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REVIEW ARTICLES
Geographical distribution of cystic fibrosis; The past 70 years of data analyzis
Seyed Bashir Mirtajani, Poopak Farnia, Maryam Hassanzad, Jalaledin Ghanavi, Parissa Farnia, Ali Akbar Velayati
October-December 2017, 1(2):105-112
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.
  6 27,374 2,279
Exploring potential of phage therapy for tuberculosis using model organism
Vijay Singh Gondil, Sanjay Chhibber
January-March 2018, 2(1):9-15
DOI:10.4103/bbrj.bbrj_93_17  
Antibiotics, one of the miracle discoveries of the 20th century after world war revolutionized the treatment and prophylaxis of infectious diseases. Antibiotics led to an increase in the quality of health-care system but with the emergence of antibiotic-resistant bacterial strains compromised their very potential. The WHO calls bacterial resistance as one of the major threats to global health, food security, and development today. Antibiotic resistance poses a need of alternative therapy to conventional antibiotics. As proved in preantibiotic era phage therapy is effective against a number of successful pathogens and can be used as an alternative strategy to restrain stern infections such as antibiotic resistance tuberculosis (TB). In the present paper, effectiveness of phage therapy and use of model organisms for developing treatment strategy for antibiotic-resistant TB is discussed so as to explore new possibilities in battle against antibiotic resistance.
  6 7,134 996
ORIGINAL ARTICLES
Predictable repeatability issues with GeneXpert-Xpert MTB/RIF (version 4) derived rifampicin resistant tuberculosis results from South India: Appreciating the limits of a technological marvel!
Praveen Sanker, Ramya Puthukkudi Kottuthodi, Anusree Puthenveettil Ambika, Vishnu T Santhosh, Ravikrishnan Balakrishnan, Sunil Kumar Mrithunjayan, Hisham Moosan
July-September 2017, 1(1):76-80
DOI:10.4103/bbrj.bbrj_6_17  
Background: GeneXpert MTB/RIF (Xpert), the fully automated cartridge-based nucleic acid amplification test for simultaneous identification of Mycobacterium tuberculosis complex and rifampicin resistance (RR), directly from samples is considered as a game changer for tuberculosis (TB) control programs worldwide. Methods: We are reporting serious issues with repeatability among a subgroup of Xpert (Version 4) identified RR results from South Indian state recently switched to Xpert by the National TB control program. Results: We have demonstrated that poor repeatability is frequently associated with those Xpert derived RR results, identified by detection of delayed amplification of any probe in the presence of positive analyte results for all probes. Another significant contributing factor was found to be lower bacterial loads in samples. The repeat tests were done by Xpert and/or by line probe assay depending on smear positivity. The finding is worrying as Xpert is recommended over other tests due to its reportedly better performance among low bacterial load samples such as pediatric, extra-pulmonary, HIV-TB co-infected, and smear negative pulmonary TB and the same samples, it seems are more likely to cause error prone RR results. Conclusions: We recommend for additional genotypic tests with specific mutant probes for detecting mutations at rpoB hot sites and growth based tests for all Xpert derived RR-TB cases identified by the above algorithm for confirmation of the presence of mutation, based on our available data.
  3 2,586 348
Evaluation of in silico protein secondary structure prediction methods by employing statistical techniques
Kandavelmani Angamuthu, Shanmughavel Piramanayagam
July-September 2017, 1(1):29-36
DOI:10.4103/bbrj.bbrj_28_17  
Background: With the advent of many new advanced techniques, sequences of a number of proteins have been made available. But the relative paucity of the experimentally determined three-dimensional structures of these proteins has paved way for the development of computational structure prediction methods. Protein secondary structure prediction is an essential step in modeling the tertiary structure. Among the various secondary structure prediction methods available, three different methods with unique working principles, namely, GOR, HNN, and SOPMA were evaluated for their efficiency to predict secondary structures. Methods: A set of 90 different proteins with known secondary structures from three major classes namely, mainly alpha, mainly beta, and mainly alpha beta was used as reference. Secondary structure data of these proteins obtained through experimental methods were compared with that of predictions made by GOR, HNN, and SOPMA respectively by employing various statistical analyses, namely paired sample test, correlation coefficient, standard deviation, standard error mean and scatter plots. Results: The secondary structure prediction tools namely, GOR and HNN were found to predict helical structures more accurately than the sheets. SOPMA was observed to predict sheets more accurately than helices. Conclusion: Based on the observed results, it could be concluded that there is no single tool that consistently predicts all the secondary structures accurately. It could also be anticipated that a combined use of these secondary prediction tools could further enhance the efficacy of in silico protein secondary structure prediction methods.
