Diagnosis of tuberculosis by direct demonstration of the pathogen or by indirect demonstration of cell mediated immunity through activation of CD 4 and / or CD 8 T lymphocytes.
Tuberculosis is a raging problem round the globe. Eradicating TB is a herculean task but is possible is efforts from all corners from the world. The diagnostics have taken a big leap and with effective medications, our dream of TB free world may come true. But unlimited efforts are need to reach our goal.
This presentation is about lab diagnosis of tuberculosis. It highlights use of currently available diagnostic methods in identifying pulmonary and extrapulmonary tuberculosis.
Tuberculosis is a raging problem round the globe. Eradicating TB is a herculean task but is possible is efforts from all corners from the world. The diagnostics have taken a big leap and with effective medications, our dream of TB free world may come true. But unlimited efforts are need to reach our goal.
This presentation is about lab diagnosis of tuberculosis. It highlights use of currently available diagnostic methods in identifying pulmonary and extrapulmonary tuberculosis.
Catridge based nucleic acid amplification test(CBNAAT) / RIF assay gene xpert POWER PONT. other normal tests versus CBNAAT. issues for cbnaat by WHO & CONCLUSION.
what is new in prevention, diagnosis and treatment of tuberculosis tb short.pptxPathKind Labs
Many changes have been made recently in Tuberculosis. The first important change is that instead of control now the focus is on eradication. for that to happen we need to change the way we detect, diagnose and treat tuberculosis.
Catridge based nucleic acid amplification test(CBNAAT) / RIF assay gene xpert POWER PONT. other normal tests versus CBNAAT. issues for cbnaat by WHO & CONCLUSION.
what is new in prevention, diagnosis and treatment of tuberculosis tb short.pptxPathKind Labs
Many changes have been made recently in Tuberculosis. The first important change is that instead of control now the focus is on eradication. for that to happen we need to change the way we detect, diagnose and treat tuberculosis.
clinical standards for ds tb treatment 2022 (1).pptxPathKind Labs
To diagnose and treat drug susceptible pulmonary tuberculosis is of paramount importance in our efforts to eliminate tuberculosis. This describes seven clincal standards which should be practiced to obtain optimum results
Preventing TB infection in HIV-infected
individuals living in medium and high TB endemic
settings
February 5, 2016
Jeffrey D. Jenks, MD, MPH
UCSD HIV & Global Health Rounds
ISO 15189 2022 standards for laboratory quality and competencePathKind Labs
The fourth edition of standards for laboratory quality and competence are available. Labs need to perform gap analysis to identify areas that need to be developed to fulfill the new requirements.
recently the fourth edition of ISO 15189 2022 have been released. It has aligned itself to its parent document ISO 17025 and focused on risk assessment
management of childhood tuberculosis in 2023.pptxPathKind Labs
diagnosis of childhood TB is a challange, but if we follow a system of screening and then appropriate diagnostic tests following contact tracing, we are likely to identify children with infection or disease and put them on appropriate treatment.
Recently ISO 15189:2022 have become available. This would help laboratories set up processes which would yield reproducible results and improve the quality of work.
viral markers in diagnosis monitoring and treatment of hepatitis b and c.pptxPathKind Labs
Hepatitis B Virus and Hepatitis C Virus infections are transmitted by parentral route. Early diagnosis and treatment can prevent cirrhosis of liver in HCV cases as drugs which can cure the infection are now available.
Covid-19 pandemic has caused over 6 million deaths and has been acknowledged as one of the worst pandemic in living memory. But antimicrobial resistance as invisble pandemic may clain more deaths every year if suitable action is not taken soon.
While MIC is a good measure of antibiotic activity, it is static and reflects in vitro activity. PK and PD of the drug needs to be considered together with MIC if we wish to obtain an in vivo prediction of drug action and success.
Procalcitonin is an excellent biomarker for antibiotic use in bacterial infections alone. POCT guided PCT levels can help decide whether to add antibiotics or not in opd settings for respiratory tract infection.
While the world was focused on covid 19, WHO has made and issued consolidated guidelines making changes in how to prevent, diagnose and treat tuberculosis.
Understanding and implementing quality management system in medical laboratoriesPathKind Labs
QMS is essential to run a good laboratory, but the various requirements pose a big challenge. Once you understand the reason for these requirements compliance may be easier.
