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Introduction: Cardiothoracic surgery is a complex and highly specialized medical field requiring precise surgical techniques and meticulous patient management. One critical aspect of this type of surgery is the accurate placement of the endobronchial double-lumen tube (DLT), which facilitates lung isolation and one-lung ventilation (OLV) during the procedure. Proper positioning of the DLT is essential to ensure adequate oxygenation, prevent complications, and optimize surgical access. Objective: This study aimed to compare the accuracy of positioning of the left DLT by the auscultation method versus the lung ultrasound technique in patients undergoing cardiothoracic surgery in both supine and lateral positions. Material and methods: A prospective, observational, and cross-sectional study was conducted in a single group of 62 patients based on the eligibility criteria. After general anesthesia, a DLT was inserted and rotated until resistance. Placement was confirmed by auscultation, ultrasound, and fibreoptic bronchoscopy. The evaluation process was done initially in a supine position, followed by a lateral position. Results: After insertion of the left DLT, initially evaluated in the supine position, sensitivity and specificity for auscultation were found to be 65.2% and 37.5%, respectively, sensitivity and specificity for ultrasonography were 82.6% and 75%, respectively. The accuracy of lung ultrasound at 80.7% (69.2%-88.6%) was higher than the accuracy of auscultation at 58.1% (45.7%-69.5%). This was followed by evaluation in lateral position, where sensitivity and specificity for auscultation were found to be 76.1% and 25% respectively, sensitivity and specificity for ultrasonography were 95.7% and 62.5%, respectively. The accuracy of lung ultrasound at 87.1% (76.6%-93.3%) was higher than the accuracy of auscultation at 62.9% (50.5%- 73.8%). Conclusion: Lung ultrasound is a superior method for assessing lung isolation and determining Double Lumen Tube position as compared to auscultation.

Objective: Laryngoscopy and intubation produce sympathoadrenal response posing risk especially in cardiac patients due to arrhythmias, myocardial ischemia increasing morbidity and mortality. Our aim is to compare lidocaine, fentanyl and dexmedetomidine in attenuation of this response in cardiac surgery patients. Material and Methods: Ninety patients were allocated into 3 groups of 30 participants each. Group A obtained 1µg/kg Dexmedetomidine for 10 minutes before laryngoscopy. Group B 1.5mg/kg of Lidocaine and Group C 2µg/kg Fentanyl 90 seconds before intubation. Hemodynamic parameters like Heart rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Rate Pressure Product (RPP) were noted before intubation and 1,3,5,10 and 15 minutes after intubation. Statistical analysis was done using Epi info version 7.2.1.0 statistical software (Chi square test, ANOVA test). Results: Dexmedetomidine had significant reduction in SBP at 1st (p-value=0.003), 5th, 10th and 15th (p-value0.05). Conclusion: Dexmedetomidine 1µg/kg given as 10 min infusion before laryngoscopy was more effective than fentanyl and lidocaine in blunting hemodynamic response to laryngoscopy and intubation in cardiac surgery patients. However due to significant hypotension associated with dexmedetomidine, it has to be used with caution in these patients.

Background: Obtaining central venous access is the basic requirement in patients undergoing cardiac surgery. Use of ultrasound (USG) for accessing IJV cannulation, improves the success rate and reduces the number of complications that may arise due to blind approach. Through this study we aimed to compare landmark vs real time USG guided IJV cannulation techniques. Methods: 190 adult patient’s undergoing cardiac surgery were randomly divided into two groups of 95 each. Patients in Group A (Landmark based approach) were being compared to Group B (USG based) in terms of – success rate, first attempt success rate, total cannulation time, number of attempts, complications and success rate among residents and consultants. Results: Success rate obtained in Group A was 89.4% compared to 100% in group B (P = 0.001). First attempt success rate was 67.36% in group A and 91.57% in group B (P < 0.001). Group B showed less number of attempts. Total cannulation time in group A (252.2 ± 66.4) sec was significantly higher (P

