Prevalence of depression and anxiety among drug resistant tuberculosis: A study in North India

BACKGROUND

Drug Resistant Tuberculosis (DR-TB) is an emergent issue in the recent decades. Multidrug resistant (MDR-TB) and Extensive drug resistant (XDR-TB) tuberculosis are the common type of DR-TB. Psychological issues like depression and anxiety are common among the chronic illnesses like tuberculosis. This study aimed at estimating the prevalence of depression and anxiety among these patients.

METHODS

Our study is conducted in a tertiary care teaching hospital in North India. This study aimed at identifying the prevalence of depression and anxiety among the drug resistant tuberculosis patients attending DOTS clinic. The depression and anxiety were screened using PHQ-9 and HAM-A inventories. Binomial and multinomial regression analysis were done to identifying the predictors of depression and anxiety.

RESULTS

The prevalence rate of depression in MDR-TB and XDR-TB is 68% and 78% respectively. The prevalence of anxiety is 54% in MDR-TB and 66% in XDR-TB respectively in our study. Duration of illness and literacy were the significant predictors of depression and anxiety.

CONCLUSION

Patients with DR-TB faces huge psychological burden and this study highlighted the toll of depression and anxiety among them. Adequate screening, identification and treatment for these disorders among DR-TB patients at their earlier treatment stage helps in improving the adherence to treatment and functionality.

Perinatal Complications in Diabetes Mellitus with Pregnancy: Comparison between Gestational Diabetes Mellitus (GDM) and Diabetes Mellitus Prior to Pregnancy

Diabetes is alarmingly high among Bangladeshi people. But there have been very few studies assessing the effect of diabetes on perinatal outcomes, particularly comparing diabetes prior to pregnancy and gestational diabetes (GDM). This cross sectional observational study was conducted in the Department of Obstetrics & Gynaecology, BIRDEM Hospital, Dhaka, Bangladesh from September 2010 to February 2011. Pregnant women admitted in BIRDEM Hospital for delivery after 28 weeks of gestation were selected to assess perinatal complications of GDM and diabetes prior to pregnancy and to compare them after taking permission from institutional review board. Perinatal complications of 50 women with gestational diabetes, 50 pregnant women with diabetes prior to pregnancy, and 50 non diabetic pregnant women as control were studied after taking written consent and the outcomes between GDM, and mother with diabetes prior to pregnancy were compared. Perinatal outcomes including congenital anomalies, birth asphyxia, macrosomia, respiratory distress syndrome (RDS), hypoglycemia, hyperbilirubinaemia, and perinatal mortality were compared. Neonatal complications were significantly higher in both pregnancy with prior diabetes (74%) and gestational diabetes (58%) when compared with non diabetic control (24%). Leading neonatal complications were macrosomia, birth asphyxia, hyperbilirubinaemia, and hypoglycemia. Macrosomia was significantly higher in GDM than non diabetic group (10% vs. 0%, p=0.003). Frequency of birth asphyxia, hyperbilirubinaemia, and hypoglycemia were significantly higher in the infant of mother with prior diabetes (22%, 54%, & 22% respectively) and GDM (20%, 38%, 18% respectively) than that of non diabetic mother (6%, 20%, 0% respectively). Compared to GDM, mother with prior diabetes had more frequent hyperbilirubinaemia (38% vs. 54%, p=0.004) and hypoglycemia (18% vs. 22%, p=0.04). Women with diabetes had worse pregnancy outcomes compared to non-diabetic mothers. Pregnancy prior to diabetes is associated with more frequent complications than gestational diabetes.

Multiple antibiotic resistance among gram negative bacteria isolated from milk in Karachi

A total of 100 Gram negative bacteria isolated from milk in Karachi were screened for their resistance to eleven commonly used antibiotics. The concentration of antibiotics used was 100 microg/ml. About 46% were found to resist antibiotics at the concentration of 100 microg/ml giving different patterns. The resistant bacteria were tested for the presence of R plasmids, both transferable and non-transferable, by conjugation, spontaneous segregation and curing with acridine orange and ethidium bromide. Among the resistant bacteria tested, eight were found to carry non-transferable R plasmids.

A survey of antibiotic resistance among E. coli strains isolated from poultry in Karachi

Studies were carried out to investigate the incidence of multiple antibiotic resistance among E .coli (total 152) isolated from poultry in Karachi to eight commonly used antibiotics: ampicillin (A), chloramphenicol (C), gentamycin (G), anamycin (K), neomycin (N), polymyxin B (P), streptomycin (S) and tetracycline (T) at the levels of 50 microg/ml, 100 microg/ml and 500 microg/ml. Tables of the results are given, showing the number of resistant strains of different patterns of antibiotic resistance at different levels. A comparison of antibiotic resistance to different number of antibiotics and the frequency of resistance to individual antibiotic at different levels is also reported. The highest frequency of resistance was against tetracycline whereas the lowest frequency of resistance was against gentamycin. Thirty R plasmids were isolated from the resistant strains and will be reported elsewhere.