  3 2,508 309
REVIEW ARTICLES
Probiotics: The marvelous factor and health benefits
S Vijayaram, S Kannan
January-March 2018, 2(1):1-8
DOI:10.4103/bbrj.bbrj_87_17  
The aim of this study is well stated to address in recent advances on probiotics in the past 50 years. Probiotics are the living cell organisms. It is a presence in human and animal gut. The probiotic organisms are natural antibiotics in the human-animal gut. This reviews the main role mechanisms of action in probiotics such as probiotics are antibiotics, probiotics in antibacterial activity, probiotic action in fish gut bacteria, dietary supplements of probiotics, gastrointestinal microbiota of fishes, microbial community of the gastrointestinal tract of fish, bioactive compounds from probiotic bacteria, probiotic uses in cancer therapeutic applications, and applications of probiotics. The most common probiotics are used in many ways such as boosting the immune system, inhibition of pathogenic organism, prevention of cancer, reduction of inflammatory bowel disease, reducing cholesterol level, and synthesis of Vitamin A. Nowadays, food products are mainly involved in chemical preservatives. These preservative agents are causing the disease to affect the human health. The probiotic food products are used to the development of human-animal health.
  3 5,216 850
The relationship between nutrition and infectious diseases: A review
Sedigheh Farhadi, Roman S Ovchinnikov
July-September 2018, 2(3):168-172
DOI:10.4103/bbrj.bbrj_69_18  
Nutrition and infectious diseases are related to each other in some aspects. First, nutrition affects the development of human body immune system. Moreover, nutrition can influence emerge of infectious diseases (e.g., gastrointestinal infections), food poisoning, intestinal diseases, and systemic infectious diseases. In this review, the mentioned aspects of the relationship between nutrition and infections are discussed. Furthermore, the relationship between malnutrition and infectious diseases, nutrition in patients with severe combined immunodeficiency and relationship between overeating and infection are reviewed. Overall, some factors can weaken the body's ability to fight infection and cause malnutrition. The factors include anorexia, traditional behaviors, reduction of intestinal absorption, metabolic damage, disorder metabolism of lipids and carbohydrates, reduction of vitamins, iron, zinc, and copper. In the case of the relationship between malnutrition and infection, a large number of studies have illustrated a bidirectional interaction of malnutrition and infection. In this aspect, to treat serious acute malnutrition and limit the rate of death, some preventive studies applied antibiotics, probiotic bacteria, and prebiotic foods. In the future, studies may be conducted on intestinal or systematic immunomodulation.
  3 24,749 2,074
ORIGINAL ARTICLES
Smear-negative pulmonary tuberculosis: Relative incidence and outcome of treatment in a drug-resistant endemic setting in Indochina
Pathum Sookaromdee, Viroj Wiwanitkit
April-June 2019, 3(2):109-110
DOI:10.4103/bbrj.bbrj_138_18  
Background: Pulmonary tuberculosis is an important public health problem at present. The disease is still highly prevalent in several areas including tropical Indochina. In the area between Thailand and Myanmar body, the emerging drug-resistant tuberculosis is an interesting problem in the present day. Early diagnose and management of tuberculosis patient is important. Methods: In this specific article, the authors summarize and discuss on the locally available data on smear-negative pulmonary tuberculosis in a drug-resistant endemic foci in Indochina. The relative incidence and the outcome of the treatment are specifically focused. Results: Based on the present study, the outcome of the treatment of cases with smear-negative pulmonary tuberculosis is similar to cases with smear-positive pulmonary tuberculosis. Conclusion: Since the outcome of the treatment of cases with smear-negative pulmonary tuberculosis is similar to cases with smear-positive pulmonary tuberculosis, therefore, it is recommended for therapeutic management of those cases.