Background: Monitoring the depth of Anesthesia using Entropy modality is essential and resourceful as it allows for more accurate hypnotic drug administration and decreased anesthetic drug consumption and shortens the recovery time. This study was performed to evaluate the effect of entropy monitoring on Sevoflurane consumption in patients undergoing Off Pump Coronary Artery Bypass Graft Surgery. Methods: A total of 60 patients of ages between 40 – 70 years and of either sex with American Society of Anesthesiologist (ASA) grade 2 and 3, planned for Off Pump Coronary Artery Bypass Graft Surgery were randomly allocated to two groups in this Randomized Controlled Trial. In the control group i.e. Group B, Sevoflurane was titrated according to changes in clinical parameters (Heart Rate (HR) and Blood Pressure (BP) changes within 20% of baseline values) and in the study group i.e. Group A, Sevoflurane was titrated to maintain State Entropy (SE) values between 40-60 accordingly. Response Entropy (RE) and State Entropy (SE) values were continuously recorded in both the groups but were displayed on the monitor only in the study group and were not displayed to the anesthesiologist in the control group. The entropy values, Sevoflurane Consumption and recovery times were compared amongst the two groups. Patients in both the groups were ventilated on Volume Control Mode of ventilator with 100% oxygen @ 2L/min. Results: There were no significant results in terms of age, sex, ASA Grade and NYHA Grade amongst the two groups. Sevoflurane consumption and time of recovery were significantly reduced in the study group i.e. Group A than the Control group i.e. Group B (p value

IntroductionDiabetes is a potent risk factor for the activation of latent tuberculosis and worsens the tuberculosis (TB) treatment outcome. The major reason for mortality and morbidity in diabetic patients is due to their increased susceptibility to TB. Thus, the study was conducted to understand the crosstalk between M. tuberculosis and its host upon latent tuberculosis infection and under hyperglycemic conditions or diabetes.MethodsAn animal model was employed to study the relationship between latent tuberculosis and diabetes. BCG immunization was done in mice before infection with M. tuberculosis, and latency was confirmed by bacillary load, histopathological changes in the lungs and gene expression of hspX, tgs1, tgs3 and tgs5. Diabetes was then induced by a single high dose of streptozotocin (150 mg/kg body weight). Host factors, like various cytokines and MMPs (Matrix metalloproteinases), which play an important role in the containment of mycobacterial infection were studied in vivo and in vitro.ResultsA murine model of latent TB was developed, which was confirmed by CFU counts (200 mg/dl. An in vitro study employing a THP-1 macrophage model of latent and active tuberculosis under normal and high glucose conditions showed that dormant bacilli were better contained in the presence of 5.5 mM glucose concentration as compared with active bacilli. However, the killing and restriction efficiency of macrophages decreased, and CFU counts increased significantly with an increase in glucose concentration.DiscussionThe decreased levels of MCP-1, decreased expression of mmp-9, and increased expression of mmp-1 in the latent group at high glucose concentrations could explain the failure of granuloma formation at high glucose conditions.

Abstract The evidence of an association between diabetes and latent tuberculosis infection (LTBI) remains limited and inconsistent. Thus, the study aims to delineate the role of diabetes in activation of latent tuberculosis infection. Murine model of latent tuberculosis and diabetes was developed, bacillary load and gene expression of resuscitation promoting factors (rpfA-E) along with histopathological changes in the lungs and spleen were studied. Treatment for LTBI [Rifampicin (RIF) + Isoniazid (INH)] was also given to latently infected mice with or without diabetes for 4 weeks. Diabetes was found to activate latent tuberculosis as the colony forming unit (CFU) counts were observed to be > 104 in lungs and spleen. The gene expression of hspX was downregulated and that of rpfB and rpfD was observed to be upregulated in latently infected mice with diabetes compared to those without diabetes. However, no significant reduction in the CFU counts was observed after 4 weeks of treatment with RIF and INH. Diabetes helps in the progression of LTBI to active disease mainly through altered expression of resuscitation promoting factors rpfB and rpfD, which can serve as important targets to reduce the shared burden of tuberculosis and diabetes.

