Seasonality of tuberculosis in India: is it real and what does it tell us?

India has a third of the world's tuberculosis cases. Large-scale expansion of a national programme in 1998 has allowed for population-based analyses of data from tuberculosis registries. We assessed seasonal trends using quarterly reports from districts with stable tuberculosis control programmes (population 115 million). In northern India, tuberculosis diagnoses peaked between April and June, and reached a nadir between October and December, whereas no seasonality was reported in the south. Overall, rates of new smear-positive tuberculosis cases were 57 per 100000 population in peak seasons versus 46 per 100000 in trough seasons. General health-seeking behaviour artifact was ruled out. Seasonality was highest in paediatric cases, suggesting variation in recent transmission.     

Improved tuberculosis case detection through public-private partnership and laboratory-based surveillance, Kannur District, Kerala, India, 2001-2002.

BACKGROUND: Efforts to intensify global tuberculosis (TB) control are limited by difficulties in coordinating with private doctors. More than half of Indian TB patients may initially consult a private provider, but many are neither diagnosed accurately nor treated effectively. We established and evaluated a public-private partnership based on surveillance of TB detected in private laboratories and use of standardised directly observed treatment regimens. METHODS: In one district, the governmental TB control programme offered training in microscopy to all large private sector laboratories, and educated private physicians on the importance of microscopy for TB diagnosis. We reviewed records from participating private laboratories and all publicly diagnosed patients. RESULTS: Of 2328 pulmonary TB patients registered from July 2001 to December 2002, 404 (17%) were detected in the private sector. The annual new AFB-positive case notification rate increased by 21%, from 27.8/100,000 in 2000 to 33.5/100,000 in 2002. Surveillance at private laboratories found an additional 260 nonregistered AFB-positive patients. CONCLUSIONS: This public-private partnership substantially increased TB case detection and established a sustainable framework for private sector involvement in TB control. In the setting of a strong public sector programme, the combination of active surveillance of private laboratories along with physician sensitisation is a promising approach to improve TB case detection.     

Infection of human T-cell leukemia virus type I and development of human T-cell leukemia lymphoma in patients with hematologic neoplasms: a possible linkage to blood transfusion

Among 354 adult patients with either hematological malignancy or aplastic anemia, eight were positive for anti-HTLV-I antibodies; six of eight had received multiple transfusions. There was an approximately 3.5-fold increase (P less than .001) of HTLV-I seropositivity in the patients with hematologic disease (8 of 354, 2.23%) compared to the healthy adults older than 20 years (34 of 5252, .65%). Two hematological patients, one with Hodgkin's disease and one with acute promyelocytic leukemia, were found to be positive for HTLV-I, and developed and died of adult T-cell leukemia/lymphoma (ATL) subsequently. Both were long-term survivors of the primary disease and had received multiple transfusions. The latent period from blood transfusion to onset of ATL was 6 months and 11 years, respectively. Immunocompromised patients, who were seropositive for HTLV-I, may be at increased risk for ATL compared to healthy carriers of HTLV-I, and the latent period may be shorter.     

Washing of new microscopic glass slides in dichromate solution does not influence sputum AFB smear results.

SETTING: Microscopy centres in Tiruvallur District, Tamil Nadu, India, implementing DOTS. OBJECTIVE: To know whether washing new glass slides in dichromate solution is essential for effective sputum acid-fast bacilli microscopy. METHODS: Two direct smears were prepared from each of 1750 sputum samples. One was made on dichromate solution-cleaned new glass slides and the other was made on unwashed new glass slides. The smears were blinded and examined. RESULTS: Of the 1750 specimens, 13.5% and 13.08% were positive for AFB using washed and unwashed slides, respectively (P = 0.12). The concordance between these two (including one grade above and one below) was 98.7%. CONCLUSION: Washing of new glass slides in dichromate solution is not essential for AFB microscopy.     

Association of initial tuberculin sensitivity, age and sex with the incidence of tuberculosis in south India: a 15-year follow-up.

