Browsing by Author "Kabra, S. K."
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- ItemEvaluation of tuberculosis diagnostics in children: 2. Methodological issues for conducting and reporting research evaluations of tuberculosis diagnostics for intrathoracic tuberculosis in children. Consensus from an expert panel(2012) Cuevas, L. E.; Browning, R.; Bossuyt, P.; Casenghi, M.; Cotton, M. F.; Cruz, A. T.; Dodd, L. E.; Drobniewski, F.; Gale, M.; Graham S. M.; Grzemska, M.; Heinrich, N.; Hesseling, A. C.; Huebner, R.; Jean-Philippe, P.; Kabra, S. K.; Kampmann, B.; Lewinsohn, D.; Li, M.; Lienhardt, C.; Mandalakas A. M.; Marais, B. J.; Menzies, H. J.; Montepiedra, G.; Mwansambo, C.; Oberhelman, R.; Palumbo, P.; Russek-Cohen, E.; Shapiro, D. E.; Smith, B.; Soto-Castellares, G.; Starke, J. R.; Swaminathan, S.; Wingfield, C.; Worrell, C.Confirming the diagnosis of childhood tuberculosis is a major challenge. However, research on childhood tuberculosis as it relates to better diagnostics is often neglected because of technical difficulties, such as the slow growth in culture, the difficulty of obtaining specimens, and the diverse and relatively nonspecific clinical presentation of tuberculosis in this age group. Researchers often use individually designed criteria for enrollment, diagnostic classifications, and reference standards, thereby hindering the interpretation and comparability of their findings. The development of standardized research approaches and definitions is therefore needed to strengthen the evaluation of new diagnostics for detection and confirmation of tuberculosis in children.In this article we present consensus statements on methodological issues for conducting research of Tuberculosis diagnostics among children, with a focus on intrathoracic tuberculosis. The statements are complementary to a clinical research case definition presented in an accompanying publication and suggest a phased approach to diagnostics evaluation; entry criteria for enrollment; methods for classification of disease certainty, including the rational use of culture within the case definition; age categories and comorbidities for reporting results; and the need to use standard operating procedures. Special consideration is given to the performance of microbiological culture in children and we also recommend for alternative methodological approaches to report findings in a standardized manner to overcome these limitations are made. This consensus statement is an important step toward ensuring greater rigor and comparability of pediatric tuberculosis diagnostic research, with the aim of realizing the full potential of better tests for children. © 2012 The Author.
- ItemRole of the QuantiFERON?-TB Gold In-Tube test in the diagnosis of intrathoracic childhood tuberculosis(INT UNION AGAINST TUBERCULOSIS LUNG DISEASE (I U A T L D), 68 BOULEVARDSAINT-MICHEL,, PARIS, FRANCE, 75006, 2013) Lodha, R.; Mukherjee, A.; Saini, D.; Saini, S.; Singh, V.; Grewal, H. M. S.; Kabra, S. K.; Aneja, S.; Arya, T.; Bhatnagar, S.; Hesseling, A. C.
- ItemVitamin D levels in Indian children with intrathoracic tuberculosis(Medknow, 2014-10) Khandelwal, Deepchand; Gupta, Nandita; Mukherjee, Aparna; Lodha, Rakesh; Singh, Varinder; Grewal, Harleen M. S.; Bhatnagar, Shinjini; Singh, Sarman; Kabra, S. K.; Delhi Pediatric TB study group; Hesseling, A. C.Background & objectives: Deficiency of vitamin D, an immunomodulator agent, is associated with increased susceptibility to tuberculosis in adults, but only limited studies are available in the paediatric age group, especially regarding association of vitamin D with type and outcome of tuberculosis. We conducted this study to determine the baseline 25-hydroxy vitamin D levels in children suffering from intrathoracic tuberculosis and its association with type and outcome of tuberculosis. Methods: Children with intrathoracic tuberculosis, diagnosed on the basis of clinico-radiological criteria, were enrolled as part of a randomized controlled trial on micronutrient supplementation in paediatric tuberculosis patients. Levels of 25-hydroxy vitamin D were measured in serum samples collected prior to starting antitubercular therapy by chemiluminescent immunoassay technology. Results: Two hundred sixty six children (mean age of 106.9 ± 43.7 months; 57.1% girls) were enrolled. Chest X-ray was suggestive of primary pulmonary complex, progressive disease and pleural effusion in 81 (30.5%), 149 (56%) and 36 (13.5%) subjects, respectively. Median serum 25-hydroxy vitamin D level was 8 ng/ml (IQR 5, 12). One hundred and eighty six (69.9%) children were vitamin D deficient (serum 25-hydroxy vitamin D <12 ng/ml), 55 (20.7%) were insufficient (12 to <20 ng/ml) and 25 (9.4%) were vitamin D sufficient (≥ 20 ng/ml). Levels of 25-hydroxy vitamin D were similar in all three types of intrathoracic tuberculosis, and in microbiologically confirmed and probable cases. Levels of 25-hydroxy vitamin D did not significantly affect outcome of the disease. Children who were deficient or insufficient were less likely to convert (become smear/culture negative) at two months as compared to those who were 25-hydroxy vitamin D sufficient ( p <0.05). Interpretation & conclusions: Majority of Indian children with newly diagnosed intrathoracic tuberculosis were deficient in vitamin D. Type of disease or outcome was not affected by 25-hydroxy vitamin D levels in these children. However, children who did not demonstrate sputum conversion after intensive phase of antitubercular therapy had lower baseline 25-hydroxy vitamin D levels as compared to those who did.