Assessing the utility of Truenat in extrapulmonary tuberculosis diagnosis - A NRL's experience.

Background: Diagnosis of extra pulmonary TB (EPTB) remains a big challenge. While data on utility of Xpert testing in EPTB diagnosis is enormous, there is limited data on Truenat MTB testing. Aim: In this study we aimed to evaluate the usefulness of Truenat in EPTB diagnosis. Materials and methods: The study included patients suspected and/or treated for EPTB located from Chennai district during the year 2021-2022. All processed EPTB samples were subjected to smear microscopy, culture and Truenat MTB testing. Results: Of the 195 samples tested, 38 (19.4%) samples were positive for EPTB by any one of the diagnostic methods (smear, culture, microscopy). Out of these 38, 16 (42.1 %) were positive for MTB by Truenat and negative by Culture, 12 (31.5%) were positive by culture but negative by Truenat and 8 (21%) were positive by both Truenat and/or smear and culture. The sensitivity and specificity of the test was calculated with the composite reference standard (Culture (exclusion of colonies as positives), clinical conditions, and smear) and was found to be 60% and 100% respectively. Conclusion: Truenat MTB test is a cost-effective rapid molecular test that can be used only for the diagnosis of presumptive EPTB and not on follow-up samples.

Strategies for safe management of hospital wastewater during the COVID-19 pandemic.

Management of hospital wastewater is a challenging task, particularly during the situations like coronavirus 2019 (COVID-19) pandemic. The hospital effluent streams are likely to contain many known and unknown contaminants including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) along with a variety of pollutants arising from pharmaceuticals, life-style chemicals, drugs, radioactive species, and human excreta from the patients. The effluents are a mixed bag of contaminants with some of them capable of infecting through contact. Hence, it is essential to identify appropriate treatment strategies for hospital waste streams. In this work, various pollutants emerging in the context of COVID-19 are examined. A methodical review is conducted on the occurrence and disinfection methods of SARS-CoV-2 in wastewater. An emphasis is given to the necessity of addressing the challenges of handling hospital effluents dynamically involved during the pandemic scenario to ensure human and environmental safety. A comparative evaluation of disinfection strategies makes it evident that the non-contact methods like ultraviolet irradiation, hydrogen peroxide vapor, and preventive approaches such as the usage of antimicrobial surface coating offer promise in reducing the chance of disease transmission. These methods are also highly efficient in comparison with other strategies. Chemical disinfection strategies such as chlorination may lead to further disinfection byproducts, complicating the treatment processes. An overall analysis of various disinfection methods is presented here, including developing methods such as membrane technologies, highlighting the merits and demerits of each of these processes. Finally, the wastewater surveillance adopted during the COVID-19 outbreak is discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s13762-023-04803-1.

Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience.

INTRODUCTION: With the emergence of multidrug-resistant organisms causing urosepsis after transrectal biopsy of prostate, the need for an alternative approach has increased. We assessed the safety and feasibility of transrectal ultrasound (TRUS) guided free-hand transperineal prostate biopsy under local anesthesia (LA) for suspected prostate cancer. MATERIALS AND METHODS: This prospective study was conducted from July 2019 to December 2020 in which patients with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination underwent magnetic resonance imaging-TRUS cognitive fusion transperineal prostate biopsy (target and systematic) using coaxial needle. Demographic, perioperative, and outcome data of 50 consecutive patients were analyzed. RESULTS: The mean age of the patients was 69.6 ± 7.61 years, median PSA 13.55 ng/mL (4.17-672) and prostate size 45cc (16-520). Prostate Imaging-Reporting and Data System (PIRADS) 2, 3, 4, and 5 lesions were found in 2, 12, 12, and 24 patients, respectively. Average procedure duration was 20 min (15-40 min) and number of cores ranged from 12 to 38 (median 20). Forty out of fifty (40/50) patients experienced only mild pain with visual analog scale ≤2. Histopathological examination showed adenocarcinoma, benign prostatic hyperplasia, and chronic prostatitis in 41, 5, and 4 patients respectively with 82% cancer detection rate (CDR). Over 95% of cases showed clinically significant cancer (International Society of Urological Pathology class ≥ 2) and 91.7% of patients with PIRADS score 4/5 and 66.7% with PIRADS score 3 had malignancy. Three patients developed complications (two hematuria, one urinary retention), both were managed conservatively and none had urosepsis. CONCLUSIONS: Free-hand transperineal prostate biopsy by coaxial needle technique under LA is safe and feasible with good tolerability, high CDR, and minimal complications particularly reduced urosepsis.

Tuning the dispersion of multiwall carbon nanotubes in co-continuous polymer blends: a generic approach.

