Childhood Intra-Thoracic Tuberculosis Clinical Presentation Determines Yield of Laboratory Diagnostic Assays.

Diagnosis of intra-thoracic tuberculosis (ITTB) in children is difficult due to the paucibacillary nature of the disease, the challenge in collecting appropriate specimens, and the low sensitivity of smear microscopy and culture. Culture and Xpert MTB/RIF provide higher diagnostic yield in presumptive TB in adults than in children. Current study was designed to understand poor yield of diagnostic assays in children. Children with presumptive ITTB were subjected to gastric aspirates and induced sputum twice. Samples were tested by Ziehl-Neelsen stain, Xpert MTB/RIF-assay, and MGIT-960 culture. Subjects were grouped as Confirmed, Unconfirmed, and Unlikely TB, and classified as progressive primary disease (PPD, lung parenchymal lesion), and primary pulmonary complex (PPC, hilar lymphadenopathy) on chest X-ray. Of children with culture-positive TB 51/394 (12.9%), culture-negative TB 305 (77.4%), and unlikely TB 38 (9.6%), 9 (2.3%) were smear positive, while 95 (24.1%) were Xpert-MTB/RIF positive. Xpert-MTB/RIF detected 40/51 culture confirmed cases (sensitivity 78.4% and NPV 96.3%). Culture was positive in more children presenting as PPD (p < 0.04). In culture-negative TB group, Xpert positivity was seen in 31% of those with PPD and 11.9% in those with PPC (p < 0.001). Conclusion: Xpert-MTB/RIF improved diagnosis by 2-fold and increased detection of MDR-TB. Both liquid culture and Xpert-MTB/RIF gave higher yield in children with lung parenchymal lesions. Children with hilar lymphadenopathy without active lung parenchymal lesions had poor diagnostic yield even with sensitive nucleic acid amplification tests, due to paucibacillary/localized disease, suggesting possible utility of invasively collected samples in early diagnosis and treatment.

Pancreas transplant in type 1 diabetes mellitus: the emerging role of islet cell transplant.

Pancreas transplant, both whole pancreas and islet cell, is a known therapeutic option for treatment of type 1 diabetes mellitus. Islet cell transplant began as an experimental therapy but is emerging to be quite beneficial due to less surgical risk and fewer complications. It is also considered a promising option in pediatric patients. In this review the authors discuss the indications, procedure, and benefits of islet cell transplant along with newer strategies for improving outcomes.

Evaluation of intraocular lens mechanical stability.

PURPOSE: To compare mechanical characteristics and stability of Clareon CNA0T0 intraocular lens (IOL) with 4 currently marketed monofocal IOLs and to evaluate axial displacement and simulated dioptric power shift using a range of compression diameters. SETTING: Alcon Laboratories, Inc., Fort Worth, Texas, USA. DESIGN: Experimental study. METHODS: Clareon CNA0T0, AcrySof SN60WF, enVista MX60, Tecnis ZCB00, and Vivinex iSert XY1 IOLs (10 per group) were assessed using standardized methods for axial displacement, optic decentration, and optic tilt per the International Organization for Standardization ISO11979-3. Axial displacement was also measured over a range of compression diameters (9.0 to 11.0 mm). RESULTS: At 10.0 mm compression, the mean axial displacement for the CNA0T0 IOL (0.02 mm ± 0.01 [SD]) was significantly lower than for the MX60, ZCB00, and XY1 IOLs (P < .005). At all compression diameters, the CNA0T0 and SN60WF IOLs had the lowest levels of axial displacement and corresponding simulated dioptric power shift at the corneal plane versus other IOL models. At 10.0 mm compression, the mean optic decentration was within ±0.06 mm for all models, and there were no significant differences between the CNA0T0 IOL and other IOLs. At 10.0 mm compression, the mean optic tilt was no greater than 1.2 degrees for all IOL models evaluated; however, the mean optic tilt for the CNA0T0 IOL was significantly lower than for the MX60 IOL (P < .005). CONCLUSION: The CNA0T0 and SN60WF IOLs showed the lowest levels of axial displacement and corresponding simulated dioptric power shift over all tested compression diameters, indicating they might provide the most consistent refractive outcomes.

