Mutation at codon 442 in the rpoB gene of Mycobacterium leprae does not confer resistance to rifampicin.

BACKGROUND: Rifampicin is the major drug in the treatment of leprosy. The rifampicin resistance of Mycobacterium leprae results from a mutation in the rpoB gene, encoding the ß subunit of RNA polymerase. As M. leprae is a non-cultivable organism observation of its growth using mouse food-pad (MFP) is the only Gold Standard assay used for confirmation of "in-vivo" drug resistance. OBJECTIVE: Any mutation at molecular level has to be verified by MFP assay for final confirmation of drug resistance in leprosy. MATERIAL AND METHODS: In the present study, M. leprae strains showing a mutation only at codon 442 Gln-His and along with mutation either at codon 424 Val-Gly or at 438 Gln-Val within the Rifampicin Resistance Determining Region (RRDR) confirmed by DNA sequencing and by high resolution melting (HRM) analysis were subjected for its growth in MFP. RESULT AND CONCLUSION: The M. leprae strain having the new mutation at codon 442 Gln-His was found to be sensitive to all the three drugs and strains having additional mutations at 424 Val-Gly and 438 Gln-Val were conferring resistance with Multi drug therapy (MDT) in MFP. These results indicate that MFP is the gold standard method for confirming the mutations detected by molecular techniques.

Vitamin-D supplementation in prediabetes reduced progression to type 2 diabetes and was associated with decreased insulin resistance and systemic inflammation: an open label randomized prospective study from Eastern India.

Vitamin-D supplementation in vitamin-D insufficient/deficient prediabetes individuals is associated with significantly lower progression to diabetes (6/55 vs. 13/49; p=0.04) and higher reversal to normoglycemia (23/55 vs. 10/49; p=0.02), associated with decreased insulin resistance and systemic inflammation (TNFα and IL6). Baseline vitamin-D and 2h blood glucose independently predicted progression to diabetes.

Primary tuberculosis of thyroid gland: a rare case report.

Tuberculosis of the thyroid gland is a rare entity, and primary tuberculosis of thyroid is even uncommon. At one time, it was believed that thyroid gland is relatively immune to tuberculosis. There are about 200 cases of thyroid tuberculosis that had been reported in world literature. These include 156 cases reviewed by Goldfarb et al (Am J Med 1965;38:825) and 1 each by Crompton et al (Tubercle 1969;50:61-64), Johnson et al (Br J Surg 1973;60:668-669), Emry (J Laryngol Otol 1980;94:553-558), and Kukreja and Sharma ML (Ind J Surg 1982;44:190-192), and a histologic diagnosis by Das et al (Acta Cytol 1992;36:517-522) and Mondal and Patra (J Laryngol Otol 1995;109:36-38). Almost all cases had primary foci elsewhere in the body. Isolated tuberculosis of the thyroid gland is extremely rare, with few reported cases; when it does occur, it may prove difficult to diagnose (J Laryngol Otol 1980;94:553-558). Among the different manifestations of tuberculous thyroiditis, abscess of the thyroid appears to be the rarest and the most dangerous (Tubercle 1969;50:61-64). Sachs et al (Am J Med 1988;85:573-575) reported 4 cases of tuberculous thyroiditis that were diagnosed preoperatively, the rest of the cases were diagnosed either from surgical specimen or from autopsy. A case of primary tuberculosis of thyroid gland presenting as abscess and diagnosed preoperatively is reported here.