MPT51 and MPT64-based antigen detection assay for the diagnosis of extrapulmonary tuberculosis from urine samples.

In view of WHO's "End-TB" strategy, we developed a non-invasive, urine-based ELISA, targeting 2 Mycobacterium tuberculosis antigens namely MPT51 and MPT64 for extrapulmonary TB (EPTB) diagnosis. Suspected EPTB patients (n = 137) [Pleural TB, Abdominal TB and Tuberculous meningitis] were categorized in "Definite" EPTB (n = 10) [Xpert-MTB/RIF and/or culture-positive], "Probable" EPTB (n = 77) and "Non-EPTB" (n = 50) groups using defined composite reference standards. ROC-curves were generated using ELISA results of "Definite" EPTB and "Non-EPTB" groups for both antigens independently and cut-off values were selected to provide 86.3% (95%CI:73.3-94.2) specificity for MPT51 and 92% (95%CI:80.8-97.8) for MPT64. The sensitivity of MPT51-ELISA and MPT64-ELISA was 70% (95%CI:34.7-93.3) and 90% (95%CI:55.5-99.7) for "Definite" EPTB group and 32.5% (95%CI:22.2-44.1) and 30.8% (95%CI:20.8-42.2) for "Probable" EPTB group, respectively. Combining the results of both ELISAs showed a 100% (95%CI:69.1-100) sensitivity in "Definite" EPTB group and 41.6% (95%CI:30.4-53.4) in "Probable" EPTB group, with an 80% (95%CI:66.3-89.9) specificity. The results demonstrated the potential of urine-based ELISAs as screening tests for EPTB diagnosis.

Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management.

Corticosteroids and l -asparaginase used in the treatment of pediatric acute lymphoblastic leukemia (ALL) can cause drug-induced diabetes mellitus (DIDM). DIDM can lead to dyselectrolytemia, a higher risk of infections including cellulitis, bacteremia, fungemia, and a higher incidence of febrile neutropenia and may have an impact on the outcome of ALL. Literature on the management of DIDM among children with ALL is sparse and the diagnostic criteria for pediatric diabetes should be carefully applied considering the acute and transient nature of DIDM during ALL therapy. Insulin remains the standard of care for DIDM management and the choice of Insulin regimen (stand-alone Neutral Protamine Hagedorn or basal bolus) should be based on the type and dose of steroids used for ALL and the pattern of hyperglycemia. A modest glycemic control (postmeal 140 to 180 mg/dL, premeal <140 mg/dL) to prevent complications of hyperglycemia, as well as hypoglycemia, would be the general approach. This review is intended to suggest evidence-based practical guidance in the diagnosis and management of DIDM during pediatric ALL therapy.

A study comparing the clinical and hormonal profile of late onset and persistent acne in adult females.

BACKGROUND: Adult acne has been classified into two major subtypes: "persistent acne" and "late onset acne". A surrogate marker of hyperandrogenism (HA) in adult female acne is the presence of clinical signs of HA and biochemical hyperandrogenemia. We compared the clinical and hormonal profiles of the two acne subtypes and evaluated the likely source of androgen excess - ovarian or adrenal. METHODS: Female acne patients 25 years of age and older were evaluated for clinical HA. Hormonal assessment included total testosterone (TT), sex hormone binding globulin (SHBG), free androgen index (FAI), anti-Mullerian hormone (AMH), 17-hydroxyprogesterone (17-OHP), dehydroepiandrosterone sulfate (DHEAS), follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), and prolactin. DHEAS and 17-OHP represented adrenal androgens and AMH indicated ovarian reserve. RESULTS: Of 120 cases, clinical HA was seen in 71.67% while biochemical hyperandrogenemia was detected in only 18.33% of patients. Though late onset was more common in adult acne patients (56.6%), the persistent acne subgroup (43.33%) had a younger age at onset, a past history of adolescent acne (51.92%), truncal predilection (44.23%), polycystic ovary syndrome (PCOS) (44.23%), significant presence of irregular menses (40.38%) and hirsutism (57.69%), and increased TT (13.46%), 17-OHP (76.92%), AMH (44.23%), and increased LH/FSH (15.38%) ratio. PCOS was seen more in the persistent acne patients with clinical HA and increased 17-OHP levels. CONCLUSION: Persistent acne patients had marked clinical HA, PCOS, and hormonal abnormalities necessitating an endocrinological evaluation. As a corollary, this subgroup would benefit from antiandrogen therapy.