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The aim of this study was to analyze the sociodemographic, clinical, immunologic, and risk factors of drug-resistant (>1000 copies/ml) and virologically suppressed (

A national sample survey of leprosy was undertaken in partnership with Indian Council of Medical Research (ICMR) institutions, National Leprosy Eradication Programme (NLEP), Panchayati Raj members, and treated leprosy patients to detect new cases of leprosy in India. The objectives of the survey were to estimate the new leprosy case load; record both Grade 1 and Grade 2 disabilities in the new cases; and to assess the magnitude of stigma and discrimination prevalent in the society. A cluster based, cross-sectional survey involving all States was used for the door-to-door survey using inverse sampling methodology. Rural and urban clusters were sampled separately. The population screened for detecting 28 new cases in rural and 30 in urban clusters was enumerated, recorded and analyzed. Data capture and analysis in different schedules were the main tools used. For quality control three tiers of experts were utilized for the confirmation of cases and disabilities. Self-stigma was assessed in more than half of the total new patients detected with disabilities by the approved questionnaire. A different questionnaire was used to assess the stigma in the community. A population of 14,725,525 (10,302,443 rural; 4,423,082 urban) was screened and 2161 new cases - 1300 paucibacillary (PB) and 861 multibacillary (MB) were detected. New case estimates for leprosy was 330,346 (95% Confidence limits, 287,445-380,851). Disabilities observed in these cases were 2.05/100,000 population and 13.9 per cent (302/2161) in new cases. Self-stigma in patients with disabilities was reduced, and the patients were well accepted by the spouse, neighbour, at workplace and in social functions.

The extent of pathogenicity of the mycobacterial infections depends on virulence factors that mediate survival inside macrophages. Virulence factors are generally believed to be specific for pathogenic species and mutated/non-functional in nonpathogenic strains. Mycobacterial TlyA can modulate the phagolysosome maturation pathway, immediately after entry into macrophages. Over-expression of open reading frame (ORF) ML1358 (tlyA) in tissues of leprosy patients by partial DNA chip and real time PCR analysis during active infection attracted our interest to explore the properties of this gene at molecular and serological levels, to understand its role in the host. Molecular properties were studied by cloning and expression of the corresponding gene in pASK-iba 43(þ) expression vector in E. coli and bioinformatics tools while sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) and ELISA were applied to investigate the serological significance of rTlyA protein in different clinical states of leprosy. We observed that TlyA has a close relation among mycobacteria with specific protein domains in slow growing intracellular adapted pathogenic species. The presence of trans-membrane domains indicates its association to the cell membrane. The study revealed its highly significant sero-reactivity (P value , 0·001) in borderline lepromatous (BL) patients, and those with reversal reaction (RR) and erythema nodosum leprosum (ENL). Its role in active infection, association with the cell membrane, presence in pathogenic species and high sero-reactivity, suggested the tlyA gene as a strong disease progression marker.

Tuberculosis (TB) is a disease of global importance. There is an increasing recognition of the role of Toll like receptors, important pattern recognition receptors of host immune system, in determining the susceptibility or resistance to TB in various populations. In an attempt to examine the importance of Toll like receptors in immune response to Mycobacterium tuberculosis infection, we explored two variants each of TLR2 and TLR9 in a population residing in Uttar Pradesh, India. Genotyping was performed to detect -196 to -174 del polymorphism and G2258A SNP (Arg753Gln, rs5743708) in TLR2 gene and -T1237C (rs5743836) and G2848A (rs352140) SNP in TLR9 gene in patients with pulmonary TB and healthy controls. The A allele of G2848A SNP in TLR9 gene was found with a marginally higher frequency among TB patients as compared to healthy controls, suggesting that A allele at position 2848 of TLR9 gene may be associated with susceptibility to TB in North Indian population [p = 0.05, Mantel–Haenszel OR = 1.34, 95% CI (1.0–1.82)].

Uttar Pradesh is the fourth largest, most populous and leading milk and meat producing state in India. Despite the huge livestock population, information on the status of paratuberculosis homogeneity and heterogeneity of Mycobacterium avium subspecies paratuberculosis (MAP) isolates of eastern Uttar Pradesh is non-existent. Present study was aimed to estimate the presence of MAP in large ruminants (Cattle and Buffaloes) of eastern Uttar Pradesh. A total 108 fecal samples were collected from farmer’s herds of large ruminants (cattle and buffaloes) from different geographical regions (Chandauli, Mughalsarai, Gazipur, and Naugarh) of eastern Uttar Pradesh and screened for the presence of MAP infection using microscopic examination, direct IS900 PCR and culture on Herrold egg yolk (HEY) medium. The isolates recovered on HEY medium were subjected to molecular identification and genotyping using IS900 PCR and IS1311 PCR-REA method, respectively. Of the 108 fecal samples, 25 (23.14%) and 11 (10.18%) samples were positive for the presence of acid-fast bacilli and growth on HEY medium, respectively. Species-wise, 17.5, 7.5% and 26.5, 11.7% fecal samples from cattle and buffaloes were found positive for the presence of acid-fast bacilli and growth on HEY medium, respectively. Isolates recovered on HEY medium with mycobactin J were positive for IS900 sequence and genotyped as Bison Type using IS1311 PCR-REA method. Present study is the first report on the presence of MAP infection and ‘Bison Type’ genotype of MAP in eastern Uttar Pradesh. These findings will be useful for the intervention of effective control measures in order to reduce the prevalence of MAP infection in domestic livestock species and prevent its spread to the human population in the regions.

