Cerebrospinal fluid lysozyme in the diagnosis of tuberculous meningitis

Pretreatment lysozyme levels in cerebrospinal fluid (CSF) were estimated in 37 patients with tuberculous meningitis (TBM), 16 with non-tuberculous meningitis (non-TBM) and 13 with non-inflammatory conditions of the central nervous system (controls) in an attempt to assess the role of CSF lysozyme in the diagnosis of TBM. Lysozyme content in the CSF was found to be elevated in all patients with bacteriologically confirmed TBM and in a large proportion of patients in whom the disease was clinically diagnosed but bacteriologically not confirmed. The enzyme was not detected in all but one of the control subjects and in most (69%) of the non-TBM patients

A novel method of staining acid-fast bacilli in sputum containers

Background & objectives: Making centrifuged deposit smears from sputum to detect acid-fast bacilli (AFB) is considered hazardous. We carried out this study to stain the centrifuged deposits with carbol-fuchsin in sputum containers and to decolourize and counterstain their smears made on glass slides. Methods: The centrifuged deposits of 180 sputum samples from pulmonary tuberculosis patients were used for making smears (initial deposit smears) and staining by Ziehl-Neelsen (ZN) method for the detection of AFB. Each of the sputum deposit was then treated with one ml of 1 per cent carbol-fuchsin and a smear made between 2 to 3 h was then decolourized and counterstained by the same procedures followed in ZN method (2 h stained deposit smear). The coded initial deposit smears and the corresponding 2 h stained deposit smears were read by the same readers and the results compared. Results: One hundred and fifty (70 positive and 80 negative) 2 h stained deposit smears were compared with initial deposit smears and the difference was not statistically significant. Interpretation & conclusion: Centrifuged deposits of sputum in sputum containers can be stained by carbol-fuchsin within 2-3 h and their smears made subsequently on glass slides can then be decolourized and counterstained by the procedures followed in ZN method for detection of AFB by light microscopy

Welding

Friction welding method is one of the most simple, economical and highly productive methods in joining similar and dissimilar metals. It is widely used in the automotive, aircraft and aerospace industrial applications. For many applications it is often necessary to join aluminium (6061) to make finished part. In this project the main aim is to weld the small thickness of aluminum (6061) plates for that friction welding machine used is of higher cost. Here the aim is reduce the cost of friction welding machine with simple parts like three phase A.C induction motor, bush, frame stand, friction tool, universal vice, vertical moving bed, horizontal moving bed, etc. The result expected would be of same strength as that of old friction welding machine. It is very easy and at same time production time is very much reduced. This machine is best suitable for mass production

Susceptibility of south Indian strains of Mycobacterium tuberculosis to tuberactinomycin

A total of 114 strains of Mycobacterium tuberculosis isolated from sputum samples of 114 patients of pulmonary tuberculosis in south India, were coded and tested for their in vitro susceptibility to tuberactinomycin (Tum) incorporated in Lowenstein-Jensen (LJ) medium. Of these strains, 95 (83.3%) and 15 (13.2%) were susceptible to Tum at 25 and 50 mg/l respectively. Only 4 (3.5%) strains were inhibited at 100 mg/l or more. Of the 37 drug sensitive strains, 2 (5.4%) were not susceptible to Tum at 25 mg/l compared to 17 (22.1%) of 77 strains-resistant to one or more of antituberculosis drugs (P <0.02). The drug susceptibility pattern of the strains revealed that there was no significant association of resistance between Tum and streptomycin or rifampicin or ethambutol or ethionamide or isoniazid. However, 15 (53.6%) of 28 kanamycin (K) resistant strains were not susceptible to Tum at 25 mg/l. This cross resistance between Tum and K was further studied in 24 and 15 K sensitive and resistant strains respectively, by correlating their proportion resistance at 16 mg/l and it was found to have a significant positive correlation (r = 0.55; X0.01)

Active community surveillance of the impact of different tuberculosis control measures, Tiruvallur, South India, 1968-2001

