monitorable indicators for the maintenance of the reference IVRI-IV colony, the first established deltamethrin and cypermethrin resistant tick line of India, were identified.

Esterase mediated resistance in deltamethrin resistant reference tick colony of Rhipicephalus (Boophilus) microplus.

Monitoring of acaricide resistance is considered as one of the important facets of integrated tick management. In an attempt of development of resistance monitoring indicators, in the present study two reference tick lines of Rhipicephalus (Boophilus) microplus maintained in the Entomology laboratory, Indian Veterinary Research Institute (IVRI), Izatnagar, India, were studied to determine the possible contributing factors involved in development of resistance to deltamethrin. Electrophoretic profiling of esterase enzymes detected high activities of EST-1 in reference resistant tick colony designated as IVRI-IV whereas it was not detectable in reference susceptible IVRI-I line of R. (B.) microplus. Esterases were further characterized as carboxylesterase or acetylcholinesterase based on inhibitor study using PMSF, eserine sulphate, malathion, TPP and copper sulphate. It was concluded that an acetylcholinesterase, EST-1, possibly plays an important role for development of deltamethrin resistance in IVRI-IV colony of R. (B.) microplus.

The mRNA expression of immune-related genes in crossbred and Tharparkar cattle in response to in vitro infection with Theileria annulata.

Tropical theileriosis is a major protozoan disease of cattle and is associated with high rates of morbidity and mortality. Indigenous cattle (Bos indicus) are less affected by this disease than exotic and crossbred cattle. Genetic basis of resistance to tropical theileriosis in indigenous cattle is not well studied. Recent reports suggest that number of immune response genes expressed differentially in exotic and indigenous breeds play an important role in breed specific resistance to tropical theileriosis. Such studies comparing expression of these genes in crossbred cattle and indigenous cattle are lacking. The present study compares the mRNA expression of immune-related genes in response to Theileria annulata infection in indigenous and crossbred cattle. Peripheral blood mononuclear cells (PBMCs) were isolated from blood samples of indigenous (Tharparkar) and crossbred (HF/BS/Jersey × Hariana) cattle and challenged with prepared ground-up tick supernatant carrying Theileria annulata sporozoites in vitro. qPCR was employed to measure relative mRNA expression of toll-like receptor 10 (TLR10), signal-regulatory protein alpha (SIRPA), MHC class II DQα (BoLA-DQA), musculoaponeurotic fibrosarcoma (MAF) and prion protein (PRNP) genes in infected and control PBMCs from crossbred and indigenous cattle. On the basis of comparative fold change analysis, significant up-regulation in SIRPA, PRNP and MHC DQα genes and significant down-regulation in TLR10, cMAF and MAFB genes in crossbreds as compared to indigenous cattle was observed. Results of the present study suggest that breed specific differential expression of the genes under study may contribute to the breed specific resistance to Theileria annulata infection in indigenous cattle compared to crossbred cattle.

Craniofacial Prosthetic Reconstruction Using Polymethyl Methacrylate Implant: A Case Report.

Large cranial defects of complex geometric shapes are challenging to reconstruct. The cranial implants has to be fabricated prior to the cranioplastic surgery. The ideal material for cranial implant has to be inert, light weight, easy to fit and adaptable to the defect, offering the best aesthetic and functional results. Here is a clinical case report of a patient who was operated for osteomyelitis in the parieto-temporal region. The defect was reconstructed with heat cure polymethylmethacrylate (PMMA). Operative closure of the defect was facilitated with ligature titanium wires with minimal prosthesis contouring. The heat cure PMMA cranial implant is a safe, easy and economic alternative with great adaptability to cranial vault defects. The cosmetic results in this patient was excellent. No post-operative complications occurred.

Di-µ-hydroxido-κ(4) O:O-di-µ-perchlorato-κ(4) O:O'-bis-[(2,2'-bi-pyridine-κ(2) N,N')copper(II)].

In the title binuclear copper(II) complex, [Cu2(ClO4)2(OH)2(C10H8N2)2], the Cu(II) ion is coordinated in the form of a Jahn-Teller distorted octahedron by two bi-pyridine N atoms, two perchlorate O atoms and two hydroxide O atoms, and displays a distorted octa-hedral geometry. The mol-ecule belongs to the symmetry point group C 2h . The Cu(II) ion is located on a twofold rotation axis and the hydroxide and perchlorate ligands are located on a mirror plane. Within the dinuclear mol-ecule, the Cu⋯Cu separation is 2.8614 (7) Å. The crystal structure exhibits O-H⋯O, C-H⋯O and π-π [centroid-centroid distance = 3.5374 (13) Å] inter-actions.

