bluuebunny/crossref_metadata_2025 huggingface dataset:
Nontuberculous Mycobacterium
Authors: Rajendran Priya , Padmapriyadarsini Chandrasekaran , Mondal Rajesh
Published: April 2023

Nontuberculous mycobacteria (NTM), considered as mere contaminants, are off late, being reported as potential pathogens through various studies. The infections due to NTM range from pulmonary to extra pulmonary including skin and soft-tissue infections, traumatic and surgical wound infections, and catheter and implant-associated infections. Although extrapulmonary infections are extensively explored, pulmonary infections are scarcely reported due to their misdiagnosis as tuberculosis caused by M. tuberculosis (MTB). Appropriate detection methods are essential in order to facilitate the differential diagnosis of NTM from MTB infections. We aimed to collate the data available on NTM diagnosis and its epidemiology in India in this review. While diagnosis of MTB itself is more challenging in India, for appropriate treatment of NTM, special training and attention is needed for differential diagnosis of the former from latter. Currently, in India, in addition to the available techniques for identification of NTM, line probe assay (Hains life sciences) is proving to be a promising tool for the detection of NTM (common mycobacteria/additional species kit) and their antimicrobial resistance (Genotype NTM-DR VER 1.0). In future, with the price of sequencing steadily coming down, with proper monitoring, whole-genome sequencing could be the test of choice to predict the species, drug resistance, outbreaks in hospitals, and transmission dynamics.
A Rare Case of Calvarial Tuberculosis in post-COVID-19 Scenario
Authors: Acharya Abhijit , Dash Atmaranjan , Otta Sarita
Published: April 2023

Isolated calvarial involvement with tuberculosis (TB) is a very rare entity, with the incidence of only 0.01% of all patients with mycobacterial infections. The factors attributable could be malnutrition, poor socioeconomic conditions, and immunodeficiency syndromes. We hereby present the case of a 35-year-old male who had recently recovered from coronavirus disease 2019 and a diagnosed case of Evan's syndrome with secondary hemophagocytic lymphohistiocytosis who presented with a scalp swelling on the right frontotemporal region. He presented to the emergency department with acute-onset generalized tonic − clonic seizures with high-grade fever. Clinically, the swelling appeared like a cystic swelling of the scalp. On evaluation, there was a collection present below the scalp communicating with the extradural space, involving the underlying skull bone. The patient was operated with drainage of the abscess plus excision of the pathological underlying skull bone. The pus revealed florid amount of acid-fast bacillus on Ziehl–Neelsen staining. The patient was started on four drugs Category 1 antitubercular regimen. The patient responded well to the combined surgical and medical treatment. It should be emphasized that TB can involve any part of the body. It should be kept as differential diagnosis of any chronic inflammatory lesion involving the bony skeleton, especially in endemic countries where combined surgical and medical treatment is usually sufficient to provide a cure.
Validation of a Novel Medium for Drug Susceptibility Testing of Mycobacterium tuberculosis against First- and Second-Line Drugs
Authors: Coban Ahmet Yilmaz
Published: April 2023

Background:

The aim of this study was the validation of AYC.2.2 agar and AYC.2.1 broth for the breakpoint values of first- and second-line drugs for Mycobacterium tuberculosis.

Method:

A total of 12 isolates including 5 reference strains and 7 well-defined clinical isolates were tested for their antituberculosis susceptibilities. Inhibitory effects of first- and second-line antituberculous drugs including isoniazid, rifampicin, streptomycin, ethambutol, amikacin, capreomycin, kanamycin, para-aminosalicylic acid, ethionamide, rifabutin, ofloxacin, levofloxacin, and moxifloxacin were tested.

Results:

According to the minimal inhibitory concentration values obtained in 7H10 agar, 7H9-S broth, AYC.2.2 agar, and AYC.2.1 broth, category agreement is 100%, and very major discrepancy (MAD), MAD, and minor discrepancy ratios were determined as 0 for all drugs.

Conclusion:

It was concluded that breakpoint values by CLSI recommendation for 7H10 agar can be also used for AYC.2.2 agar and AYC.2.1 broth. In addition, further multicenter studies are needed to use the new medium in routine mycobacteriology laboratories.
Antituberculosis Activity of Polyphenols of Areca Catechu
Authors: Raju Archana , De Subrata Suparna , Ray Mukti Kanta , Degani Mariam Sohel
Published: April 2023

Background:

Polyphenols have been studied for their potential involvement in the prevention of various chronic diseases as well as for their antimicrobial potential. The crude extracts of arecanut have been reported to have antiinfective properties. We aimed to explore the endosperm of Areca catechu (arecanut) for the extraction of polyphenol components and to study the antituberculosis activity of these polyphenol against Mycobacterium tuberculosis H37Rv.

Method:

A comparative extraction was performed using microwave and Soxlet apparatus. High performance liquid chromatography (HPLC) technique was used for the estimation of the extracted polyphenols. The minimum inhibitory concentration (MIC) values against M.tuberculosis H37Rv stain, Staphylococcus aureus and Escherichia coli were estimated by resazurin microtiter assay.

Results:

There was a 11-fold increase in the total phenolic content by microwave assisted extraction compared to the Soxhlet extraction. The powdered extract was found to be active with MIC value of 0.975 ± 0.02 μg/mL. Fractionation and HPLC-based estimation of the extract revealed catechin, epicatechin, and epigallocatechin gallate to be the polyphenol components in the ethanol fraction.

