Value of dual testing for identifying tuberculous infection

Setting: A rural community in Chingleput district in Tamil Nadu state in south India. Objective: To determine the value of dual testing with PPD-S and PPD-B for identifying subjects with a tuberculous infection. Design: About 240,000 subjects in rural south India, all of whom were tested initially with PPD-S and PPD-B, were followed up for 15 years, mainly by total population survey once in every 212 years. The incidence of culture-positive tuberculosis was estimated using life-table technique. Results: Among 17,530 subjects with an intermediate reaction (8–11 mm) to PPD-S at intake, 285 with an induration to PPD-S exceeding the induration to PPD-B by at least 2 mm, had a significantly higher incidence of culture-positive tuberculosis than the remaining (154 and 93 per 100,000), and similarly 481 who had an induration of o10mm to PPD-B compared to those with X10mm (131 and 93 per 100,000). These subjects may be regarded as having a tuberculous infection. Infection with non-tuberculous mycobacteria conferred protection of about 30% against the development of tuberculosis over a 15-year period. Conclusion: In subjects with an intermediate reaction (8–11 mm) to PPD-S, dual testing with PPD-B enabled identification of those with a tuberculous infection. Most of the reactions were due to non-tuberculous mycobacteria

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

The Virulence in the Guinea-pig of Tubercle Bacilli Isolated before Treatment from South Indian Patients with Pulmonary Tuberculosis: 1. Homogeneity of the Investigation and a Critique of the Virulence Test

A series of studies on the virulence in the guinea-pig of tubercle bacilli isolated before treatment from Indian tuberculous patients admitted to a controlled comparison of different regimens of domiciliary chemotherapy has recently been undertaken by the Tuberculosis Chemotherapy Centre, Madras. The main object of these studies was to determine whether the differences in virulence of the tubercle bacilli obtained from Indian patients before the start of chemotherapy were related to the severtiy or type of the patients’ disease at that time and to the subsequent response to treatment. Before these relationships could be‘ investigated, however, it was necessary to find out whether the results of the virulence tests, which were carried out over a period of two-and-a-half years at the Centre and at the Microbiological Research Establishment, Porton, England, could be considered as a unified whole-that, is, as if they had all been done on the same day in the same laboratory. A proportion of the cultures was stored at – 20°C for 44-78 weeks, but this did not affect their virulence. Inter-experimental variation was found to be small in the Porton series of tests and undetectable in the Madras series, and the results in the latter series could be successfully adjusted to those in the former by allowing for differences in the means and standard deviations of the distributions for the two series. The measure of virulence used was found to be reasonably acceptable for the analysis of variance technique. Suggestions are made as to ways of improving the efficiency of the experimental design in future studies

The Virulence in the Guinea-pig of Tubercle Bacilli Isolated before Treatment from South Indian Patients with Pulmonary Tuberculosis 3. Virulence related to Pretreatment Status of Disease and to Response to Chemotherapy

This is the last of a series of three reports from the Tuberculosis Chemotherapy Centre Madras, on a study undertaken with the object of finding out whether differences in the virulence in the guinea-pig of tubercle bacilli isolated from South Indian tuberculous patients before the start of chemotherapy are related to the severity of the patients’ disease on admission to treatment and to the subsequent response to chemotherapy. The 281 patients in this study were drawn from the patients admitted to a l-year comparison of four domiciliary chemotherapeutic regimens : (a) 3.9-5.5 mg/kg isoniazid plus 0.2-0.3 g/kg sodium PAS daily, divided into two doses (PH series) ; (b) 7.8-9.6 mg/kg isoniazid alone daily in one dose (HI-I series) ; (c) 7.8-9.6 mg/kg isoniazid alone daily, divided into two doses (HI-2 series) ; (d) 3.9-5.5 mg/kg isoniazid alone daily, divided into two doses (H series). No evidence was found of an association between the virulence of the organisms and any pretreatment condition of known prognostic importance. There was no association between pretreatment virulence and progress during treatment in the PH series (the most effective regimen). In the other series, however, the progress was more satisfactory in patients infected with organisms of low virulence than in those infected with organisms of high virulence, the association between virulence and progress attaining statistical significance in the combined HI-2 and H series (the least effective regimens) and only just failing to do so in the smaller HI-1 series. Possible explanations are put forward both for the absence of an association between virulence and severity of disease on admission and for the presence of an association between virulence and response in the patients treated with isoniazid alone

