1.  

Kabra SK, Lodha R, Seth V. Some current concepts on childhood tuberculosis. Indian J Med Res. 2004 Oct; 120(4):387-97. Review.

Department of Pediatrics, All India Institute of Medical Sciences, D II/23, An sari Nagger, New Delhi 110-029, India. skkabra@hotmail.com

As children acquire infection with Mycobacterium tuberculosis from adults in their environment, the epidemiology of childhood tuberculosis (TB) follows that in adults. While global burden of childhood tuberculosis is unclear, in developing countries the annual risk of tuberculosis infection in children is 2- 5 per cent. Nearly 8-20 per cent of the deaths caused by tuberculosis occur in children. It has been suggested that BCG vaccination is responsible for decrease in the occurrence of disseminated and severe disease. Localized forms of illness, e.g., intrathoracic lymphadenopathy, and localized CNS disease have been reported to occur with greater frequency in vaccinated children. Human immunodeficiency virus (HIV) infected children are at an increased risk of tuberculosis, particularly disseminated disease. Diagnosis of TB in children presents special problems as the sputum is generally not available for examination. Diagnostic algorithms include scoring system utilizing clinical parameters and results of investigations. Various diagnostic techniques such as improved culture techniques, serodiagnosis, and nucleic acid amplification have been developed and evaluated to improve diagnosis of childhood tuberculosis. Serodiagnosis is an attractive investigation but till date none of the tests showed desirable sensitivity and specificity. Tests based on nucleic acid amplification are a promising development. Relatively less experience in children, need for technical expertise and high cost are the limiting factors for their use in childhood tuberculosis. Short-course chemotherapy for childhood tuberculosis is well established. Treatment with intermittent regimens is comparable to daily regimens. Directly observed treatment strategy (DOTS) has also shown encouraging results. Pattern of drug resistance among children with TB tends to reflect those found among adults in the same population. The rates of drug resistance to any drug vary from 20 to 80 per cent in different geographic regions.

2.  

Misra UK, Kalita J. The role of sensory and motor evoked potentials in the prognosis of Pott's paraplegia. Clin Neurophysiol. 2004 Oct; 115(10):2267-73.

Department of Neurology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raebareily Road, Lucknow-26014, India. ukmisra@sgpgi.ac.in

OBJECTIVE: In view of paucity of evoked potential changes in Pott's paraplegia, it is proposed to evaluate the role of motor and somatosensory evoked potentials in predicting the outcome. METHODS: Consecutive patients with Pott's paraplegia during 1993-2003 were subjected to detailed clinical, radiological and evoked potential study. The latter comprised of tibial somatosensory evoked potential (SEP) and motor evoked potential (MEP) study to tibialis anterior. The patients were clinically evaluated at 6 and 12 months and the outcome was defined into poor (bed ridden), partial (dependent for activities of daily living) and complete recovery (independent). The evoked potential findings were correlated with clinical and radiological findings and outcome. RESULTS: There were 39 patients whose age ranged between 16 and 70 (mean 42.1) years and 22 were females. The mean duration of symptoms was 8.2 months. Sensory motor deficit was present in 18 and pure motor signs in 21 patients. Five patients had quadriplegia and remaining had paraplegia. The muscle weakness was severe in 12 and moderate in 15 patients. In 12 patients, lower limb power was normal but they had lower limb hyper-reflexia with or without spasticity suggesting pyramidal dysfunction. Pinprick and joint position sensations were abnormal in 18 patients. MRI was abnormal in all and revealed cervical involvement in 7, thoracic in 22 and lumbar in 10 patients. Paravertebral soft tissue shadow was present in 36 and cord compression in 30 patients. Motor evoked potential was abnormal in 19 patients (unrecordable in 11 patients, 21 sides and prolonged in 8 patients, 14 sides). SEP was abnormal in 18 patients (unrecordable in 15 patients, 25 sides and prolonged central conduction in 8 patients, 9 sides). Both MEP and SEP were abnormal in 16, normal in 18, and only MEP was abnormal in 3 and only SEP in 2 patients. At 6 month 25 patients had complete, 9 partial and 5 poor recovery. At 1 year 33 had complete and 4 partial recovery. SEP and MEP abnormalities correlated with respective sensory and motor functions, vertebral level and outcome at 6 and 12 months. CONCLUSIONS: MEP and SEP both are helpful in predicting 6-month outcome. Combining SEP and MEP gives stronger correlation with 6-month outcome compared to only MEP or SEP. The potential role of evoked potentials in deciding different therapeutic strategies needs further studies.

3.  

Gupta S, Shende N, Kumar S, Harinath BC. Isolation of excretory secretory protein 6 kDa antigen (ES-6) and its seroreactivity in patients with different stages of pulmonary tuberculosis and healthy household contacts. Biomedical Research, 2005; 16(1): 23-27.

An Excretory Secretory protein antigen of 6 kDa (ES-6) was isolated from Mycobacterium tuberculosis H₃₇Ra culture filtrate by gel filtration using fast protein liquid chromatography. Seroreactivity of ES-6 antigen was compared with earlier reported diagnostically useful ES-31 and ES-43 antigens at different stage of pulmonary tuberculosis and in household contacts of the patients. The ES-31 and ES-43 antigens showed good immune response in chronic and relapse cases respectively while ES-6 antigen has shown comparatively low immune response in these cases. However ES-6 showed increased seroreactivity in household contacts of pulmonary tuberculosis patients. These results suggest the heterogeneous responses of antigens in different disease conditions and immune response to   ES-6 antigen may be associated with latent infection for predicting active disease in course of time, as observed in the follow up of these individuals.