Conclusions:

The bioactivity of these polyphenols confirmed their presence and complementary effect in the extract form. Because the toxic alkaloid arecoline, known to be present in arecanut, did not show any activity individually, the bioactivity of the extract was attributed to the nontoxic polyphenols present. This extract also showed selective inhibition of M. tuberculosis over other gram positive and gram-negative bacteria, thereby establishing that arecanut is an exploitable selective source of polyphenols acting against M. tuberculosis.
Reversible Cerebellar Ataxia and Bipolar Disorder Secondary to Tuberculous Adrenalitis
Authors: Abdulla Mansoor C.
Published: April 2023

Addison's disease is primary adrenal insufficiency which is most commonly due to an autoimmune disease. Patients usually presents with fatigue, anorexia, gastrointestinal complaints, salt craving, and orthostatic hypotension. Rare manifestations during presentation can result in diagnostic dilemma. A 53-year-old male presented with cerebellar ataxia and bipolar disorder secondary to Addison's disease (due to tuberculous adrenalitis) which improved following treatment with steroids. We describe a patient with Addison's disease who presented with two rare manifestations which to our knowledge is the first such report.
To Study the Clinico-Radiological Profile of Patients of Pulmonary Tuberculosis with Deep Vein Thrombosis
Authors: Sharma Deepak , Sethi Prabhpreet , Yadav Anita
Published: April 2023

Objective:

The objective of the study was to study the clinico-radiological profile of patients of pulmonary tuberculosis (TB) with deep vein thrombosis (DVT).

Method:

This is a prospective cross-sectional observational study from September 2017 to March 2019 on diagnosed patients of pulmonary TB who attended the outpatient department or presented with signs and symptoms of DVT.

Results:

A total of forty patients were included, out of them 57.5% were males. Nearly 45% of the patients belonged to the upper lower class. Nearly 77.5% of cases were undernourished and did not have any comorbid conditions. Sputum smear was reported positive in 92.5% of cases. Bilateral disease was seen in 95% of cases. Far advanced chest X-ray involvement was seen in 72.5% of cases. Newly diagnosed cases of TB were 87.5%. Maximum thrombus formation was seen 97.5% in superficial femoral vein and 92.5% in the common femoral and popliteal vein. Hypoxia was reported in 62.5% of cases. Interval between diagnosis of TB and the development of DVT was 2–3 weeks in a maximum of 35% of cases.

Conclusion:

The clinical profile of TB with DVT shows a male predominance with upper lower class more prone to develop disease and its complications. Poor physical built is seen in the majority of patients with TB and DVT. New cases of TB are still on rise. Single comorbid condition cannot define the increased risk of DVT in TB. Superficial venous system of lower limb is more prone to develop thrombus. Time interval between TB and development of DVT is variable and cannot be predicted.
Ethambutol-Induced Bullous Skin Lesions in Mycobacterium kansasii Lung Infection
Authors: Kollipara Venkateswara K. , Horowitz Mitchell , Lantz Jeffery , Nagy-Agren Stephanie
Published: April 2023

Mycobacterium kansasii is the second most common cause of nontuberculous mycobacterial (NTM) lung disease after Mycobacterium avium complex infection in the United States.[1] The first-line therapy for M. kansasii is a three-drug regimen including rifampin, isoniazid, and ethambutol. We present a case of a patient with pulmonary M. kansasii who developed bullous skin lesions while receiving this regimen and again after rechallenge with ethambutol. In patients with intolerance to one of the first-line antibiotics, a multidisciplinary team approach to starting second-line agents is needed. Ethambutol should be included in the differential diagnosis of drug-induced bullous skin lesions in treated patients with NTM, who develop new onset rash with blisters or ulceration.
A Polymorphous Cutaneous Tuberculosis
Authors: Azendour Hasna , Meziane Mariame , Znati Kaoutar , Benzekri Laila , Senouci Karima
Published: April 2023

Cutaneous tuberculosis is uncommon, comprising 1%–2% of all extrapulmonary manifestations. It has a wide clinical spectrum. The clinical presentation depends on the route of the infection, the pathogenicity of the bacteria, and the immune status of the host. Association of multiple forms in a same patient is uncommon. We report a case of disseminated tuberculosis with polymorphous cutaneous lesions in an immunocompetent woman, combining scrofuloderma, gummas, and sporotrichoid lesions, along with tuberculous adenitis and bone tuberculosis.
Genetic Diversity of Nontuberculous Mycobacteria among Symptomatic Tuberculosis Negative Patients in Kenya
Authors: Mwangi Zakayo Maingi , Mukiri Nellie Njambi , Onyambu Frank Gekara , Wallace Bulimo Dimbuson
Published: April 2023

Background:

Non-Tuberculous Mycobacteria (NTM) transmission to humans occurs through inhalation of dust particles or vaporized water containing NTM leading to pulmonary manifestations. NTM infections are often misdiagnosed for tuberculosis (TB) due to their similar clinical and radiological manifestations.

Aims and Objectives:

We, therefore, performed a species-level identification of NTM in symptomatic TB negative patients through sequencing of the hsp65 gene.

Materials and Methods:

We conducted a cross-sectional study at the National Tuberculosis Reference Laboratory in the period between January to November 2020. One hundred and sixty-six mycobacterial culture-positive samples that tested negative for TB using capilia underwent Polymerase Chain Reaction targeting the hsp65 gene. Isolates showing a band with gel electrophoresis at 441 bp position were sequenced using Sanger technology. Geneious software was used to analyze the obtained sequences, and the National Center for Biotechnology Information gene database identified NTM species for each isolate. A phylogenetic tree was constructed from the DNA sequences and evolutionary distances computed using the general time-reversible method. Pearson chi-square was used to determine the association between NTM infection and participants' characteristics.

Results:

Our study identified 43 different NTM species. The dominant NTM belonged to Mycobacterium avium complex 37 (31%). Slow-growing NTM were the majority at 86 (71%) while rapid-growing NTM were 36 (29%). A significant association (P<0.05) was observed for regions and age, while patient type had a weak likelihood of NTM infection.

