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Introduction: Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus (HIV)-infected individuals. The risk of eventually developing active TB from latent TB infection (LTBI) is about 10% per year in HIV-positive patients in contrast to 10% lifetime risk in HIV-negative patients. Until recently, the tuberculin skin test (TST) was the only tool available for diagnosing LTBI. Interferon-gamma release assays (IGRAs) were recently developed and address many of the limitations of TST test, especially in immunocompromised state. Aims and Objectives: (1) To determine the prevalence of latent, active pulmonary, and multidrug-resistant (MDR)-TB among HIV-positive patients in and around Aligarh region; (2) sensitivity and specificity of TST and IGRAs for diagnosis of LTBI in HIV positive patients; and (3) to assess drug resistance and mutational patterns of the clinical isolates of MDR-TB in HIV-TB co-infection. Materials and Methods: A cross-sectional study was done on all the patients attended the ICTC centre, JNMC, AMU Aligarh, seropositive for HIV, i.e. 469 (sample size) for the study period of 2 years from October 2015 to October 2017. All 469 HIV-positive patients were screened for latent and active pulmonary TB. Diagnosis of TB (active and latent) was made using clinical, radiological, and microbiological tests. TST and IGRA testing along with CD4 cell counts were also determined. Line probe assay was also done to assess drug resistance and mutational patterns of MDR-TB in HIV patients. Results: In our study, prevalence of HIV infection was 5.04%. Sixty-seven (14.28%) patients were as active TB (HIV-TB co-infection), out of which only one patient (1.49%) was confirmed as MDR-TB, 117 (24.94%) were diagnosed as LTBI. It was also evaluated that IGRA has more sensitivity (75%) and specificity (76%) than TST with sensitivity of 71.7% and specificity 66%. Conclusion: As there is no gold standard test for latent TB, longitudinal follow-up is needed to interpret discordant test results. There is a need to interpret negative QFT results with caution and to test for latent TB at higher CD4 counts, if possible. Interferon gamma assays can become better tool for diagnosis of especially for latent TB. However, more research study required for establish their relevance, especially in immunocompromised states.

Background: Aspergillosis is one of the most common fungal infection among both general patients and immunocompromised individuals. Methods: The study was carried out on 2 groups of patients: immunocompetent and immunocompromised comprising of a total of 90 patients. Microscopy, culture, identification of isolates was done and some specialised tests on serum and BAL for antigen detection were performed. Result: Most of the patients i.e., 47 (31.3%) were between 31-40 years with a mean age of 32.5 years. The male to female ratio was 1.8:1. Galactomannan antigen was positive in 13 (28.9%) BAL samples and in 15 (33.3%) serum samples wherein the 45 BAL samples represented immunocompetent cases and 45 serum samples represented immunocompromised cases. Sensitivity and specificity of GM assay in BAL samples were found to be 100% and 97% respectively. On the other hand, sensitivity and specificity in serum samples were found to be 94.1% and 100% respectively. All patients were categorized into 4 categories as proven IPA, probable IPA, possible IPA and non-IPA. 22 (24.4%) patients were of proven invasive pulmonary aspergillosis (IPA), 7 (7.8%) of probable IPA, 2 (2.2%) belonged to possible IPA while 59 (65.5%) were of non IPA. All of the cases of proven IPA were positive on culture. Conclusion: GM assay in BAL is a very sensitive and specific marker for Aspergillosis while in case of serum samples it is somewhat lesser sensitive.