Self-similar shear-thickening behavior in CTAB/NaSal surfactant solutions

The effect of salt concentration Cs on the critical shear rate required for the onset of shear thickening and apparent relaxation time of the shear-thickened phase, has been investigated systematically for dilute CTAB/NaSal solutions. Experimental data suggest a self-similar behavior of the critical shear rate and relaxation time as functions of Cs. Specifically, the former ~ Cs^(-6) whereas the latter ~ Cs^(6) such that an effective Weissenberg number for the onset of the shear thickened phase is only weakly dependent on Cs. A procedure has been developed to collapse the apparent shear viscosity versus shear rate data obtained for various values of Cs into a single master curve. The effect of Cs on the elastic modulus and mesh size of the shear-induced gel phase for different surfactant concentrations is discussed. Experiments performed using different flow cells (Couette and cone-and-plate) show that the critical shear rate, relaxation time and the maximum viscosity attained are geometry-independent. The elastic modulus of the gel phase inferred indirectly by employing simplified hydrodynamic instability analysis of a sheared gel-fluid interface is in qualitative agreement with that predicted for an entangled phase of living polymers. A qualitative mechanism that combines the effect of Cs on average micelle length and Debye parameter with shear-induced configurational changes of rod-like micelles is proposed to rationalize the self-similarity of SIS formation.Comment: 27 pages, 17 figure

Development and validation of anthropometric prediction equations for estimation of lean body mass and appendicular lean soft tissue in Indian men and women.

Lean body mass (LBM) and muscle mass remain difficult to quantify in large epidemiological studies due to the unavailability of inexpensive methods. We therefore developed anthropometric prediction equations to estimate the LBM and appendicular lean soft tissue (ALST) using dual-energy X-ray absorptiometry (DXA) as a reference method. Healthy volunteers (n = 2,220; 36% women; age 18-79 yr), representing a wide range of body mass index (14-44 kg/m(2)), participated in this study. Their LBM, including ALST, was assessed by DXA along with anthropometric measurements. The sample was divided into prediction (60%) and validation (40%) sets. In the prediction set, a number of prediction models were constructed using DXA-measured LBM and ALST estimates as dependent variables and a combination of anthropometric indices as independent variables. These equations were cross-validated in the validation set. Simple equations using age, height, and weight explained >90% variation in the LBM and ALST in both men and women. Additional variables (hip and limb circumferences and sum of skinfold thicknesses) increased the explained variation by 5-8% in the fully adjusted models predicting LBM and ALST. More complex equations using all of the above anthropometric variables could predict the DXA-measured LBM and ALST accurately, as indicated by low standard error of the estimate (LBM: 1.47 kg and 1.63 kg for men and women, respectively), as well as good agreement by Bland-Altman analyses (Bland JM, Altman D. Lancet 1: 307-310, 1986). These equations could be a valuable tool in large epidemiological studies assessing these body compartments in Indians and other population groups with similar body composition

Superiority of deformable image co-registration in the integration of diagnostic positron emission tomography-computed tomography to the radiotherapy treatment planning pathway for oesophageal carcinoma