Melt-mixed blends of polyamide 6 and acrylonitrile-butadiene-styrene (PA6/ABS) with multiwall carbon nanotubes (MWNTs) were prepared with the intention to develop conducting composites. A generic strategy, namely specific interactions combined with reactive coupling, was adopted to facilitate and to retain the 'network-like' structure of MWNTs during melt-mixing. This was facilitated by the sodium salt of 6-amino hexanoic acid (Na-AHA) and certain phosphonium based modifiers, where it was envisaged that these modifiers would establish specific interactions (either 'cation-π' or 'π-π' ) with the 'π-electron' clouds of MWNTs, as well as restricting them in the PA6 phase of the blends via reactive coupling. This route eventually led to a remarkable increase in the electrical conductivity and dielectric constant in the blends with MWNTs. Raman, FTIR and TEM investigations further supported these observations.

Management of pregnancy in transplant recipients.

Transplantation offers the best prospect of pregnancy in fertile women with various types of end-stage organ disease. Based on data from the USA National Transplantation Pregnancy Registry, >70% of posttransplant pregnancies have a successful live birth. Greatest experience has been seen in transplants involving the kidney, followed by the liver and then heart. Most pregnancies do not affect graft function significantly but are associated with significant obstetric problems such as spontaneous abortions, premature deliveries, low birthweight, intrauterine growth retardation, preeclampsia, etc. Cesarian section is required in 30% to 50% of patients, due to obstetric or maternal concerns. Neonatal death is rare, but 30% to 50% of live births have complications. Thus, management requires a multidisciplinary team. Similar data have been documented in developed Asian countries such as Japan and Singapore. Although fertility is restored early (<6 months), the current recommendation is to wait for >/=1 year, if not 2 years, after transplantation before allowing pregnancy. Patients without evidence of graft dysfunction and hypertension are more likely to have successful outcomes. Acute rejections may occur but the incidence does not appear to be increased dramatically. Treatment should be to similar to that of nonpregnancy treatment. Further pregnancies may be considered in instances of good outcome for the graft, fetus, and mother. Significant experience and safety has been accumulated in treatment using cyclosporine, azathioprine, prednisolone, and tacrolimus. However, few data are available with regard to the newer immunosuppressants, such as mycophenolate mofetil, and thus these agents are not recommended. Most live births have normal growth and development. Although there is much information available on posttransplant pregnancy it is imperative that each center maintains its own registry of pregnancy and offspring outcomes.

Genetic variability of begomoviruses associated with cotton leaf curl disease originating from India.

Cotton leaf curl disease (CLCuD) causing viruses belong to the Begomovirus genus of the family Geminiviridae. Most begomoviruses are bipartite with two molecules of circular single stranded DNA (A and B) encapsidated in icosahedral geminate particles. However, the begomoviruses associated with CLCuD have DNA-beta instead of DNA-B. In this communication we report the complete genomic sequence of DNA-A component of two CLCuD-causing begomoviruses, cotton leaf curl Kokhran virus-Dabawali (CLCuKV-Dab), tomato leaf curl Bangalore virus-Cotton [Fatehabad] (ToLCBV-Cotton [Fat]) and partial sequences of two other isolates cotton leaf curl Rajasthan virus-Bangalore (CLCuRV-Ban) and cotton leaf curl Kokhran virus-Ganganagar (CLCuKV-Gang). A phylogenetic analysis of these isolates along with other related begomoviruses showed that ToLCBV-Cotton [Fat] isolate was closest to the tomato leaf curl Bangalore virus-5 (ToLCBV-Ban5) where as CLCuKV-Dab isolate was close to the cotton leaf curl Kokhran virus-Faisalabad1 (CLCuKV-Fai1), cotton leaf curl Kokhran virus-72b (CLCuKV-72b) and cotton leaf curl Kokhran virus-806b (CLCuKV-806b) isolates from Pakistan. The phylogenetic analysis further showed that the ToLCBV-Cotton [Fat] and CLCuKV-Dab isolates along with CLCuKV-Fai1, CLCuKV-72b and CLCuKV-806b are closer to the ToLCBV, tomato leaf curl Gujarat virus (ToLCGV), tomato leaf curl Gujarat virus-Varanasi (ToLCGV-Var) and tomato leaf curl Sri Lanka virus (ToLCSLV) isolates, where as cotton leaf curl Alabad virus-804a (CLCuAV-804a), cotton leaf curl Multhan virus (CLCuMV) cluster with the isolates from cotton leaf curl Rajasthan virus (CLCuRV) and okra yellow vein mosaic virus (OYVMV). These results demonstrate the extensive variability observed in this group of viruses. The AC4 ORF is the least conserved among these viruses. In order to further asses the variability in the CLCuD-causing begomoviruses, the region showing minimum similarity in the DNA-A sequence was first determined by a comparison of segments of different lengths of the aligned sequences. The results indicated that region 2411-424 (771 nt) was the least conserved. A phylogenetic tree constructed using the sequences of all the CLCuD causing begomoviruses, corresponding to the least conserved region showed that they form two distinct clusters.

Epstein-Barr virus-associated T-cell lymphoma in solid organ transplant recipients.