Background: Tuberculosis (TB) remains a major global health problem. India accounts for the one-fourth of the global TB burden. For resource-limited countries like India having high burden of TB, smear microscopy is the most commonly used method for microbiological diagnosis. Although culture being highly sensitive and specific method, it is time-consuming. Under Revised National TB Control Program (RNTCP), Ziehl–Neelsen (ZN) stain-based microscopy and light-emitting diode-based fluorescent microscopy (LED-FM) are being recommended. Aim: The present study was done to determine the sensitivity and specificity of ZN stain-based microscopy and FM (LED-FM) keeping solid culture as gold standard. Materials and Methods: A total of 1503 sputum samples were collected from suspected cases of pulmonary TB (new or previously treated). They were processed and subjected to ZN (conventional light microscopy), Auramine-O (AO) staining (LED-FM) and solid culture on Lowenstein–Jensen medium for detection of acid-fast bacilli. Positive smears were graded according to RNTCP guidelines. Results: Sensitivity, specificity, positive predictive value, and negative predictive value of ZN staining technique were 84.93%, 95.74%, 96.50%, and 82.16%, respectively, and that of FM was 95.25%, 91.33%, 93.81%, and 93.31%, respectively. Conclusion: LED-FM being more sensitive, especially in detecting the paucibacillary cases and less time-consuming, has advantage over ZN method. Nation-wide implementation will lead to improved diagnosis, thus better control of TB.

Introduction: An upper respiratory tract infection which can be either due to increased airway bacterial load or emergence of new bacterial strain is the most common cause of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Other factors responsible for exacerbation include viral infections, pollution and other unidentified pathogens. Aim: To evaluate the local pattern of bacterial and fungal isolates from patients diagnosed with AECOPD and forming an antibiogram of the hospital. Materials and Methods: A total of 200 clinically diagnosed cases of AECOPD of age ≥40 years were included in the study. Sputum sample was obtained from the patients and processed according to standard lab procedures. Statistical analysis was done by using Statistical Package for Social Sciences (SPSS) version-20. The test applied in the current study was modified chi-square used for comparison of proportion to analyse statistical significance for antibiotic sensitivity. The p-value

Introduction: Invasive fungal infections are increasingly common in the nosocomial setting. Materials and Methods: The patients were divided into two groups immunocompetent and immunocompromised that is, patients with significant neutropenia

Background: The prevalence of multidrug-resistant-tuberculosis (MDR-TB) among new and previously treated cases is increasing worldwide as well as in India. Rapid detection of MDR-TB allows the establishment of an effective treatment regimen; minimizes the risk of further resistance, and limits the spread of drug-resistant strains. Early diagnosis of MDR-TB is the need of the hour in high-TB burden countries like India, and GenotypeMTBDRplus is quite sensitive and specific in determining the molecular resistance in drugs such as rifampicin and isoniazid. Methods: The present study was done for molecular detection of rifampicin and isoniazid resistance and resistance patterns among MDR-TB suspects and comparison of resistance patterns among new and previously treated cases by GenoType® MTBDRplus Line Probe Assay. A total of 1268 sputum samples of MDR-TB suspects were subjected to fluorescent microscopy. Fluorescent microscopy positive samples were subjected to GenoType® MTBDRplus (HAIN Lifescience) assay. Results: MDR-TB was detected 11.02%, 20.03% in new and previously treated cases. Among MDR-TB patients S531 L was the most common mutation detected in rpoB gene; 71.43% in new, and 72.17% in previously treated cases. S315T1 was the most common mutation noted in katG gene; 100% in new and 81.74% in previously treated. While in hA gene, it was C15T (7.8%) among previously treated cases. Conclusion: MDR-TB has high prevalence in the western part of Uttar Pradesh, India. Previously treated cases have even more high rate of MDR-TB than new TB cases. The most dominant gene mutations associated with resistance to INH and RIF were observed in codon 315 of the katG gene and codon 531 of the rpoB gene. While comparing the mutation patterns by Genotype MTBDRplus assay, previously treated cases showed more diversity of mutations and had greater number of unknown mutations.