In vivo evaluation of a new hydrophobic acrylic intraocular lens in the rabbit model.

PURPOSE: To evaluate the uveal and capsular biocompatibility as well as positioning stability of a new hydrophobic acrylic intraocular lens (IOL) in vivo in the rabbit model and compare it with a commercially available IOL. SETTING: John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Experimental study. METHODS: Fifteen New Zealand rabbits had the new test IOL (Clareon CNA0T0) implanted in one eye and a control IOL (Acrysof SN60WF) implanted in the contralateral eye. The test IOL is manufactured from a new hydrophobic acrylic material incorporating ultraviolet blocker and blue light filter. Its design is based on the control IOL's platform. The rabbits were followed up with weekly slitlamp evaluations, which assessed inflammatory reactions as well as capsular bag opacification. Anterior chamber depth was measured at 1 and 4 weeks post-implantation (high-frequency ultrasound). After 4 weeks, the rabbits were killed humanely and the eyes were enucleated. The anterior segment was evaluated from the posterior or Miyake-Apple view, and was then processed for complete histopathology. RESULTS: There were no statistically significant differences between test and control eyes in terms of postoperative inflammation and capsular biocompatibility, including posterior capsule opacification (P = .34, paired t test), and anterior capsule opacification (P = .53, paired t test), as observed during clinical and pathological evaluation. In vivo axial positioning for the test IOL was comparable to the control IOL and stable over time (P = .531 versus P = .788). CONCLUSIONS: The new IOL showed biocompatibility and stability comparable to the control IOL.

Knowledge and awareness regarding menstruation and HIV/AIDS among schoolgoing adolescent girls.

INTRODUCTION: Menstruation in our country is associated with various myths and restrictions leading to lack of awareness among adolescent girls. Insufficient menstrual hygiene practices are the cause of stress associated with menstruation and reproductive tract infections. Sexually transmitted infections and HIV/AIDS are not openly discussed in our society making adolescents vulnerable to them. AIM: To assess the knowledge of school going adolescent girls regarding menstrual hygiene and HIV/AIDS. MATERIALS AND METHODS: Girls studying in class 8th-12th standard and who have attained menarche were included in the study. A predesigned questionnaire, which consisted of questions related to menstrual awareness and knowledge about HIV/AIDS was used for data collection. Data was analysed using SPSS software and results were interpreted into percentages. RESULTS: 282 girls took part in the study. Mean age of girls was 14.70 ± 1.5 years. Median age of girls was 15 years. Knowledge regarding menstrual hygiene and HIV/AIDS was found to be only satisfactory leaving a scope of improvement. Mother was the main source of information regarding both menstruation and HIV/AIDS. CONCLUSION: A comprehensive health education programme involving mothers is required to remove various misconceptions and taboos associated with menstruation and make it a pleasant experience for adolescent girls. Information, education and awareness programmes need to be strengthened to spread awareness regarding HIV/AIDS.

Predictors of Microbiologically Confirmed Intrathoracic Tuberculosis.

