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Heavy metal content in water, sediment, and tissues of six commonly used edible fishes from Adyar estuary, southeast coast of India, was assessed for metal bioaccumulation. The enrichment of metals in estuarine sediment is due to the discharge of contaminated water from the Chennai Metropolis. The enrichment factor indicated that metals such as Cr (EF=30.9) and Cu (EF=31.9) are highly enriched and fall under the very severe category. Bioaccumulation factor (BAF) revealed that the concentration of heavy metals viz. Ni, Cr, Pb, Cu, Co, Zn, Fe, and Mn in different tissues of fishes was several times higher than their concentrations in water. Moreover, high concentration of heavy metals, especially Cu and Cr was noticed in the muscle and liver tissues of the fishes which are higher than the WHO standards. Among the studied fishes, Arius parkii and Gerres oyena showed higher levels of bioaccumulation in terms of toxic metals. • Heavy metals in fish tissues, water and sediment from Adyar estuary was assessed. • Enrichment factor revealed metals like Cr and Cu are highly enriched. • Sources from geogenic and anthropogenic origin are the cause for contamination. • Arius parkii and Gerres oyena shows higher level of metal bioaccumulation. [ABSTRACT FROM AUTHOR]

Background: Drug-resistant tuberculosis (DR-TB) is one of the challenging forms of TB to treat, not only in adults but also in children and adolescents. Further, there is a void in the treatment strategy exclusively for children due to various reasons, including paucity of pharmacokinetic (PK) data on anti-TB drugs across the globe. In this context, the present study aimed at assessing the PK of some of the anti-TB drugs used in DR-TB treatment regimens., Method: A multicentre observational study was conducted among DR-TB children and adolescents (n = 200) aged 1-18 years (median: 12 years; IQR: 9-14) treated under programmatic settings in India. Steady-state PK (intensive: n = 89; and sparse: n = 111) evaluation of moxifloxacin, levofloxacin, cycloserine, ethionamide, rifampicin, isoniazid and pyrazinamide was carried out by measuring plasma levels using HPLC methods., Results: In the study population, the frequency of achieving peak plasma concentrations ranged between 13% (for rifampicin) to 82% (for pyrazinamide), whereas the frequency of suboptimal peak concentration for pyrazinamide, cycloserine, moxifloxacin, levofloxacin and rifampicin was 15%, 19%, 29%, 41% and 74%, respectively. Further, the frequency of supratherapeutic levels among patients varied between 3% for pyrazinamide and 60% for isoniazid. In the below-12 years age category, the median plasma maximum concentration and 12 h exposure of moxifloxacin were significantly lower than that of the above-12 years category despite similar weight-adjusted dosing., Conclusions: Age significantly impacted the plasma concentration and exposure of moxifloxacin. The observed frequencies of suboptimal and supratherapeutic concentrations underscore the necessity for dose optimization and therapeutic drug monitoring in children and adolescents undergoing DR-TB treatment., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Estimating the burden of TB at the subnational level is critical to planning and prioritizing resources for TB control activities according to the local epidemiological situation. We report the experiences and operational challenges of implementing a TB prevalence survey at the subnational level in India. Information was collected from research reports that gathered data from periodic meetings, informal discussions with study teams, letters of communication, and various site visit reports. During the implementation of the survey, several challenges were encountered, including frequent turnover in human resources, lack of survey participation and community engagement, breakdown of X-ray machines, laboratory issues that delayed sputum sample testing, delays in X-ray reading, and network and Internet connectivity issues that impeded data management. To help ensure the survey was implemented in a timely manner, we developed several solutions, including planning ahead to anticipate challenges, ensuring timely communication, having a high commitment from all stakeholders, having strong team motivation, providing repetitive hands-on training, and involving local leaders to increase community engagement. This experience may help future states and countries that plan to conduct TB prevalence surveys to address these anticipated challenges and develop alternative strategies well in advance., (© Giridharan et al.)

