Molecular Detection and Differentiation of Mycobacterium Tuberculosis Complex and Non-tuberculous Mycobacterium in the Clinical Specimens by Real Time PCR.

Mycobacteria are subdivided into three groups: the Mycobacterium tuberculosis complex, the non-tuberculous mycobacteria called NTM or MOTT (Mycobacteria Other Than Tuberculosis) and Mycobacterium leprae. Over the past few decades, the incidence of infections caused by NTM has increased world wide. The differentiation of Mycobacterium tuberculosis complex from NTM is of primary importance for infection control and choice of antimicrobial therapy. However, there is so far no report in Bangladesh about the detection of NTM and hence differentiation of MTB and NTM. Neither acid-fast bacilli (AFB) staining nor histopathology can discriminate MTB and NTM. In order to detect and differentiate Mycobacterium tuberculosis complex and NTM we used commercially available LyteStar TB/NTM Real Time PCR kit (Altona Diagnostics, Germany) and analyzed 782 clinical specimens from tuberculosis suspected patients. We have found 49 MTB and 74 NTM positive samples from variety of clinical specimens such as sputum, bronchial lavages, body fluids, tissues, needle aspirates and swabs. Many of the PCR positive specimens were AFB negative on direct microscopic examination thus, indicating strong sensitivity of PCR than AFB staining. This is the first report in the country about detection of NTM and it warrants further elaborate investigation. Moreover, our results showed that multiplex real-time PCR assay is an effective sensitive tool for the rapid identification and differentiation of MTB and NTM directly from clinical specimens.

Effect of Adherence to Protocolized Targeted Intensifications of Disease-modifying Antirheumatic Drugs on Treatment Outcomes in Rheumatoid Arthritis: Results from an Australian Early Arthritis Cohort.

OBJECTIVE: To investigate the association between adherence to treat-to-target (T2T) protocol and disease activity, functional outcomes, and radiographic outcomes in early rheumatoid arthritis (RA). METHODS: Data from a longitudinal cohort of patients with early RA were used. Adherence was determined at each followup visit over 3 years according to predefined criteria. The primary endpoint was remission according to Disease Activity Score in 28 joints (DAS28) and Simplified Disease Activity Index (SDAI) criteria. Functional and radiographic outcomes measured by modified Health Assessment Questionnaire and modified total Sharp score, respectively, were secondary endpoints. RESULTS: A total of 198 patients with 3078 clinic visits over 3 years were included in this analysis. After adjusting for relevant variables, although there was no significant association between adherence to T2T and remission rate after 1 year, the associations reached significance after 3 years for both DAS28 (OR 1.71, 95% CI 1.16-2.50; p = 0.006) and SDAI criteria (OR 1.94, 95% CI 1.06-3.56; p = 0.033). After 3 years, adherence was also associated with improvement in physical function (ß=0.12, 95% CI 0.06-0.18; p < 0.0001). None of the radiographic outcomes were associated with adherence after either 1 or 3 years, although there was a trend for higher adherence to be associated with less radiographic progression at the end of the study (p = 0.061). CONCLUSION: Increased adherence to T2T was associated with better longterm disease activity and functional outcomes, which suggests that the benefit of a T2T protocol may be enhanced by ensuring adequate adherence.

Prevalence and Risk Factors of Elevated Blood Lead in Children in Gold Ore Processing Communities, Zamfara, Nigeria, 2012.

BACKGROUND: In March 2010, Medecins Sans Frontieres/Doctors Without Borders detected an outbreak of acute lead poisoning in Zamfara State, northwestern Nigeria, linked to low-technology gold ore processing. The outbreak killed more than 400 children ≤5 years of age in the first half of 2010 and has left more than 2,000 children with permanent disabilities. OBJECTIVES: The aims of this study were to estimate the statewide prevalence of children ≤5 years old with elevated blood lead levels (BLLs) in gold ore processing and non-ore-processing communities, and to identify factors associated with elevated blood lead levels in children. METHODS: A representative, population-based study of ore processing and non-ore-processing villages was conducted throughout Zamfara in 2012. Blood samples from children, outdoor soil samples, indoor dust samples, and survey data on ore processing activities and other lead sources were collected from 383 children ≤5 years old in 383 family compounds across 56 villages. RESULTS: 17.2% of compounds reported that at least one member had processed ore in the preceding 12 months (95% confidence intervals (CI): 9.7, 24.7). The prevalence of BLLs ≥10 µg/dL in children ≤5 years old was 38.2% (95% CI: 26.5, 51.4) in compounds with members who processed ore and 22.3% (95% CI: 17.8, 27.7) in compounds where no one processed ore. Ore processing activities were associated with higher lead concentrations in soil, dust, and blood samples. Other factors associated with elevated BLL were a child's age and sex, breastfeeding, drinking water from a piped tap, and exposure to eye cosmetics. CONCLUSIONS: Childhood lead poisoning is widespread in Zamfara State in both ore processing and non-ore-processing settings, although it is more prevalent in ore processing areas. Although most children's BLLs were below the recommended level for chelation therapy, environmental remediation and use of safer ore processing practices are needed to prevent further exposures. PATIENT CONSENT: Obtained. ETHICS APPROVAL: The study protocol was approved by the US Centers for Disease Control Institutional Review Board-A and the National Health Research Ethics Committee of Nigeria. COMPETING INTERESTS: The authors declare no competing financial interests.