Conclusion:

Our study characterized the diversity of NTM in Kenya for the first time and showed that species belonging to M. Avium Complex are the most prevalent in the country.
A Successful Salvage Story
Authors: Venkitakrishnan Rajesh , George Leya Sara , Shahi Anabi , Mani Sheena Liz , Augustine Jolsana , Ramachandran Divya , Vija Anand
Published: April 2023

The reported occurrence of ocular infections with nontuberculous mycobacterial (NTM) infections has been increasing in the past few decades. NTM are known to cause intraocular infections as well as infections of the ocular appendages and are often recalcitrant to medical therapy. Uveal involvement due to NTM is rare and most reported cases have predisposing factors such as cataract surgery or immunocompromised states. Diagnosis and treatment pose challenge due to difficulty in procuring sufficient clinical material to obtain microbial diagnosis and inadequate response to medical therapy. The clinical challenge is further heightened in the presence of an underlying rheumatologic disease that is known to cause uveitis. We share the case of a young gentleman with ankylosing spondylitis who was being treated with secukinumab with good response to joint symptoms. He developed sudden onset uveitis which was diagnosed to be due to NTM infection based on aqueous humor polymerase chain reaction studies. He had a good clinical response to an empirical anti-mycobacterial regime with the restoration of vision. This report narrates the first case of NTM uveitis secondary to secukinumab therapy.
The Real Burden of Tuberculosis
Authors: Agarwal Swapnil , Chaurasia Zini , Malik Dishant Kumar , Gupta Renu , Singh Cheta , Jain Surbhi
Published: April 2023

Introduction:

Developing nations have a huge burden of tuberculosis (TB), because of which many cases are undetected and diagnosed only on autopsies. The purpose of this study was to find these cases in a series of consecutive autopsies conducted at a tertiary care centers.

Materials and Methods:

This retrospective study of 7-year duration from 2014 to 2020 consisted of reviewing 767 autopsies. The records of cases where a diagnosis of TB were established on histopathology were noted and evaluated.

Results:

Of 767 autopsies, TB was the diagnosis on histopathology in 72 cases. Of the 72 cases, 53 cases were undiagnosed antemortem and incidentally detected on autopsy. The study showed a male predominance with a 1.52:1 male-to-female ratio. The most common age group involved was the second decade. The study constitutes 26 cases of isolated pulmonary TB, 23 cases of disseminated TB, three cases of solitary renal TB, and one case of hepatic TB. The liver was the most commonly involved organ along with the lung in cases of disseminated TB, followed by the spleen, kidney, pancreas, intestine, brain, and heart.

Discussion:

Epidemiology and research on TB may be affected by these hidden cases which are unraveled incidentally on autopsy. These cases must always be reported and brought to the attention of clinicians for nation's better public health.
Molecular Detection of Mycobacterium tuberculosis Complex Species in Triatomines Found in Urban Households and Peridomiciles in a City with High Prevalence of Tuberculosis in Northeastern Brazil
Authors: Silva Caroliny Soares , Gondim Costa Lima Luana Nepomuceno , Batista Lima Karla Valéria , Freitas de Almeida Rosa Livia , da Conceição Marília Lima , Parente Cynara Carvalho , Rocha Amanda Albuquerque , da Silva Thales Candido , de Oliveira Sancho Soraya , Frota Cristiane Cunha
Published: April 2023

Background:

Triatomine insects, native to northeastern Brazil, have been found in the urban peridomicile. The city of Sobral has a high number of tuberculosis cases and several triatomine species. This study investigates the presence of mycobacteria, particularly Mycobacterium tuberculosis complex (MTBC) species, in triatomines captured in the urban perimeter of Sobral.

Methods:

We analyzed 167 triatomines captured in urban households and peridomiciles of Sobral. Mycobacteria were identified by the PRA-hsp65 method followed by partial sequencing of the hsp65 and rpoB genes. The sequences confirmed as MTBC were also typed by mycobacterial interspersed repetitive units-variable number tandem repeats (MIRU-VNTR) and spoligotyping.

Results:

Triatoma brasiliensis (38.6%), Triatoma pseudomaculata (32.9%), Panstrongylus lutzi (24.3%) were the most frequently identified. In 51.1% (70/167) of them, species of the Mycobacteriaceae family were detected by PRA-hsp65; of these, 31.4% (22/70) were identified as belonging to MTBC species. Nine (12.9%) of the triatomine samples were confirmed by sequencing as belonging to MTBC species. MIRU-VNTR genotyping suggests that the presence of different MTBC sublines in the triatomines should be investigated.

Conclusion:

This is the first report of MTBC lineages in triatomine insects. These results indicate the migration and adaptation of these insects in an urban setting.
Early Secreted Antigenic Target of 6 Kda-Like Proteins of Mycobacterium tuberculosis
Authors: Mustafa Abu Salim
Published: April 2023

Background:

Early secreted antigenic target of 6 kDa (ESAT6) is low-molecular-weight and immunodominant protein of Mycobacterium tuberculosis with relevance to diagnosis and vaccine development. Analysis of the M. tuberculosis genome has shown the existence of 23 ESAT6-like genes. This study was aimed to determine M. tuberculosis-specificity vis-à-vis crossreactivity of ESAT6-like genes and encoded proteins and their potential in the diagnosis and vaccine development.

Methods:

All ESAT6-like proteins were characterized using the webserver Tuberculist. The sequence identities were determined using basic local alignment search tool.