1,2-Bis(2-hy-droxy-5-methyl-benzyl-idene)hydrazine.

The mol-ecular structure of the title compound, C16H16N2O2, is stabilized by intra-molecular O-H⋯N hydrogen bonds with S(6) graph-set motifs, so that the mol-ecule is almost planar, with a C=N-N=C torsion angle of -179.7 (2)° and a dihedral angle of 1.82 (12)° between the aromatic rings. In the crystal, weak C-H⋯π inter-actions lead to the formation of a three-dimensional network.

6-Chloro-2-(4-meth-oxy-phen-yl)-4-phenyl-quinoline.

In the title compound, C22H16ClNO, the quinoline ring system makes dihedral angles of 56.30 (6) and 7.93 (6)°, respectively, with the adjacent phenyl and benzene rings. The dihedral angle between these phenyl and benzene rings is 56.97 (8)°. In the crystal, weak C-H⋯π and π-π [centroid-centroid distances of 3.7699 (9) and 3.8390 (9) Å] inter-actions link the mol-ecules into a layer parallel to the ab plane.

Oriental theileriosis associated with a new genotype of Theileria orientalis in buffalo (Bubalus bubalis) calves in Uttar Pradesh, India.

Theileria orientalis is known to cause a benign infection in cattle and buffalo (Bubalus bubalis). However, the Ikeda and Chitose genotypes of the parasite cause lethal disease in beef and dairy cattle. Recently an outbreak of clinical oriental theileriosis occurred in buffalo calves in a Government Animal Husbandry and Agricultural Farm located in Uttar Pradesh, India. Examination of Giemsa stained thin blood smears revealed typical rod-shaped T. orientalis piroplasms in the erythrocytes. The clinical signs included pyrexia, nasal discharge, lacrimation, lethargy, inappetence and anaemia with varying degrees of paleness of the visible mucous membranes. Vascular congestion in internal organs, pulmonary emphysema and consolidation of lungs, focal areas of necrosis in the heart with mononuclear cell infiltration, focal mononuclear cell aggregation in the cortex and tubular degeneration of the kidney were significant necropsy findings. The T. orientalis major piroplasm surface protein (MPSP) gene was amplified by polymerase chain reaction (PCR) using specific primers. The nucleotide sequence analysis of the PCR product revealed 84.8% identity between the T. orientalis Uttar Pradesh isolate and other reference genotypes available in the public domain. Furthermore, the phylogenetic analysis of the MPSP gene sequence ratified that this is a new genotype of T. orientalis. This is the first report of a clinical outbreak of oriental theileriosis in Indian buffalo calves caused by a novel genotype of T. orientalis.

A Multi-copy Nucleic Acid-Based Diagnostic Test for Bovine Tropical Theileriosis.

BACKGROUND: Bovine tropical theileriosis (BTT) is a haemoprotozoan tick-borne disease that implicates huge losses to livestock in terms of considerable mortality and morbidity in tropical and subtropical regions of the globe. Currently available diagnostic methods have less specificity and sensitivity towards the detection of Theileria species. Therefore, an attempt was made to diagnose Theileria annulata by targeting a multi-copy gene, viz. mitochondrially encoded cytochrome b (MT-CYB) gene via polymerase chain reaction (PCR) in different agro-zones of India. METHODS AND RESULTS: 129 cattle blood samples were collected from major livestock rearing regions of India and processed for both molecular and microscopic techniques. Screening of Giemsa-stained thin blood smears was able to detect 14 samples (10.85%) as positive for T. annulata. However, the MT-CYB gene-based PCR assay detected 107 samples (82.94%) positive for T. annulata out of 129 samples. Furthermore, the MT-CYB gene-based PCR assay was standardized in terms of its sensitivity and specificity. Specificity of PCR assay was evaluated against other common haemoprotozoan parasites of tropical countries viz. Babesia bigemina, Anaplasma marginale and Trypanosoma evansi. The multi-copy MT-CYB gene-based PCR assay provided an optimum level of sensitivity (up to the level of 10 femtogram) and high specificity. Haematological examination (Hb, PCV and TLC) of 113 samples revealed significantly (p < 0.05) decreased Hb and PCV levels in positive animals in comparison with the control group of healthy animals. However, the control group had significantly higher (p < 0.001) TLC levels than the positive group. CONCLUSION: The MT-CYB gene-based PCR assay was found to be highly sensitive that can accurately detect the occurrence of T. annulata infection in carrier animals which are potential infection sources to healthier populations in naive demographic locations through infected ticks.