Childhood lead poisoning associated with gold ore processing: a village-level investigation-Zamfara State, Nigeria, October-November 2010.

BACKGROUND: During May-June 2010, a childhood lead poisoning outbreak related to gold ore processing was confirmed in two villages in Zamfara State, Nigeria. During June-September of that year, villages with suspected or confirmed childhood lead poisoning continued to be identified in Zamfara State. OBJECTIVES: We investigated the extent of childhood lead poisoning [≥ 1 child with a blood lead level (BLL) ≥ 10 µg/dL] and lead contamination (≥ 1 soil/dust sample with a lead level > 400 parts per million) among villages in Zamfara State and identified villages that should be prioritized for urgent interventions. METHODS: We used chain-referral sampling to identify villages of interest, defined as villages suspected of participation in gold ore processing during the previous 12 months. We interviewed villagers, determined BLLs among children < 5 years of age, and analyzed soil/dust from public areas and homes for lead. RESULTS: We identified 131 villages of interest and visited 74 (56%) villages in three local government areas. Fifty-four (77%) of 70 villages that completed the survey reported gold ore processing. Ore-processing villages were more likely to have ≥ 1 child < 5 years of age with lead poisoning (68% vs. 50%, p = 0.17) or death following convulsions (74% vs. 44%, p = 0.02). Soil/dust contamination and BLL ≥ 45 µg/dL were identified in ore-processing villages only [50% (p < 0.001) and 15% (p = 0.22), respectively]. The odds of childhood lead poisoning or lead contamination was 3.5 times as high in ore-processing villages than the other villages (95% confidence interval: 1.1, 11.3). CONCLUSION: Childhood lead poisoning and lead contamination were widespread in surveyed areas, particularly among villages that had processed ore recently. Urgent interventions are required to reduce lead exposure, morbidity, and mortality in affected communities.

Medication adherence in diabetes mellitus and self management practices among type-2 diabetics in Ethiopia.

BACKGROUND: Type-2 diabetes mellitus and its complication are becoming more prevalent in Ethiopia. Evidence abound that the most important predictor of reduction of morbidity and mortality due to diabetes complication is the level of glycemic control achieved. AIMS: The aim is to assess adherence to anti diabetic drug therapy and self management practice among type-2 diabetic patient in Ethiopia. PATIENTS AND METHOD: The study consists of two phases. A cross-sectional review of randomly selected 384 case notes of type-2 diabetic patient that attend diabetes mellitus clinic over 3 month and cross-sectional interview, with pre tested adherence and self management and monitoring tool questioner of 347 consecutive patients that attend in Jimma university specialized hospital diabetic clinic. RESULT: Oral hypoglycemic agent were prescribed for 351(91.4) of the patient while insulin and oral hypoglycemic agent was prescribed in 33(8.6%). About 312 (88.9%) patients on oral hypoglycemic agent were on mono therapy, the most frequently prescribed oral hypoglycemic agent was glibenclamide 232(74.3%) and metformine 80(25.7%). Only 41.8% of the patient had adequate glycemic control. The main external factors for non adherence were lack of finance (37.1%) followed by perceived side effect of drug 29.2%. Only 6.5% patient who missed their medications disclosed to physician during consultation. The knowledge and practice of critical component of diabetes self management behavior were generally low among the patient studied. CONCLUSION: Majority of the patient with type 2 diabetes in Ethiopia are managed by OHA monotherapy mainly glybenclamide and metformine. While the current prescribing strategy do not achieve glycemic control on majority of the patient. This is due to poor adherence with the prescribed drug regimen and poor knowledge and practice of successful self management.

External dose assessment from the measured radioactivity in soil samples collected from the Islamabad capital territory, Pakistan.