Results:

The genes for six ESAT6-like proteins were located in M. tuberculosis-specific genomic regions of differences (RDs), i.e., EsxA and EsxB in RD1, EsxO and EsxP in RD7, and EsxV and EsxW in RD9. The genes for other ESAT6-like proteins were located in the genomic regions shared with other mycobacteria. Based on sequence identities, the ESA6-like proteins were divided into four subfamilies of 15 proteins and no subfamily of 8 proteins. The members of subfamilies 1-4 shared extensive sequence identities among the members of each subfamily. Each member of subfamily 1 (EsxI, EsxL, EsxN, EsxO, EsxV) and subfamily 2 (EsxJ, EsxK, EsxM, EsxP, EsxW) were homologs. Hence, the gene sequences identical to EsxO and EsxP located in RD7, and EsxV and EsxW located in RD9 were also present in the regions of M. tuberculosis genome shared with other mycobacteria.

Conclusion:

Because of their specificity to M. tuberculosis, only EsxA (ESAT6) and EsxB (CFP10) will be useful in the specific diagnosis. However, other ESAT6-like proteins may be useful for vaccine development against tuberculosis.
Immune Reconstitution Inflammatory Syndrome in Mycobacterium chimaera Mediastinitis
Authors: Haddad Sara , Tayyar Ralph , Lawrence Leah , Lande Leah , Santoro Jerome
Published: April 2023

Mycobacterium chimaera has been described in postoperative cardiovascular procedures in patients after an outbreak of contaminated 3T heater–cooler units. Immune reconstitution inflammatory syndrome (IRIS) has been mostly reported in immunocompromised patients, especially HIV after starting therapy. Our case is a 52-year-old immunocompetent male who was diagnosed with M. chimaera mediastinitis a year after Type A dissection repair and was started on quadruple antimicrobial therapy. He clinically improved but 8 months into therapy he presented with a declining kidney function, pancytopenia, and hypercalcemia which after bone marrow and kidney biopsies were attributed to IRIS. Our patient's diagnosis spared him subsequent surgery. IRIS during the treatment of nontuberculous mycobacteria must be suspected even in immunocompetent patients as reaching the diagnosis is very helpful in preventing additional diagnostic and therapeutic measures.
Predictors of Treatment Outcomes in Drug Resistant Tuberculosis-Observational Retrospective Study
Authors: Johnson July Mary , Mohapatra Aswini Kumar , Velladath Saleena Ummer , Shettigar Kavitha S
Published: April 2023

Background:

In this study, we evaluate the predictors of treatment outcomes in drug resistant tuberculosis.

Methods:

An observational retrospective study was conducted by using the medical records of patients confirmed for TB at Kasturba Medical College from January 2015 to December 2018.

Results:

Four hundred and sixty-two TB patients were included in this study. Of the total TB-confirmed patients, about 85.1% are diagnosed with pulmonary TB (PTB) (n = 393), 11.7% were extrapulmonary tuberculosis (EPTB) (n = 54), and 3.2% (n = 15) cases had both PTB and EPTB. Among the 462 cases, the frequency of multidrug-resistant TB (MDR-TB) was 25% (n = 117), extensively drug-resistant TB was 1% (n = 3), and non-MDR cases were 74% (n = 342). The frequency of unsuccessful treatment outcome was 92.9% (n = 429) and successful outcome was 7.1% (n = 33). There were 68.2% of new and 31.8% retreatment cases of TB. HIV co-infection was found in 2.3% (n = 14) of TB cases, and among them, 64.3% (n = 9) were found in PTB cases. The major comorbidities found were diabetes (21.2%), weight loss (12.6%), and anemia (12.6%). There was a difference in rate of PTB cases across years decreasing in the year 2017, whereas ETB cases were increasing in the year 2017. The TB treatment success rate was increased from 2015 (4.8%) to 2018 (8.3%).

Conclusion:

The higher rate of poor treatment outcome emphasizes the need of improvement in TB surveillance, treatment, more stringent follow-up, monitoring, and patient education to ensure complete and successful treatment.
Changes of Th1 and Th2 Cytokines Levels among Sudanese Tuberculosis Patients during Treatment
Authors: Abdul-Aziz Ahmed A. , Elhassan Mogahid M. , Yousuf Amjad M. , Hamid Mohamed E. , Abdulsalam Salma A. , Gafar Rana A. , Elmekki Miskelyemen A.
Published: April 2023

Background:

The interaction of T cells with infected macrophages depends on the interplay of cytokines produced in each cell, and this mechanism is a key to protective immunity against Mycobacterium tuberculosis. Extensive research has been devoted to studying the changes in systemic cytokine levels in patients with tuberculosis (TB), but the results are inconclusive. Determine Th1 and Th2 cytokine immune response levels among new TB patients compared to follow-up and healthy control

. Design:

Cross-sectional laboratory-based study.

Setting:

Immunology Laboratory, National Center for Research.

Methods:

Blood samples (n = 145) were collected from confirmed new TB cases, follow-up TB cases, and from healthy controls. Participants were initially diagnosed by microcopy using Ziehl–Neelsen smear method and confirmed by polymerase chain reaction using IS6110. Cytokine levels (interleukin-10 [IL-10], tumor necrosis factor alpha [TNF-α], and Interferon-gamma [IFN-γ]) were measured directly from plasma using sandwich enzyme-linked immunosorbent assay.

Main Outcome Measures:

Measuring Th1 cytokines (IFN-γ and TNF-α) and Th2 cytokine (IL-10). One hundred and forty-five cases (new TB cases, 85; follow-up, 25; and healthy control, 35) were included in this study.