OBJECTIVE: To determine the association of initial tuberculin sensitivity, age and sex with the development of tuberculosis. METHODS: A 15-year follow-up of 280000 subjects in south India, where new cases of tuberculosis were detected mainly by periodic population surveys. Life-table technique was employed to estimate tuberculosis incidence and disease risk in survivors. The independent effect of tuberculin sensitivity, sex and age at intake was determined using Cox's proportional hazard model. RESULTS: Taking subjects with reaction size 0-7 mm to 3 IU PPD-S as reference group, the adjusted relative risk (RR) for developing culture-positive tuberculosis was 1.1, 1.9, 2.9, 3.6 and 3.3 for those with indurations of 8-11, 12-15, 16-19, 20-24 and > or = 25 mm (P < 0.01). Considering subjects aged 0-4 years as reference group, the adjusted RR for the other groups increased from 1.7 to 10.8 (P < 0.01). Males had a substantially higher incidence (adjusted RR 3.0, P < 0.001). The risk of culture-positive tuberculosis over 15 years in survivors was 3.3% (5.0% in males and 1.6% in females), and increased substantially with tuberculin sensitivity at intake. In those with > or = 12 mm at intake, the approximate lifetime risk was 6.1% (8.6% in males and 3.1% in females). CONCLUSION: The incidence of tuberculosis increased steadily with tuberculin sensitivity to PPD-S and age at intake. Males had a significantly higher risk than females in every PPD-S group and the overall risk was three-fold higher.     

PapD-like chaperones provide the missing information for folding of pilin proteins

A fundamental question in molecular biology is how proteins fold into domains that can serve as assembly modules for building up large macromolecular structures. The biogenesis of pili on the surface of Gram-negative bacteria requires the orchestration of a complex process that includes protein synthesis, folding via small chaperones, secretion, and assembly. The results presented here support the hypothesis that pilus subunit folding and biogenesis proceed via mechanisms termed donor strand complementation and donor strand exchange. Here we show that the steric information necessary for pilus subunit folding is not contained in one polypeptide sequence. Rather, the missing information is transiently donated by a strand of a small chaperone to allow folding. Providing the missing information for folding, via a 13-amino acid peptide extension to the C-terminal end of a pilus subunit, resulted in the production of a protein that no longer required the chaperone to fold. This mechanism of small periplasmic chaperone function described here deviates from classical hsp60 chaperone-assisted folding.     

A relapse of paratyphoid fever after treatment with ciprofloxacin in a child with congenital biliary atresia

This report describes a relapse of Salmonella paratyphi B infection in a child with biliary atresia, following 2 weeks of treatment with ciprofloxacin. The recrudescence was complicated by the development of osteomyelitis and was treated with chloramphenicol, trimethoprim, ceftriaxone and ampicillin in succession.     

雌二醇对动情间期切除卵巢母羊黄体生成素分泌脉冲的抑制作用

动情间期母羊切除卵巢并皮下植入持续释放的E_2后,平均LH基础分泌水平和LH脉冲幅高比对照组显著减低,LH脉冲频率无明显改变。LH的平均基础分泌水平和脉?中幅高显著相关。表明植入E_2对垂体LH分泌的抑制作用主要是抑制LH对GnRH的反应,作用部位在垂体,不在下丘脑。LH基础分泌水平的下降,亦可能是E_2的抑制作用所致。     

The Asp84Glu variant of the melanocortin 1 receptor (MC1R) is associated with melanoma

Melanocyte stimulating hormone (MSH) plays an important role in determining the cutaneous response to ultraviolet radiation and may also influence melanoma progression. We have previously shown that variants of the melanocortin receptor present on melanocytes, MC1R, are associated with sun sensitivity and red hair in a UK population and therefore now consider the gene as a candidate for melanoma susceptibility. We have compared the frequency of known MC1R variants in the second and seventh transmembrane domains in 43 melanoma cases and 44 controls. MC1R variants were more common in cases than controls (chi 2 = 6.75, 1 d.f.; P = 0.0094) with a relative risk to carriers of variant alleles compared with normal homozygotes of 3.91 (95% c.l.: 1.48-10.35), and a population risk attributable to carriers of 34.6% (95% c.i. 10.7-52.1%). The Asp84Glu variant was only present in melanoma cases and appears to be of particular significance. The contribution of variant MC1R alleles was largely independent of skin type. Variants of the MC1R gene are likely to be causally associated with the development of melanoma.