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   Table of Contents - Current issue
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October-December 2017
Volume 1 | Issue 2
Page Nos. 85-168

Online since Thursday, November 23, 2017

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REVIEW ARTICLES  

Tuberculosis Serology is Useful in Rural Areas Highly accessed article p. 85
Roland Maes
DOI:10.4103/bbrj.bbrj_82_17  
The fight on tuberculosis initiated after World War II with the imposition of the Bacillus Calmette–Guérin (BCG) vaccine by the WHO in 1950, and the discovery of the drug streptomycin, which was rapidly followed by a recommended 4 drug regimen (isoniazid, ethambutol, rifampicin, pyrazinamide, and streptomycin being reserved to resistant cases). The diagnostic that justified a treatment was based on the microscopic examination of bacterial presence in sputum, that is, the bacilloscopy, and on culture in vitro of the pathogen, which is more expensive and much more demanding on time. During the following 7 decennia, this approach remained unchanged: no new vaccines were developed despite the documented observed ineffectiveness of the BCG, and the 4 drug regimen (plus streptomycin) admitted additional drugs only from 2012 on. The ineffectiveness of the original 4 + 1-drug cocktail, that became obvious in France in 1994, is traced in part to the immunodepressing effect of some of them. The use of only four drugs also favors defensive mutations by the pathogen. The late addition of more antibiotics to the regular regimen applied to multidrug-resistant-cases may be useful on the immediate term but side effects are crimpling and evidently, measures in addition to “more drugs” must be taken to control the disease. A diagnostic based exclusively on antigen detection remained the norm during nearly 7 decennia. This detection benefited from technologically improved methods (e.g., the interferon test and the numerous nucleic acid amplification tests). The latest of these is the GeneXpert/RIF test. This newly devised antigen test is a quantitative improvement on previous tests detecting the presence of the antigen. However, due to its centralized system of analysis and inaccuracy, it is not suited for rural areas, and it does not favor communication between mycobacteriologist, immunologist, and clinician. In this review article, the concentration is on those rare publications that highlighted the problem posed by various diagnostic tests and their application.
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Impact of geographical information system on public health sciences p. 94
Jafar Aghajani, Parissa Farnia, Ali Akbar Velayati
DOI:10.4103/bbrj.bbrj_34_17  
In this brief review, the geographic information systems (GISs) and its beneficial influence in the field of health were discussed and highlighted. Basically, GIS is a computerized system that can significantly add to assess and monitor the effects of environmental factors (namely, population, air pollution, location, climatic changes) on public health problems. The main benefits of GIS in health services are mapping and/or visualizing of disease distribution, which will ultimately improves our understanding of disease diversities and their spatial patterns. Therefore, GIS technology is capable of providing the intra- and inter-logical connection between health, social services, and natural environment.
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Current perspectives on velocardiofacial syndrome p. 101
Saikrishna Lakkakula, Ulaganathan Baraneedharan, Bhaskar V. K. S. Lakkakula
DOI:10.4103/bbrj.bbrj_63_17  
Velocardiofacial syndrome (VCFS) is one of the most common genetic disorders that affect every major system in the body. The worldwide frequency of VCFS is 1 in 2000 live births. A search using the terms and variants of velo-cardio facial syndrome, VCFS, and disabilities within PubMed, Embase, and Scopus was carried out and restricted to human studies published in English. Further, reference lists were checked to identify relevant studies. The phenotypic spectrum of VCFS overlaps with that of DiGeorge syndrome and includes physical, cognitive, behavioral, and neurological disabilities. The VCFS is caused by hemizygous deletions on chromosome 22q11.2 and usually diagnosed at childhood. Several approaches, such as fluorescence in situ hybridization and polymerase chain reaction-based techniques, have been applied to analyze deleted regions. As majority of the VCFS children have multiple diagnoses, it may need more time to find appropriate combination of medications that will work for them. Treatment for VCFS is always depended on child's age, overall health, medical history, and child's tolerance for specific medications, procedures, or therapies, and parents' opinion or preference.
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Geographical distribution of cystic fibrosis; The past 70 years of data analyzis p. 105
Seyed Bashir Mirtajani, Poopak Farnia, Maryam Hassanzad, Jalaledin Ghanavi, Parissa Farnia, Ali Akbar Velayati
DOI:10.4103/bbrj.bbrj_81_17  
Cystic fibrosis (CF) has been generally well defined throughout the world although its prevalence is very difficult to ascertain for a number of reasons, including the fact that the medical/scientific literature and patient registries vary in quality in different countries. In the present review literature (1938–2017), we found out the higher frequency of registered CF patients in the European Union. This could be due to strong clinical awareness and greater health facilities. In contrast, we found a very irregular report from Asian and African countries. In these countries, the national CF registration system is mostly lacking or it is individualized-based research. In this situation, the estimation of various risk factors such as ethnicity and/or races is remained to be resolved. Overall, this review outlines the urgent need for revitalization of national and global CF registration, worldwide.