Results:

The study population were mainly males (70.3%) compared to females (29.7%) and 87.5% aged between 21 to 60 year. The plasma IFN-γ levels were found significantly higher in new TB cases (mean 35.38 pg/m; confidence interval: 29.32–41.43) than in the follow-up patients and the healthy control (P = 0.000). There were no significant differences in TNF-α and IL-10 levels among the new TB cases and the follow-up and healthy control (P = 0.852 and P = 0.340, respectively).

Conclusions:

Direct plasma IFN-γ level can be used in TB patient follow-up as a recovery marker as it correlated well with the appearance of the disease and treatment response.
A Multidrug-Resistant Tuberculosis Outbreak in a Language School
Authors: Itaki Mariya , Endo Masayuki , Ikedo Keiko , Kayebeta Aya , Takahashi Ikumi , Ota Masaki , Hirao Susumu , Nagata Yoko
Published: April 2023

Background:

Japan has successfully reduced the burden of tuberculosis (TB) in the past seven decades; however, there are still some issues in eliminating TB. Its presence in immigrants, particularly multidrug-resistant (MDR) TB, is one of them. In mid-September 2019, a teenage Chinese male student in a morning class of a Japanese language school in Tokyo, Japan, was diagnosed with sputum smear-positive pulmonary MDR-TB.

Method:

The outbreak cases were analyzed in a cohort study.

Results:

We investigated 138 students and 18 teachers, of whom 81 (51.9%) were male, 115 (73.7%) were aged from 20 to 29 years, and 124 (76.9%) were from China. Four other students in the same classroom and another in a different classroom from the index patient in the morning classes were also diagnosed with MDR-TB disease by the end of November 2020. In addition, 31 cases of latent TB infection (LTBI) were detected among the students and teachers. Students in the same classroom had the highest risk of TB infection (78.9%, 95% confidence interval [CI]: 54.4%–93.9%) with a relative risk of 8.6 (95% CI: 3.9–19.0), followed by students in the other classrooms of the morning classes (25.9%, 95% CI: 15.0%–39.7%) with a relative risk of 2.8 (95% CI: 1.2–6.8), compared with the afternoon class students (9.2%, 95% CI: 3.5–19.0) who had minimal contact with the index patient.

Conclusion:

National TB programs should adopt prophylaxis regimens for MDR-TB LTBI cases and provide prophylaxis to them, particularly if related to an outbreak. The Japanese government should screen immigrants for TB, particularly those from TB-endemic areas.
Spoligotyping and Polymerase Chain Reaction Based Mycobacterium Bovis Strains Typing with Methods (Enterobacterial Repetitive Intergenic Consensus-Polymerase Chain Reaction, Randomly Amplified Polymorphic Dnas-Polymerase Chain Reaction and Out Polymerase Chain Reaction)
Authors: Sahin Funda , Tarhan Gülnur , Cinoglu Halil , Kayar Mediha Begüm , Yakici Gülfer
Published: April 2023

Background:

In this study, it was aimed to investigate Mycobacterium bovis strains isolated from lungs and lymph nodes of slaughtered animals on clonal level by using different methods such as spoligotyping, enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR), randomly amplified polymorphic DNAs (RAPD-PCR) and OUT-PCR. Comparative evaluation of these methods was further conducted.

Methods:

A total of 38 M. bovis isolates were evaluated in the study. DNA isolation of all M. bovis strains isolated from pruvat free Löwenstein Jensen medium was done by boiling method for ERIC-PCR, RAPD-PCR, and OUT PCR. Mickle device was used for DNA isolation for spoligotyping method.

Results:

In 38 M. bovis isolates examined in our study, 4 different groups were determined by spoligotyping and RAPD-PCR test methods, and 5 different groups were detected in ERIC-PCR tests. In the OUT-PCR tests, the band which provides sufficient type separation was not observed.

Conclusion:

ERIC-PCR, RAPD-PCR, and OUT-PCR methods are easily applicable, simple, and relatively inexpensive methods for evaluating the differences between origins in the typing of M. bovis. The tests need to be evaluated in more detail with extensive studies.
Concomitant Disseminated Tuberculosis and Lepromatous Leprosy in a Previously Healthy Male
Authors: Kaur Baldeep , Kaur Daljinderjit , Gupta Monica , Agrawal Nandini , Lehl Sarabmeet Singh
Published: April 2023

Tuberculosis (TB) and leprosy are two chronic mycobacterial infections caused by intracellular Gram-positive aerobic acid-fast bacilli. Both have highly variable presentations depending on immunological milieu of the host and account for significant disease morbidity. The burden of these age-old infections of humanity still remains high in India. Regardless of the same geographical endemicity of the two, coinfections are sparsely reported. Indeed, studies have revealed an antagonism between them. Of the few coinfections reported in the past, majority were diagnosed over a temporal sequence, with one occurring after the other, and most of these were localized forms of TB associated with leprosy. Only a single case of disseminated TB and lepromatous leprosy has been reported in the medical literature till date. Here, we report another rare case of disseminated TB and lepromatous leprosy that ultimately proved fatal for the patient. The diagnosis of the two diseases was made simultaneously which is again infrequent in the reported literature.
Practices toward Presumptive Tuberculosis Clients among Patent Medicine Vendors in Ebonyi State Nigeria
Authors: Onah Cosmas Kenan , Azuogu Benedict Ndubueze , Ossai Edmund Ndudi , Agu Adaoha Pearl , Ogbonnaya Lawrence Ulu , Onwasigwe Chika
Published: April 2023

Background:

Tuberculosis (TB) is a major cause of ill-health and death globally but a serious challenge to its control is low case notification. In low- and middle-income countries, most patients with symptoms of the disease first seek care from patent medicine vendors (PMVs) who are not formerly trained to manage TB. The practices of PMVs toward presumptive TB are pivotal to control of TB.