RT PCR is too slow for effective control of spread of cov 2 infection, rapid antigen test by giving results in less than 30 minutes can help identify infected persons leading to quick isolation.Lack of sensitivity can be compensated by repeating RAT after a day or so.
investigation of infertility with focus on genetic basis of infertilityPathKind Labs
Infertility if quite common. Understanding genetic basis of infertility can help in making the right decision on what diseases can be transmitted to the offspring and which IVF technique would be most helpful in overcoming infertility.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
1. Recent Advances
in
Laboratory Diagnosis of Tuberculosis
Prof. Ashok Rattan,
MD, MAMS, Common Wealth Fellow, SEARO TA, INSA DFG, WHO Lab Director (CAREC/PAHO)
Advisor: Pathkind Labs Knowledge Forum, R & D and Quality,
2. A disease of great antiquity
• Fossile bones 9000 BC show evidence
• Egyptian mummies: Spinal caries 2400 BC
• 1500 BC mention of consumption in India
• Hippocrates 460 – 370 BC recognized phthisis (felt it was heredity)
Tuberculosis, Phthisis
3. Since its discovery 137 years ago TB has claimed more
than 1 billion lives
• Which is more than those claimed by (all of the below)
• Malaria
• Small Pox
• HIV/AIDS
• Cholera
• Plague
• Influenza
4.
5.
6. Commonest method for diagnosis of TB
1885
2019
A change in mind set is required
Mark Twain said, “ You cannot keep doing
the same thing and expect different
results”
7. Can you submit sample
likely to contain Mtb ?
Yes
Gene xpert combo
Mtb + or –
RIF R or S
Culture
In Smear positive cases
LPA 1 or LPA 2
MDR & XDR
No, submit 5 ml blood
in lithium heparin vial
Normal
Latent TB [CD4]
Recent exposure /
active TB [CD8]
Tuberculosis Clinically suspected ? Pulmonary or Extra Pulmonary ?
8. Improving detection
• CO2 production
• O2 consumption
– Radiometric
– Fluorescent
– Colourimetric
– Pressure sensor
– Decrease TAT by half
•14 C Palmitate 14 CO2
9.
10. Speed Of Growth Of M.tuberculosis (MGIT 960 vs L J Media)
1st wk 2nd wk 3rd wk 4th wk 5th wk 6th wk
166
0
132
23
55
46
23
63
13
48
2
24
391 204
Data generated in 2007 – 08 by Dr Bansidhar Tarai under guidance of
Dr Ashok Rattan during their tenure in Religare SRL Reference Lab, Gurgaon, unpublished
Time-to-Detection in Culture Predicts Risk of
Mycobacterium tuberculosis Transmission:
Matthew K. O’Shea et al. [UK] Clinical Infectious Diseases 2014;59(2):177–85
TTD < 9 days identifies patients at high risk of transmitting tuberculosis and is superior to
sputum smear.
11. Molecular Biology Detection on clinical samples
• In the past: Polymerase Chain Reaction (PCR)
• Lab made tests
• Variable performance
• High cross contamination
• Inhibitors in clinical samples
• Real Time PCR [Cepheid]
• Closed system
• Simple sample processing
• Bacteria are made inactivated, no chance of infection
• Rapid results [2 hours]
• Detection of M tb and Rif Resistance [surrogate marker for MDR]
• Extensively field tested in different parts of the world
• 30 million cartridges used
• Cost subsidized for developing countries by Bill Clinton Foundation
12. Gene Xpert MTB/RIF
• WHO endorsed Cartridge based, closed RT PCR for
• Detection of MTB &
• RIF Resistance (as surrogate for MDR TB)
• Contains Internal quality controls for
• Sample Processing (SPC)
• Probe Check (PCC)
• Amplifies a 192 bp region of MTB rpoB gene
• RIF resistance is detected by 5 overlapping molecular beacon probes
that are complementary to entire 81 bp region of RRDR of rpoB gene
13. Gene Xpert Report
Gene Xpert MTB/RIF is Positive / Negative
Mycobacterium tuberculosis DNA Detected / Not Detected
Quantitation High / Medium / Low / Very Low
Rifampicin Resistance Present / Absent
Result:
MTB Quantitation Result Ct Range
High < 16
Medium 16 – 22
Low 22 – 28
Very Low 28
Rifampicin result result types, when MTB is DETECTED
Rifampicin resistance Detected: a mutation in the rpoB gene has been detected that falls within the valid delta Ct setting.