Background: Isoniazid (INH) and rifampicin (Rif) are the key first-line antituberculosis drugs, and resistance to these drugs i.e., multi-drug-resistant tuberculosis (MDR-TB), is likely to result in treatment failure and poor clinical outcomes. India has the highest burden of TB and MDR-TB in the world, disproportionately high even for India's population. The GenoType® MTBDRplus molecular method allows rapid detection of Rif and INH resistance. Aim: The present study was done to compare the performance of line probe assay test (GenoType® MTBDRplus) with solid culture method for an early diagnosis of MDR-TB. Methods: Totally 1503 sputum samples of MDR-TB suspects were subjected to fluorescent microscopy. Decontamination was done by N-acetyl-L-cysteine and sodium hydroxide method. Fluorescent microscopy-positive samples were subjected to GenoType® MTBDRplus (HAIN Lifescience) assay. Sixty-two random samples were compared with phenotypic drug susceptibility testing (DST) (1% proportion method) using solid culture method by Lowenstein–Jensen media. Results: The sensitivity, specificity, positive predictive value and negative predictive value for detection of resistance to Rif were 94.74%, 95.35%, 90% and 97.62% and to INH were 92.00%, 91.89%, 88.46% and 94.44%, respectively, in comparison with the phenotypic DST. Conclusion: GenoType® MTBDRplus has good sensitivity and specificity in detecting MDR-TB cases with a significantly lesser turnaround time as compared to conventional DST method and simultaneous detection of Rif and INH resistance. This technique saves several weeks of time required for culture and DST.

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic, premalignant condition of the oral mucosa and one of the commonest potentially malignant disorders amongst the Asian population. The objective of this study was to investigate the association of etiologic factors with: age, frequency, duration of consumption of areca nut and its derivatives, and the severity of clinical manifestations. METHODS: A cross-sectional, multi centric study was conducted over 8 years on clinically diagnosed OSMF cases (n = 765) from both public and private tertiary care centers. Sample size was determined by World Health Organization sample size calculator. Consumption of areca nut in different forms, frequency of daily usage, years of chewing, degree of mouth opening and duration of the condition were recorded. Level of significance was kept at P ≤ 0.05. RESULTS: A total of 765 patients of OSMF were examined, of whom 396 (51.8%) were male and 369 (48.2%) female with a mean age of 29.17 years. Mild OSMF was seen in 61 cases (8.0%), moderate OSMF in 353 (46.1%) and severe OSMF in 417 (54.5%) subjects. Areca nut and other derivatives were most frequently consumed and showed significant risk in the severity of OSMF (P ≤ 0.0001). Age of the sample and duration of chewing years were also significant (P = 0.012). CONCLUSIONS: The relative risk of OSMF increased with duration and frequency of areca nut consumption especially from an early age of onset.

Introduction: Tuberculosis (TB) remains a significant public health problem with an estimated onethird of the world’s population being infected. Cytokines play a major role in protection against Mycobacterium tuberculosis infection and regulate the immune responses at cellular level. Most studies on cytokines during TB are from ‘in vitro’-stimulated lymphoid cells with few reports on in vivo plasma levels. This study was aimed to evaluate the levels of TNF-α & IL4 in new, underOriginal Research Article Fatima et al.; BMRJ, 7(4): 159-166, 2015; Article no.BMRJ.2015.107 160 treatment (UT) and multidrug resistant (MDR) pulmonary and extra-pulmonary cases. Methodology: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Levels of TNF-α and IL-4 were measured in 76 serum samples from TB patients by ELISA kit (Diaclone France) along with 10 BCG vaccinated control. A complete clinical, radiological & treatment data was collected on questionnaire forms of each patients. Results: TNF-α levels were elevated in new (P 0.05). TNF-α and IL-4 levels showed no significant variations according to site of involvement in pulmonary vs. extra-pulmonary TB cases. Conclusion: An understanding of the development of this response may lead to insight into pathogenesis and novel therapies for TB.

Pulmonary Tuberculosis (TB) is a global public health threat. It has a worldwide distribution with a very high prevalence in Asian countries. A correct diagnosis forms an important and indispensable part of proper and timely treatment. Detection of acid fast bacilli in direct smears has considerable clinical and epidemiological value and remains the most widely used rapid diagnostic test. In smear negative cases, radiography has an important role to play. Directly Observed Treatment Short Course (DOTS) strategy is one of the most cost-effective health interventions to treat tuberculosis. Samples from clinically suspected cases of TB were screened for the presence of Acid Fast Bacilli (AFB). Radiography and culture was done for the AFB negative cases. 760 cases of pulmonary TB were diagnosed by smear examination and 412 by radiography. 270 cases of pulmonary TB were diagnosed in the study. Of the 1422 patients put on DOTS, out of which 1138 (80.1%) were successfully treated. Thus, smear examination for AFB and radiography should go hand in hand for correct diagnosis and treatment of TB by DOTS which is a very successful regimen for developing countries like India.