  2 625 86
Concurrent dengue and tuberculosis: An estimated incidence in endemic tropical country and explanation for low observed incidence
Beuy Joob, Viroj Wiwanitkit
April-June 2019, 3(2):111-116
DOI:10.4103/bbrj.bbrj_37_19  
Background: In tropical developing countries, there are several common infectious diseases including tuberculosis and dengue. The concurrence between dengue and tuberculosis is possible. Methods: Here, the authors perform a mathematical model study to estimate the incidence of concurrent dengue and tuberculosis in Thailand, a tropical country in Indochina. The estimation is performed based on joint probability principle. Results: The estimated incidence of concurrent dengue and tuberculosis in the studied setting is equal to 0.148/100,000 population. Conclusion: There is a low incidence of concurrent dengue and tuberculosis, and this might be due to several possible reasons.
  2 1,096 99
Isolation, characterization, statistical optimization, and application of a novel broad-spectrum capsular depolymerase against Klebsiella pneumoniae from Bacillus siamensis SCVJ30
Sanjay Chhibber, Vijay Singh Gondil, Jasreen Kaur
April-June 2018, 2(2):125-131
DOI:10.4103/bbrj.bbrj_40_18  
Background: Bacterial resistance is one of the most challenging and emerging public healthcare crisis in the modern era. Along with antibiotic degrading strategies, bacteria also evolved to produce extracellular polymers such as capsular polysaccharide (CPS) which not only provides immune protection but also act as a permeability barrier to antibiotics. The use of therapeutic enzymes alone and in combination with antibiotics has opened a new window for clinicians and researchers. Methods: In the present study, isolation of broad-spectrum capsular depolymerase bacterium was attempted from a number of environmental samples followed by 16SrRNA characterization. Optimization of capsular depolymerase production was performed by the one variable at time (OVAT) method and response surface methodology (RSM). Capsular depolymerase was partially purified using ammonium sulfate saturation method. Capsule stripping effects of depolymerase were analyzed using microscopic visualization of the capsule and antibiotic susceptibility test. Results: Thirty-two capsular depolymerase producing bacteria were isolated in this study and broad-spectrum depolymerase producing Isolate-30 was characterized as Bacillus siamensis SCVJ30 according to the 16srRNA sequencing. Depolymerase production was optimized using OVAT method and RSM. Relatively high yields (1.92 IU/ml) of capsular depolymerase were obtained in a medium containing 1 mg magnesium sulfate, 7 mg peptone and at 9 pH. A 115% increase in capsular depolymerase production was observed under optimal conditions than unoptimized conditions. Microscopic visualization of the capsule and antibiotic susceptibility testing postulates the positive effect of depolymerase on antibiotic effi cacy against Klebsiella pneumoniae. Conclusion: Further characterization of the enzyme will help in developing broad-spectrum depolymerase as a potent therapeutic agent against drug-resistant strains.
  2 1,390 199
REVIEW ARTICLES
Impact of geographical information system on public health sciences
Jafar Aghajani, Parissa Farnia, Ali Akbar Velayati
October-December 2017, 1(2):94-100
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.
  2 4,265 553
CASE REPORT
Pacemaker site infection caused by Rapidly Growing Nontuberculous Mycobacteria (RGM)
Jhansi Vani Devana, Narasimhan Calambur, B Ravinder Reddy
January-March 2018, 2(1):82-84
DOI:10.4103/bbrj.bbrj_6_18  
There has been an increased use of cardiac pacemaker device utilization in cardiac patients with a corresponding increase of device-related infections in these patients. The common cause of postpacemaker implantation infection is either Gram-positive or Gram-negative bacteria. Infection of pacemaker implantation site due to nontuberculous mycobacteria is rare. Globally, thirty-two cases of pacemaker device infections caused by nontuberculous mycobacteria were reported. It is important to carry out not only species identification of mycobacteria but also drug susceptibility testing to start precise treatment to those patients, who are infected with atypical mycobacteria. We report a patient with pacemaker pocket infection due to Mycobacterium chelonae.
