Household food insecurity is associated with low interferon-gamma levels in pregnant Indian women.

SETTING: Over 20% of tuberculosis (TB) cases during pregnancy occur in India. OBJECTIVE: To determine the association between household food insecurity and interferon-gamma (IFN-γ) levels in pregnancy. DESIGN: Pregnant women in India were administered the Household Food Insecurity Access Scale (HFIAS) questionnaire and underwent an IFN-γ release assay. Logistic regression was used to identify factors associated with food insecurity. RESULTS: Of 538 women, 60 (11%) had household food insecurity, 47 (78%) of which were moderate or severe food insecure. After mitogen stimulation, moderate or severe food insecure women had a median IFN-γ concentration of 4.2 IU/ml (IQR 2.2-9.8) vs. 8.4 IU/ml (IQR 3.0-10) in women with no or mild food insecurity (P = 0.03). In multivariate analysis, higher IFN-γ concentrations were associated with human immunodeficiency virus infection (OR 1.3, 95%CI 0.51-2.1, P = 0.001), and inversely associated with moderate or severe food insecurity (OR -1.6, 95%CI -2.9 to -0.27, P = 0.02) and the number of adults in the household (OR -0.08, 95%CI -0.16 to -0.01, P = 0.03). There was no association between food insecurity and IFN-γ response to Mycobacterium tuberculosis antigen. CONCLUSION: Food insecurity in pregnancy is associated with low IFN-γ levels. There was no association between food insecurity and IFN-γ response to M. tuberculosis antigen, but our study was underpowered to detect this outcome.

Xpert(®) MTB/RIF for improved case detection of extra-pulmonary TB in a tertiary care setting in urban India.

SETTING: Department of microbiology at a tertiary care hospital, Mumbai, India. OBJECTIVE: To determine 1) the sensitivity and specificity of the Xpert(®) MTB/RIF assay in comparison with microscopy and culture in extra-pulmonary tuberculosis (EPTB), and 2) the number of additional cases of EPTB and rifampicin (RMP) resistance detected using this assay. DESIGN: The study was conducted from July 2013 to April 2015. All consecutive patients with clinically suspected EPTB referred for microscopic examination to the Department of Microbiology that were sufficient in specimen volume were included in the study. RESULTS: Of the 728 specimens included in the study, respectively 5.5%, 23.5% and 20.9% were positive on smear, culture and Xpert. Compared to culture, Xpert had a sensitivity of 84.2% (95%CI 81.4-86.6) and specificity of 98.2% (95%CI 90-104). All specimens with high and medium load on assay were positive on culture; 28 (18.4%) specimens were RMP-resistant and 124 (81.6%) were Xpert-susceptible. No additional RMP-resistant cases were detected using Xpert as compared to phenotypic drug susceptibility testing. CONCLUSION: The ability of the Xpert assay to rapidly detect a significantly greater number of bacteriologically confirmed EPTB cases, including RMP-resistant cases, makes it an important diagnostic tool in a TB-endemic country.

Rapid antibiotic susceptibility testing of Mycobacterium tuberculosis: its utility in resource poor settings.

PURPOSE: To compare the rapid colorimetric nitrate reductase based antibiotic susceptibility (CONRAS) test performed on Mycobacterium tuberculosis isolates with the conventional method i.e, the proportion method. METHODS: One hundred clinical isolates of M. tuberculosis were tested for susceptibility to isoniazid (INH) and rifampicin (RIF) by the conventional proportion method and CONRAS in Middlebrook 7H9 liquid medium enriched with growth supplements (MB7H9S). RESULTS: The performance of the CONRAS test was evaluated using proportion method as the gold standard. The sensitivity (ability to detect true drug resistance) and specificity (ability to detect true drug susceptibility) of the CONRAS test to INH was 93.75 and 98.52% and for RIF it was 96.10 and 100% respectively. The mean time for reporting was 6.3 days and the test showed excellent reproducibility. The kappa (k) value for INH was 0.92 and for RIF was 0.99, indicating excellent agreement between the two methods. CONCLUSIONS: CONRAS test is a rapid and reliable method of drug susceptibility for M. tuberculosis.

Why are rural Indian women so thin? Findings from a village in Maharashtra.

OBJECTIVE: To identify social, behavioural and cultural factors that explain the thinness of young women relative to their men in rural Maharashtra, India. DESIGN: Twelve focus group discussions were conducted to explore the villagers' understanding of why women in their area might be thinner than men. SETTING: Pabal village and surrounding hamlets, in the Pune district of Maharashtra, India. SUBJECTS: Samples of young mothers and fathers, grandmothers and grandfathers were selected from families in the village with children below 10 years of age. RESULTS: Four factors were identified that the villagers felt contributed to the disparity in thinness. First, marriage isolated girls from their own families and villages, and brought the expectation of early motherhood. Young brides were often unable to relax and eat adequately. Second, marriage increased the workload of young women. They were expected to do the heaviest household chores as well as farm work in this predominantly agricultural community. Third, women had no financial autonomy or freedom of movement, and were therefore denied access to supplementary food sources available to men. Fourth, young women felt responsible for their household's health and success. They were encouraged to fast regularly to ensure this. Despite feeling responsible, young women had no control over factors that might affect the household's well being. This made them anxious and worried a great deal of the time. CONCLUSIONS: Interventions to improve the nutritional status of young women in this region need to recognise the roles and responsibilities taken up by young brides.

Cri du chat syndrome.

Three cases of cri du chat syndrome with varying ages of presentation are compared and contrasted to highlight the clinical features and evolution of the phenotype with time.

9p-Syndrome.

A 2 1/2 month old male child was admitted with loose motions and mild dehydration. He was full term normal delivery, born of a non-consanguinous marriage. On examination, he had trigonocephaly; anteverted nostrils, long philtrum and hypoplastic supraorbital ridges. X-ray showed sutural separation. Karyotyping confirmed deletion of short arm of chromosome 9 distal to band p22.