Aims To investigate the use of image co-registration in incorporating diagnostic positron emission tomography-computed tomography (PET-CT) directly into the radiotherapy treatment planning pathway, and to describe the pattern of local recurrence relative to the PET-avid volume. Materials and methods Fourteen patients were retrospectively identified, six of whom had local recurrence. The accuracy of deformable image registration (DIR) and rigid registration of the diagnostic PET-CT and recurrence CT, to the planning CT, were quantitatively assessed by comparing co-registration of oesophagus, trachea and aorta contours. DIR was used to examine the correlation between PET-avid volumes, dosimetry and site of recurrence. Results Positional metrics including the dice similarity coefficient (DSC) and conformity index (CI), showed DIR to be superior to rigid registration in the co-registration of diagnostic and recurrence imaging to the planning CT. For diagnostic PET-CT, DIR was superior to rigid registration in the transfer of oesophagus (DSC = 0.75 versus 0.65, P < 0.009 and CI = 0.59 versus 0.48, P < 0.003), trachea (DSC = 0.88 versus 0.65, P < 0.004 and CI = 0.78 versus 0.51, P < 0.0001) and aorta structures (DSC = 0.93 versus 0.86, P < 0.006 and CI = 0.86 versus 0.76, P < 0.006). For recurrence imaging, DIR was superior to rigid registration in the transfer of trachea (DSC = 0.91 versus 0.66, P < 0.03 and CI = 0.83 versus 0.51, P < 0.02) and oesophagus structures (DSC = 0.74 versus 0.51, P < 0.004 and CI = 0.61 versus 0.37, P < 0.006) with a non-significant trend for the aorta (DSC = 0.91 versus 0.75, P < 0.08 and CI = 0.83 versus 0.63, P < 0.06) structure. A mean inclusivity index of 0.93 (range 0.79–1) showed that the relapse volume was within the planning target volume (PTVPET-CT); all relapses occurred within the high dose region. Conclusion DIR is superior to rigid registration in the co-registration of PET-CT and recurrence CT to the planning CT, and can be considered in the direct integration of PET-CT to the treatment planning process. Local recurrences occur within the PTVPET-CT, suggesting that this is a suitable target for dose-escalation strategies

Generalized calculation of magnetic coupling constants for Mott-Hubbard insulators: Application to ferromagnetic Cr compounds

Using a Rayleigh-Schr\"odinger perturbation expansion of multi-band Hubbard models, we present analytic expressions for the super-exchange coupling constants between magnetic transition metal ions of arbitrary separation in Mott-Hubbard insulators. The only restrictions are i) all ligand ions are closed shell anions and ii) all contributing interaction paths are of equal length. For short paths, our results essentially confirm the Goodenough-Kanamori-Anderson rules, yet in general there does not exist any simple rule to predict the sign of the magnetic coupling constants. The most favorable situation for ferromagnetic coupling is found for ions with less than half filled d shells, the (relative) tendency to ferromagnetic coupling increases with increasing path length. As an application, the magnetic interactions of the Cr compounds Rb$_2$CrCl$_4$, CrCl$_3$, CrBr$_3$ and CrI$_3$ are investigated, all of which except CrCl$_3$ are ferromagnets.Comment: 13 pages, 6 eps figures, submitted to Phys Rev

BRIGHT ASTEROIDS IN THE RED SEA - AN EMERGING PATHOGEN CANDIDA HAEMOLUNII: ARE AZOLES THE TREATMENT OPTION?

This is a case study of a 15-year-old female who on chemotherapy and central line catheter-related bloodstream candidemia presented with recurrentepisodes of candidemia, was febrile and breathless. She was diagnosed of Candida haemulonii fungemia. Echinocandins was started as this species ofCandida is usually resistant to the commonly used antifungal agents. On treatment, the patient was afebrile and discharged.Keywords: Candida haemulonii, Candidemia, Case report, Emerging pathogenÂ

Fibre bundle formulation of nonrelativistic quantum mechanics: I. Introduction. The evolution transport

We propose a new systematic fibre bundle formulation of nonrelativistic quantum mechanics. The new form of the theory is equivalent to the usual one but it is in harmony with the modern trends in theoretical physics and potentially admits new generalizations in different directions. In it a pure state of some quantum system is described by a state section (along paths) of a (Hilbert) fibre bundle. Its evolution is determined through the bundle (analogue of the) Schr\"odinger equation. Now the dynamical variables and the density operator are described via bundle morphisms (along paths). The mentioned quantities are connected by a number of relations derived in this work. The present first part of this investigation is devoted to the introduction of basic concepts on which the fibre bundle approach to quantum mechanics rests. We show that the evolution of pure quantum-mechanical states can be described as a suitable linear transport along paths, called evolution transport, of the state sections in the Hilbert fibre bundle of states of a considered quantum system.Comment: 26 standard (11pt, A4) LaTeX 2e pages. The packages AMS-LaTeX and amsfonts are required. Revised: new material, references, and comments are added. Minor style chages. Continuation of quan-ph/9803083. For continuation of the this series see http://www.inrne.bas.bg/mathmod/bozhome