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ORIGINAL ARTICLES Top

A study of the diurnal height changes among sample of adults aged 30 years and above in Ghana p. 113
Frederick Vuvor, Obed Harrison
DOI:10.4103/bbrj.bbrj_97_17  
Background: The diurnal variations in stature significantly affect the reliability of height data. Diurnal variation in stature affects the reliability of any data that involves height measurement without a correction factor at different times of the day. The aim of this study was to determine the diurnal height loss of adults aged ≥30 years in the Greater Accra Region of Ghana. Methods: A total of 90 individuals were randomly sampled. Weight and height measurements were taken twice a day between 5.30–7.30 am and 5–7 pm. The WHO Stepwise questionnaires were used to gather all information on subjects. Results: The maximum height loss between 7 am and 7 pm from the study was 2.7 cm whereas mean was 1.61 cm. There was a greater mean height loss in males (1.63 cm) than in females (1.59 cm), greater mean body mass index (BMI) difference between morning and evening BMI was observed for females (1.21 kg/m2) than in males (1.02 kg/m2). There was a significant association between height loss and occupational activities (P < 0.001). Conclusion: The height of the individuals significantly reduced from 7 am to 7 pm and increased from 7 pm to 7 am. The major factor that contributes to diurnal height variations is the level of occupational activity performed in a day. No significant relationships were established between age, sex, total caloric intake, and diurnal height loss.
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Chronic myeloid leukemia and ferritin levels p. 120
Kumar Saurabh, Veena Singh Ghalaut, Jyoti Bala
DOI:10.4103/bbrj.bbrj_64_17  
Background: Ferritin is a positive acute-phase reactant, exhibiting increased levels in blood during the acute-phase response. High plasma ferritin levels have been reported for various types of cancers, irrespective of the amount of total body iron. Hence, this study was designed to assess the status of ferritin levels in chronic myeloid leukemia (CML) patients both before and after chemotherapy and to compare them with age- and sex-matched healthy controls. Methods: Thirty patients of CML after confirmed diagnosis were taken up for the study. CML patients were treated by imatinib therapy. Serum ferritin was estimated by enzyme-linked immunosorbent assay in thirty newly diagnosed CML patients and in thirty age- and sex-matched healthy controls. The test was repeated at first complete remission or at 3 months (whichever is earlier) in CML patients. Patients and controls were categorized into three groups as follows: (1) Group I: Control group –age- and sex-matched healthy volunteers (2) Group II: CML patients at the time of diagnosis (before imatinib therapy) (3) Group III: CML patients at first complete remission or at 3 months of imatinib therapy (whichever is earlier). Results: The ferritin levels were significantly increased in Group II and Group III (387.68 ± 221.61 ng/mL and 295.43 ± 169.17 ng/mL, respectively) as compared to controls (73.27 ± 60.82 ng/mL) (P = 0.000 and P = 0.000, respectively). The ferritin levels were decreased in Group III as compared to Group II, although the difference was not statistically significant (P = 0.075). Conclusion: Our study revealed that serum ferritin could be a useful marker in determining disease progression or monitor the effectiveness of treatment in leukemic patients.
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Critical concentrations of surfactant combination regimens with MTAD™ on vancomycin-sensitive Enterococcus faecalis p. 124
Manikandan Ravinanthanan, Mithra N Hegde, Veena Shetty, Suchetha Kumari
DOI:10.4103/bbrj.bbrj_78_17  
Background: Enterococcus faecalis is an opportunistic pathogen with greater virulence traits and has gained significance in endodontic literature. It is resistant to most irrigants and medicaments with significant posttreatment reversal cultures. The purpose of this study was to evaluate the critical concentrations of irrigants and surfactants and the possible outcome of the combination regimen on E. faecalis. Methods: Five percent sodium hypochlorite (NaOCl), chlorhexidine (CHX), iodine potassium iodide (IKI), and surfactants such as cetrimide (CTR) and sodium dodecyl sulfate (SDS) were prepared. BioPure™ MTAD™ served as control. Minimum inhibitory concentration was performed to determine the dilution fold and dilution factor by serial dilution, followed by minimum bactericidal concentration on agar plates. Results: Although CHX performed better than MTAD™, it proved to be bacteriostatic in action at lower concentrations. NaOCl and IKI were found to be inferior and were excluded. CTR was found to be better than MTAD™; while SDS showed insignificant results. The combination surfactant regimens (CHX + CTR; CHX + SDS) performed in a synergistic fashion and achieved higher eradication rates. Bactericidal action with narrow margins between critical concentrations was recorded and found to be superior to any test irrigant, including MTAD™. Conclusion: Critical concentrations of surfactant combination regimens were found to be highly effective at lower dilutions on E. faecalis. This combination can overcome the limitations, potentiate antimicrobial spectrum, and increase the substantive antimicrobial action of CHX application in clinical endodontics.