Colicin production/resistance associated with R-plasmids of Gram negative bacteria isolated from poultry in Karachi

R plasmids of Gram negative bacteria isolated from poultry in Karachi were studied for their properties of colicin production and resistance. Of 39 R plasmids studied, 23 resisted colicin where as only one R-plasmid produced colicin.

Curing of R plasmids present in gram negative bacteria isolated from poultry in Karachi by ethidium bromide

R plasmids of Gram negative bacteria isolated from poultry in Karachi were studied for their curing by ethidium bromide (EBr) in E. coli AB 712. Of 12 R plasmids studied, 3 were lost by treatment with ethidium bromide.

Prolonged stability of R plasmids KR61 and KR61-A in Salmonella host

The R plasmids, KR61 and KR61-A, that were originally isolated from a clinical strain of Aerobacter aerogenes in 1971 and determined resistance to kanamycin (Km), neomycin (Nm), streptomycin (Sm), tetracycline (Tc); and ampicillin (Ap) respectively were found stable in Salmonella typhimurium LT2 even after 22 years of cultivation on antibiotic free media. KR61, carrying resistance to KmNmSmTc, not only maintained all its resistances but also maintained its conjugal transferability (RTF) as indicated by its subsequent transfer to Escherichia and Salmonella hosts. KR61-A that carried resistance to Ap and lacked an RTF could be mobilized by KR61 from S. typhimurium LT2, constructed to bear KR61-A and KR61, to E. coli recipients. S. typhimurium LT2 carrying KR61-A + KR61 (ApKmNmSmTc), showed the characteristic conjugal transfer of resistances in following three patterns: (i) Ap, (ii) KmNmSmTc and (iii) ApKmNmSmTc. The findings reported here are based on conjugal isolation of plasmids. Physical isolation of KR61 and KR61-A was never made.

Multiple antibiotic resistance among gram negative bacteria isolated from poultry

Gram negative bacteria, including species of Salmonella, Escherichia, Pseudomonas and Klebsiella, isolated from poultry, were screened for their resistance to the commonly used antibiotics: ampicillin, chloramphenicol, gentamycin, kanamycin, neomycin, polymyxin B, streptomycin and tetracycline. Of the 500 bacteria screened, 351 were found to be resistant to one or more antibiotics at the level of 50 micrograms/ml. Various patterns of antibiotic resistance observed during these studies have been reported.

Histochemical enzyme pattern of microfilaria of Setaria cervi

The present study deals with the histochemical localization of glucose-6-phosphatase, malic dehydrogenase and aldolase in the microfilaria of Setaria cervi. Marked activity of glucose-6-phosphatase was observed in the cephalic cells, excretory and anal pores, G-cells and Innenkörper. Malic dehydrogenase activity was noted throughout the body (including cuticle) of the microfilaria except for Innenkörper. Intense aldolase activity was observed in the excretory pore and G-cells only. Muscle cells and anal pore were negative for this enzyme.

Serum protein changes and their correlation with antibody production in rabbits following induced Setaria cervi infection

The sera obtained from normal control and Setaria cervi infected rabbits were analysed weekly both qualitatively and quantitatively. Electrophoretic studies as well as biochemical estimation reveal an increase in total protein and globulin and a decrease in albumin level. The changes were more marked in the third week, followed by a declining phase reaching an almost normal level by the sixth week. The increased globulin level analysed electrophoretically also coincided with the appearance of 2 precipitin arcs in immunoelectrophoretic analysis indicating a correlation between antibody production and hyperglobulinaemia.

Effect of anthelmintics on the enzyme activities of Setaria cervi (Nematoda: Filarioidea)

The present study deals with the comparative efficacy of Hetrazan, levamisole and tetramisole on the enzyme activities of adult Setaria cervi worms. The drugs were administered orally to white rats, intraperitoneally infected with the bovine filariid, Setaria cervi. Biochemical assays revealed the decreased activities of glucose-6-phosphatase, fructose-1,6-diphosphatase, lactate dehydrogenase and adenosine triphosphatase in the drug-treated worms. Hetrazan was relatively more effective than tetramisole and levamisole. A possible role of these enzymes in the energy supply and survival of the worm has been briefly discussed.

Low level and high level DNA rearrangements in Escherichia coli

It can be argued that all organisms exhibit two levels of DNA rearrangements. At a low level they may occur sporadically in cells, perhaps largely because of spontaneous activity of transposable genetic elements. A high level may be induced in special circumstances if functions that cause rearrangements are hyperactive. As an example of low level genetic rearrangements, we have studied the occurrence of spontaneous polar mutations in the early regions of prophage Mu. We isolated 49 independent prophage mutants, which are defective in replication ad expression of late genes; 44 were in the B region and 5 were in the A region. In the B region, 68% were IS1 insertions, 9% were IS5 insertions and 9% were IS2 insertions; 14% showed no insertion. In the A region, all 5 were IS5 insertions. Thus most spontaneous polar mutations in Escherichia coli appear to the insertions. IS1 is the most common insertion; however, certain DNA rearrangements are exemplified by DNA fusion and DNA dissociation that occur when replication-transposition functions of Mu are induced.