Aim:

The aim of this study was to describe the pattern of practices toward presumptive TB and assess their determinants among PMVs.

Method:

The study was carried out in Ebonyi State Nigeria using descriptive cross-sectional design. Through a multistage sampling, 250 PMVs were selected and interviewed. Data were collected using pretested interviewer-administered questionnaire and analyzed with IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA). Chi-square test and binary logistic regression were used to determine factors associated with practices toward presumptive TB with P value set at 0.05 for statistical significance.

Results:

Almost half (48.8%) of the respondents engaged in poor practices by inadequate referral of clients (45.2%), delayed referral (69.6%), and unstandardized treatment with antibiotics (56.4%). There was no statistically significant association between independent variables and practice and none of the variables significantly predicted practice.

Conclusions:

There were poor practices toward presumptive TB shown in inadequate referral, delayed referral, and unstandardized treatment of clients. We recommend that PMVs should be trained and regularly sensitized about TB to improve their practices and that regulatory authorities should enforce policies on antibiotics distribution and sale.
Pott's Disease (Tuberculous Spondylitis)
Authors: Pintor Inês Almeida , Pereira Flávio , Cavadas Susana , Lopes Pedro
Published: April 2023

Pott's disease is a vertebral infection caused by Mycobacterium tuberculosis. Indolent nature and subacute course are associated with late diagnosis. A clinical case is presented whose diagnosis was delayed by atypical presentation with progressive worsening of symptoms. Magnetic resonance imaging (MRI) of the dorsolumbar spine revealed T7–T8 angulation suggestive of secondary injury, with intracanalar extension and spinal cord compression. Gastric aspirate cultures, direct microscopy, and polymerase chain reaction (PCR) were A 79-yearold female came to the emergency department with right back pain, pleuritic, with 12 h of evolution. Anorexia and weight loss,1 month evolution. Computed tomography (CT) of the dorsal spine revealed T7–T8 lytic lesions, suggestive of secondary nature. Objectively:weight loss and pain during thoracic palpation. Annalistically: normocytic/normochromic anemia, hypercalcemia, hepatic cholestasis, C-reactive protein (CRP) 7.12 mg/dL. Chest X-ray and electrocardiogram without alterations. She was admitted in Internal Medicine service. Analytically: hypophosphatemia, parathyroid hormone elevated, CRP 6 mg/dL, Beta-2 microglobulin elevated, dyslipidemia, iron and folicacid deficiency.negative for M. tuberculosis. T8 aspiration CT guided: cultures/direct microscopy negative, PCR positive for M. tuberculosis. Introductionof antitubercular drugs. Worsening of symptomatology, with paraparesia. MRI of the dorsal spine revealed spondylodiscitis and spinal cordcompression in T7–T8. Diagnosis revealed vertebral tuberculosis with spinal cord compression. She was transferred to neurosurgery servicefor surgical treatment. There was clinical and analytical improvement. Draws attention to difficulty in diagnose a treatable disease in a patientwith a rare presentation.
Tuberculosis Presenting as Metastatic Lung Cancer
Authors: Saleemi Sarfraz A , Alothman Bader , Alamer Mohammed , Alsayari Sultan , Almogbel Abdulaziz , Mohammed Shamayel
Published: April 2023

Mycobacterium tuberculosis infection (TB) masquerading as lung tumor is well reported, but its mimicry as metastatic thoracic cancer is rare. We report the case of a young male who presented with clinical and radiological picture of lung cancer but investigations confirmed it as TB. A 35-year-old male, with 18-pack year of smoking history, presented with dry cough, anorexia, weight loss, and lower back and left hip pain. Chest imaging showed right upper lobe speculated mass with mediastinal and hilar lymphadenopathy and a lytic lesion in the left sacral area. Magnetic resonance imaging of the spine and pelvis revealed lytic lesion in the left sacrum. Fluorodeoxyglucose positron emission tomography computed tomography scan of the whole body showed hypermetabolic lung lesion with ipsilateral mediastinal, supraclavicular, splenic, and bone metastasis in the left aspect of the sacrum. Computed tomography (CT)-guided biopsy of the lung lesion showed necrotizing granuloma and tissue culture was positive for pan-susceptible M. tuberculosis. Follow-up CT scan showed complete resolution of the lung lesion and lymph nodes after anti-TB treatment with significant reduction in the sacral lesion. Mycobacterial infection may mimic metastatic lung cancer and should always be considered a differential diagnosis.
Yogic Principles of Artha and Dāna with Reference to Individual and Corporate Social Responsibility
Authors: Dayananda Swamy HR , Nagarajan Karuna , Babu Natesh
Published: April 2023

A key element of all the Indian systems of philosophy is self-realization, leading toMokṣa.Yoga, a branch of Indian philosophy, describes the techniques to attain the goal ofKaivalyaorMokṣa. ThePuruṣārthas, which are the foundation of human pursuits, combine the spiritual value ofMokṣawithArthaandKāmaworldly requirements, governed byDharma.Arthais the foundation for two purposes, according toKauṭilya's Arthaśāstra:DharmaandKāma. In the absence of affluence and security at society or at the individual level, following ethics and fulfilling desires become difficult. Hardships rear evil and disgust, while affluence rears virtues and love. The Vedic and philosophical traditions advocate wise use of wealth – onself-improvement, economic commotion, and charitable giving (Dāna).Rgvedamentions that whatever is given to others selflessly asDānareturns many times over (Rgveda: 1–8).Yogaalso specifies the disciplines ofAparigraha(non-hoarding) andAsteya(non-stealing), a balancing act of striking an equilibrium between our desires and virtues. Human beings have one universal duty orDharma, which is a virtue. By virtue is meant the cultivation of compassion for our fellow beings; an individual social responsibility (ISR) which means to share and coexist with all living beings including insects, animals, etc., If ISR becomes a way of life, then corporate social responsibility will occur by its very nature. Nature follows the principle of “Idam-na-mama” – “this is not mine; it is for collective well-being.” The ocean, sun, stars, moon, wind, trees, etc., perform functions to give to other's welfare not for themselves.
Yoga Module for Somatoform Pain Disorders
Authors: Jha Monika , Dumbala Sowjanya , Gulati Kankan , Bhargav Hemant , Arasappa Rashmi , Varambally Shivarama , Gangadhar BN , Desai Geetha
Published: April 2023

Background:

Yoga practices have been found to be useful in chronic pain conditions but studies focussing specifically on somatoform pain disorders (SPDs) are limited.