Background: Off-pump coronary artery bypass grafting (OPCABG) is associated with hemodynamic fluctuations which usually require the use of various vasoactive drugs like norepinephrine and phenylephrine The aim of this study was to evaluate the effect of low dose vasopressin on hemodynamics in patients undergoing Off-pump Coronary Artery Bypass Graft Surgery (OPCABG). Methods: Sixty patients undergoing elective Off pump coronary artery bypass grafting (CABG) having triple vessel coronary artery disease (CAD). were randomly divided into two groups: group A (n=30), patients received Vasopressin 0.03 IU/min via infusion pump (diluted in 50 ml syringe) during the LIMA extraction and continued till the end of surgery; group B (n==30), patients received normal saline infusion pump during the LIMA extraction and continued till the end of surgery. The anesthetic technique was the same in both the groups. Hemodynamic parameters were recorded at various time intervals during the surgery. Results: HR, CO and CI were lower and MAP, SVR and SVRI were higher in vasopressin group. CVP was stable with no significant difference in SV and SVV. Conclusion: To achieve better intra operative hemodynamic stability during the triple vascular coronary anastomosis and to cope up with post-operative vasodilatory shock, low dose vasopressin infusion is a safe option.

Objective: The objective of the study is to know type of hypertension affecting pregnant women and impact on perinatal outcome. Subject and Methods: This is a prospective cohort study; 120 women with hypertensive disorders of pregnancy (HDP) at gestation ≥28 weeks who delivered in our institute were enrolled. Sociodemography, gestational age, mode of delivery, APGAR, birth weight, fetal growth restriction (FGR), and perinatal outcome were recorded. Mean ± standard deviation or proportions, analysis of variance, Chi-square test, and odds ratio were used for statistical analysis. Results: Preeclampsia (PE) was most prevalent hypertensive disorder of pregnancy (44.2%), followed by eclampsia (27.50%), gestational hypertension (23.3%), and chronic hypertension (CH) (5.0%). In PE group, 61.8% had FGR, 65.5% newborns were preterm, 74.6% had low birth weight, and 54.1% needed neonatal intensive care unit (NICU) admission. In eclampsia group, 42.9% had fetal growth restriction, 65.7% preterm, 80% low birth weight, and 78.6% NICU admission. PE women delivered more fetal growth-restricted babies with odd ratio of 2.37 (95% confidence interval [CI]: 1.15, 4.9) and at lower gestation with odd ratio of 2.00 (95% CI: 0.95, 4.21). Eclampsia group had more newborn with low APGAR 1 min, NICU admissions, and those requiring ventilator with odds ratio of 3.10 (95% CI: 1.37, 7.03), 4.48 (95% CI: 1.64, 12.24), and 4.09 (95% CI: 1.6, 10.46), respectively. Perinatal mortality was 10, 9, and 2 in eclampsia, PE, and gestational hypertension groups, respectively, with overall rate of 16.9%. PE and eclampsia comprised 71.70% of HDP but contributed 90.5% of all perinatal deaths. Conclusion: Preeclampsia-eclampsia is associated with increased risk of adverse perinatal outcomes as compared to gestational and CH, necessitating screening, vigilant antenatal care, timely intervention, and referral.