  1 1,577 137
Multiple peroneal nerve abscesses: The first presentation of borderline tuberculoid leprosy
Aanchal Arora, Bhavna Kaul, Avninder Singh
April-June 2018, 2(2):159-160
DOI:10.4103/bbrj.bbrj_23_18  
A 53-year-old male presented with multiple swellings over the left leg associated with sensory loss and weak dorsiflexion of the left foot for 4 months. Neurophysiological studies revealed absent sensory and motor action potentials in the left common peroneal nerve. Multiple hypoechoic areas were seen in the subcutaneous plane on ultrasound and were found to be nerve abscesses along the peroneal neurovascular bundle on magnetic resonance imaging of the left leg. Skin biopsy was suggestive of borderline tuberculoid leprosy. He was started on corticosteroids and paucibacillary multidrug therapy. The swelling subsided over the next 1 month, and the motor paralysis improved gradually with treatment.
  1 1,152 132
ORIGINAL ARTICLES
Role of magnesium in preeclampsia
Simmi Kharb, K Goel, J Bhardwaj, S Nanda
July-September 2018, 2(3):178-180
DOI:10.4103/bbrj.bbrj_70_18  
Background: The present study was planned to study the role of Mg in preeclampsia and its correlation with dietary intake of proteins and calories by analyzing serum Mg at 20 weeks, delivery, and cord blood Mg levels. Methods: The study was conducted in 102 pregnant women aged 17–36 years attending the outpatient department (OPD) before 20 weeks of gestation. The study samples were drawn twice: once before 20 weeks during visit in the OPD and second within 1 h of childbirth. Serum was analyzed for Mg levels using spectrophotometric method. Furthermore, thyroid-stimulating hormone and glucose challenge test were done as per the standard methods. Results: In normal pregnant women, the mean serum Mg level at <20 weeks of gestation was 2.03 ± 0.34 mg/dl, at term was 1.93 ± 0.41 mg/dl, and in cord blood was 1.84 ± 0.35 mg/dl. Conclusion: The study data support the hypothesis that Mg deficiency might be the causative factor in the development of preeclampsia.
  1 2,866 401
Comparative study of LoopampTM Mycobacterium tuberculosis Complex Kit for Rapid Detection of Mycobacterium tuberculosis complex in cameroon
Valerie Flore Donkeng Donfack, Laure Ngando, Eric Walter Yone Pefura, Dieudonné Shubesi Che, Ghislaine Ateba, Jean Joel Rim Bigna, Jean Louis Abena Foe, Christopher Kuaban, Sara Eyangoh
January-March 2018, 2(1):46-52
DOI:10.4103/bbrj.bbrj_86_17  
Background: The most practical test for identifying tuberculosis (TB) in developing countries remains smear microscopy. However, due to its low sensitivity, a new point-of-care diagnostic method has been developed. The purpose of this study was to assess the performance of TB-Loop-mediated isothermal amplification (TB-LAMP) test on sputum samples of suspected TB cases. Methods: Suspected pulmonary TB patients (527) from Jamot Hospital and without any history of anti-TB treatment were consecutively included in the study. Smear microscopy, TB-LAMP, GeneXpert® MTB/RIF, and liquid culture using BACTEC 960 Mycobacteria Growth Indicator Tube (MGIT) were performed on sputum samples collected from these patients. The sensitivity and specificity of TB-LAMP were compared with smear microscopy and GeneXpert® MTB/RIF. MGIT culture was the gold standard. Results: TB-LAMP and smear microscopy showed sensitivities of 82.6% (95% confidence interval [CI], 76.9–87.2) and 53.6% (95% CI, 46.8–60.3), respectively, and specificities of 96.0% (95% CI, 93.2–97.7) and 99.0% (95% CI, 97.1–99.7), respectively. The sensitivity and specificity of TB-LAMP were similar to GeneXpert®, (89.9%; 95% CI, 85.0–93.3 and 97.0%; 95% CI, 94.4–98.4). Conclusion: TB-LAMP is more sensitive than currently used microscopy. It presents a favorable diagnostic tool for TB in peripheral laboratories with limited equipment, such as those in developing countries.