Aims:

Current study aims to develop and test the feasibility of a yoga program for patients with SPDs.

Materials and Methodology:

Athorough search of traditional and contemporary literature was performed with the objective of formulating a yoga program for reducing chronic non-specific pain and associated psychological distress. Content validity of the program was then determined by taking the opinion of 18 yoga experts (who had >5 years of experience in treating mental health disorders) using content validation ratio (CVR) through Lawshe's formula. The feasibility of the module was tested on 10 subjects diagnosed with SPDs as per the International Classification of Diseases (ICD) -10 criteria using standard scales.

Results:

In the finalized module, 70.83% (34 out of 48 items) of the practices were retained along with the modifications as suggested by the experts. Two practices were not found to be feasible (Trikonasana and Shalabhasana) and hence were removed from the final module. A significant reduction in pain severity was observed in the subjects after practising the yoga module for 2 weeks. The content validity index for the whole module (average of all CVRs) was 0.55.

Conclusions:

Ayoga module was developed for SPD. The content validity of the module was found to be good. The module was found safe and potentially useful for reducing pain severity in patients with SPD. Future studies should test the efficacy of the developed program through a randomized controlled clinical trial.
Effect of Community-Based Structured Yoga Program on Hba1c Level among Type 2 Diabetes Mellitus Patients
Authors: Misra Puneet , Sharma Gautam , Tandon Nikhil , Kant Shashi , Sangral Meenu , Rai Sanjay K , Yadav Kapil , Vishnubhatla Sreenivas , Mandal Suprakash , Kardam Priyanka , Thakur Nishakar
Published: April 2023

Context:

In view of the rising burden of type 2 diabetes mellitus (DM) cases in India, there is an urgent need for an effective, low-cost, sustainable intervention controlling diabetes thus preventing complications.

Aims:

This study aimed to assess the effect of structured yoga programs on diabetes.

Subjects and Methods:

This was a community-based interventional study that was conducted in an urban resettlement colony of Delhi, India. Known diabetes patients with glycated hemoglobin (Hb1Ac) ≥6.5% were enrolled from 12 randomly selected blocks of the community with a sample size of 192 in each intervention and wait-listed control arm. The intervention was structured yoga of 50 min daily, 2 consecutive weeks in a nearby park and health center followed by twice a week home practice up to the 3rd month. The primary outcome measure was HbA1c% and secondary outcome measures were lipid profile and fasting blood glucose.

Statistical Analysis Used:

Aper-protocol analysis was done. Mean, standard deviation (SD), and 95% confidence interval were estimated. The level of significance was considered for 0.05.

Results:

There was a significant decrease of Hb1Ac (0.5%, SD = 1.5, P = 0.02), total cholesterol (11.7 mg/dl, SD = 40.5, P < 0.01), and low-density lipoprotein (3.2 mg/dl, SD = 37.4, P < 0.01) from baseline to end line in the intervention group. These changes in intervention group were also significantly different from the change in the wait-listed control group. The other variables did not change significantly.

Conclusions:

It revealed that structured yoga program improved glycemic outcome and lipid profile of individuals in a community-based setting. Yoga can be a feasible strategy to control hyperglycemia, lipid levels, and can help better control type 2 DM.
A Correlation Study between Tri-Guna and Emotional Style
Authors: Ravindra P. N. , Babu Prashanth
Published: April 2023

Background:

Science of well-being is getting focused across all walks of life from health care to organizational behavior. Indian psychological principles of Tri-Guna offer a universal theoretical framework to understand the behavioral aspects of emotions and well-being, whereas affective neurosciences have explored neural circuits underlying few universal emotional styles. Both Tri-Guna and emotional styles are dynamic and vulnerable for modifications with training. Hence, establishing a relation between Tri-Guna and emotional style offers a novel insight to explore neural basis of Tri-Guna and its application in health and behavioral sciences.

Aims:

To establish the correlation between Tri-Guna and emotional styles in healthy adult subjects.

Materials and Methods:

Healthy adults (n= 121, 18–21 years) of both genders were individually administered with questionnaires to assess Tri-Guna (Vedic personality inventory) and emotional style (emotional style questionnaire). The relationship between Tri Guna (Sattva, Rajas and Tamas) and Six dimensions of emotional styles (attention, self awareness, outlook, resilience, social intuition and sensitivity to context) were assessed using Pearson's correlation coefficient.

Results:

All the emotional styles showed a positive correlation with Sattva and negative with Rajas and Tamas, except resilience. Resilience showed a negative correlation with Sattva and positive with Rajas and Tamas. Further, between Rajas and Tamas, emotional styles showed a stronger correlation with Tamas.