Mycobacterium tuberculosis has the potential to escape various cellular defense mechanisms for its survival which include various oxidative stress responses, inhibition of phagosome-lysosomes fusion and alterations in cell death mechanisms of host macrophages that are crucial for its infectivity and dissemination. Diabetic patients are more susceptible to developing tuberculosis because of impairement of innate immunity and prevailing higher glucose levels. Our earlier observations have demonstrated alterations in the protein profile of M. tuberculosis exposed to concurrent high glucose and tuberculosis conditions suggesting a crosstalk between host and pathogen under high glucose conditions. Since high glucose environment plays crucial role in the interaction of mycobacterium with host macrophages which provide a niche for the survival of M. tuberculosis, it is important to understand various interactive mechanisms under such conditions. Initial phagocytosis and containment of M. tuberculosis by macrophages, mode of macrophage cell death, respiratory burst responses, Mycobacterium and lysosomal co-localization were studied in M. tuberculosis H37Rv infected cells in the presence of varied concentrations of glucose in order to mimic diabetes like conditions. It was observed that initial attachment, phagocytosis and later containment were less effective under high glucose conditions in comparison to normal glucose. Mycobacterium infected cells showed more necrosis than apoptosis as cell death mechanism during the course of infection under high glucose concentrations. Co-localization and respiratory burst assay also indicated evasion strategies adopted by M. tuberculosis under such conditions. This study by using THP1 macrophage model of tuberculosis and high glucose conditions showed immune evasion strategies adapted during co-pathogenesis of tuberculosis and diabetes.

Context: Local anesthetic wound infiltration is employed as a part of multimodal analgesia to reduce opiate consumption and pain after lower segment cesarean section (LSCS). Additional blockade of pain pathway at spinal level by ketamine prolongs the duration of analgesia. Aims: To compare analgesic efficacy of subcutaneous wound infiltration of levobupivacaine or levobupivacaine plus ketamine following LSCS. Material and Methods: Randomized double blind study was conducted on 60 parturients undergoing LSCS under spinal anesthesia. Group A received surgical wound infiltration with 0.5% levobupivacaine 2 mg/kg body weight and Group B parturients were infiltrated with 0.5% levobupivacaine plus ketamine 1 mg/kg body weight diluted with normal saline. Postoperative pain scores, time to first rescue analgesia (FRA), hemodynamic parameters, and total opioid analgesic consumption were assessed. Results: Pain free period and time to FRA was 1.5 hours later in group B, which also had reduced mean VAS scores. In addition, the overall pain scores and total opioid consumption were significantly less (P = 0.003) in Group B. Only 50% in Group B and 97% parturients in Group A needed rescue analgesia. Patient satisfaction score was statistically superior in Group B (P = 0.009). Incidence of nausea and vomiting was comparable between the groups (P = 0.554). Conclusions: Addition of ketamine to levobupivacaine for surgical wound infiltration prolongs the analgesia duration, improves patient satisfaction, and decreases 24-hour opioid consumption.

BackgroundDiabetes is an important risk factor for developing tuberculosis. This association leads to exacerbation of tuberculosis symptoms and delayed treatment of both the diseases. Molecular mechanism and biomarkers/drug targets related to copathogenesis of tuberculosis and diabetes are still poorly understood. In this study, proteomics based 2D-MALDI/MS approach was employed to identify host signature proteins which are altered during copathogenesis of tuberculosis and diabetes.MethodsComparative proteome of human peripheral blood mononuclear cells (PBMCs) from healthy controls, tuberculosis and diabetes patients in comparison to comorbid diabetes and tuberculosis patients was analyzed. Gel based proteomics approach followed by in gel trypsin digestion and peptide identification by mass spectrometry was used for signature protein identification.ResultsTotal of 18 protein spots with differential expression in tuberculosis and diabetes copathogenesis (TBDM) patients in comparison to other groups were identified. These proteins belonged to four functional categories i.e. structural, cell cycle/growth regulation, signaling and intermediary metabolism. These include Vimentin, tubulin beta chain protein, Actin related protein 2/3 complex subunit 2, coffilin 1 (Structural), PDZ LIM domain protein, Rho-GDP dissociation inhibitor, Ras related protein Rab (signaling), superoxide dismutase, dCTPpyrophosphatase 1, Transcription initiation factor TFIID subunit 12, three isoforms of Peptidylprolylcis-trans isomerase A, SH3 domain containing protein (metabolism), three isoforms of Protein S100A9 and S100A8 (cell cycle progression/growth regulation).ConclusionProteins identified to be differentially expressed in TBDM patient can act as potent biomarkers and as predictors for copathogenesis of tuberculosis and diabetes.