It is a well known fact that natural radionuclides are the major contributors towards the gamma ray exposure received by the general public. In this context, soil samples were collected from the Islamabad capital territory and activities due to (226)Ra, (232)Th, (40)K and (137)Cs were measured using gamma ray spectrometry: activities ranged from 41.5-106.2 Bq kg(-1), 4.0-193.8 Bq kg(-1), 325.3-657.4 Bq kg(-1) and 1.6-9.45 Bq kg(-1), respectively. From the measured activities, the external hazard index, internal hazard index, absorbed dose rate and mean annual effective dose were calculated. External and internal hazard indices were calculated as 0.76 and 0.95, respectively. The mean absorbed dose rate was found to be 130.97 nGy h(-1). The mean effective dose was estimated as 0.16 mSv y(-1), which is less than the maximum permissible dose of 1 mSv y(-1).

Chemotherapy induced toxicities in therapeutic trials of Acute Lymphoblastic Leukaemia.

It is common practice in therapeutic trials in Acute Lymphoblastic Leukaemia (ALL) to treat chemotherapy induced toxicities. In this study, 50 newly diagnosed ALL patients were enrolled and the median age was 14.5 years. 32 patients were male and 18 female. Prognostic factors were analysed. Remission induction, consolidation and maintenance therapy with conventional combination chemotherapy and CNS prophylaxis with intrathecal methotrexate and radiotherapy were instituted to all patients for long term event free survival. Results of induction therapy and overall outcomes of treatment were observed. Chemotherapy induced toxicities were also detected and treated accordingly. These toxicities were described in 4 groups depending on the frequency of their development in chemotherapy received patients. Haematological and gastrointestinal side effects and alopecia were expected i.e., developed in >75% of patients. Prednisolone and vincristine induced toxicities were common i.e., observed in >25% of patients. Hepatic complications and anthracycline induced tachycardia were occasional i.e., occurred in <25% and localized phlebitis and/ or soft tissue necrosis were rare and accidental i.e., developed in 5% of patients.

Correlation of ultrasonographic findings with ultrasound guided fine needle aspiration of liver lesion.

Ultrasonographic findings of liver were correlated with cytological findings in a series of 50 patients. Multiple lesions described by ultrasonography and suggested as HCC/TB were proved to be metastatic in 60% cases and hepatocellular carcinoma in 40% cases by cytological examination. Multiple lesions suggested as metastatic lesions in ultrasonography was proved as such by cytology in 83% cases. Solitary lesion suggested as neoplastic in ultrasonography was proved as such in cytology in 90% cases. Of the 2 patients suggested as diffuse parenchymal lesion revealed cytological findings of cirrhosis in one case and that of TB in other. Serum alpha-feto protein and Carcinoembryogenic antigen (CEA) was done in all the cases. Serum alpha-feto protein was higher in hepatocellular carcinoma and CEA was higher in metastatic lesions. Ultrasound guided fine needle aspiration of liver can play more role in diagnosis and classification of liver disease than ultrasonographic comment alone, as it requires greater degree of precision to reach diagnostic accuracy.

Effect of high protein carbohydrate free diet on the evolution of diabetes mellitus in rats.

Diabetes was induced in seventy seven Long Evans rats of both sexes by injecting streptozotocin (STZ). Some of these diabetic rats were provided with a high protein-carbohydrate (HP-CHO) free diet. The diabetic state of the rats on HP-CHO free diet was compared with that of the diabetic rats on normal diet and the control rats on normal diet. Diabetic state was assessed through the diet consumption, body weight changes, urinary glucose loss and blood glucose estimation. From the fifth day the rats on HP-CHO free diet showed significant reduction of blood glucose level and urinary glucose loss.

Methylxanthine-induced attenuation of pecking in chickens.

1. Apomorphine induced dose-dependent pecking in chickens. 2. The response was decreased by theophylline or caffeine in a dose-dependent manner. 3. Administration of theophylline or caffeine alone did not exert any effect on pecking behaviour. 4. Dipyridamole administration neither induced pecking nor altered the pecking induced by apomorphine. 5. Administration of 5-N-ethylcarboxamide-adenosine to animals caused variable effects on pecking induced by apomorphine. The drug did not induce pecking by itself. 6. It is concluded that the inhibitory response to methylxanthines may be mediated through blockade of adenosine receptors. However, to prove this, more experiments are needed.

Familial localised scleroderma from Bangladesh: two case reports.

Familial scleroderma is rare. There have been few reported cases of familial scleroderma in medical literature. This report adds one more instance to the literature. Two members in one family had clinically and histologically established localised scleroderma (morphea). The hereditary aspect of the disease has not been well established. But this instance along with the previous documented instance suggest that genetic factor may play a role in the etiopathogenesis of the disease.