  1 1,530 199
Genetic polymorphism of rare mutations in Mycobacterium tuberculosis-infected patients in Delhi
Himanshu Vashistha, Mahmud Hanif, Kamal Kishore Chopra, Divya Shrivastava, Ashwani Khanna
January-March 2018, 2(1):74-81
DOI:10.4103/bbrj.bbrj_13_18  
Background: There is a wide variation in existing Mycobacterium tuberculosis strains across the globe, and false results in line probe assay (LPA) can occur due to the presence of unique genetic mutations in different settings. Objectives: An attempt was made to observe uncommon mutations in multidrug-resistant tuberculosis (MDR-TB) strains and determination of genetic diversity by spoligotyping and to study the treatment outcome in patients with uncommon mutations. Materials and Methods: Band pattern analysis of LPA strips was performed as per manufacturer's instructions. DNA sequencing was performed to confirm the presence of uncommon mutations in Intermediate Reference Laboratory in Delhi state. Results: Four uncommon mutations were recognized along with 12 unique spoligotype patterns which serve as an update to worldwide databases. The noteworthy presence of a spoligotype previously rarely seen in India was the SIT53/T1 pattern. Central Asian (CAS) spoligotype was highly associated with MDR followed by Beijing type. During follow-up, the treatment outcomes of cases showing uncommon mutations were considered as cured, after completion of their treatment. Conclusion: The rifampicin resistance appears to be an effective marker of MDR-TB. The presence of uncommon mutations confirms genetic polymorphism that may require treatment targeted at both drug-resistant and drug-susceptible phenotypes for the better management of patients with MDR-TB.
  1 1,586 203
Analysis of endothelial progenitor subpopulation cells, oxidative DNA damage, and their role in coronary artery disease
Mahaboob Vali Shaik, Munni Shaik, Subramanyam Gangapatnam
April-June 2018, 2(2):136-141
DOI:10.4103/bbrj.bbrj_41_18  
Background: Endothelial dysfunction has been associated for the cause of atherosclerosis or cardiovascular diseases (CVDs). Endothelial progenitor cells (EPCs) are exposed to oxidative stress during vascular injury as residents of blood vessel walls or as circulating cells homing to the sites of neovascularization. The current study was designed to analyze various subpopulations of EPCs and their DNA damage in CVDs. Methods: The study included 50 coronary artery disease (CAD) patients which was confirmed by angiography and 50 age-matched healthy controls without CAD. Flow cytometric analysis performed to measure subpopulations in EPCs in the peripheral blood using markers such as CD34, CD133, VEGFR2, and CD45. Oxidative DNA damage was analyzed in CD34+ cells. Mean EPC count was expressed as a percentage of total white blood cells. Three different subpopulations with CD45−/CD133+/VEGFR2+, CD45−/CD34+/VEGFR2+, and CD45−/CD34+/CD133+ coexpressions were measured with various percentages. Results: Subpopulation of CD45−/CD34+/VEGFR2+ cells had shown significant (P = 0.001) decrease in CAD patients in comparison with the healthy controls. There was no significant difference in the subpopulations of CD45−/CD34+/CD133+ cells (P = 0.005) and CD45−/CD133+/VEGFR2+ cells (P = 0.005) in CAD and healthy controls. The CD45−/CD34+/VEGFR2+ subpopulation EPC showed positive correlation with the severity of coronary stenosis (r = 0.35, P = 0.026), while other EPC subpopulation count did not show any correlation. Oxidative DNA damage was higher in CAD compared with controls. The number of EPC subpopulation CD45−/CD34+/VEGFR2+ was inversely correlated with oxidative DNA damage (P = 0.001), hypertension (P = 0.001), and diabetes mellitus (P = 0.004). Conclusion: We observed an association between CD45−/CD34+/VEGFR2 subpopulation EPCs and DNA damage in CAD condition. These findings support a cell biologist in searching the role of EPC populations in the pathophysiology or diagnosis of the disease by a clinician.