Post-transplantation lymphoproliferative diseases (PTLDs) are a heterogenous group of lymphoid proliferative disorders occurring in transplant patients. Most PTLDs are B-cell in origin; T-cell PTLDs are seldom reported, and EBV-associated T-cell PTLDs are rare. The first case of a T-cell, non-EBV-associated PTLD was first described in a renal allograft recipient in 1987. A total of 40 cases of T-cell PTLDs in solid organ transplant recipients have been reported. However, so far only 16 cases of EBV-associated T-cell PTLDs have been reported in the literature. The sites of occurrence of EBV-associated T-cell PTLDs were in the gastrointestinal tract, lungs, bone marrow, skin, liver and spleen. The pathogenesis of EBV-associated T-cell PTLD is uncertain; it is speculated that the EBV may infect a subset of T-cells that express the CD21 receptor. The present treatment of EBV-associated T-cell PTLD consists of surgical removal, reduction or withdrawal of immunosuppression and/or radiotherapy and chemotherapy. The prognosis is uncertain, and the 1-year survival for patients who were followed up for 1 year was 50%.

Lack of long-term benefits of steroid withdrawal in renal transplant recipients.

Glucocorticoids used in renal transplantation have been associated with numerous adverse effects. Most studies that showed short-term benefits of steroid withdrawal made comparisons for patients administered prednisone, 10 to 17.5 mg/d, versus no prednisone. Few have studied long-term benefits of steroid withdrawal. We performed a retrospective review and identified 58 patients administered cyclosporine, azathioprine, and prednisone who underwent complete steroid withdrawal. Post-steroid withdrawal follow-up was 7.6 +/- 1.9 years. Nine patients restarted prednisone therapy, 3 patients lost their grafts (2 of those restarted on prednisone therapy), and 2 patients died with functioning grafts. When prednisone dosage was tapered from 10 mg/d to 10 mg every other day, clinically significant improvements were seen in weight, systolic and diastolic blood pressure, blood pressure medications, glycosylated hemoglobin level, and diabetic medications. No further benefits were seen in these parameters and total cholesterol level on complete steroid withdrawal from prednisone, 10 mg every other day. Most of the earlier benefits were not sustained on long-term follow-up, and the increase in these parameters was similar to that of a similar matched control group (that underwent transplantation during the same period) maintained on prednisone, 5 mg/d. Major differences were decreases in creatinine clearances and hemoglobin levels, which were greater in the steroid-withdrawal group (7.4 +/- 1.9 mL/min and 1.2 +/- 0.2 g/dL, respectively) compared with the control group (2.6 +/- 1.5 mL/min and 0.5 +/- 0.2 g/dL, respectively). In conclusion, most of the metabolic benefits were seen with steroid dosage taper from prednisone, 10 mg/d to 10 mg every other day, with no further benefits with steroid withdrawal. Most of these benefits were not sustained on long-term follow-up, questioning the utility of steroid withdrawal.

Once-daily intraperitoneal gentamicin is effective therapy for gram-negative CAPD peritonitis.

OBJECTIVE: To report our 3-year experience with the use of once-daily intraperitoneal (IP) gentamicin in the treatment of gram-negative continuous ambulatory peritoneal dialysis (CAPD) peritonitis. DESIGN: A prospective cohort study in prevalent CAPD patients. SETTING: A tertiary care institution. PATIENTS: All CAPD patients who presented with new episodes of peritonitis were studied. At presentation with peritonitis, IP vancomycin and gentamicin were administered as empirical therapy. IP gentamicin was given at a single daily dose of 40 mg/2 L in the overnight bag. The antimicrobial agents were reviewed when the culture results became available. Intraperitoneal ceftazidime was added for the treatment of pseudomonas peritonitis. MAIN OUTCOME MEASURES: Results of microbiological cultures and clinical outcomes of peritonitis were analyzed. RESULTS: Over a 36-month period, 190 episodes of peritonitis were recorded, of which 62/190 episodes (32.6%) isolated gram-negative organisms. The gram-negative organisms isolated were Escherichia coli, 15/62 episodes (24.1%); Pseudomonas aeruginosa, 12/62 episodes (19.4%); Acinetobacter spp, 12/62 episodes (19.4%); Klebsiella spp, 10/62 episodes (16.1%); and others, 13/62 episodes (21.0%). The overall treatment success rate was 66.1%. The treatment success rates were 74.0% if pseudomonas infections were excluded, 76.1% if gentamicin-resistant pathogens were excluded, and 80.5% if both pseudomonas infections and gentamicin-resistant pathogens were excluded. CONCLUSIONS: Once-daily IP gentamicin appears to be effective in the treatment of gram-negative CAPD peritonitis.

A diagnostic dilemma in an elderly patient with bone pains.

A 61-year-old patient presented with multiple bone pains. Biochemical, haematological and radiological investigations initially suggested a diagnosis of osteomalacia because of the presence of hypocalcaemia and looser zones. There were also multiple lytic bone lesions and bone scan showed multiple hot spots suggesting multiple bone secondaries. The key investigation in this case was examination of the bone marrow.