Indian J Med Res
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Progression of HIV infection is largely dependent on the interaction between the viral factors and host factors. HIV primarily infects the CD4 lymphocytes in the body. It brings about the destruction of CD4 cells through multiple mechanisms including apoptosis. ⋯ One of the gray areas is the role of mucosal immune response in HIV infection. However, it is clear that it is not a single component but orchestrated action of different immune mechanisms will decide the outcome of HIV infection. The studies in persons exposed to HIV infection but who are uninfected and the long term non-progressors will be critical for understanding the immunopathogenesis of HIV infection.
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The mechanism underlying the development of tolerance to morphine is not clearly understood though a number of factors have been implicated. One of the likely factors may be increased activity of anti-opioid peptides like nociceptin (also known as orphanin FQ or N/OFQ). N/OFQ and morphine bind to opioid receptor-like 1 (ORL1) receptor and muopioid receptor respectively. The present work was undertaken to investigate the density of ORL1 and mu (mu) receptor expression in the spinal cord of mice after inducing morphine tolerance. ⋯ The present study showed that both, ORL1 and mu-opioid receptors were expressed in areas of the spinal cord, concerned with transmission of pain signals. The density of these receptors increased in the superficial laminae (I-II) though not significantly from control after morphine tolerance. The increase in ORL1 receptors could oppose the analgesic action of morphine, contributing to tolerance. Further studies need to be done to elucidate the mechanism of morphine tolerance.
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Multidrug-resistant tuberculosis (MDR-TB) caused by Mycobacterium tuberculosis resistant to both isoniazid and rifampicin with or without resistance to other drugs is among the most worrisome elements of the pandemic of antibiotic resistance. Globally, about three per cent of all newly diagnosed patients have MDR-TB. The proportion is higher in patients who have previously received antituberculosis treatment reflecting the failure of programmes designed to ensure complete cure of patients with tuberculosis. ⋯ Management of MDR-TB is a challenge which should be undertaken by experienced clinicians at centres equipped with reliable laboratory service for mycobacterial culture and in vitro sensitivity testing as it requires prolonged use of expensive second-line drugs with a significant potential for toxicity. Judicious use of drugs, supervised individualised treatment, focussed clinical, radiological and bacteriological follow up, use of surgery at the appropriate juncture are key factors in the successful management of these patients. In certain areas, currently available programme approach may not be adequate and innovative approaches such as DOTS-plus may have to be employed to effectively control MDR-TB.
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The membership list of genus mycobacterium is ever expanding and it has grown to 95 in year 2003. While leprosy and tuberculosis are specific diseases caused by mycobacteria, other members are usually saprophytes but can be opportunistic and at times deadly pathogens. These other mycobacteria are referred to as atypical mycobacteria, non-tuberculous mycobacteria (NTM) or mycobacteria other than tubercle bacilli (MOTT). ⋯ Several biochemical, chemical (lipid) and molecular techniques have been developed for rapid identification of these species. Along with suggestive clinical features, poor response to antitubercular treatment and repeated isolation of the organisms from the clinical specimens these techniques can help in establishing correct diagnosis. Further, many drugs like rifampicin, rifabutin, ethambutol, clofazimine, amikacin, new generation quinolones and macrolides effective against mycobacterial infections are available that can be used in appropriate combinations and dosage to treat these infections.