Background: Varieties of methods are available for more obstinate tooth discoloration such as crowns, veneer, and micro and macro abrasion of enamel, but tooth bleaching gained high patient acceptance. The aim of the present research was to estimate changes in surface enamel composition after bleaching 16% carbamide peroxide (CP) (home-use bleaching) with 38% hydrogen peroxide (HP) (in office bleaching). Materials and Methods: A total of 90 enamel slabs from 45 sound human third molars were randomly divided into three groups. Of three groups, per group had thirty samples (n = 30), of which samples of Group 1 were placed in artificial saliva at 37°C in incubator (Memart, Germany) during complete experiment. Sample of Groups 2 and 3 was treated with power whitening gel (White Smile 2011, Germany) and tooth whitening pen (white Smile 2011, Germany), respectively. Later on, after bleaching treatment, discs were thoroughly washed and stored in artificial saliva at 37°C in incubator. Chemical analysis was done with energy dispersive spectroscopy (Edx) detector to detect changes in surface composition. Results: Energy dispersive X-ray spectroscopy (Edx) analysis showed no significant difference between all the three groups for Ca% mass (P > 0.99) and Ca% atomic (P > 0.99), C% mass (P = 0.78) and C% atomic (P = 0.76), and O% mass (P > 0.99) and O% atomic (P = 0.28). Similar results were shown for Na, Mg, P, and F. Conclusion: Statistically insignificant effect was observed on enamel composition with both bleaching agents (38% HP and 16% CP).

Background Aspergillus antigens such as galactomannan antigen, a cell wall polysaccharide, can be detected in patient’s serum or bronchoalveolar lavage. To study the prevalence of Aspergillus infection in patients with bronchogenic carcinoma, we measured galactomannan antigen in serum and bronchoalveolar lavage samples of patients with bronchogenic carcinoma. Methods The study was conducted on 45 bronchogenic carcinoma patients. The diagnosis of lung cancer was confirmed by bronchoscopy, histopathological and radiological examinations. Bronchoalveolar lavage fluid collected from each patient by fiberoptic bronchoscopy was subjected to direct microscopy and culture on Sabouraud’s dextrose agar and Czapek-Dox agar, and Aspergillus galactomannan antigen was measured in serum and bronchoalveolar lavage samples. Results The majority of patients were male (93.3%) in the age group 51–60 years, 88.9% were addicted to gutka chewing, and 82.1% were addicted to smoking. Most patients complained of cough (73%) and shortness of breath (51.1%). Squamous cell carcinoma (64.4%) was the most common malignancy, followed by adenocarcinoma (13.3%). On culture of bronchoalveolar lavage samples, 35.5% showed growth of Aspergillus spp. ( Aspergillus fumigatus in 17.8%, Aspergillus flavus in 13.3%, and Aspergillus niger in 4.4%). Galactomannan antigen was detected in 58.3% of bronchoalveolar lavage samples and 47.2% of serum samples. Conclusions There is a high prevalence of aspergillosis in patients with lung carcinoma, especially among smokers and gutka chewers.

Rheumatoid arthritis (RA) is a chronic systemic disease of unknown etiology characterized by articular involvement, extra-articular involvement, and the presence of serum rheumatoid factor. Pulmonary involvement in RA is a common extra-articular manifestation of rheumatoid arthritis (RA) that confers significant morbidity and mortality. We undertook this study to determine the prevalence and spectrum of pulmonary abnormalities in patients with rheumatoid arthritis (RA) from a North Indian town. 62 patients who met the American College of Rheumatology (formerly the American Rheumatism Association) 1987 classification criteria for RA were subjected to clinical examination of chest, X-Ray-chest (CXR), pulmonary function tests (PFT) and high resonance computed tomography (HRCT). 40.3% patients had some pulmonary symptoms with exertional dyspnoea in 21%, cough with expectoration in 17.7%, fine respiratory rales in 11.3%, patients X-ray chest bilateral lower zone haziness in 16% and prominent pulmonary vasculature in 3.2%. 43% had abnormal PFT-restrictive pattern in 29%, obstructive pattern 8% and mixed pattern in 6.4%. HRCT revealed abnormal findings in 33.8% commonest being ground glass pattern in both lower lobes 19.3%, sub pleural reticulations in 9.6%, pleural thickening in 3.2% and pulmonary vascular prominence in 1.6%. To provide optimal treatment, physicians must always consider the possibility of associated pulmonary manifestations when patients with RA are evaluated.