1'-(4-Bromo-phen-yl)-4'-{4-[(2-oxo-1,2,3,4-tetra-hydro-naphthalen-2-yl-idene)meth-yl]phen-yl}-3'',4''-dihydro-acenaphthylene-1-spiro-2'-pyrrolidine-3'-spiro-2''-naphthalene-2,1''(1H,2''H)-dione.

In the title compound, C(47)H(34)BrNO(3), the central benzene ring makes a dihedral angle of 42.71 (7)° with the bromo-phenyl ring. The pyrrolidine ring adopts an envelope conformation. The mol-ecular structure is stabilized by weak intra-molecular C-H⋯O inter-actions and the crystal packing is stabilized by weak inter-molecular C-H⋯π inter-actions.

Diethyl 2-{[3-(2,4,6-trimethyl-benz-yl)-1-phenyl-sulfonyl-1H-indol-2-yl]methyl-idene}propane-dioate.

In the title compound, C(32)H(33)NO(6)S, the indole ring system makes dihedral angles of 62.78 (10) and 80.53 (8)°, respectively, with the phenyl and benzene rings. In the crystal, the mol-ecules are linked through inter-molecular C-H⋯O hydrogen bonds, forming a chain along the a axis. Between the chains, a weak aromatic π-π stacking inter-action [centroid-centroid distance = 3.831 (2) Å] is observed.

Six-hole versus Four-hole Miniplates in Isolated, Unilateral Angle Fracture of the Mandible.

AIM: The aim of the study was to find the suitable situation for the fixation of "six" hole miniplates in open reduction and internal fixation of displaced and nondisplaced unilateral angle of the mandible fractures. SUBJECTS AND METHODS: Displaced, nondisplaced, simple, compound (linear and noncomminuted) isolated unilateral angle fractures with or without occlusal derangement were included in this study. STATISTICAL ANALYSIS USED: Chi-square test was used for the statistical analysis. RESULTS: The parameters assessed preoperatively and postoperatively were mouth opening, occlusion, neurosensory deficit such as paresthesia, intraoperative time, stability of fragments, and access to the retromolar trigone which showed that the six-hole titanium miniplate was clinically useful in special clinical situations when compared to four-hole titanium miniplate. CONCLUSION: To conclude, six-hole titanium miniplate was clinically useful when compared to four-hole titanium miniplate in the following special clinical situations such as bone loss following extraction of third molar, no posterior occlusion and instability of fracture moderately displaced fracture needs more stability.

Protein Nutrition in Autism.

Autism is a developmental disorder that affects communication and behavior. Although autism can be diagnosed at any age, it is said to be a "developmental disorder" because symptoms generally appear in the first 2 years of life. The primary cause of autism is still not clear and therapy is currently restricted to controlling behavioral abnormalities. However, emerging studies have shown a link between mitochondrial dysfunction and autism. Dietary supplements that promote mitochondrial biogenesis and inhibit the production of oxidative stress have been used to treat autism patients. Dietary adjustments in treating autism is a novel approach to suppress autistic symptoms. Supplementation with antioxidants has been found to not only inhibit cognitive decline but also improve behavioral symptoms in autism. Dietary supplements fortified with vitamins should only be given under the supervision of a physician. A wide range of nutraceuticals are under clinical trials to understand whether they physiologically target mitochondrial pathways and improve the quality of life in autism.

Comparison of the history obtained by patient-completed questionnaires with doctors' standard notes for patients with acute abdominal pain.