This study reports a retrospective analysis of the records of 2709 leprosy patients, attending the Out patient’s Clinic at Agra, over a 1-year period, 2005. The patients with leprosy have been categorized into three groups, viz., regular, irregular and the drop-outs. The number of drop-out patients was significantly higher [Z=2.16, p=0.05] among males, 32.14% (667) when compared with females, 26.50% (168). Religion was not observed to be a significant determinant in the regularity, irregularity and/or drop-out among the patients but the locality/residential background seemed to play a key role in Clinic attendance. Patients from urban areas were less regular 38.9% (218) and the number of irregulars and drop-outs were more, i.e., 24.1% (135) and 37% (207), respectively when compared with the patients from rural areas [X2 =14.894, p=0.00006]. Pauci-bacillary or multibacillary type of leprosy did not appear to be a significant determinant in the regularity, irregularity and / or drop-out among the patients. With regard to the various professions, the number of irregulars and drop-outs among patients engaged in some kind of business seemed to be more. The patients in whom the disease had become inactive, 69.7% (60) seemed to be more regular in clinic attendance than the patients with active leprosy disease. The irregularity and drop-out rate was significantly less [X2=5.107, p=0.078]. In all, 1226 (45.26%) patients were found to be regular in clinic attendance but 648 (23.92%) patients were irregular and 835(30.83%) patients were dropouts. The present study looked at the characteristics and factors responsible for irregular attendance of a large number of patients over a 1-year period, even after 50 years of implementation of the Leprosy Control/elimination programmes. This study is the first of its kind in Northern India.

Background & objectives: The immune responses to different antigens of Mycobacterium tuberculosis H37Rv vary from patient to patient with tuberculosis (TB). Therefore, significant difference might be documented between the H37Rv with long histories of passages and recent clinical isolates of M. tuberculosis. In the present study, immune response of TB patients and healthy controls against 39 clinical M. tuberculosis isolates was correlated with laboratory strain H37Rv. Methods: The antibody response was studied coating whole cell extracts and culture filtrate proteins of M. tuberculosis isolates and laboratory strain H37Rv by enzyme linked immunosorbent assay (ELISA). Lymphoproliferation was studied by incorporation of tritiated thymidine and cytokines (IFN-γ and IL-4) by using commercially available kits. Results: Sero-reactivity to whole cell extract (WCE) of 11 clinical isolates was higher with pooled serum and individual's serum from tuberculosis patients showed significant reactivity (P

Mycobacterium avium subspecies paratuberculosis (MAP) has emerged as a major health problem for domestic livestock and human beings. Reduced per animal productivity of domestic livestock seriously impacts the economics of dairy farming globally. High to very high bioload of MAP in domestic livestock and also in the human population has been reported from north India. Presence of live MAP bacilli in commercial supplies of raw and pasteurized milk and milk products indicates its public health significance. MAP is not inactivated during pasteurization, therefore, entering into human food chain daily. Recovery of MAP from patients with inflammatory bowel disease or Crohn's disease and animal healthcare workers suffering with chronic gastrointestinal problems indicate a close association of MAP with a number of chronic and other diseases affecting human health. Higher bioload of MAP in the animals increases the risk of exposure to the human population with MAP. This review summarizes the current status of MAP infection in animals as well as in human beings and also highlights the prospects of effective management and control of disease in animals to reduce the risk of exposure to human population.

Background: Mood stabilizers are drugs used to steady/balance the mood, and are also used to manage symptoms of aggression and impulsivity. There is disparity in prescription pattern across the globe. Aim: The aim of this study was to observe prescription pattern of mood stabilizers for the treatment of bipolar disorder with or without psychotic symptoms. Materials and Methods: A sample of 100 adult patients was selected to participate in the study. First 5 patients of bipolar disorder with or without psychotic symptoms from twenty out-patient departments of various consultant psychiatrists of Department of Psychiatry (C.S.M. Medical University, Lucknow) were included in the sample. A written informed consent was obtained and survey method was adopted to conduct the study. Results and Conclusion: Lithium was found to be the most frequently prescribed mood stabilizer, sodium valproate ranked second while carbamazepine was least frequently prescribed.

Elimination of tuberculosis (TB) largely depends upon definitive rapid diagnosis and treatment. Widely used diagnostic tests do not qualify for use in a developing country due to lack of either desired accuracy or their cost. In the present study an enzyme-linked immunosorbent assay was used to evaluate the diagnostic potential of an immuno-dominant 30/32-kDa mycolyl transferase complex (Ag85 complex) and Mycobacterium tuberculosis-specific proteins (ESAT-6 and CFP-10) of the RD1 region. Higher sensitivity (84.1%) with Ag85 complex was observed compared with ESAT-6 (64.9%) and CFP-10 (66%), with almost similar specificity (Ag85: 85.2%, ESAT-6: 88.9%, CFP-10: 85.2%), whereas the individual components of Ag85 complex, i.e. Ag85A, Ag85B, and Ag85C, showed sensitivities of 44.6, 34, and 80.9% and specificities of 55.6, 74.1, and 40.7% respectively. A cocktail of Ag85 complex, ESAT-6, CFP-10, Ag85A, Ag85B, and Ag85C antigens also could not help in increasing either sensitivity (51.1%) or specificity (85.2%). Furthermore, immunoblot analysis using clinical isolates as well as a standard strain (H37Rv) of M. tuberculosis also showed strong reactivity of sera from TB patients to Ag85 complex and, to a lesser extent, also to ESAT-6. To conclude, use of Ag85 complex along with ESAT-6 and CFP-10 seems to be promising in minimizing the heterogeneous sero-responses of adult TB cases.