  1 1,212 167
Involvement of Gas6 protein in mouse model of lipopolysaccharide-induced lung inflammation
William R Surin, Surbhi Mundra, Chellakkan S Blesson, Ramachandra S Gudde
April-June 2018, 2(2):146-151
DOI:10.4103/bbrj.bbrj_27_18  
Background: Gas6 is a product of growth arrest-specific gene 6 and is mostly expressed by the growth-arrested organs and is implicated in thrombosis, various inflammation, and age-related diseases. However, its role in chronic obstructive pulmonary disease has not been investigated yet. Methods: We developed lipopolysaccharide-induced mouse model of chronic lung inflammation to study its involvement. Therefore, male C57BL/6 mice (20–25 g) were grouped into control and LPS group; each group having 15 animals each. LPS group was nebulized with LPS (1 mg/ml) for 45 min, once a week for 8 weeks to induce chronic inflammatory conditions in the lungs by use of nebulizer. The mice model was validated by assessing infiltration of various immune cells (T-cells, B-cells, and neutrophils) into the lungs and pro-inflammatory and anti-inflammatory cytokine profile by cytokine bead array kit by flow cytometry. Lung deterioration was assessed by lung histology. The level of gas6 protein from the lung homogenate was measured by quantikine enzyme-linked immunosorbent assay kit. Furthermore, lung homogenate was analyzed by Western blotting for expression profile of gas6 protein. Results: There was significant increase in the level of T-cells (19±8% vs 65±11%), B-cells (24±7% vs 64±10%), and neutrophils (22±9% vs 57±10%) and significant increase in the level of tumor necrosis factor (200 ± 17 pg/ml vs. 1222 ± 152 pg/ml) and IL-6 (106 ± 13 pg/ml vs. 448 ± 122 pg/ml). Lung deterioration was observed in LPS group. We observed significant increase in the level of gas6 protein in lung homogenate in LPS group (0.16 ± 0.1 ng/ml vs. 4.2 ± 0.1 ng/ml). Furthermore, we found significant increase in gas6 protein in the lung homogenate of LPS-treated group by Western blotting. Conclusion: The current study establishes the involvement gas6 protein in lung inflammation.
  1 1,236 130
Experience with the quantitative lytA gene real-time polymerase chain reaction for the detection of Streptococcus pneumoniae from pediatric whole blood in Pakistan
Furqan Kabir, Sahrish Muneer, Adil Kalam, Ana Sami, Shahida Qureshi, Aneeta Hotwani, Atif Riaz, Syed Mohiuddin, Mohammad Tahir Yousafzai, Sara Hussain, Asad Ali, Sadia Shakoor
July-September 2017, 1(1):71-75
DOI:10.4103/bbrj.bbrj_26_17  
Background: We present our experience with optimization and diagnostic use of quantitative real-time polymerase chain reaction (PCR) targeting the lytA gene of Streptococcus pneumoniae for the detection of S. pneumoniae in whole blood of children <5 years of age. The assay was optimized to detect ≥5 CFU/10 μl or 1 copy of DNA/2 μl of blood. Methods: This assay was applied on 1912 whole blood specimens collected from children <5 years of age with pneumonia, of which 35 specimens were lytA positive. The bacterial loads were determined through categorization of load into five different categories, i.e., very high load, high load, moderate load, low load, and very low load. Results: Of the 35 lytA-positive samples, 9 (25.71%), 4 (11.42%), 1 (2.85%), 13 (37.14%), and 8 (22.85%) were categorized as very high load, high load, moderate load, low load, and very low load, respectively. Extracted samples were also subjected to serotyping by the Centers for Disease Control and Prevention PCR scheme. Positive samples with very high load and high load category were serotyped successfully in all instances. A high proportion of samples with low and very low load (61.53% and 75%, respectively) remained untypeable by the currently proposed schemes. Conclusions: LytA PCR assay in whole blood provides rapid and sensitive results for the diagnosis of invasive S. pneumoniae disease in a resource-limited setting, while also being amenable to quantitation and serotyping.
