The immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This study was ...conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sputum smear and culture conversion as well as the prevention of relapse.
This randomized double-blind placebo-controlled trial was conducted in three sites in India. HIV negative participants aged 15-60 years with sputum smear positive PTB were recruited according to the Revised National Tuberculosis Control Program guidelines and were randomly assigned (1:1) to receive standard anti-tubercular treatment (ATT) with either supplemental dose of oral vitamin D3 (60,000 IU/sachet weekly for first two months, fortnightly for next four months followed by monthly for the next 18 months) or placebo with same schedule. The primary outcome was relapse of PTB and secondary outcomes were time to conversion of sputum smear and sputum culture.
A total of 846 participants were enrolled between February 1, 2017 to February 27, 2021, and randomly assigned to receive either 60,000 IU vitamin D3 (n = 424) or placebo (n = 422) along with standard ATT. Among the 697 who were cured of PTB, relapse occurred in 14 participants from the vitamin D group and 19 participants from the placebo group (hazard risk ratio 0.68, 95%CI 0.34 to 1.37, log rank p value 0.29). Similarly, no statistically significant difference was seen in time to sputum smear and sputum culture conversion between both groups. Five patients died each in vitamin D and placebo groups, but none of the deaths were attributable to the study intervention. Serum levels of vitamin D were significantly raised in the vitamin D group as compared to the placebo group, with other blood parameters not showing any significant difference between groups.
The study reveals that vitamin D supplementation does not seem to have any beneficial effect in the treatment of PTB in terms to the prevention of relapse and time to sputum smear and culture conversion.
CTRI/2021/02/030977 (ICMR, Clinical trial registry-India).
Aim
To characterize Th1/Th2/Th17 cytokine profile (IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ, and IL-17A) among different stages of COVID-19 infection.
Methods
This was a cross-sectional study which ...included six healthy individuals and 68 patients who were admitted with COVID-19 in the Department of Medicine, at All India Institute of Medical Sciences, New Delhi, from July 2020 to September 2020. Patients were categorized into mild, moderate, and severe COVID-19 groups, and serum samples were drawn for the measurement of Th1/Th2/Th17 cytokines (IL-4, IL-6, IL-10, TNF-α, IFN-γ, and IL-17A) which was done by BD™ Cytometric Bead Array.
Results
All the cytokines showed dynamic expression in the COVID-19 group, of which only IL-6 was statistically significant. Among the three severity groups of COVID-19, increased severity did not transform into increased cytokine level, with the exception for IL-6, which was statistically significant.
Conclusions
In our small sample study, six cytokines expressions were evaluated however most of them were elevated in COVID-19 patients but were not statistically significant except IL-6.
Coronavirus disease has myriad manifestations and can present with predominantly extrapulmonary manifestations. We describe a 50-year-old man, a person living with HIV (PLHA), a non-Hodgkin lymphoma ...survivor, who presented with isolated severe thrombocytopenia. He was found to have immune-mediated thrombocytopenia, and showed excellent response to intravenous immunoglobulins.
Abstract
Background
Globally around 40% of histoplasmosis has been reported in HIV population, with other risk factors being transplant recipients, immunosuppressive agents (steroids, TNF-alpha ...inhibitors) and extreme of ages. Histoplasmosis in India has mostly been reported from the Gangetic plains (Figure 1).
Methods
This current study was conducted in a tertiary care hospital of northern India between January 1, 2021 and December 31, 2022 to look at the epidemiology, clinical profile and treatment outcome of Histoplasmosis patients in a non-HIV cohort. This was a single centered, observational study. All patients with proven Histoplasmosis (according to EORTC/MSGERC 2019 criteria) were included.
Results
Baseline Characteristics: This study involved 20 patients with a mean age of 52.05 ± 10.87 years with 70% being male. All the patients were from endemic areas of Gangetic belt in India. Majority of the patients (80%) were immunocompetent (Table 1). All cases (100%) were diagnosed on histopathology.
Clinical and Laboratory Characteristics
The common reported complains were fever (75%), weight loss (70%), loss of appetite (75%), skin lesions (25%) and pain abdomen (15%). Mean duration of various symptoms was 3±1.29 months. Hepato-splenomegaly was seen in 45% of cases followed by adrenal involvement (40%), enlarged lymph nodes (35%), skin and oral mucosa involvement (25%) (Figure 2). Out eight patients had who adrenal involvement, five patients (25%) had isolated involvement based on imaging (CT/PET-CT). Cytopenias was seen in upto 75% cases with around 40% had deranged liver functions (Table 2). The most common syndromic diagnosis was progressive disseminated histoplasmosis (PDH) seen in 13 patients with a median age of 49 (30-76) years.
