Hematological Parameters in Patients with Pulmonary Tuberculosis and its Presentation among Favorable and Unfavorable Treatment Outcomes.

BACKGROUND: Tuberculosis (TB) management continues to be a challenge globally; weakened immunity plays a significant role in the reactivation of TB. There is limited information on hematological parameters in patients with pulmonary TB and its association with outcome. OBJECTIVES: We present hematological parameters of newly diagnosed sputum-positive pulmonary TB patients enrolled in a randomized, clinical trial that assessed the efficacy and safety of 3 and 4 regimens using moxifloxacin. MATERIALS AND METHODS: Blood hematological parameters at baseline, comparison of the baseline and end of treatment values, including the monocytes by lymphocytes ratio (M/L), neutrophil lymphocyte ratio (N/L), and platelet lymphocyte ratio (P/L) between the patients with favorable and unfavorable TB treatment outcome, and among different age group and sex presented in this paper. RESULTS: Among the total 1059 patients, 782 were males, the mean hemoglobin (HB) ± standard deviation (SD) was 11.5 g/dL ± 2.0, the mean white blood cell (WBC) count ± SD was 9800 ± 3009 and the mean platelet count (in lakhs) ± SD was 4.24 ± 1.42 cells/uL. There was an increase from baseline in the mean hemoglobin, eosinophil, and lymphocyte count and a decrease in mean neutrophil, monocyte counts to the end of treatment. There was a decrease in baseline mean total WBC count posttreatment, both in favorable (10,271 cells/uL ± 3007 SD to 6689 cells/uL ± 1837 SD, [P ≤ 0.001]), and unfavorable TB outcome patients. CONCLUSION: An increase in HB, and a decrease in WBC count, M/L, N/L, and P/L ratio is possible at the end of TB treatment and future studies to correlate blood hematology parameters with TB treatment outcome.

Multi-objective optimization for minimize cutting force and power consumption in corn stalk chopping processes.

This study was on optimization of the cutting processes for corn stalks, which serve as significant sources of biomass and forage. The reduction of cutting force is crucial for enhancing energy efficiency. Cutting velocity rises, which can lead to significant power usage with minimal shear forces. Therefore, the objective is to minimize both the cutting force and power consumption. To address this multi-objective optimization problem, a modified Taguchi method was employed. Chauvenet's criterion was used to assess the validity of statistical scatter in repeated test data. The test samples had an 81 % moisture content. Through analysis of variance (ANOVA), the optimal chopping process parameters were identified as velocity of 4.4 m/s, approach angle of 30°, and feeding angle of 50°. The refined empirical relationships indicated that the cutting force ranges from 180.55 N to 393.37 N, while the cutting power ranges from 16.81 W to 44.05 W. In a single test, the output responses for the optimal parameter set were 26.32 W for power consumption and 242.60 N for cutting force, both are within the estimated range. The considerable scatter observed in repeated test data is likely due to variations in corn stalk thickness. These findings are valuable for the operation of chopping machines, ensuring minimal cutting force and power consumption when handling corn stalks residues.

Low Serum Concentrations of Rifampicin and Pyrazinamide Associated with Poor Treatment Outcomes in Children with Tuberculosis Related to HIV Status.

OBJECTIVES: To compare the pharmacokinetics of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) between HIV-infected and HIV-uninfected children with tuberculosis (TB) and correlate it with TB treatment outcome. METHODS: HIV-uninfected (n = 84) and HIV-infected (n = 77) children with TB receiving standard thrice weekly treatment were recruited from 6 hospitals in India. Semi-intensive pharmacokinetic sampling was performed during intensive phase of TB treatment after directly observed administration of drugs. Drug concentrations were measured by high performance liquid chromatography. INH acetylator status was determined, and nutritional assessment was done. Children were followed-up and treatment outcomes noted. RESULTS: Children with HIV and TB had significantly lower RMP peak concentration (Cmax) (2.6 vs. 5.1 µg/mL; P < 0.001) and exposure [area under the time-concentration curve (AUC0-8); 10.4 vs. 23.4 µg/mL h; P < 0.001] than those with TB. Among HIV-infected children, a significantly higher proportion had stunting (77% vs. 29%; P < 0.001) and underweight (73% vs. 38%; P < 0.001) compared with children with TB. Combining both groups, RMP Cmax (P = 0.001; adjusted odds ratio = 1.437; 95% confidence interval: 1.157-1.784) and PZA Cmax (P = 0.027; adjusted odds ratio = 1.041; 95% confidence interval: 1.005-1.079) significantly influenced treatment outcome. CONCLUSIONS: HIV infection was associated with lower Cmax of RMP and INH and AUC0-8 of RMP. Over 90% of children in both groups had subtherapeutic RMP Cmax. Cmax of RMP and PZA significantly influenced TB treatment outcome in children with TB. The findings have important clinical implications and suggest the need to increase anti-TB drug doses in children with HIV and TB.