Background: Intraocular tuberculosis (IOTB), an extrapulmonary manifestation of tuberculosis of the eye, has unique and varied clinical presentations with poorly understood pathogenesis. As it is a significant cause of inflammation and visual morbidity, particularly in TB endemic countries, it is essential to study the pathogenesis of IOTB. Clinical and histopathologic studies suggest the presence of Mycobacterium tuberculosis in retinal pigment epithelium (RPE) cells.Methods: A human retinal pigment epithelium (ARPE-19) cell line was infected with a virulent strain of M. tuberculosis (H37Rv). Electron microscopy and colony forming units (CFU) assay were performed to monitor the M. tuberculosis adherence, invasion, and intracellular replication, whereas confocal microscopy was done to study its intracellular fate in the RPE cells. To understand the pathogenesis, the transcriptional profile of M. tuberculosis in ARPE-19 cells was studied by whole genome microarray. Three upregulated M. tuberculosis transcripts were also examined in human IOTB vitreous samples.Results: Scanning electron micrographs of the infected ARPE-19 cells indicated adherence of bacilli, which were further observed to be internalized as monitored by transmission electron microscopy. The CFU assay showed that 22.7 and 8.4% of the initial inoculum of bacilli adhered and invaded the ARPE-19 cells, respectively, with an increase in fold CFU from 1 dpi (0.84) to 5dpi (6.58). The intracellular bacilli were co-localized with lysosomal-associated membrane protein-1 (LAMP-1) and LAMP-2 in ARPE-19 cells. The transcriptome study of intracellular bacilli showed that most of the upregulated transcripts correspond to the genes encoding the proteins involved in the processes such as adherence (e.g., Rv1759c and Rv1026), invasion (e.g., Rv1971 and Rv0169), virulence (e.g., Rv2844 and Rv0775), and intracellular survival (e.g., Rv1884c and Rv2450c) as well as regulators of various metabolic pathways. Two of the upregulated transcripts (Rv1971, Rv1230c) were also present in the vitreous samples of the IOTB patients.Conclusions:M. tuberculosis is phagocytosed by RPE cells and utilizes these cells for intracellular multiplication with the involvement of late endosomal/lysosomal compartments and alters its transcriptional profile plausibly for its intracellular adaptation and survival. The findings of the present study could be important to understanding the molecular pathogenesis of IOTB with a potential role in the development of diagnostics and therapeutics for IOTB.

Background Ever since its characterization in the 1970s, allergic fungal rhinosinusitis (AFRS) has been the subject of much controversy, especially regarding its pathogenesis. In this study, we analyzed the differential expression of genes that encode protease-activated receptors (PAR) in patients with AFRS and patients with chronic rhinosinusitis, and tried to understand the pathogenic basis of this disease. Objective To analyze the differential expression of PAR genes in patients with AFRS and in patients with chronic rhinosinusitis. Methods Mucosa from ethmoid sinuses of 51 patients (tests and controls) was biopsied and evaluated for messenger RNA expression of PAR genes by using reverse transcriptase–polymerase chain reaction. Each of the four PAR genes, i.e., par1, par2, par3 and par4 was amplified, the final gene products were run on 1.8% agarose gel and analyzed by densitometry to calculate differential expression. The significance level was determined as p ≤ 0.05. Results It was observed that the expressions of all four par genes were higher in the test samples compared with the controls, but statistical significance was achieved only for par1 (p=0.004) and par2 (p=0.05). Comparative expression of the four PAR genes was also performed within the test and control groups, and a statistically significant difference was seen between par1 and par2 (p=0.007), par1 and par3 (p=0.029), par1 and par4 (p=0.0001), par2 and par4 (p=0.002), and par3 and par4 (p=0.009) in the test group. In the control group as well, par1, par2, and par3 exhibited a higher expression compared with par4 but the difference was significant between par3 and par4 genes only. Conclusion Patients with AFRS expressed increased levels of PAR genes in their nasal mucosa, and, of the four PAR genes, a higher expression of par1, par2, and par3 was observed in both the groups compared with par4. This information contributes toward our understanding of pathogenesis and possibly treatment of AFRS.