OBJECTIVE: To identify risk factors for microbiologically confirmed intrathoracic tuberculosis in children. METHODS: Children, 6 mo to 15 y of age, attending the out-patient department of a tertiary care centre in India, with probable intrathoracic tuberculosis were enrolled. Microbiological confirmation of tuberculosis was defined as positivity on smear (Ziehl-Neelsen staining) and/or Xpert MTB/RIF and/or MGIT-960 culture. Association of various factors with microbiological confirmation were assessed by univariate and multivariate analysis. RESULTS: Microbiologic confirmation was documented in 39 (25%) of 153 patients enrolled. On univariate analysis, microbiological positivity was associated with female gender, higher mean (SD) age [136.6 (31.8) vs. 117.3 (41.4) mo], parenchymal lesion on chest radiograph, low body mass index for age, having symptoms of cough and weight loss, lower mean (SD) hemoglobin [10.4 (1.37) g/dl vs. 11(1.52) g/dl; p = 0.04], and higher mean (SD) monocyte: lymphocyte ratio [0.38 (0.30) vs. 0.24 (0.02); p = 0.37]. Higher proportion of microbiologically negative children were BCG vaccinated (95% vs. 79%; p = 0.002). On multivariate analysis, microbiological positivity showed significant association with low body mass index for age (p = 0.033) and higher monocyte: lymphocyte ratio (p = 0.037). CONCLUSIONS: Low body mass index for age and higher monocyte: lymphocyte ratios were associated with microbiological confirmation in children with intrathoracic tuberculosis.

Sexual resilience within intimate relations among unmarried adolescent girls seeking abortion in an abortion clinic of Delhi, India.

BACKGROUND AND OBJECTIVES: Sexually experienced, unmarried adolescent women, usually commence sex, with marriage in mind. Initially, they resist sex but are unsuccessful due to lack of resilience to end an oppressive relationship, or convince their partners to postpone sex or use protection. To retain partners, they accept unprotected sex and suffer its consequences such as unwanted pregnancies, sexually transmitted diseases, HIV/AIDS and cervical cancer. Considerable numbers of adolescents face this emotional stress and suffer the consequences, while some manage to endure and emerge from the ordeal. This study attempts to determine this resilience and extrapolate it to others who might not be so successful without an intervention. METHODOLOGY: The study compares sexual resilience in 100 unmarried adolescent abortion-seekers, in terms of time taken from meeting the partner, to sexual debut and correlates this with background factors such as age, education, family income, self-esteem, sexual knowledge, attitude toward pre-marital sex (PMS) and partner pressure. RESULTS: Mean debut age was 17.32 years. Partners took more initiative to form emotional (64%) and physical relationship (78%). Adolescent girls' initiative reduced markedly from emotional (22%) to physical relation (5%). Correlation of sexual resilience with age, family income education and knowledge was not significant. It was significantly correlated with attitude toward PMS, self-esteem and partner pressure. INTERPRETATION AND CONCLUSION: It is desirable to improve self-esteem and attitude of young women to build negotiation skills in intimate relations. Counselors have to reorient the perspectives to improve attitude toward abstinence and increase self-esteem to resist pressure from partners.

A novel mutation c.1048A>T at codon 350(Lys>Stop) in PROC gene causing neonatal purpura fulminans.

Purpura fulminans in the neonatal period due to severe congenital protein C deficiency (protein C activity <1 IU/dl) is a rare autosomal recessive disorder. If untreated, it is fatal. Early identification of such patients may be lifesaving. Acquired deficiency of protein C caused by increased consumption as overt disseminated intravascular coagulation (DIC) and severe infection creates a diagnostic dilemma. Mutation analysis plays a critical role in confirming the diagnosis of the disease and offering prenatal diagnosis. In this report, we describe a newborn who presented with purpura fulminans and DIC, molecular analysis showed a novel c.1048A>T transversion in a homozygous state at codon 350 (Lys>Stop) of protein C (PROC) gene. Prenatal diagnosis in subsequent pregnancy was done which revealed the affected fetus had the same mutation in homozygous form.

Novel STXBP2 mutation causing familial hemophagocytic lymphohistiocytosis.

Familial Hemophagocytic Lymphohistiocytosis (FHL) is a rare autosomal recessive disorder. Diagnosis is established in presence of genetic mutation or positive family history in one of the siblings. Common genetic mutations associated with FHL are mutations in gene PRF1 (also known as FHL 2), UNC13D (FHL 3) and STX11 (FHL 4). Recently mutation in STXBP2 encoding syntaxin binding protein 2 (Munc 18 -2) has been found to be associated with FHL type 5. Here we describe the first reported Indian patient with homozygous mutation in STX BP2 gene (c1697 G > A resulting in amino acid change p.G566D) causing FHL 5.