Background: Tuberculosis is curable, but community surveys documenting epidemiological impact of the WHO-recommended DOTS strategy on tuberculosis prevalence have not been published. We used active community surveillance to compare the impact of DOTS with earlier programmes. Methods: We conducted tuberculosis disease surveys using random cluster sampling of a rural population in South India approximately every 2.5 years from 1968 to 1986, using radiography as a screening tool for sputum examination. In 1999, DOTS was implemented in the area. Prevalence surveys using radiography and symptom screening were conducted at the start of DOTS implementation and after 2.5 years. Results: From 1968 to 1999, culture-positive and smear-positive tuberculosis declined by 2.3 and 2.5% per annum compared with 11.9 and 5.6% after DOTS implementation. The 2.5 year period of DOTS implementation accounted for one-fourth of the decline in prevalence of culture-positive tuberculosis over 33 years. Multivariate analysis showed that prevalence of culture-positive tuberculosis decreased substantially (10.0% per annum, 95% CI: 2.8–16.6%) owing to DOTS after only slight declines related to temporal trends (2.1% annual decline, 95% CI: 1.1–3.2%) and short-course chemotherapy (1.5% annual decline, 95% CI: �9.7% to 11.5%). Under DOTS, the proportion of total cases identified through clinical care increased from 81 to 92%. Conclusions: Following DOTS implementation, prevalence of culture-positive tuberculosis decreased rapidly following a gradual decline for the previous 30 years. In the absence of a large HIV epidemic and with relatively low levels of rifampicin resistance, DOTS was associated with rapid reduction of tuberculosis prevalenc

Influence of drug susceptibility on treatment outcome and susceptibility profile of 'failures' to category II regimen

Objective: To assess the influence of drug resistance on treatment outcome among patients treated with Category-II regimen and document drug susceptibility pattern of “Failures” to this regimen. Design: A retrospective analysis of patients registered from May 1999 through December 2004. Results: Treatment success was 42% among 572 patients and was similar among patients with fully susceptible or resistant but non-MDR organisms (41% of 254 and 40% of 128 patients, respectively). Among 49 MDR-TB patients, 27% had successful treatment outcome. The failure rates among patients with fully susceptible, resistant but non-MDR and MDR bacilli, were 6%, 12% and 27% respectively. Default was significantly higher among males (53% vs. 34%: p<0.01) smokers (57% vs. 36%: p <0.001), alcoholics (58% vs. 39%: p <0.001) and patients with higher initial smear grading (2+ or 3+, 56% vs. scanty or 1+, 44%: p <0.01). DST results were available for 60% (31 of 52) of failures and 10 had MDR-TB. Conclusion: The low success rate to the re-treatment regimen was mainly due to non-compliance. Failure was observed among 9% of patients and MDR-TB was 32% among Category II failures. The currently recommended Category II regimen appears to be adequate for majority of re-treatment cases

Is it worth treating category I failure patients with category II regimen?

Background: Very little information is available on the drug susceptibility profile among patients who are treated with standardized short-course chemotherapy regimens under programme conditions. Methods: Sputum samples were collected from new sputum smear-positive patients declared ‘failure’ after treatment with Category I regimen under tuberculosis control programme using DOTS strategy from a rural area of Tamil Nadu. Results: Of 1463 patients started on Category I regimen between May1999 and December 2002, 74 cases were declared as ‘failures’ (smear positive at 5/6 months of treatment). We collected sputum samples from 60 (81%) of 74 ‘failures’ and 27% (16 of 60) of them were culture-negative for M tuberculosis and 17% (10 of 60) had organisms resistant to Isoniazid and Rifampicin (MDR TB). Conclusion: Based on the drug susceptibility profile at the time of ‘failure’, treating Category I ‘failures’ with Category II regimen with close monitoring appears to be justified

Estimation of burden of tuberculosis in India for the year 2000

Background & objectives: Data on the burden of tuberculosis (TB) in India are vital for programme planners to plan the resource requirements and for monitoring the nation-wide TB control programme. There was a need to revise the earlier estimate on the burden of TB in India based on the increase in population and current epidemiological data. This study estimates the burden of disease for the year 2000 based on recent prevalence of TB and annual risk of tuberculosis infection (ARTI) estimates. Methods: Data on prevalence generated among adults by the Tuberculosis Research Centre (TRC), Chennai, among children by National Tuberculosis Institute (NTI), Bangalore, and the ARTI estimates from the nation-wide sample survey by NTI and TRC were used for the estimation. The prevalence of disease corresponding to 1 per cent ARTI was extrapolated to different parts of the country using the estimates of ARTI and the population in those areas and added together to get the total cases. Abacillary cases that required treatment were estimated from X-ray abnormals. The estimates of bacillary, abacillary and extrapulmonary cases were then combined to get the national burden. Results: The estimated number of bacillary cases was 3.8 million (95% CI: 2.8 - 4.7). The number of abacillary cases was estimated to be 3.9 million and that for extrapulmonary cases was 0.8 million giving a total burden of 8.5 million (95% CI: 6.3-10.4) for 2000. Interpretation & conclusion: The present estimate differs from the earlier estimates because we have included the disease burden of X-ray cases that are likely to breakdown to bacillary cases in a one year period, and extrapulmonary TB cases. The current estimates provided baseline information for advocacy and planning resource allocation for TB control activities. Also, these estimates can be compared with that in future years to measure the long term impact of TB control activities in India