Recurrent Tuberculosis patients contribute to a significant proportion of TB burden in India. A nationwide survey was conducted during 2019-2021 across India among adults to estimate the prevalence of TB. A total of 322480 individuals were screened and 1402 were having TB. Of this, 381 (27.1%) had recurrent TB. The crude prevalence (95% CI) of recurrent TB was 118 (107-131) per 100,000 population. The median duration between episodes of TB was 24 months. The proportion of drug resistant TB was 11.3% and 3.6% in the recurrent group and new TB patients respectively. Higher prevalence of recurrent TB was observed in elderly, males, malnourished, known diabetics, smokers, and alcohol users. (p<0.001). To prevent TB recurrence, all treated tuberculosis patients must be followed at least for 24 months, with screening for Chest X-ray, liquid culture every 6 months, smoking cessation, alcohol cessation, nutritional interventions and good diabetic management., Competing Interests: The authors have no conflict of interest to declare., (Copyright: © 2023 Giridharan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

A pilot study with a mixed-methods design was conducted to estimate the time for tuberculosis (TB) treatment initiation and associated factors among children with central nervous system-TB (CNS-TB). A total of 38 children were enrolled for the quantitative component, and 20 in-depth interviews were conducted. The median duration (interquartile range) from onset of symptoms to treatment initiation was 23 (11, 55) days. About 44% and 31% of the children presented with Stage II and Stage III of CNS-TB, respectively. The major reasons for delay were symptoms not taken seriously (50%) and too many referrals (21%). About 89% of the families went into catastrophic health expenditure due to the disease. The treatment delay may be due to both patient delay and health system delay. Tailoring approaches to target the pediatric population could further improve early detection and treatment initiation of CNS-TB., Competing Interests: None

Background: Airborne infection control (AIC) is a less focused aspect of tuberculosis (TB) prevention. We describe AIC practices in primary health care centres, awareness and practices of AIC among health care providers (HCPs) and TB patients. We implemented a package of interventions to improve awareness and practices among them and assessed its impact., Methodology: The study used a quasi-experimental study design. A semi-structured checklist was used for health facility assessment and a self-administered questionnaire of HCPs. Pre- and postintervention assessments were made in urban primary health centers (UPHCs), HCPs, and patients. Interventions included sharing facility-specific recommendations, AIC plans and guidelines, HCP training, and patient education. Statistical difference between the two time periods was assessed using the Chi-square test., Results: A total of 23 and 25 UPHCs were included for pre- and postintervention assessments. All 25 centers participated in interventions. Open areas were >20% of ground area in all facilities. No AIC committee was present in any of the facilities at both pre- and postintervention. Of all HCPs, 7% (23/337) versus 65% (202/310) had undergone AIC training. Good awareness improved from 24% (81/337) to 71% (220/310) after intervention (P < 0.001). Appropriate cough hygiene was known to 20% (51/262) versus 58% (152/263) patients at two assessments (P < 0.001)., Conclusion: Comprehensive intervention, including supportive supervision of health centers, training of HCPs, and patient education, can improve AIC practices.

SETTING: TBM-KIDS is a phase I/II trial enrolling children with tuberculous meningitis (TBM) in three tertiary referral centers in India and Malawi. OBJECTIVE: To describe the challenges encountered in conducting the first randomized clinical trial of antimicrobial agents in pediatric TBM. DESIGN: The sources of the data were primarily monthly trial reports, non-enrollment case report forms, study diaries and registers maintained for recruitment, experiences shared by key team members during regular study calls and comments from site review visits. We reviewed, broadly categorized, and describe in detail the challenges encountered by study teams in trial implementation. RESULTS: Over 17 months, 3371 children with clinical presentations consistent with meningoencephalitis or undergoing lumbar puncture were assessed for eligibility; 21 (<1%) met enrollment criteria. We encountered challenges related to diagnosis, management of sick children, large catchment areas, adverse event attribution, concomitant medications, infrastructure requirements, expensive pediatric formulations with short expiry, and detection of treatment response in a highly variable disease across the age continuum. Training and adaptation of tools for neurocognitive and neurologic function assessment were necessary. Special care was undertaken to explain study participation to distraught caregivers and manage children longitudinally. CONCLUSION: Interventional trials in pediatric TBM are challenging but are critically important for improving the treatment of a disease that disables children physically, cognitively and emotionally. Sharing these challenges may help to address them more effectively as a TB research community and to advance treatments for this at-risk population.

A multiplex PCR (mPCR) for the differentiation of Indian FMDV serotypes, O, A, Asia 1 and C was developed and evaluated on 142 clinical and 39 cell culture samples. On the latter samples both the tests worked well with 100% efficiency, whereas on clinical samples mPCR had better efficiency than ELISA. The test was found to be specific for FMDV. The detection limit of the assay was varied among the serotypes; it was most sensitive on types A and Asia 1 and least sensitive on type C. The mPCR clearly identified the serotype and in some cases detected dual infections. The test is sensitive and reliable and can be used for serotyping of ELISA negative samples.