Pulmonary tuberculosis, the disease caused by Mycobacterium tuberculosis, still retains a top rank among the deadliest communicable diseases. Sputum expectorated during the disease continues to be a primary diagnostic specimen and also serves as a reservoir of bacteria. The expression pattern of mycobacteria in sputum will lead to an insight into bacterial adaptation at the most highly transmissible stage of infection and can also help in identifying newer diagnostic as well as drug targets. Thus, in the present study, a whole genome microarray of Mycobacterium tuberculosis was used to elucidate the transcriptional profile of mycobacteria in the sputum samples of smear positive pulmonary tuberculosis patients. Overall, the mycobacteria in sputum appeared to be in a low energy and low replicative state as compared to in vitro grown log phase M. tb with downregulation of genes involved in ATP synthesis, aerobic respiration and translational machinery. Simultaneously, downregulation was also seen in the genes involved in secretion machinery of mycobacteria along with the downregulation of genes involved in the synthesis of phthiocerol dimycocerosate and phenol glycolipids. In contrast, the majority of the genes which showed an upregulation in sputum mycobacteria were of unknown function. Further identification of these genes may provide new insights into the mycobacterial behavior during this phase of infection and may help in deciphering candidates for development of better diagnostic and drug candidates.

Background: Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Aortic clamping and declamping can lead to profound haemodynamic changes, myocardial infarction, ventricular failure or even death may result. These complications are important challenges in anesthetic management of these patients. Methods :0 Between August, 2010 and April, 2012, descending thoracic aorta to femoral artery bypass grafting was used to revascularize lower limbs in 11 patients in our institute. The anesthetic management of these patients is described here. Epidural catheter placement was done in T 5-6 or T 6-7 space for post operative pain relief. Induction was done by, Inj. Glycopyrolate 0.2 mg, Inj. Fentanyl 5 μg/kg., Inj. Pentothal sodium 5 mg/kg, Inj. Rocuronium 0.9 mg/kg, IPPV done. Left sided double lumen tube was inserted, Maintenance of Anesthesia was done by O 2 + N 2 O (30:70). Increments of Vecuronium and Fentanyl were given Monitoring of Heart rate, arterial pressure, central venous pressure were continuously displayed. The available pharmacological agents were used when there is deviation of more than 15% from base line. Results: In our study, inspite of measures taken to control rise in blood pressure during aortic cross clamping, a rise of 90 mm of Hg in one patient and 60-80 mm of Hg in four patients was observed, which was managed by sodium nitropruside infusion. At the end of surgery seven patients were extubated on the operation table. In remaining four patients DLT was replaced by single lumen endotracheal tube and were shifted to ICU on IPPV. They weaned off gradually in 3-5 hours. In our series blood loss was 400 ml to 1000 ml. There was no mortality in the first 24 hours. Postoperative bleeding was reported in one case which was re-explored and stood well. Conclusion: The anesthetic technique during aortic surgery is directed at minimizing the hemodynamic effects of cross clamping in order to maintain the myocardial oxygen supply demand ratio.

Introduction: Most of the children suffer from severe anxiety and apprehension when they are separated from their parents or family members for the induction of anaesthesia. Materials and Methods: In a prospective randomized double blind study, the intra-nasal and sub-lingual administration of midazolam in paediatric patients who were undergoing root canal procedures which required general anaesthesia was evaluated in 60 children who were aged between 2-6 years, with ASA physical status I and II by using a new midazolam atomiser spray. The patients were divided into two groups of 30 patients each and they received midazolam 0.3mgkg-1 either intranasally or sub-lingually in a randomized manner. The heart rate, oxygen saturation (spo2), respiratory rate and the degree of sedation before and at 5 min, 10 min and 15 min (separation score) after the drug administration, during the mask application (mask acceptance score), before induction (induction score) and during the recovery at 10 min, 20min and 30mins (recovery score) were recorded and compared. Results: In our study, 60% of the paediatric patients cried during the administration of midazolam by the intra-nasal route, while only 16% of the paediatric patients cried during its administration by the sub-lingual route. A bitter taste was observed in 45% (14/30) of the patients who received midazolam by the sublingual route. Although there was a slight increase in the heart rate in the intra-nasal group, no statistically significant variation in the heart rate, the respiratory rate and the oxygen saturation was found from the baseline in both the groups (P>0.05). A sedation score of >3(approx) was achieved in both the groups within 10 minutes of the drug administration. The response to the child parent separation, the mask application score , the induction score and the recovery score did not differ significantly between the two groups ( P >0.05). Conclusion: Both the intra-nasal and sub-lingual administration of midazolam as a Pre-medication is safe and equally effective in paediatric patients.