Purpose: To study the factors influencing sputum smear conversion including Serum C-Reactive Protein (CRP) and its correlation with disease severity in tuberculosis patients. Method: Levels of Serum-CRP concentrations were deter-mined in 60 patients with pulmonary tuberculosis, 30 healthy volunteers and patients in follow-up after completion of antitubercular treatment (DOTS therapy). Results: Serum-CRP levels were found to be significantly higher in smear-positive group as compared with the follow-up patients and smear-negative control group. The values were 43.65 ± 23.68, 9.88 ± 5.23 and 4.04 ± 3.85 mg/L respectively (P Conclusion: Serum-CRP levels are significantly correlated with disease severity in patients with active pulmonary tuberculosis. Thus these findings from the present study would certainly add new criteria for early diagnosis of TB, which may lead to development of new strategies to treat TB.

Primary infection with TORCH complex (Toxoplasma, Rubella, Cytomegalovirus (CMV), and Herpes simplex virus II (HSV-II)) in pregnant women can lead to adverse outcome. A total of 303 sera samples were collected at Dept. of Microbiology, J.NM.C, Aligarh from pregnant women with bad obstetric history (BOH) and 75 pregnant women without BOH. IgM antibodies were detected by ELISA method using CALBIOTECH kits (USA). Of the 303 pregnant women with BOH, 16 (5.9%) were positive for Toxoplasma, 14(5.1%) were positive for Rubella, 7 (2.3%) were positive for CMV and 2 (0.6%) were positive for HSV. 4 (1.58%) patients were positive for both Toxoplasma and Rubella and 2 (0.79%) were positive for Rubella and CMV. In the control group 1 (2%) sample each was positive for Toxoplasma and Rubella and none was positive for CMV& HSV (P

Around one fourth of patients infected with human immunodeficiency virus (HIV) and given antiretroviral therapy (ART) experience inflammatory or cellular proliferative disease associated with a preexisting opportunistic infection. Many such infections are subclinical or quiescent before the patient begins ART. Cryptococcal immune reconstitution inflammatory syndrome may present as a clinical deterioration or new presentation of cryptococcal disease following initiation of antiretroviral therapy (ART) and is believed to be caused by recovery of Cryptococcus-specific immune responses. In the following report we present a case of expeditious developed IRIS in the form of cryptococcal meningitis.

Hydatid disease remains a serious health problem in Mediterranean countries. Living in a rural area is an important risk factor for the disease. Hydatid cysts are usually located in the liver, lungs and brain. Mediastinal hydatid disease is very rare and has been noted only anecdotally in the literature. The present article reports a case of a mediastinal hydatid cyst rupturing into the pleural cavity, which was associated with pneumothorax of the same side. The patient’s previous chest x-rays (posteroanterior and left lateral views) showed a well-defined mediastinal mass on the left side, and contrast-enhanced computed tomography of the thorax (taken a few days after the chest x-ray) showed multiple round-to-oval soft tissue opacities with partial collapse of the left lung. An indirect hemagglutination test for echinococcus was positive. Even after two weeks of intercostal tube drainage, the patient’s condition did not improve. During thoracotomy, multiple daughter cysts were found in the pleural cavity, and the diagnosis of a hydatid cyst was confirmed after histopathological examination.