  1 1,843 217
Development of tracheal reconstruction methods from scaffold engineering to injectable matrix
Jalaledin Ghanavi, Poopak Farnia, Afshin Bahrami, Hamid Reza Jabbari, Ali Akbar Velayati
July-September 2017, 1(1):19-24
DOI:10.4103/bbrj.bbrj_55_17  
Backgrand: For patients with long segment of tracheal stenosis, resection and replacement is necessary. Tracheal reconstruction associated with complications such as stenosis, insufficiency of blood supply and surgical complication. Methods: In this study, we prepared collagen-chitosan scaffold and sheep's decellularized trachea plus culture medium with nanocup contain growth factors for chondrocyte and fibroblast-epithelial cell culture in rotary bioreactor. After attachment of cells, engineered trachea put into the omentum. Peritoneal stem cell interact with the epithelial and chondrocytes with attendance of growth factors released from nanocup. The bioengineered trachea with omental pedicle transposed from behind the sternum and transplanted in the position of resected trachea. In third experiment, we introduce the in situ tracheal repair technique with injectable matrix for reconstruction of long-segmental stenosis of trachea in a 29-year-old woman. Results: Severe tortuosity in the first experiment and mild stenosis was seen in the second experiment. In third experiment, normal shape in tracheal diameter was seen at injection sites. The interior portion of the trachea at virtual computed tomography (CT) scan and bronchoscopy were similarity to normal after four month fallowing up of injection. Conclusions: Severe tortuosity, mild stenosis in whole length of trachea in this study and disadvantage of trachea transplantation include open surgery, fatal consequences of anastomosis leakage, and rupture besides large mediastinal vessels; hence, we decided to introduce the novel in situ tracheal repair technique. Injectable bioresorbable scaffolds may be used as a temporary scaffolding for transplanted cells and thereby allow the cells to secrete extracellular matrix of their own to enable, in the long term, a complete and natural tissue replacement.
  1 1,894 264
Thyroid dysfunction in early pregnancy and spontaneous abortion
Preeti Gahlawat, Aditi Singh, Smiti Nanda, Simmi Kharb
July-September 2017, 1(1):81-84
DOI:10.4103/bbrj.bbrj_27_17  
Background: Pregnancy is associated with significant but reversible changes in thyroid function. Abnormal thyroid hormone levels could give rise to increased malplacentation increase to malplacentation that underlies the association between maternal thyroid dysfunction and adverse obstetric outcomes such as fetal brain damage, preterm births, and fetal death. Aim: The present study was planned to predict the risk of abortion in pregnancy by studying the relation between thyroid profile and rate of abortion. Methods: This prospective observational study was carried out in 100 pregnant women with a singleton pregnancy of 6–12 weeks of gestation in the Department of Biochemistry in collaboration with the Department of Obstetrics and Gynaecology, Pt. B.D. Sharma, PGIMS, Rohtak. The patients were divided into three groups, namely, Group 1 (n = 30, control group) included normal pregnant women with no history of abortion; Group 2 (n = 35) included pregnant females with previous history of abortion; and Group 3 (n = 35) comprised pregnant women coming with chief complaint of bleeding per vaginum. A volume of 5 mL blood sample was taken and serum was separated using centrifugation. Triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) levels were estimated by chemiluminiscence. Results: T3, T4 and levels were comparable in all the three groups and the difference was not statistically significant. TSH levels were found to be negatively correlated with T3 and T4 values in the three groups. Only, 13% of the patients had spontaneous abortion. Nearly 6.66% of the patients in Group 1, 11.42% in Group 2 and 19.99% of patients in Group 3 ended up in abortion. TSH was found to be strongly associated with abortion in all the three groups (P ≤ 0.001). TSH levels were significantly higher in the first trimester in women who had an abortion than pregnant women who had a successful continuation of pregnancy. Conclusions: TSH was strongly associated with abortion in the first trimester in all the three groups.
  1 5,491 407
High rates of human immunodeficiency virus and drug resistance in tuberculosis patients in Manila, Philippines
Marietta B Solante, Haorile Chagan-Yasutan, Toshio Hattori, Susan Leano, Anna Marie Celina G Garfin, Dick Van Soolingen, Elizabeth Telan
October-December 2017, 1(2):157-162
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.
  1 2,062 260
REVIEW ARTICLES
Tuberculosis Serology is Useful in Rural Areas
Roland Maes
October-December 2017, 1(2):85-93
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.