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Genotypic characterization of rpoB, katG and inhA gene of multi drug tuberculosis isolates from extra pulmonary tuberculosis p. 129
Anand Kumar Maurya, Vijaya Laskshmi Nag, Surya Kant, Ram Awadh Singh Kushwaha, Tapan N Dhole
DOI:10.4103/bbrj.bbrj_57_17  
Background: Multidrug-resistant tuberculosis (MDR-TB) has appeared public health concern worldwide. Circulating of drug resistance strains is rising problem in MDR-TB among extra pulmonary TB (EPTB) cases. The objective of this study was to the genotypic characterization of MDR-TB isolates from EPTB and correlate with a phenotypic MDR-TB pattern in this region. Methods: This was study conducted prospectively manner. One hundred and sixty-four M. tuberculosis complex isolates were processed for first-line phenotypic drug susceptibility testing to rifampicin, isoniazid (INH), streptomycin, and ethambutol. Phenotypic confirmed MDR-TB strains were further characterized by gene sequencing for genotypic analysis of rpoB, katG, and inhA. Results: Among 164 MTBC strains, 39.1% of strains were resistant to first-line antitubercular drugs, and 13.4% were MDR-TB along with EPTB cases. In one strain, katG and inhA gene were absent in sequencing analysis. S531 L (61.9%) and S315T (71.4%) mutations were the most predominant mutation in MDR-TB isolates among EPTB cases. Conclusion: Molecular drug resistance testing allows to improved diagnosis, reduces the risk of additional resistance and effective treatment of drug resistance TB. Molecular DST testing can help in the detection for MDR-TB which helps in the prompt initiation of effective antitubercular therapy.
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Urine creatinine and anthropometric indices of sportsmen and women p. 134
Matilda Steiner-Asiedu, Juliet Vickar, Frederick Vuvor, Isaac Agbemafle, Yusif M Tahiru
DOI:10.4103/bbrj.bbrj_71_17  
Background: Interpretation of the different aerobic and anaerobic metabolism, training, and anthropometric indices of sportspersons from different sports discipline can aid in improving sports performance. This study sought to evaluate the association between urine creatinine concentration (UCR) and percentage body fat (%BF), body mass index (BMI), and duration of training (DOT) among University of Ghana sportspersons. Methods: A cross-sectional study design was used. Information on background characteristics, body weight, height, %BF, and sporting activity profiles were gathered on a convenient sample of 101 University of Ghana sportsmen and women across all levels of study. BMI and %BF were determined using the Omron Fat Loss Monitor™. Creatinine concentration in 24-h urine samples was analyzed using Jaffe's reaction, and absorbance read spectrophotometrically at 530 nm. Results: Mean age was 22 ± 3 years. Thirty-one percent (31%) of the participants played football, whereas 69% took part in other sports (handball, volleyball, rugby, and baseball). Average daily DOT of 113.6 ± 44 min (males) and 95.1 ± 54 min (females) was reported by the participants. Mean BMI and %BF were 23.1 ± 3.7 Kg/m2 and 23.2 ± 9.0%, respectively. The mean BMI was within normal range as per the WHO standards, whereas %BF exceeded required limits for each sports discipline. UCR was higher for males (1.2 ± 0.5 g/d) as compared to females (0.8 ± 0.5 g/d). There was a weak positive correlation between UCR and BMI (r = 0.123; P = 0.22) and between UCR and DOT (r = 0.074; P = 0.46). %BF and UCR were inversely related (r = −0.114, P = 0.26). There was no association between UCR and type of sports (P = 0.24). There was a significant association between the type of sports and BMI (P = 0.002). Conclusion: There was a weak positive correlation between creatinine and BMI as well as training duration. Type of sports played is a significant predictor of sportspersons' BMI.
