A study to evaluate the efficacy and safety of intradermal and intralesional Purified Protein Derivative (PPD) for treatment of common warts in children

: Viral warts are common dermatological diseases with wide range of treatment modalities. Utilization of various vaccines and skin test antigens has broadened the horizon of available immunotherapeutic agents for the treatment of warts. In this study, we compared efficacy and safety of intradermal and intralesional purified protein derivative (PPD) for treating common warts in children. Toevaluate efficacy and safety of intradermal and intralesional PPD in treatment of common warts in children.: 180 children (aged 5-15 years) with common warts were randomly divided to receive intradermal (n=90) PPD 10 TU/0.1 ml at middle third of right forearm or intralesional PPD (n=90) 0.1 ml in the largest wart once in 2-weeks till there is complete clearance or maximum of five injections whichever is earlier. Patients were followed at 4 week after last injection for assessment of response, adverse effects, and recurrence of common warts. : Complete, partial clearance and no response in 51.2%, 45.3% and 2.3% children was observed in intradermal group as compared to 54.2%, 42.5% and 1.1% response in intralesional group respectively. Recurrence of warts was observed in 1.2% and 2.2% children in intradermal and intralesional group respectively. Pain was the most common adverse effect in both groups followed by erythema lasting for 2-3 days not warranting for discontinuation of treatment in any patient.: Overall 96.5% and 96.7% patients in both intradermal and intralesional group responded to treatment respectively. We conclude that immunotherapy with PPD appears safe, effective, and acceptable treatment modality for common warts in children. Although intralesional group showed slightly higher efficacy for warts (0.2%), intradermal PPD has advantage of less pain, high patient satisfaction, less spillage of injection material onto surroundings and better compliance over intralesional group and hence can be considered as valuable first line treatment in children in resource poor developing countries.

Evaluation of pediatric patients with јuvenile idiopathic arthritis treated with biological therapy Tocilizumab (Actemra)

Juvenile idiopathic arthritis (JIA) is the most common chronic disease in childhood. It manifests a heterogenic group of symptoms of arthritis, lasting at least 6 weeks and it appears before the age of 16. Patients who had no good therapeutic response to conventional therapy with Methotrexate were treated with biological therapy. The aim of this paper was to evaluate 9 patients who were receiving Tocilizumab at the Department of Rheumocardiology, University Clinic of Pediatric Diseases in Skopje. Materials and methods: Our study included 9 patients treated at our Department with biological therapy with Tocilizumab. Prior to initiation of the biological therapy, all patients underwent laboratory investigations, purified protein derivative (PPD) skin test for tuberculosis, X ray of the lungs and heart, and analysis of hepatitis markers. All patients were treated with amp. Actemra (tocilizumab) 8 mg/kg/tt i.v. Two of the patients had a severe form of the disease (one with severe systemic form and one with severe oligoarticular form of JIA). All presented patients had clinical remission of the disease. Conclusion: Therapy with tocilizumab in patients with juvenile idiopathic arthritis is a good therapeutic choice. The results obtained in our study have shown a significant therapeutic effect of tocilizumab even in severe forms of the disease.

Tuberculosis prevalence in animals and humans in the Republic of Kazakhstan

Background and Aim: Tuberculosis is an infectious disease that affects humans and animals. This study aimed to review the influence of economic and organizational, veterinary, and sanitary measures on the epizootic situation of animal tuberculosis and the epidemiological situation of human tuberculosis in the Republic of Kazakhstan. Materials and Methods: The epizootic situation of cattle tuberculosis in Kazakhstan was studied based on the annual statistics of allergy testing of animals with tuberculosis by the Committee for Veterinary Control and Supervision of the Ministry of Agriculture of the Republic of Kazakhstan, according to the results of allergic, clinical, and pathological studies, including laboratory studies of biomaterials from animals that reacted to tuberculin. Tuberculinization of cattle in the country is performed twice in the spring and autumn using tuberculin purified protein derivative for mammals. In addition, mass diagnosis of human tuberculosis is conducted by radiology. Results: The authors assessed the epizootic situation of tuberculosis in cattle in Kazakhstan from 1991 to 2019. The analysis results showed that at the beginning, the epizootic situation in cattle tuberculosis was challenging. However, since 2001, there has been a noticeable decrease in tuberculosis in animals in Kazakhstan, which has had a favorable effect on the epidemic situation of human tuberculosis. Conclusion: According to the analysis results, the measures used in the Republic of Kazakhstan to prevent tuberculosis improved the well-being of livestock farms. The proper conduct by qualified veterinary specialists on allergy testing of animals and differential diagnosis of nonspecific tuberculin reactions allows establishing an accurate epizootic picture of tuberculosis. Furthermore, strict adherence to instructions on the diagnosis and prevention of tuberculosis, implementation of developed veterinary, sanitary, and organization, and economic measures can improve the epizootic picture of tuberculosis, reducing the risk of human tuberculosis.