Single dose piperazine therapy for Ascaris lumbricoides: an unsuccessful method of promoting growth

One-hundred eighty-five Bangladeshi children age 1 1/2 to 8 yr with no Ascaris lumbricoides infection or with light, moderate, or heavy infection were randomly assigned to treatment of placebo groups, with treatment given in a double-blind fashion. The groups were comparable for nutritional and socioeconomic parameters. Treatment consisted of a single dose of piperazine citrate administered twice within a 2-wk period. The cure rates for the low, moderate, and heavy A. lumbricoides infected subgroups were 53, 31, and 36%, respectively. With more severe infections, worm eradication was more difficult and the rate of reinfection after treatment was more rapid. The rate of reinfection was significantly different for the low A. lumbricoides infected treatment and placebo subgroups for 5 months after treatment, for the moderate treatment and placebo subgroups for 3 months after treatment, and for the heavy A. lumbricoides infected treatment and placebo subgroups there was a difference, although not significant, for 1 month after treatment. Anthropometric measurements were obtained for a period of 11 months. Analysis of covariance revealed no significant difference for change of weight, change of height, weight-for age, weight-for-height, height-for-age, triceps skinfold, midarm circumference, and the abdominal girth to chest circumference ratio between the treatment and placebo groups after drug administration. The results of this study do not support single dose worm therapy as a means to enhance growth.

DNA rearrangements associated with reversion of bacteriophage Mu-induced mutations

Excision of transposable genetic elements from host DNA is different from the classical prophage lambda type of excision in that it occurs at low frequency and is mostly imprecise; only a minority of excision events restores the wild-type host sequences. In bacteriophage Mu, a highly efficient transposon, imprecise excision is 10-100 times more frequent than precise excision. We have examined a large number of these excision events by starting with mucts X mutants located in the Z gene of the lac operon of Escherichia coli. Mucts X mutants are defective prophages whose excision occurs at a measurable frequency. Imprecise excision was monitored by selecting for melibiose+ (Mel+) phenotype, which requires only a functioning lacY gene. Mel+ revertants exhibit an array of DNA rearrangements and fall in four main classes, the predominant one being comprised of revertants that have no detectable Mu DNA. Most of these revertants can further revert to Lac+. Perhaps 5 base-pair duplications, originally present at prophage-host junctions, are left in these lacZ-Y+ revertants, and they can be further repaired to lacZ+. Another class has, in addition to the loss of Mu DNA, deletions that extend generally, but not always, to only one side of the prophage. The other two classes of revertants, surprisingly, still have Mu DNA in the lacZ gene. One class has deletions in the Z gene, whereas, no deletions can be detected in the other. Many of the revertants in the last class can further revert to lacZ+, indicating that the lacY gene must have been turned on by a rearrangement within Mu DNA. Apparently, all of the detectable precise and most of the imprecise excision events require functioning of the Mu A gene. We suggest that a block in large-scale Mu replication allows the excision process to proceed.

Bacteriophage Mu-induced modification of DNA is dependent upon a host function

The DNA of bacteriophage Mu, extracted from induced lysates, is partially resistant to digestion by the endonuclease BalI. This modification of DNA is controlled by the Mu modification function (mom), which acts in conjunction with the dam (DNA-adenine methylation) function of Escherichia coli. Since the BalI recognition site is apparently different from the dam recognition site, these results imply that either the specificity of the dam function is changed by the mom function or the mom function requires the dam function for its activity.

Genetic properties of RM 98, an R plasmid of Salmonella which determines sensitivity to the phage IKe

An R plasmid of Salmonella, RM98, which determines sensitivity ot the phage IKe (IKeS) and confers resistance to ampicillin (Ap), streptomycin (Sm) and tetracycline (Tc) was studied for its genetic properties in Salmonella typhimurium and Escherichia coli, Transduction of RM98 by P22 in Salmonella yielded transductants of which some had acquired all the recognizable markers (Ap, Sm, Tc, IKeS and resistance transfer factor or RTF) associated with RM98. This transduction pattern resembles the P22 transduction pattern of IKe-specific R plasmids: R45, R46, R48, R205 and N3. Preliminary genetic analysis of RM98 has indicated that the determinants of IKeS and RTF are closely linked and the determinants of Ap and Sm are closer to RTF-IKeS than they are to Tc.

Stable coexistence of Rfi factors in Escherichia coli

Strains of Escherichia coli K12 constructed to bear combinations of pairs of Rfi− factors originating from other strains, have been found to maintain them stably in antibiotic-free media. Compatibility between these factors of the same fi type, which were all able to propagate a phage specific for one of them, was inferred from the absence of entry exclusion for the donor factor and their ability to coexist in the same cell without any selective pressure. The findings reported here indicate heterogeneity among this group of Rfi− factors. This conclusion is further supported by observations that some pairs of these Rfi− factors show no evidence of recombination.