MULTIDRUG RESISTANT TUBERCULOSIS – BIOMECHANISM,EPIDEMIOLOGY AND MANAGEMENT STRATEGIES

Muitidrug resistant tuberculosis has shown an alarming increase and this assumes added importance in view of the increasing number of HIV infected patients. This article reviews the biomechanism of resistance and discusses the present stategies that are available and recommended to tackle the rising incidence of tuberculosis due to resistant mycobacteria.KEYWORDS: Antitubereular drugs, Drug resistance, Mycobacterium tuberculosis     

Vitamin A intake and xerophthalmia among Indian children

OBJECTIVE: To estimate prevalence of xerophthalmia and to assess dietary intake of vitamin A in Indian children aged under 6 y. DESIGN: Cross sectional study. STUDY SETTING: Urban slums under Urban Health Centre affiliated to Department of Preventive and Social Medicine, Government Medical College, Nagpur, India. PARTICIPANTS: The study included 1094 all children under 6 y of age, from two randomly selected urban slums. METHODS: Xerophthalmia was diagnosed on the basis of ocular signs and symptoms (WHO recommendations). Dietary intake of vitamin A was assessed by using one year recall method recommended by International Vitamin A Consultative Group. RESULTS: Prevalence of xerophthalmia was estimated to be 8.7%. Nine hundred and ninety-five (90.9%) study subjects were identified as inhabitants consuming dietary vitamin A at below recommended levels. (UPF score < 210). Five hundred and ninety-three (54.2%) study subjects were consuming dietary vitamin A at approximately less than 200 RE/d (UPF score < 120) while 402 (36.2%) were consuming approximately 200-300 RE/d (UPF score 120-210). The prevalence of xerophthalmia was found to be decreasing as the score of usual pattern of food consumption (UPF) increased. CONCLUSIONS: Children with a dietary intake represented by a UPF score of less than 120 were at high risk of developing xerophthalmia, whereas, those consuming vitamin A equal to a UPF score greater than 120 were at comparatively less risk despite being below the recommended levels.     

Functional and quality of life outcome after non-operatively managed proximal humeral fractures

Background

Fractures of the proximal humerus are common and most often treated non-operatively. However, long-term follow-up studies focusing on functional results and quality of life in patients after this type of fracture are scarce. The primary aim of this study is to report the long-term functional and quality of life outcome in patients with a proximal humeral fracture.

Materials and methods

A retrospective analysis of all consecutive patients undergoing non-operative treatment for a proximal humeral fracture in a level 2 trauma centre between January 2000 and December 2013 was performed. A database consisting of all relevant demographic, patient and fracture characteristics was created. Subsequently, a questionnaire containing the DASH (Disabilities of the Arm, Shoulder and Hand) score, EuroQol-5D (EQ-5D), VAS (visual analogue scale) score, and subjective questions was sent to all patients.

Results

A total of 410 patients (65 male, 345 female) were included for analyses. Average follow-up was 90 ± 48 months. DASH-scores <15 were considered as good. A median DASH-score of 6.67 [0.83–22.50] was found. A significant lower DASH-score was seen in patients under the age of 65 compared to older patients (p < 0.001). In comparison to an age-matched general Dutch population, Health related Quality of Life (HrQoL) on the EQ-us was not significantly worse in our study population (difference 0.02). Strong (negative) correlation was found between DASH-score and VAS-score, and DASH-score and HrQoL, respectively ρ = ?0.534 and ρ = ?0.787.

Conclusion

Long-term functional and quality of life outcomes are good in most patients after proximal humeral fractures, but negatively correlated to each other.

Level of evidence

Level III.

     

Prevalence and correlates of mental health problems in prostate cancer survivors: A case-control study comparing survivors with general population peers

Objective

The purpose of this study was to identify factors associated with mental health (MH) problems in prostate cancer (PC) survivors. Toward this end, we evaluated (1) differences in the prevalence of MH problems between PC survivors and age-matched men from the general population (GenPop) and (2) correlates of MH in PC survivors and the GenPop.