Contraceptive methods: needs, options and utilization.

OBJECTIVES: Background-Contraception is the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures. An effective contraception allows a physical relationship without fear of an unwanted pregnancy and ensures freedom to have children when desired. The aim is to achieve contraception in maximum comfort and privacy, with minimum cost and side effects. Some methods, like male and female condoms, also provide twin advantage of protection from sexually transmitted diseases. The burden of unsafe abortion lies primarily in developing countries. Here, contraceptive prevalence is measured among currently married women of reproductive age, and levels have not yet reached those that exist in developed countries. CONCLUSION: In countries like India, there is a dire need for contraceptive methods to be more women friendly, accessible and provide adequate privacy. Providers also need to be sensitive to special needs of adolescents as they are at a critically vulnerable segment.

Shape of the isolated ex-vivo human crystalline lens.

PURPOSE: To develop an age-dependent mathematical model of the isolated ex-vivo human crystalline lens shape to serve as basis for use in computational modeling. METHODS: Profiles of whole isolated human lenses (n=27) aged 6 to 82, were measured from shadow-photogrammetric images. Two methods were used to analyze the lenses. In the two curves method (TCM) the anterior and posterior surfaces of the lens were fit to 10th-order even polynomials and in the one curve method (OCM) the contour of one half-meridional section of the lens was fit to 10th-order polynomials. The age-dependence of the polynomial coefficients was assessed. The analysis was used to produce an age-dependent polynomial model of the whole lens shape. RESULTS: The root mean squared errors for the fits ranged from 11 to 70 microm for the OCM, 9 to 27 microm for the posterior surface of the TCM and 8 to 134 microm for the anterior surface of the TCM. The coefficients of the OCM did not display a significant trend with age. The 2nd-, 6th- and 10th-order coefficients of the anterior surface of the TCM decreased with age while the 8th-order coefficient increased. For the posterior surface of the TCM, the 8th-order coefficient significantly decreased with age and the 10th-order coefficient increased. The age-dependent equations of both the models provide a reliable model from age 20 to 60. The OCM model can be used for lenses older than 60 as well. CONCLUSION: The shape of the whole human crystalline lens can be accurately modeled with 10th-order polynomial functions. These models can serve to improve computational modeling, such as finite element (FE) modeling of crystalline lenses.

Role of the lens capsule on the mechanical accommodative response in a lens stretcher.

PURPOSE: To determine whether changes in elastic properties of the lens capsule ex vivo with age contribute to the forces necessary for accommodation. METHODS: Postmortem human (n = 22; age average: 41 +/- 17 years; range: 6-7) and cynomolgus monkey (n = 19; age average: 7.7 +/- 1.8 years, range: 4.2-10) tissues including the lens, capsule, zonules, ciliary body, and sclera were mounted in an optomechanical lens-stretching system. Starting at 0 load, the sclera was symmetrically stretched to 2 mm in 0.25-mm steps at a speed of 0.1 mm x s(-1). The load and lens diameter were measured at each step. The lens contents were removed through a mini-capsulorhexis. The stretching cycles were repeated on the empty capsular bag. The forces necessary to stretch the natural lens and empty bag were quantified as a function of age and compared. RESULTS: The force needed to stretch the empty lens capsule was independent of age (human, 2.6-34.9 g/mm [25.2-342.7 mN/mm]; monkey, 8.2-21.3 g/mm [80.3-208.6 mN/mm]). The ratio of the force necessary to stretch the empty lens capsule to the force necessary to stretch the natural lens decreased with age in the human and monkey lenses (P = 0.003, P = 0.72, respectively). CONCLUSIONS: The mechanical properties of the empty lens capsule assessed ex vivo in a lens stretcher remain constant with age, suggesting that the changes in elasticity of the lens capsule do not play a significant role in presbyopia. In young eyes, the lens capsule determines the force necessary to stretch the whole lens. The age-related increase in force needed to stretch the lens is due to changes in the lens contents.