  1 2,110 367
Recent methods for diagnosis of nontuberculous mycobacteria infections: Relevance in clinical practice
Anand Kumar Maurya, Vijaya Lakshmi Nag, Surya Kant, Anuradha Sharma, Ravi Shekhar Gadepalli, Ram Awadh Singh Kushwaha
July-September 2017, 1(1):14-18
DOI:10.4103/bbrj.bbrj_18_17  
Nontuberculous mycobacteria (NTM) infections are ever more important in recent years for leading causes of morbidity and mortality worldwide. Clinical appearance of Mycobacterium tuberculosis (TB) complex and NTM is same, but the treatment regimen is always different. NTM is challenging for both diagnostic and therapeutic with reason that it mimic pathological, microbiological, immunological, and radiological findings of TB. Newer molecular diagnostic methods allow for a better identification of NTM infections in patients not responding to antitubercular treatment and falsely categorized as drug-resistant TB. This article will explore the recent methods for the diagnosis and identification of NTM infections in clinical practice. In the future, the molecular-based diagnosis will significantly reduce the turnaround time of the diagnosis and thereby improving patient outcome.
  1 4,067 754
Epidemiology of multi-drug-resistant tuberculosis in Northern India
Ankur Kumar, Amresh Kumar Singh, Vandana Upadhyay, Jayesh Pandey
April-June 2018, 2(2):112-121
DOI:10.4103/bbrj.bbrj_26_18  
India is the world's second most populous country, accounting for a quarter of the world's annual incidence of tuberculosis (TB). Every year around 2 million people develop TB in India and 300,000 die due to the TB. The emergence of drug-resistant-TB (DR-TB) has become a major public health concern in India. This situation is worsened by the appearance of multi-drug-resistant (MDR) strains of Mycobacterium tuberculosis. We sought to determine the characteristics and relative frequency of transmission of MDR-TB in North India and their association with the clinical and epidemiological characteristics of TB-patients and to mitigate the impeding drug-resistant TB epidemic in the country; it will help to established TB surveillance system effectively in the country. Diagnosis of MDR-TB prompts an appropriate treatment for patients with presumptive MDR-TB or rifampicin resistance in TB patients who have failed treatment with first-line drugs. If left undiagnosed or poorly treated, MDR-TB patients suffer for months to years before succumbing to the disease; hence, transmission of MDR-TB continues MDR-TB patients were found to be significantly higher in previously treated patients in comparison to newly diagnosed patients. The emerging drug susceptibility testing patterns and enlisting the help of an expert in DR-TB should be sought sooner rather than later through more than 100 established DR-TB centers across the country. To control the primary transmission of MDR-TB in Northern India, we recommend that improving the social support, living standards, and medical security of each patient should become a priority.
  1 4,868 580
Useful approaches for reducing aflatoxin M1 content in milk and dairy products
Fatemeh Naeimipour, Jafar Aghajani, Saba Amiri Kojuri, Saman Ayoubi
April-June 2018, 2(2):94-99
DOI:10.4103/bbrj.bbrj_59_18  
The quality and safety of food are of major importance. Using contaminated animals' milk and meat may result in human disease. Among microorganisms, fungal toxins, especially aflatoxin B-1 (AFB1), are of special importance. Aflatoxin M-1 (AFM-1) is a metabolite that is produced by conversion and hydroxylation of AFB-1. Both toxins can cause acute and chronic mycotoxicosis mainly through ingestion of contaminated milk. Hence, it is critical to control and decrease these microorganisms. Despite cost-effective efforts, preventing foods contamination due to aflatoxins (AFs) is not only an expensive but also a difficult task. The best agricultural monitoring during preharvest and postharvest stages cannot eliminate the AFs, especially AFM-1 from milk and dairy products because of the high resistance of these toxins. There have been numerous studies investigating the methods of AF detoxification or reduction from infected milk. By focusing on advantages and disadvantages of preventative procedures using probiotics, antibodies, chemisorbents and even additives, one can choose one or several procedures to eliminate or reduce AFM-1 in milk and its byproducts efficiently.
  1 5,228 693
* Source: CrossRef