One hundred and sixty symptomatic confirmed human immunodeficiency virus (HIV)-positive patients, of both sexes with lower respiratory tract infection were taken as a study population, and the clinicomycological profile was correlated with the immunological status of the patients with particular reference to CD4 counts. Relevant samples were collected and subjected to direct microscopy, fungal culture and antigen detection.

Introduction: Mycobacterium tuberculosis (Mtb) infects one third of the world population. Despite advance in therapy, tuberculosis (TB) remains responsible for 2-3 million deaths annually. During TB, cytokines play a role in host defense. Many cytokines are produced during TB with a predominance of Th1 cytokines during the early stage and Th2 cytokines in the later stages of the infection. The present study aims to screen tumor necrosis factor-alpha (TNF-α), interferon gamma (IFN-γ), interleukin (IL)-12p70, IL-4, IL-6, and IL-1β among TB patients and controls. Materials and Methods: The study was conducted at the Department Of Microbiology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India. Different cytokine levels were measured in 65 samples of TB patients of whom 30 (46.1%) were new TB cases and 35 (53.8%) were suspected multidrug-resistant (MDR)-TB cases along with 15 bacille Calmette-Guerin (BCG) vaccinated healthy controls by enzyme-linked immunosorbent assay (ELISA) (Diaclone, France). Complete clinical, radiological, and treatment data were collected. Informed consent was taken from all subjects. Study was approved by the Institutional Bioethical Committee, Jawahar Lal Nehru Medical College. Statistical analysis had been performed by using Sigma plot (10.0). Results: The serum concentration of TNF-α, IFN-γ, IL-12p 70 , IL-1β, and IL-6 in patients with active TB and MDR-TB was elevated than in patients after anti-TB treatment (P < 0.001), in contacts (P < 0.001) and in controls (P < 0.001). It was found that IL-6 seems critical in resistance to TB. IL-4 concentration increased only in MDR-TB patients (P < 0.001) as compared to controls. All these cytokines showed no significant variations according to the site of involvement in pulmonary versus extrapulmonary TB cases. Conclusions: Measuring the serum levels of several cytokines may be useful for evaluating the activity of TB disease and monitoring the clinical effects of anti-tubercular treatment (ATT). The serum TNF-α, IFN-γ, IL-12p 70 , IL-1β and IL-6 level can be a useful marker to diagnose the effectiveness of therapy in the patients.

Introduction The occurrence of tuberculosis in the flat bones of the skull is very rare. Only eight cases of tuberculosis of the frontal bone have been reported in the literature. Case presentation A 14-year-old girl of Asian ethnicity presented with gradual loss of vision. A computed tomography scan of her head showed a diffuse, homogeneously ill-defined hyperdense lesion of size 2.9 × 5.3 cm (anteroposterior × thickness) involving the right orbit. Biopsy of the lesion confirmed the presence of epithelioid cells and Langerhans giant cells with caseous material. After surgical debridement with antitubercular treatment, the patient had an uneventful recovery. Conclusion Although rare, tuberculosis can affect the flat bones of the skull. Tuberculosis of the frontal bone can be included in the differential diagnosis of blindness.