Background: Pulmonary tuberculosis (TB) is caused by Mycobacterium tuberculosis (M. tb). In lungs, alveolar macrophages and type II alveolar epithelial cells serve as a replicative niche for this pathogen. Secretory proteins released by actively replicating tubercle bacilli are known to interact with host cells at the initial stages of infection. To understand the role of these cells in TB pathogenesis, it is important to identify the mycobacterial components involved in interaction with alveolar epithelial cells. Materials and Methods: We fractionated the whole secretory proteome of M. tb H 37 Rv into 10 narrow molecular mass fractions (A1-A10; 90 kDa) that were studied for their binding potential with A549; type II alveolar epithelial cell line. We also studied the consequences of this interaction in terms of change in epithelial cell viability by MTT assay and cytokine release by ELISA. Results: Our results show that several mycobacterial proteins bind and confer cytolysis in epithelial cells. Amongst all the fractions, proteins ranging from 35-45 kDa (A5) exhibited highest binding to A549 cells with a consequence of cytolysis of these cells. This fraction (A5) also led to release of various cytokines important in anti-mycobacterial immunity. Conclusion: Fraction A5 (35-45 kDa) of mycobacterial secretory proteome play an important role in mediating M. tb interaction with type II alveolar epithelial cells with the consequences detrimental for the TB pathogenesis. Further studies are being carried out to identify the candidate proteins from this region.

Purpose: Conventional diagnostic techniques for detecting Mycobacterium avium infection are far from satisfactory. As serodiagnostic tests for M. avium infection have been shown to be simple and rapid, the present study was carried out to identify and evaluate M. avium secretory protein(s) of diagnostic potential. Materials and Methods: Initially, by differential immunoblotting, a specific protein band of 45-50 kDa was recognized. Anion exchange column chromatography was used for purification of proteins. After fractionation, blast search was carried out. Further immunoreactivity studies were done with M. avium and Mycobacterium tuberculosis infected mice sera. Clinical utilization was confirmed by conducting indirect enzyme-linked immunosorbent assay (ELISA) with serum samples from mycobacterial infected patients. Results: A complex of three proteins (Aro-Tal-AST) of molecular weight ~48 kDa, shown to be Aro A homologue (Aro), transaldolase (Tal) and aspartate transaminase (AST) by blast search was separated. Immunoreactivity studies of purified complex protein with mice sera confirmed it to be specific for M. avium infection. Indirect ELISA with patient samples further confirmed it to be M. avium infection specific. Conclusion: Aro-Tal-AST protein is specifically recognized by patients infected with M. avium and can be used as a marker for simple and rapid ELISA based tests for differential diagnosis of M. avium infection in patients with M. avium complex (MAC).