Optical power of the isolated human crystalline lens.

PURPOSE: To characterize the age dependence of isolated human crystalline lens power and quantify the contributions of the lens surfaces and refractive index gradient. METHODS: Experiments were performed on 100 eyes of 73 donors (average 2.8 +/- 1.6 days postmortem) with an age range of 6 to 94 years. Lens power was measured with a modified commercial lensmeter or with an optical system based on the Scheiner principle. The radius of curvature and asphericity of the isolated lens surfaces were measured by shadow photography. For each lens, the contributions of the surfaces and the refractive index gradient to the measured lens power were calculated by using optical ray-tracing software. The age dependency of these refractive powers was assessed. RESULTS: The total refractive power and surface refractive power both showed a biphasic age dependency. The total power decreased at a rate of -0.41 D/y between ages 6 and 58.1, and increased at a rate of 0.33D/y between ages 58.1 and 82. The surface contribution decreased at a rate of -0.13 D/y between ages 6 and 55.2 and increased at a rate of 0.04 D/y between ages 55.2 and 94. The relative contribution of the surfaces increased by 0.17% per year. The equivalent refractive index also showed a biphasic age dependency with a decrease at a rate of -3.9 x 10(-4) per year from ages 6 to 60.4 followed by a plateau. CONCLUSIONS: The lens power decreases with age, due mainly to a decrease in the contribution of the gradient. The use of a constant equivalent refractive index value to calculate lens power with the lens maker formula will underestimate the power of young lenses and overestimate the power of older lenses.

Fibroblast attachment to smooth and microtextured PET and thin cp-Ti films.

Improving the biological performance of engineered implants apposing interfacing tissues is a critical issue in Biomaterials Science and Engineering. Micromotion at the soft tissue-implant interface has been shown to sustain an inflammatory response. To eliminate micromotion, it is desirable to promote cellular and extracellular matrix adhesion to the implant surface. Surfaces are modified topographically or chemically to effect cellular adhesion and to influence cellular interactions and function. Previous studies have identified the specific topographical characteristics that appear to elicit cellular attachment. This in vitro study compares the independent effects of surface chemistry and topography on fibroblast-test specimen proximity. Titanium (Ti) was sputter-coated in stepwise, increasing thickness (20-350 nm) onto a series of either smooth or microtextured polyethylene terephthalate (PET), resulting in a stepwise change from a PET surface to a Ti surface. The series was evaluated in a 3-day fibroblast culture with transmission electron microscopy (TEM) for cell-test specimen proximity. Fibroblast proximity to the coverslip surface increases, as the Ti thickness increases, on either smooth or textured test specimens. Furthermore, fibroblasts were firmly attached to the ridge tops on the coated textured test specimens. Therefore, fibroblast apposition is strongly enhanced by microtextured surfaces and Ti rather than smooth surfaces and PET.

Effect of titanium surface texture on the cell-biomaterial interface.

To improve the in vivo performance of engineered implants, this study examines the independent effects of surface chemistry and topography on fibroblast morphology and density in vitro. Titanium (Ti) was sputter-coated onto smooth and microtextured polyethylene terephthalate (PET). Test specimens were evaluated in 24-h, fibroblast cultures and assessed with scanning electron microscopy (SEM) for cellular morphology and density. Fibroblast density increased, as the Ti film thickness increased. The fibroblasts exhibited contact guidance on the textured test specimens. The greatest cellular density was found on the Ti-coated, textured test specimens. In conclusion, Ti and surface texture appeared to strongly influence fibroblast density and morphology as compared to PET and smooth surfaces.