Objectives: This study aimed to develop a novel model for detection of extended spectrum beta-lactamase (ESBL), AmpC and metallo-betalactamase (MBL) producing Serratia and Citrobacter species using cefoperazone sulbactam as well as other inducer-substrate combinations in a disc approximation assay. In the absence of molecular tools in developing countries, we attempted to standardize simple phenotypic techniques for detection of beta-lactamases to allow effective patient care in our countries. These techniques have been scarcely used in Serratia and Citrobacter spp., which are emerging as significant pathogens in our region. Methodology: Clinical isolates of Serratia and Citrobacter were tested for ESBL production. Cefoperazone (CP)/cefoperazone sulbactam (CPS), piperacillin (PIP)/piperacillin-tazobactam (TZP) and ceftazidime (CAZ)/ceftazidime-clavulanic acid (CAZ-CLAV) combinations were compared for their ability to detect ESBL producers phenotypically. Multi-drug resistant strains were further tested for detection of inducible/derepressed AmpC mutants by a disc approximation assay. Isolates were screened for MBL production by Imipenem (IMI). MBL production was confirmed using Ethylenediaminetetraacetic acid (EDTA) in a double disc synergy assay and Hodge test. Minimal inhibitory concentration (MIC) was performed for CP, CPS and IMI by agar dilution method for all isolates of Serratia and Citrobacter spp. Results: Thirty-three percent of isolates of Serratia spp. and 35.4% of Citrobacter spp. were ESBL producers. CPS was a more sensitive inducer of ESBL than TZP and CAZ/CAZ-CLAV. AmpC producers were detected in 25.6% of the isolates of Serratia spp. (40% inducible and 60% derepressed mutants) and in 35.4% of the isolates of Citrobacter spp. (33% inducible and 66% derepressed mutants). Six isolates (four class B and two class A) of Serratia and eight isolates (seven class B and one class A) of Citrobacter spp. were MBL producers. Multiple mechanisms co-existed in eight isolates of Serratia and 15 isolates of Citrobacter spp. CPS was more effective in identifying ESBLs and inducible AmpC producers as well as type 1 carbapenemases than TZP and CAZ-CLAV were able to identify inducible AmpC producers. Conclusions: The high prevalence of ESBL, AmpC, and MBL in Serratia and Citrobacter species in this study suggests that detection of these by phenotypic methods in the absence of more specific molecular tests should be actively considered in not only developing countries but also in the developed world as this approach can lead to timely and appropriate antibiotic treatment. CPS may be advised due to the triple advantage of detection of all three types of beta-lactamases.

Stomatococcus mucilaginosus is a Gram-positive, catalase-variable organism considered part of the normal human oral and upper respiratory tract flora. Although traditionally believed to be an organism of low virulence, Stomatococcus mucilaginosus has been reported to be an opportunistic pathogen in immunocompromised patients. We describe what we believe is the first reported case of Stomatococcus mucilaginosus meningitis in a healthy child. The isolate was multidrug-resistant, susceptible only to vancomycin. The patient was treated successfully with vancomycin after initial trials with amikacin and cefotaxime.

Introduction: Tuberculosis (TB) remains a significant public health problem, with an estimated one-third of the world's population being infected. Cytokines play a major role in protection against Mycobacterium tuberculosis ( M. tuberculosis ) infection and regulate the immune responses at a cellular level. Most studies on cytokines during TB are from in vitro -stimulated lymphoid cells with few reports on in vivo plasma levels. The aim of this study was to evaluate the levels of tumor necrosis factor-α (TNF-α) in new, undertreatment (UT), and multidrug-resistant (MDR) pulmonary and extrapulmonary cases. Materials and Methods: The study was conducted in the Department of Microbiology, Jawaharlal Nehru Medical College (J.N.M.C.), Aligarh Muslim University (A.M.U.), Aligarh, Uttar Pradesh, India. Results: The levels of TNF-α were measured in 76 serum samples from TB patients by an enzyme linked immunosorbent assay (ELISA) kit (Diaclone Sas, 1 BD, A Flemming Besancon Cedax, France), along with 10 healthy controls. Complete clinical, radiological and treatment data were collected. The TNF-α levels were elevated in new cases ( P P P > 0.05). Conclusions: An understanding of this response may lead to an insight into the pathogenesis and novel therapies for TB.

Mycobacterium tuberculosis (Mtb) infects approximately one third of world population. Many cytokines are produced during tuberculosis, with predominance of Th1 cytokines during the early stage and Th2 cytokines in the later stages of the infection. Most studies on cytokines during TB are from ‘in vitro’-stimulated lymphoid cells with few reports on in vivo plasma levels. The high expression of IL-4 has been implicated as a virulence factor. In the present study we examined the level of IL-4 in the serum of active tuberculosis in new cases, during anti-tubercular therapy and MDR cases. This Study was conducted at Department Of Microbiology, JNMC, AMU, Aligarh. A total 76 blood samples of Pulmonary & Extra-Pulmonary tuberculosis patients were tested by ELISA (Diaclone France) along with 10 healthy controls. The test was carried out according to the manufacturer instructions. O.D. was taken at 450 nm. There was no stastical difference in age and sex in our study. The level of IL-4 show significant changes in MDR TB cases (P 0.05). An understanding of the development of the cellular immune response may lead to insight into pathogenesis and novel therapies for TB. Further studies are needed to address the role of cytokines in immunity to TB under natural conditions.