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The diagnostic utility of anyplex plus™ MTB/NTM cycle threshold for detection of Mycobacterium tuberculosis complex among new and retreatment cases from a referral hospital in Limpopo Province, South Africa p. 141
Disego Mmatau Mpanyane, Tibello N. C. Maguga-Phasha, Felistus Mashinya, Lesibana Anthony Malinga
DOI:10.4103/bbrj.bbrj_85_17  
Background: The objective of the study was to detect Mycobacterium tuberculosis (MTB) complex using a diagnostic Anyplex plus™ MTB/NTM (Seegene Incorporated, Korea) assay in new and retreatment cases of tuberculosis (TB) in rural South Africa. Methods: We prospectively collected 204 clinical isolates from patients with new and retreatment cases residing in rural to urban areas attending a tertiary hospital. The clinical isolates were decontaminated and DNA extracted according to manufactures instructions. GenoType MTBDRplus version 2 was performed on extracted DNA and positive MTB isolates were run on Anyplex plus™ MTB/NTM assay. Culture (gold standard) and smear microscopy were used as reference standards for correct diagnosis of TB. Results: A total of 101 (49.5%) clinical isolates had valid MTB results using Genotype MTBDRplus version 2. Anyplex plus™ MTB/NTM was able to detect 68 cases (67.3%) when compared to GenoType MTBDRplus version 2. Cycle threshold (CT) of Anyplex plus™ MTB/NTM assay was able to distinguish between true and false positives for both culture and smear microscopy. A CT cutoff value of 25.9 and 37.0 could be used to differentiate between the bacilliary load of new and retreatment cases, respectively, for true positives. Conclusion: The novel technique was able to detect TB bacilliary load from new and retreatment clinical specimens using CT values.
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Increased expression of interleukin-17A in the lesional skin indicates increase of serum antibody anti-phenolic glycolipid-I in leprosy patients p. 147
Hendra Gunawan, Merlinda Nur Annissa, Reiva Farah Dwiyana, Erda Avriyanti, Oki Suwarsa
DOI:10.4103/bbrj.bbrj_84_17  
Background: In lepromatous type of leprosy, the serum titer of the antibody against phenolic glycolipid (PGL)-I-a-specific antigen in leprosy that is produced by B cell is high. Whereas, the interleukin (IL)-17A expressed by T-helper 17 cells could induce B-cell differentiation. The role of IL-17A in leprosy is still unknown. Hence, this study aimed to assess a correlation between IL-17A expression in the lesional skin and anti-PGL-I immunoglobulin (Ig) M serum levels in leprosy patients. Methods: This study was performed in Leprosy Clinic, Dr. Hasan Sadikin Hospital Bandung, Indonesia, using a cross-sectional analytical study. A punch biopsy obtained from 49 leprosy patients was included through consecutive sampling for measurement of IL-17A expression in the skin by immunohistochemistry scoring (histoscore). Furthermore, the anti-PGL-I IgM level in serum is evaluated by enzyme-linked immunosorbent assay. Results: The IL-17A expressions in the skin biopsies of tuberculoid (TT), borderline tuberculoid (BT), mid-borderline (BB), borderline lepromatous (BL), and lepromatous leprosy (LL) patients using histoscore were 1.00, 2.31, 4.63, 5.06, and 10.14, respectively, and they showed significant differences (P = 0.0001). The titer of anti-PGL-I IgM levels was 89 pg/ml, 555 pg/ml, 1.244 pg/ml, 1.920 pg/ml, and 23.591 pg/ml in TT, BT, BB, BL, and LL patients, respectively, and they showed significant differences (P = 0.005). The results of Rank–Spearman correlation analysis between IL-17A expression in the skin and anti-PGL-I IgM serum levels were as follows: r = 0.767 and P = 0.0001. Conclusion: These results suggested that the increase of IL-17A expression in the lesional skin indicates the increase of anti-PGL-I IgM serum levels in leprosy.