Pharmacokinetics of first-line antituberculosis drugs in HIV-infected children with tuberculosis treated with intermittent regimens in India.

The objective of this report was to study the pharmacokinetics of rifampin (RMP), isoniazid (INH), and pyrazinamide (PZA) in HIV-infected children with tuberculosis (TB) treated with a thrice-weekly anti-TB regimen in the government program in India. Seventy-seven HIV-infected children with TB aged 1 to 15 years from six hospitals in India were recruited. During the intensive phase of TB treatment with directly observed administration of the drugs, a complete pharmacokinetic study was performed. Drug concentrations were measured by high-performance liquid chromatography. A multivariable regression analysis was done to explore the factors impacting drug levels and treatment outcomes. The proportions of children with subnormal peak concentrations (Cmax) of RMP, INH, and PZA were 97%, 28%, and 33%, respectively. Children less than 5 years old had a lower median Cmax and lower exposure (area under the time-concentration curve from 0 to 8 h [AUC0-8]) of INH (Cmax, 2.5 versus 5.1 µg/ml, respectively [P=0.016]; AUC0-8, 11.1 versus 22.0 µg/ml·h, respectively [P=0.047[) and PZA (Cmax, 34.1 versus 42.3 µg/ml, respectively [P=0.055]; AUC0-8, 177.9 versus 221.7 µg/ml·h, respectively [P=0.05]) than those more than 5 years old. In children with unfavorable versus favorable outcomes, the median Cmax of RMP (1.0 versus 2.8 µg/ml, respectively; P=0.002) and PZA (31.9 versus 44.4 µg/ml, respectively; P=0.045) were significantly lower. Among all factors studied, the PZA Cmax influenced TB treatment outcome (P=0.011; adjusted odds ratio, 1.094; 95% confidence interval, 1.021 to 1.173). A high proportion of children with HIV and TB had a subnormal RMP Cmax. The PZA Cmax significantly influenced treatment outcome. These findings have important clinical implications and emphasize that drug doses in HIV-infected children with TB have to be optimized.

Cadmium and copper toxicity in three marine macroalgae: evaluation of the biochemical responses and DNA damage.

Marine macroalgae have evolved a different mechanism to maintain physiological concentrations of essential metal ions and non-essential metals. The objective of the present work was to evaluate the antioxidant response and DNA damage of copper and cadmium ions in three halophytes, namely, Acanthophora spicifera, Chaetomorpha antennina, and Ulva reticulata. Accumulation of copper was significantly higher (P < 0.05) than that of cadmium. Biochemical responses showed that copper was considerably more toxic than cadmium (P < 0.05). Decreases in glutathione content and fluctuations of super oxide dismutase, catalase, and glutathione peroxidase activities were observed corresponding to time and concentration of exposure. Interestingly, it was also observed that antioxidant levels decreased as a result of metal accumulation, which may be due to free radicals generated by copper and cadmium in seaweeds. The present study also showed that copper and cadmium increased oxidative stress and induced antioxidant defense systems against reactive oxygen species. The order of toxicity for metals in the studied seaweeds was U. reticulata > A. spicifera > C. antennina. DNA damage index analysis supported that copper was significantly (P < 0.05) more toxic than cadmium. Bioaccumulation, biochemical responses, and DNA damage observed in the here analyzed marine macroalgae after exposure to selected metals indicate that these marine organisms represent useful bioindicators of marine pollution.

Variability in the segregating generation of eggplant for earliness and yield.