Conclusions:

Sattva guna showed an association with emotional styles that favors to develop a positive emotional pattern. Having fairly understood neural circuitry of emotional styles, this first preliminary correlation data will provide a theoretical framework to explore neural circuitry involved in understanding emotional aspects of Tri-Guna.
Correlation of Heart Rate Variability with Carotid Intima Media Thickness after 6 Month of Yoga Intervention in Prediabetics
Authors: Saboo Neha , Kacker Sudhanshu , Rathore Jeevraj
Published: April 2023

Introduction:

Atherosclerotic carotid intimamedia thickness (CIMT) may be associated with alterations in the autonomic functions. The aim of this study was to investigate the effect of 6-month yoga intervention on heart rate variability (HRV) and CIMT in elderly subjects and the correlation between HRV and CIMT.

Methodology:

This was a randomized controlled study, in which a total of 250 subjects were enrolled. Randomization and allocation in yoga and control groups were performed using computer-generated random numbers. The CIMT was determined by B-mode ultrasonography, and cardiac autonomic function was determined through frequency domain parameter of HRV measures at baseline and after 6 months of yoga intervention.

Results:

Participants had a mean age of 45.4 ± 6.4 years, and a mean CIMT in control (0.70 ± 0.05) and study group (0.69 ± 0.073), and low frequency/high frequency (LF/HF) ratio in control (2.20 ± 1.05) and study group (0.57 ± 0.54). Yoga group had evidence of increased vagal activity in the frequency domain (HF and LF/HF ratio, P < 0.001) with respect to control group. Moreover, a study group showed lower intimamedia thickness (IMT) than control subjects (P < 0.01). In the whole population, LF/HF ratio positively and significantly correlated (r = 0.665, P < 0.01) to IMT.

Conclusion:

This study demonstrated that, after yoga intervention, LF/HF ratio is positively correlated with CIMT, a putative index of atherosclerosis, confirming cardiac autonomic neuropathy as a part of the pathophysiological pathway for atherosclerosis. It confirms that the regular yoga represents a valuable strategy to counter impairments of cardiac autonomic activity and artery structural changes.
Yoga for Caregiving Dyads Experiencing Chronic Pain
Authors: Gibson Barbara Ann , Puymbroeck Marieke Van , Fruhauf Christine A. , Schmid Arlene A. , Portz Jennifer D.
Published: April 2023

Context:

Caregivers often provide unpaid care for family members and friends with physical disabilities, often to the detriment of their health and well-being. Caregivers often experience pain, and individuals with physical disabilities also are likely to experience pain. Merging yoga and self-management to Develop Skills Study (MY-Skills) is an intervention that merges self-management education with yoga for dyads experiencing chronic pain.

Aim:

This article presents the yoga protocol for the MY-Skills intervention.

Methods:

The yoga protocol was revised based on feedback from six caregiving dyads. The protocol focuses on reducing pain interference and supporting the caregiving dyad.

Results:

The final yoga protocol incorporated the following elements: Centering and mantra, prana vidya and pranayama, asanas, mudra, and guided savasana/dhyana.

Conclusion:

The MY-Skills yoga protocol was modified by a yoga therapist with feedback from study participants. Revisions focused on the caregiving dyad, with specific attention to reducing pain interference.
The effect of additional sucrose on the value of tensile strength and elongation of chicken legs gelatin film
Authors: Fauziyah Begum , Fatimatussholichah Dyah , Syarifah Aldila Raudatus , Ma'arif Burhan
Published: April 2023

Gelatin is a clear, flavorless, and colorless biopolymer formed by the denaturation of collagen protein in animal tissues. Gelatin is an important ingredient in the manufacture of capsule shell films. The tensile strength and elongation values of gelatin film indicate its quality. Sucrose is one of the ingredients that can affect the tensile strength and elongation of the gelatin film. To determine the effect of adding sucrose on the tensile strength and elongation of the chicken leg skin gelatin film. To extract the gelatin, clean, sliced chicken leg skin was freeze-dried, ground into powder, and extracted. The characteristics of chicken skin gelatin were measured using Fourier-transform infrared, and the data were read in the 4000–400 cm− 1 range for 32 scans. Pouring the solution into a mold, flattening it, and drying it at 40°C results in a film that has been tested for tensile strength and elongation. Gelatin films with a 30% sucrose addition had the best tensile strength and elongation values, with a tensile strength of 3.03 MPa and an elongation of 152.02%. Sucrose alters the tensile strength and elongation of chicken leg gelatin film. 30% sucrose provides better tensile and elongation strength.
Prevalence and pattern of third molars impaction
Authors: Shaari Ramizu Bin , Awang Nawi Mohamad Arif , Khaleel Ameera Kamal , AlRifai Ali Sultan
Published: April 2023

Third molar impaction is considered a prevalent issue. The research aimed to study the pervasiveness and pattern of impaction in Karbala/Iraqi population. Orthopantomograms were studied regarding its angulation, impaction depth, and correlation with ramus. The outcomes manifested that the prevalence of 3rd impacted molars was 34.71%, with the proportion of male to female as 0.83:1. Impacted mandibular 3rd molars were significantly encountered. The prevalence of vertical angulation, mesioangular, horizontal, and inverted were significantly associated with the impacted mandibular 3rd molars (P < 0.05). However, the prevalence of distoangular and bucco/lingual was significantly associated (P < 0.05) with the upper impacted 3rd molars. Level C of impaction was significantly (P < 0.05) the most typical level in the maxilla impacted the 3rd molar, and level A and level B of impaction were significantly (P < 0.05) the most prevalent level correlated with the mandibular 3rd molar impaction. Class II was significantly (P < 0.05) the frequently occurring condition subsequent to Classes III and I. In conclusion, the impaction of 3rd molars was significantly predominant in females and lower jaw. The vertical angulation, level C of impaction associated with maxillary 3rd molars and levels A and B of impaction related with mandibular 3rd molars, and Class II are the most encountered conditions.