"MANTOUX TESTING IN UVEITIS PATIENTS AND TREATMENT OF PRESUMED INTRAOCULAR TUBERCULOSIS IN WESTERN UP"

Tuberculosis is re-emergingasaglobalhealthproblem.Itisaslowlyprogressive,chronic,granulomatous infectioncausedby M.tuberculosiswhichusuallyaffectslungs,butcanalsoaffectotherorganslikeCVS,GI,CNS,SKINandEYES. Choroidal tubercles and tuberculomas are reported to be the most common intraocular manifestations of TB and the most commonintraocularclinicalpresentationappearstobeposterioruveitis. ThediagnosisofocularTBisconsideredinsettingsof1.IsolationofM.tuberculosisfromocularfluidsortissuespecimen.Byamicrobiologicalorhistopathologicalstudy,PCR. 2.AspresumedoculardiseasesuggestiveofTBwithprovensystemicactivedisease. 3.Presumedoculardiseasewithoutevidenceofactivesystemicdisease. DiagnosticCriteriaForPresumedIntraocularTbUveitiswere. 1.Ocular findings consistent with possible intraocular TB with no other cause of uveitis suggested by history of symptoms,or ancillarytestings. 2.StronglypositiveMANTOUX OR TUBERCULINSKINTESTING(>10mmareaofinduration/necrosis) 3.Responsetoantituberculartherapywithabsenceofrecurrences. The aims of our study were to evaluate prevalence of Mantoux positive in newly referred uveitis patients in whom systemic evaluationwasperformedandtoassesstheoutcomeoftreatmentforpresumedintraoculartuberculosisinselectedpatients. MATERIALANDMETHOD The studywas conductedin theRetinaClinic atUpgradeddepartmentof Ophthalmology,LLRM medicalcollege,Meerut,India.Itwasaprospective,noncomparative,interventionalcaseseries. PatientsofocularinflammationreferredtoRetinaClinicwhounderwentsystemicevaluationwereincludedinthestudy A total of patients who satisfy the inclusion criteria , underwent systemic evaluation which include blood tests, chest radiograph,and tuberculin skin testing (0.05 _g purified protein derivative in 0.1 ml,equivalent to 2.5 tuberculin units) Both erythema and induration was measured at 48 hours,and the result were judged to be positive if induration was more than 10 mm Antituberculosis therapyi.eisoniazid300mg/day,rifampin600mg/day,ethambutol 15mg/kg/day,andpyrazinamide25–30 mg /kg/ day for the first 2 months ,thereafter rifampin and isoniazid were used for another 4–7 months was initiated for patients who had clinical findings consistent with possible intraocular tuberculosis,a positive tuberculin skin test result Responsetotherapywasassessedintermsofincreaseordecreaseorresolution OBSERVATIONAND RESULT Ofthe total 32patients 9patients havepositive tubercular contact history and30patientswere mantouxpositive.(94%),ofwhich78%havetheirindurationsizeof>15mmand8patientshavepositivex-rayfindings.(25%) Out of these 32 patients, 25 received antituberculous therapy for 9 months. In addition all of these patients also received systemicprednisone(1mg/kg/day)untilaclinicaleffectwasseenandthenaslowreductionofdosewasdone. 7patientsweredroppedoutfromthestudy. Out of these 25 patients which were started on treatment, 24 patients (96%) showed improvement in their clinical status, 19 patients (76%) showed improvement in their visual acuity after treatment and 35.6 % patients attained visual acuity of 6/9 or better. CONCLUSION Treatment with antitubercular therapy combined with systemic corticosteroids induces resolution of inflammation with no recurrences. So, mantoux testing should remain an integral part of the systemic work-up for uveitis patients.

A Comparative Study of Tuberculin Reactions to 2 TU and 5 TU of Purified Protein Derivative in a Tertiary Care Center

Introduction: Globally, tuberculosis (TB) is the second leading cause of deaths related to an infectious disease, after HIV. Tuberculin skin testing (TST) which is also called Mantoux test or purified protein derivative (PPD) test remains a useful tool to diagnose TB in children. Current recommendation is to use 2 TU PPD RT23 for all diagnostic purposes. TST or Mantoux test is considered positive if the induration is 10 mm or more. Due to non-availability of 2 TU, unstandardized TST with 5, 10 TU RT23 is in practice which can cause problems in reading of test results. Objectives: The objectives of the study were to compare the tuberculin reaction sizes to 2 TU and 5 TU doses of RT 23 with Tween 80 at 46–48 h and 76–78 h. Methodology: All children who were aged < 18 years and are known case of TB were included in the study. Each child was administered dual intradermal injections with 2 TU and 5 TU doses of tuberculin on the volar aspect of the forearm until a wheal was visible at the injected area. The reactions to both the tests were read at 46–48 h and 70–72 h. Institutional Ethics Committee approval was taken before start of the study. The statistical analysis was performed using SPSS 22 version software. Results A total number of cases included in the study during the study period were 81 cases, out of which 52 (64.19%) were male and 29 (35.8%) were female. Among those 81 cases, the mean reaction to 2 TU at 46–48 h was 12.79 mm and at 76–78 h was 15.33 mm. The mean reaction to 5 TU at 46–48 h was 18.89 mm and at 76–78 h was 22.80 mm. Among the cases, the mean size of induration at 46–48 h was lesser than that of 76–78 h in both 2 TU and 5 TU and it was statistically significant. Reactions to 2 TU and 5 TU PPD can be made comparable using the equation, 5 TU = (2 TU × 0.599) + 11.233 at 46–48 h and 5 TU = (2 TU × 0.074) + 21.66 at 76–78 h. ConclusionThus to conclude, cutaneous hypersensitivity to 2 TU PPD can be made comparison using the equation, 5 TU = (2 TU × 0.