Isolation and transformation of the pyruvate kinase gene of Aspergillus nidulans

Summary The Aspergillus nidulans pyruvate kinase gene was isolated by heterologous hybridization using the corresponding yeast gene as a probe. A 2.9 kb EcoRI/BamHI fragment, which exclusively hybridized to the yeast gene, was subcloned in pBR322. This clone was used to transform an A. nidulans pkiA deletion mutant to PKI⁺. The analysis of transformants with respect to the kind of integration revealed about 80% homologous integration – 55% by a double cross-over event (type III integration), 25% by a single cross-over event (type I integration). Type II transformants (20%) that arise by non-homologous integration have not been further characterized with respect to the sites of integration.A direct correlation between the number of copies of the gene integrated into the genome and the measured pyruvate kinase activity was found after growth on a glycolytic carbon source. From this, it was concluded that the 2.9 kb EcoRI/BamHI fragment contains the complete pyruvate kinase structural gene, including the promoter region.However, after growth on a gluconeogenic carbon source, the regulation of gene expression was found to be disturbed. On acetate an increase in activity per gene copy (0.2 IU) was found in the transformants, as compared with wild-type levels. It is suggested that the pyruvate kinase gene is regulated by negative control, and that some sequences involved in this regulation are missing in the cloned fragment.Abbreviations ATP Adenosinetriphosphate - MM Minimal medium - PEP Phosphoenolpyruvate     

Ultrastructure of the cortical epithelium of the rat thymus after in vivo exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) is known for inducing cortical atrophy in the rat thymus. The present study was conducted to provide ultrastructural evidence for the cortical epithelium to be a target for TCDD in vivo. Juvenile male Wistar rats were orally intubated once with either 50 or 150 g/kg TCDD and killed 4 or 10 days thereafter. Major changes were found in the cortical thymic epithelium. First, a relative shift occurred from pale to darker cortical epithelial cell types, as judged by their nuclear and cytoplasmic electron density. This effect was most prominent at 10 days after exposure to 150 g/kg TCDD. The increased electron density of the cortical epithelium indicates an altered state of cellular differentiation. Secondly, at the 150 g/kg dose level focal epithelial cell aggregates were seen both at day 4 and day 10 after administration. This aggregation may either be compound induced or represent a secondary event to the collapse of the thymic stroma. Thirdly, increased vacuolation of cortical epithelial cells was apparent. This effect is interpreted as a consequence rather than a cause of thymocyte depletion from the cortex. This study indicates that TCDD exposure affects the cortical epithelium of the rat thymus at a high dose level. Electron microscopy reveals that the differentiation of epithelial cells is altered. In addition, epithelial cell aggregates are formed.     

Relationships of the Dendritic Arborizations of Ventral Striatomesencephalic Projection Neurons With Boundaries of Striatal Compartments. An In Vitro Intracellular Labelling Study in the Rat

We studied the relationships of the dendrites of ventral striatomesencephalic projection neurons with the compartmental structure of the ventral striatum, as revealed by enkephalin immunohistochemistry. Lightly fixed slices were employed in which Lucifer yellow was intracellulary injected into neurons that were retrogradely labelled following Fast Blue injections in the ventral tegmental area. Double immunohistochemical staining was carried out using antisera to Lucifer yellow and Leu-enkephalin. Most of the 226 injected cells were located in the core region of the nucleus accumbens. All these neurons were of the small- to medium-sized spiny type. The dendritic arborizations of over 90% of the cells remained within the compartment in which the parent cell bodies resided. The dendrites of most of these neurons abutted the border of the compartment, whereas a smaller number of neurons had dendrites that were distant from any compartmental boundary. The dendrites of fewer than 10% of the neurons crossed the borders of compartments. Only a few cells were injected in the shell region of the nucleus accumbens. None of these neurons extended its dendrites into the core region of the nucleus or into the territory of the clusters of small cells which characterize the shell. The present results demonstrate that the dendrites of the great majority of ventral striatomesencephalic neurons comply with the boundaries of ventral striatal enkephalin compartments. Together with the results of previous studies showing that such compartments are selectively innervated by thalamic and cortical afferents, and have outputs to different areas in the ventral mesencephalon, the present data suggest the existence of discrete channels through the ventral striatum.