Rifampicin resistance Not detected: no mutation in the rpoB has been detected
Rifampicin resistance Indeterminate: The MTB concentration was very low and resistance couldnot be detected.
17. Antibodies tests
• From Agglutination to SAFA all techniques have been tried
• Cannot differentiate between infection and disease
• Positive even in healthy individuals
• WHO and GOI have banned the use of Antibody tests
18. In Vitro Diagnostic Tests : Cell Mediated Immunity
Antigen
presenting
cell
Memory
T-cell
Presentation of
mycobacterial antigens
IFN-
IFN-
IL-8, etc.
IL-8, etc.
TNF-
TNF-
Andersen P, et al. Lancet 2000;356:1099
21. 3rd Generation
Quantiferon TB Gold IT (in Tube method)
• Grey cap tube (Nil control)
• Red cap tube (TB Ag)
• Purple cap tube (Mitogen control)
• Collect 1 ml blood into each tube and mix well
• Transfer to Lab ASAP
• For detection of Latent TB, has negative predictive value
22.
23. Attribute Tuberculin Skin Test
(Mantoux Test)
IGRA
Type In vivo In vitro
Sample Injected into skin (intradermal) 5 mL of Blood in Lithium Heparin tube
Visits 2 1
Antigen used PPD ESAT 6 & CFT 10 from Mtb RD1 region
Cross reaction with BCG Yes No
Use For diagnosis of LTBI Latent TB & now recent exposure of
contacts or active TB
Results Read after 48 or 72 hours ELISA test after 24 hours of exposure
Reading Subjective Objective
Booster effect Yes No
Cost Low High
24. CD 8
CD 8+ cells assessed in adults with LTBI or active TB disease by FACS
CD 8+ cells found more frequently in PTB (67%), ETB (37%) than LTBI (15%)
CD 8+ cells found in high frequency in Smear + than Smear - patients
29. CD8 T-cells
• Suppress Mycobacteria tuberculosis growth
• Kill infected cells
• Directly lyse intracellular Mycobacteria
• TB specific CD8 T cells that produce IFN-Ύ have been
• More frequently detected in those with active TB disease vs latent infection
• Associated with recent exposure
• Detectable in active TB subjects with HIV co-infection & young children
30.
31. We are calling this test TB Sure to avoid any confusion
TB SURE
42. Caution
• A NEGATIVE TB Sure® result doesnot preclude the possibility of
Mycobacterium tuberculosis infection or disease
• 1. Sample may have been collected before development of CMI response
• 2. Hetrophil antibodies or non specific IFN-Ύ production from other
inflammatory conditions may mask specific response to ESAT 6 or CFP 10.
• A POSITIVE TB Sure® shouldnot be the sole or definitive basis for
determining infection or disease with M tuberculosis. It should be
accompanied by addition clinical and laboratory investigations.
50. Quantiferon TB Gold Plus [TB Sure®]
• Is a blood test, provides indirect evidence of infection
• Can detect LTBI as well as recent exposure & active infection
• Can be used for monitoring of response to treatment [0, 3 & 6 Month]
• Not effected by HIV status [till CD4 count is < 100 /mm3
• Doesnot detect Drug resistance
• Gene Xpert & MGIT culture [Gene xpert combo] is preferred if bacteria
containing sample can be submitted e.g. sputum, pus, fluid, biopsy, csf
51.
52.
53.
54. Can you submit sample
likely to contain Mtb ?
Yes
Gene xpert combo
Mtb + or –
RIF R or S
Culture
In Smear positive cases
LPA 1 or LPA 2
MDR & XDR
No, submit 5 ml blood
in lithium heparin vial
Normal
Latent TB [CD4]
Recent exposure /
active TB [CD8]
Tuberculosis Clinically suspected ? Pulmonary or Extra Pulmonary ?
55.
56. TB Sure® Reports
Possible
Negative Mitogen TB 1- N TB 2- N TB 2 – TB 1 Report
IU / mL
< 8 > 0.5 < 0.35 < 0.35 < 0.5 Reference Range
0.05 4.08 0.10 0.12 0.02 Infection with M tuberculosis unlikely
0.05 7.61 4.14 3.16 -- 0.92 LTBI
0.20 1.10 4.26 9.34 5.09 Active disease / Recent Infection
0.2 0.2 0.2 0.2 0 Indeterminate
8.2 > 10 > 10 > 10 ? Indeterminate