In the past, very little efforts have been taken for development of inbred lines of brinjal through the exploitation of genetic variability present in the exotic hybrids. F2 generation obtained from the selfing of F1 hybrid provides all possible variations. So, selection with particular objectives in F2 generation is very much effective and selfing of those selected genotypes generation after generation helps to develop inbred lines (similar to the parental lines of the exotic hybrids). These inbreds with desired characters including high yield potential can be used as High Yielding Variety (HYV) as well as the parents for hybrid variety. To increase the genetic yield potential, the maximum utilization of the desirable characters for synthesizing of any ideal genotypes is essential. Variability in brinjal is expected to be immense as the fruits vary greatly in shape and size. The present investigation was undertaken at Department of Horticulture, Agricultural College and Research Institute, Madurai during 2011 to determine variability in segregants of eggplant (Solanum melogena L.). The crosses L5 x T4 (Palamedu Local x EP 65) and L4 x T1 (Alagarkovil Local x Annamalai) had the highest mean with high variability for individual fruit weight and fruit yield per plant. These crosses were best for using as a base population for further improvement in fruit yield and fruit weight as they had high heritability and genetic advance. Favorable low mean with high variability occurred for days to first flowering (earliness) in the crosses L5 x T2 (Palamedu Local x KKM 1) and L4 x T2 (Alagarkovil Local x KKM 1). Direct selection may be executed considering these genotypes for selection towards the development of early in flowering and high yielding brinjal variety.

Immune reconstitution inflammatory syndrome in HIV-infected patients with and without prior tuberculosis.

We conducted a nested case-control study in a cohort of patients initiating antiretroviral therapy (ART) to identify risk factors and common manifestations of immune reconstitution inflammatory syndrome (IRIS) and to validate the Robertson criteria for IRIS prediction. HIV-infected patients at the Tuberculosis Research Centre clinics, Chennai and Madurai, India, initiating ART between July 2004 and June 2005 were prospectively studied. Of 97 patients (62% men, median age 32 years, median CD4 count 63 cells/µL) included, 34 developed IRIS. IRIS was more common in patients with a prior history of tuberculosis (74% versus 52%, P = 0.04), median time to development was 46 days and the sensitivity and specificity of the Robertson criteria to predict IRIS were 91% and 22%, respectively. In this population, IRIS was a common event, more so among patients with prior tuberculosis, and neither the rate of CD4 increase nor the Robertson criteria were useful in predicting its development.

Production optimization and properties of beta glucosidases from a marine fungus Aspergillus-SA 58.

Aspergillus strain SA 58, showing considerable beta glucosidase production was selected as the potential strain. The fungus showed enzyme production in both acidic and alkaline pH. A temperature of 35 degrees C was found to be optimum for enzyme production. Maximum enzyme production was seen when pectin was used as the carbon source (80 U/ml). In solid-state fermentation, an enzyme production of 6200 U/g Initial Dry Substrate was noted. The strain produced two extra cellular enzymes and two intra cellular enzymes. For both the extra cellular enzymes (BGL A and BGL B), 60 degrees C was found to be optimum temperature for activity. BGL A showed an optimum pH of 4.0 while BGL B showed an optimum pH of 3.0 for activity. Both the enzymes showed a second peak of activity at pH 9.0. Both BGL A and BGL B showed high thermal stabilities with residual activities of 86% and 85% even after 6h of incubation at 50 degrees C.

HIV & smoking in India.

There are approximately 2.5 million people living with HIV/AIDS (PLWHA) in India - the young being particularly vulnerable. The prevalence of smoking has increased in India especially among rural, lower socio-economic and illiterate men. Studies have shown that HIV-infected smokers may be at additional risk for several infectious and non-infectious complications, including malignancies and cardiovascular events. Smoking alters immunological mechanisms and suppresses host defenses in the alveolar environment. HIV-infected smokers have also been found to have a poorer response to antiretroviral therapy and a higher risk of death. HIV-infected individuals who smoke could be at a greater risk for developing TB and subsequently suffer higher morbidity and mortality than those who do not smoke. Currently available smoking cessation interventions like physician's advice, nicotine replacement therapy and pharmacological agents like bupropion and varenicline have had varying degrees of success. Smoking cessation intervention in the HIV-infected population might be more complex because of associated psychosocial problems like drug addiction, alcoholism, depression, etc. More research including clinical trials testing the efficacy of smoking cessation interventions in HIV infected persons is required in India. In addition to public health measures like banning smoking in public places and raising tobacco tax, comprehensive guidelines for health workers can help address this problem. Counselling on smoking cessation should be one of the main components of primary care, especially in the management of HIV-infected persons. This review highlights the importance of smoking cessation among HIV-infected persons in India.

Nutritional status of persons with HIV infection, persons with HIV infection and tuberculosis, and HIV-negative individuals from southern India.

We compared the nutritional status of individuals with human immunodeficiency virus (HIV) infection alone, individuals with HIV infection and tuberculosis (after completion of antituberculosis treatment), and HIV-negative individuals and found that malnutrition, anemia, and hypoalbuminemia were most pronounced among HIV-positive patients with tuberculosis. Weight loss was associated with loss of fat in female patients and with loss of body cell mass in male patients.