Introduction: Women presenting with unhealthy cervix needs to be evaluated with Papanicolaou (Pap) smear for epithelial abnormalities. Aim: To detect epithelial cell abnormalities in unhealthy cervix using the 2001Bethesda system of reporting for cervical cytology and to confirm histopathologicaly the findings of Pap smear. Materials and Methods: In this study, 125 women with clinical diagnosis of unhealthy cervix underwent conventional cytology. Cervical biopsies were taken from abnormal areas seen on colposcopy and sent for histopathology Results: Out of 125 Pap smears, 122 were satisfactory for evaluation (19 normal, 86 negative for intraepithelial lesion or malignancy and 17 with epithelial cell abnormality) and 3 were unsatisfactory (one hemorrhagic and two severe inflammation). Out of 17 (13.60%) cases with epithelial cell abnormality, ASCUS was seen in 6 (4.80%), LSIL in 7 (5.60%), HSIL in 1 (0.80%), squamous cell carcinoma in 1 (0.80%), AGC endocervical in 1 (0.80%) and adenocarcinoma in 1 (0.80%) patients. Cervical biopsy was taken in 67 women. Diagnostic accuracy of Pap smear for preinvasive and invasive disease was 81.15% with overall sensitivity and specificity 78.57% and 88.67% respectively and predictive value of 64.71%. Conclusion: Women with clinical diagnosis of unhealthy cervix should be evaluated by cytology to detect any premalignant or malignant lesions. The Bethesda system for cervical cytology reporting should be used universally as it will give a standardized interpretation.

The need for an accurate, rapid, simple and affordable point-of-care (POC) test for Tuberculosis (TB) that can be implemented in microscopy centers and other peripheral health-care settings in the TB-endemic countries remains unmet. This manuscript describes preliminary results of a new prototype rapid lateral flow TB test based on detection of antibodies to immunodominant epitopes (peptides) derived from carefully selected, highly immunogenic M. tuberculosis cell-wall proteins. Peptide selection was initially based on recognition by antibodies in sera from TB patients but not in PPD-/PPD+/BCG-vaccinated individuals from TB-endemic settings. The peptides were conjugated to BSA; the purified peptide-BSA conjugates striped onto nitrocellulose membrane and adsorbed onto colloidal gold particles to devise the prototype test, and evaluated for reactivity with sera from 3 PPD-, 29 PPD+, 15 PPD-unknown healthy subjects, 10 patients with non-TB lung disease and 124 smear-positive TB patients. The assay parameters were adjusted to determine positive/negative status within 15 minutes via visual or instrumented assessment. There was minimal or no reactivity of sera from non-TB subjects with the striped BSA-peptides demonstrating the lack of anti-peptide antibodies in subjects with latent TB and/or BCG vaccination. Sera from most TB patients demonstrated reactivity with one or more peptides. The sensitivity of antibody detection ranged from 28-85% with the 9 BSA-peptides. Three peptides were further evaluated with sera from 400 subjects, including additional PPD-/PPD+/PPD-unknown healthy contacts, close hospital contacts and household contacts of untreated TB patients, patients with non-TB lung disease, and HIV+TB- patients. Combination of the 3 peptides provided sensitivity and specificity>90%. While the final fully optimized lateral flow POC test for TB is under development, these preliminary results demonstrate that an antibody-detection based rapid POC lateral flow test based on select combinations of immunodominant M. tb-specific epitopes may potentially replace microscopy for TB diagnosis in TB-endemic settings.

The samples of Bi2Sr2Ca2Cu3-xMnxO10+δ (x = 0.0 to 0.30) were prepared by the standard solid-state reaction method. The phase identification characteristics of synthesized (HTSC) materials were explored through powder X-ray diffractometer reveals that all the samples crystallize in orthorhombic structure with lattice parameters a = 5.4053 Å, b = 5.4110 Å and c = 37.0642 Å up to Mn concentration of x = 0.30. The critical temperature (Tc) measured by standard four probe method has been found to depress from 108 K to 70 K as Mn content (x) increases from 0.00 to 0.30. The effects of sintering temperature on the surface morphology of Bi2Sr2Ca2Cu3-xMnxO10+δ have also been investigated. The surface morphology investigated through scanning electron microscope and atomic force microscopy (SEM & AFM) results that voids are decreasing but grains size increases as the Mn concentration increases besides, nanosphere like structures on the surface of the Mn doped Bi2Sr2Ca2Cu3-xMnxO10+δ (Bi-2223) samples.