BACKGROUND: Studies have shown that proformas improve the information recorded by junior doctors when they clerk patients with acute abdominal pain. This increases their diagnostic accuracy, but doctors are reluctant to use them. Patient-completed questionnaires are being used in elective surgery, but can they be used for patients with acute abdominal pain? OBJECTIVE: To evaluate the history obtained by patient-completed questionnaires in patients with acute abdominal pain and compare this with the history recorded by the admitting junior doctors. DESIGN: Prospective observational study. SUBJECTS: 116 adult patients aged 17-90 admitted as an emergency to the Department of Surgery at Ysbyty Gwynedd in North Wales. MAIN OUTCOME MEASURES: Differences in the amount of information collected using patient-completed questionnaires and the history recorded by junior doctors. The questionnaires contained 17 points relating to general symptoms of the acute abdomen and five points related to gynaecological symptoms. RESULTS: Of the 116 patients studied, 100 (86.2%) completed the questionnaires. There were 60 female and 40 male patients and the median age was 49 years (range 17-90). Doctors recorded fewer than 50% of the general symptoms for acute abdominal pain and patients recorded 90% or more (p<0.0001). Doctors' documentation of gynaecological symptoms was better, but still less detailed than patients' (52-76% vs 92-100%). CONCLUSION: Patient-completed questionnaires can be used to obtain a more accurate history than junior doctors for most patients admitted with acute abdominal pain.

2-Chloro-methyl-3-methyl-1-phenyl-sulfonyl-1H-indole.

In the title compound, C(16)H(14)ClNO(2)S, the phenyl ring makes a dihedral angle of 78.1 (1)° with the indole ring system. The mol-ecular structure is stabilized by weak intra-molecular C-H⋯O inter-actions. The crystal structure exhibits weak inter-molecular C-H⋯O, C-H⋯π and π-π [centroid-centroid distances = 3.620 (1)-3.794 (1) Å] inter-actions.

(2-Methyl-1-phenyl-sulfonyl-1H-indol-3-yl)phenyl-methyl acetate.

In the title compound, C(24)H(21)NO(4)S, the indole ring system makes dihedral angles of 77.8 (1) and 85.4 (1)°, respectively, with the S- and C-bound phenyl rings. The mol-ecular structure is stabilized by a weak intra-molecular C-H⋯O hydrogen bond. In the crystal, a weak inter-molecular C-H⋯O hydrogen bond and a C-H⋯π inter-action are also observed.

High seroprevalence of Toxoplasma gondii in goats in Jharkhand state of India.

Toxoplasmosis, caused by Toxoplasma gondii, is an important food borne zoonosis worldwide. Although goat meat constitutes an important dietary protein source, improperly cooked meat is a potential source of infection to humans. Data on prevalence of toxoplasma in goat is scanty from India. Serological detection is the practical option for prevalence studies on T. gondii, as no biological stage of the parasite is present in the clinical materials from the intermediate hosts. The present study was undertaken in the Jharkhand state of India which is largely inhabited by economically weaker aborigine population, who depend largely on animal husbandry for livelihood. A total of 445 serum samples were collected for testing, which represented goats under intensive and free range system of rearing. T. gondii specific IgG antibodies were detected in 42.47% (n = 189) samples by rSAG1 based indirect ELISA. The seroprevalence data were analyzed in respect of age, sex, breed of the goats and altitude of the study area as well as rearing conditions of the animals to establish correlation, if any. Though age and sex of the animals had a direct correlation with infection, the same could not be established with the other factors. The sensitivity and specificity of the diagnostic ELISA were compared with IFAT, as well as with a commercially available ELISA kit. The rSAG1-ELISA had 92.66% sensitivity and 90.67% specificity with a positive predictive value of 86.77% and negative predictive value 94.92% when compared with IFAT, whereas when compared with the commercial ELISA kit, 87.50% sensitivity and 90.91% specificity with a positive predictive value of 91.30% and negative predictive value 86.96% were observed. Inter rater agreement (kappa) was calculated. rSAG1-ELISA showed good agreement with IFAT (kappa = 0.824) and commercially available ELISA Kit (kappa = 0.783). Receiver Operating Characteristics (ROC) curve analysis, revealed a larger area under curve (AUC) of 0.99 (95%CI, 0.97-1.0) when compared with IFAT as gold standard and a highest relative sensitivity 91.30 (95% CI 72-98.3) and specificity 1.0 (95% CI 85.2-100) for the cut off value of 0.6005. The present study revealed high seroprevalence of T. gondii in goats from Jharkhand, which has public health significance.