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Effect of levamisole on alkaline phosphatase activity and immunoglobulin secretion of lipopolysaccharide-stimulated murine splenic lymphocytes p. 151
Nageshwari Badgu, Ramchander Merugu
DOI:10.4103/bbrj.bbrj_83_17  
Background: Alkaline phosphatases (APase) are a group of enzymes whose activity increases above normal levels in conditions of diseases such as cancer. In the present study, the role of APase using mitogen-stimulated murine lymphocytes was investigated. Methods: U266B1 cells and RPMI 8226 cultures were kept at 37°C in a humidified incubator with 5% CO2. The cultures were pulsed with 0.5 μCi of 3H-thymidine and were harvested onto glass fiber filter using Skatron automatic cell harvester. The dried filters were transferred into toluene-based scintillation cocktail, and the radioactivity was measured using Beckman scintillation counter. APase activity was determined by p-nitrophenol phosphate hydrolysis. The intracellular immunoglobulin E (IgE) content was quantified by western blot assay. U266 B1 and RPMI 8226 were cultured at 0.25 × 106/ml with and without 1 mM levamisole for 48 h, and 15 ml of the culture supernatant was collected and lyophilized. Electrophoresis was carried out on 30 μl of the dialyzed samples. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) was performed and the gels were silver stained. Results: APase may be involved in the constitutive proliferation as well as in Ig secretion of myeloma cells. It was observed that murine splenic lymphocytes showed an increase in proliferative response concomitant with an increase in the APase activity and Ig secretion upon mitogenic stimulation (0.5–2.5 mM, P > 0.05). Conclusion: Levamisole significantly inhibited the APase activity when added to the lipopolysaccharide-stimulated cells at the initiation of the culture. Significance of the present study is discussed in the light of existing literature.
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High rates of human immunodeficiency virus and drug resistance in tuberculosis patients in Manila, Philippines p. 157
Marietta B Solante, Haorile Chagan-Yasutan, Toshio Hattori, Susan Leano, Anna Marie Celina G Garfin, Dick Van Soolingen, Elizabeth Telan
DOI:10.4103/bbrj.bbrj_72_17  
Background: The incidence of tuberculosis (TB) in the Philippines is 288/100,000 populations (2014), wherein 2% of new cases and 21% of retreatment cases are multidrug-resistant TB (MDR-TB). In addition, the rate of human immunodeficiency virus (HIV) infection has been alarmingly over the past 7 years in the subpopulation of men who have sex with men in the Philippines. In June 2016, there were 841 new HIV-seropositive individuals reported to the HIV/AIDS and Antiretroviral Therapy Registry of the Philippines. In the present study, we aimed to investigate the prevalence of HIV among MDR-TB patients in a Manila hospital from 2011 to 2015. Methods: TB patients who referred to the programmatic management of drug-resistant TB (2012 to 2015) were tested for MDR-TB (using Xpert MTB/RIF assay) and HIV infection. In addition, the available data that belong to patients before the introduction of the Xpert MTB/RIF assay were included. Results: A total of 4515 presumptive drug-resistant TB patients were screened (2012–2015) to determine the percentage of MDR-TB cases: 16% (2012), 14% (2013), and 11% (2014 and 2015). Among the MDR-TB patients, the percentage of HIV-positive cases increased yearly: 0.5% (2011), 3% (2012), 5% (2013), 9% (2014), and 15% (2015). The high mortality rate ranged from 42% to 66%. The cure rate among the enrolled MDR-TB cases was 47% in 2012, which increased from 27% in 2011, but it did not improve thereafter (46% in 2013 and 51% in 2014). Conclusion: A remarkable increase in the prevalence of HIV among MDR-TB patients was found. The raises are alarming and need urgent attention on different risk factors and/or living style of patients.
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CASE REPORTS Top

Intracranial hematoma after stent treatment disappearance of ruptured anterior cerebral artery aneurysms with internal carotid artery stenosis p. 163
Shui Yu, Chengjian Sun, Yanhua Wang, Chunpeng Yu
DOI:10.4103/bbrj.bbrj_79_17  
A male patient presented with explosive headache and urinary incontinence due to intracranial hemorrhage, a small aneurysm of the right anterior cerebral artery and severe stenosis of the left internal carotid artery was diagnosis via digital subtraction angiography (DSA). Interestingly, DSA revealed aneurysms disappeared. Stent was performed in the left internal carotid artery. Moreover, vascular angioplasty was performed at the location of the aneurysm to reduce the risk of aneurysm rupture. Unfortunately, the patient suffered from intracranial hemorrhage and discharged with hemiparesis.
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Rice body formation in a case of subdeltoid bursa tuberculosis: An uncommon presentation p. 166
Mohd Ilyas, Tameem Ahmad Bhat, Ghanshyam Dev
DOI:10.4103/bbrj.bbrj_88_17  
Rice bodies looking like swelling on specific magnetic resonance sequences are an unusual presentation of subdeltoid tuberculous inflammatory involvement. Rice bodies represent the infarcted or sloughed off synovium due to the inflammatory process. We present a case of a 21-year-old male patient who complained of a soft-tissue swelling around the right shoulder presumed to be a lipoma. The aim of presenting this case is to expand the differential diagnosis of soft-tissue swelling around the shoulder whenever such a condition is encountered.
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