Treatment
13 patients (65%) received induction with Amphotericin B (liposomal) followed by switching to oral itraconazole and 7 patients (35%) got up front itraconazole. At a media follow up of 8 months, 40% of patients had completed treatment and one had patient died.
Conclusion
In a high tuberculosis endemic county like India, Histoplasmosis pose a diagnostic challenge. Although the median time to diagnosis is longer (delay in diagnosis), the overall outcome is good. Majority of our patients were younger immunocompetent individual.
Disclosures
All Authors: No reported disclosures
BackgroundThe immunomodulatory effects of vitamin D are widely recognized and a few studies have been conducted to determine its utility in the treatment of tuberculosis, with mixed results. This ...study was conducted to see if vitamin D supplementation in patients with active pulmonary tuberculosis (PTB) in the Indian population contributed to sputum smear and culture conversion as well as the prevention of relapse.MethodsThis randomized double-blind placebo-controlled trial was conducted in three sites in India. HIV negative participants aged 15-60 years with sputum smear positive PTB were recruited according to the Revised National Tuberculosis Control Program guidelines and were randomly assigned (1:1) to receive standard anti-tubercular treatment (ATT) with either supplemental dose of oral vitamin D3 (60,000 IU/sachet weekly for first two months, fortnightly for next four months followed by monthly for the next 18 months) or placebo with same schedule. The primary outcome was relapse of PTB and secondary outcomes were time to conversion of sputum smear and sputum culture.ResultsA total of 846 participants were enrolled between February 1, 2017 to February 27, 2021, and randomly assigned to receive either 60,000 IU vitamin D3 (n = 424) or placebo (n = 422) along with standard ATT. Among the 697 who were cured of PTB, relapse occurred in 14 participants from the vitamin D group and 19 participants from the placebo group (hazard risk ratio 0.68, 95%CI 0.34 to 1.37, log rank p value 0.29). Similarly, no statistically significant difference was seen in time to sputum smear and sputum culture conversion between both groups. Five patients died each in vitamin D and placebo groups, but none of the deaths were attributable to the study intervention. Serum levels of vitamin D were significantly raised in the vitamin D group as compared to the placebo group, with other blood parameters not showing any significant difference between groups.ConclusionsThe study reveals that vitamin D supplementation does not seem to have any beneficial effect in the treatment of PTB in terms to the prevention of relapse and time to sputum smear and culture conversion.Trial registrationCTRI/2021/02/030977 (ICMR, Clinical trial registry-India).
To compare the effects of vibration therapy and massage in prevention of DOMS.
Pre-test and Post-test Control-Group Design was used, 45 healthy female non athletic Subjects were recruited and ...randomly distributed to the three groups (15 subject in each group). After the subject's initial status was measured experimental groups received vibration therapy (50 Hz vibration for five minutes) or massage therapy (15 minutes) intervention and control group received no treatment, just prior to the eccentric exercise. Subjects were undergoing the following measurements to evaluate the changes in the muscle condition: muscle soreness (pain perception), Range of Motion (ROM), Maximum Isometric Force (MIF), Repetition maximum (RM), Lactate dehydrogenase (LDH) and Cretain Kinase (CK) level. All the parameters except LDH, CK and 1RM were measured before, immediately post intervention, immediately post exercise, 24 hours post exercise, 48 hours post exercise and 72 hours post exercise. LDH, CK and 1 RM were measured before and 48 hours post exercise.
Muscle soreness was reported to be significantly less for experimental (vibration and massage) group (p=0.000) as compared to control group at 24, 48, and 72 hours of post-exercise. Experimental and control group did not show any significant difference in MIF immediate (p=0.2898), 24 hours (p=0.4173), 48 hours (p=0.752) and 72 hours (p=0.5297) of post-exercise. Range of motion demonstrated significant recovery in experimental groups in 48 hours (p=0.0016) and 72 hours (p=0.0463). Massage therapy showed significant recovery in 1RM (p=0.000) compared to control group and vibration therapy shows significantly less LDH level (p=0.000) 48 hours of post exercise compare to control group. CK at 48 hours of post exercise in vibration group (p=0.000) and massage group showed (p=0.002) significant difference as compared to control group.
Vibration therapy and massage are equally effective in prevention of DOMS. Massage is effective in restoration of concentric strength (1 RM). Yet vibration therapy shows clinically early reduction of pain and is effective in decreasing the level of LDH in 48 hours post exercise periods.
PDF