Subcutaneous tissue emphysema is observed in a several clinical settings but spontaneous subcutaneous emphysema in the absence of pneumothorax with broncho pleuro subcutaneous fistula is rare. We report a case of spontaneous subcutaneous emphysema secondary to cavitary pulmonary tuberculosis in the absence of pneumothorax.

Background:- Syphilis generally considered to be a sexually transmitted disease, can also be transmitted in utero, and rarely by blood transfusion or non-sexual contact and is characterized by episodes of active disease, interrupted by latency. Congenital syphilis poses a significant challenge especially because infants may be still born, asymptomatic or present with a variable clinical picture at birth. Syphilis has been implicated in increasing susceptibility to HIV infection. We under took this study to determine the seroprevalence of syphilis in a tertiary care setting of Northern India and to identify an association with HIV-infection. Material & Method: - Of the total 19860 samples received during 5 years, VDRL was performed on 19860 samples and TPHA on 65 samples. Results: - 65 (0.33%) were found to be positive by VDRL. The patient’s positive for syphilis included 23 pregnant females (0.15% of the ANC samples received), 14(21.5%) HIV positive patients, 24 were from STD clinic (2.3% of the samples received from STD clinic). Conclusions: - The strong association between syphilis and HIV seroprevelence in this study suggests that acceleration of direct linkages between STI testing and HIV counseling and testing will be useful in enhancing the control of STI and HIV in India.

As compared to aspergilloma which is usually developed after complication of tuberculosis in India, endobronchial aspergilloma is a rare disease entity. We report a rare case of endobronchial aspergilloma which is presented radiologically as a solitary pulmonary nodule. A 24-year-old male presented to the Department of Tuberculosis and Chest Diseases with moderate to severe hemoptysis for the last three months. Chest X-ray (PA view) showed ill-defined homogenous shadow in the right upper zone. CECT Thorax review showed intrabronchial mass in the posterior segment of the right upper lobe. CT-guided FNAC was performed, which reveals Aspergillus hyphae mixed with sputum and necrotic material, without any evidence of malignancy. Fibreoptic bronchoscopy was done, it reveals a ball-like region, occluding partially, the lumen of the posterior segment of right upper lobe with hyperemia. The ball was movable. Biopsy was performed and it revealed a partially eroded lining of metaplastic squamous epithelium, overline of chronically inflamed granulation tissue and scar intermingled with fungal hyphae. Serological test for Aspergillus precipitin was positive. The ball was removed using forceps and basket. Endobronchial aspergilloma may be present as solitary pulmonary nodule on chest X-ray. Bronchoscopic and endobronchial biopsies are invaluable in the diagnosis of endobronchial aspergilloma.

A 24 years old female was presented with a 2 weeks history of fever (high grade), cough, fatigue, shortness of breath, chest pain right side and low back ache. Patient prefers to lie towards right side. CECT thorax reveals empyema thoracic with paravertebral extension. Patient was put on IV antibiotic according to culture and sensitivity. Clinical and Radiological improvement was evident after 1 week.

We are describing a case of idiopathic pulmonary artery aneurysm, which pre­sented to us with complaints of shortness of breath and chest pain. Chest -X ray showed a homogenous opacity occupying left mid and lower zone, CECT thorax revealed a pulmonary artery aneurysm which was compressing the left bronchus and causing atlectasis. The patient was managed surgically

Summary A lung hernia refers to part of a lung pushing through a tear, or bulging through a weak spot, in the chest wall, neck passageway or diaphragm. Lung hernia is a distinctly rare event, regardless of its location and cause. Most lung hernias are acquired traumatic thoracic hernias, most commonly caused by vigorous coughing with a subsequent rib fracture. We report a rare case of lung hernia through the left anterior chest wall in a middle-aged male.