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when a person is suspected with
tuberculosis or tb of the lungs
coughing out a sputum sample helps quick
diagnosis
but the same cannot be done if it is tb
of the brain or spine or the intestines
or bones
obtaining localized samples in such
cases requires surgical intervention at
a super specialty hospital
something not easily available or
affordable especially in tb endemic
countries
even with genome sequencing and other
modern diagnostic tests for tuberculosis
patient fallout is a major worry even
today
but with grant and aid support from the
united states india science and
technology endowment fund health is
close
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we bring your story of collaboration
from the university of california davis
sacramento and from new delhi and bhopal
in india
from the university of california
davis's medical center's department of
pathology and laboratory medicine
this is professor imran khan
developing a blood
test for tuberculosis has been very
challenging
so this
current funding from
uis stf is enabling us to perform a
study in india biggest advantage what we
see
that if everything goes well
then you know extrapolated vocabulary
which is very difficult to diagnose say
for example the
tv of the brain or tb of the bone or tb
of the intestine which are very very
difficult to diagnose they can be
diagnosed
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with 55 to 60 million tests required
annually in india for over 30 strains of
the tb bacteria today
it is rather tough for even the finest
doctors to pinpoint the exact strain
that is actually causing the disease
since children under 5 do not produce
sputum doctors are in a fix
how should the doctors here at the
community health center carry out a
sputum test for him
could the power of science and
technology come to the rescue
nextgen's diagnostics generates a
signature for each disease-causing
strain of tb
sputum or no sputum x-ray or no x-ray
basilic culture test or no culture test
the bacteria cannot hide any longer from
the prying eyes of this new age test
that can catch all forms of tuberculosis
look at these little wells here they
have different blood samples from
different patients
something entirely unheard of with a lot
of diagnostic tests for tb these wells
are most important part of the overall
test which means that the
basic component which is the heart of
the product which are the
conjugated beads
which are beads which have the antigens
coated
they are placed in each of the wells
and each well actually acts as one
patient sample reservoir
so we put when we do the test we put the
all the reagents in each well and each
patient sample is then distributed into
different wells
and you can see there is a
row and a column identification which
tracks the patient id and the well id
and here at the university of california
davis medical center
dr rashmi ravindran performs a test
using the well plate and what's more you
could even post the blood sample sitting
dry on these cards
it's the membrane here that does the job
by keeping the protein in the blood safe
enough for the tests to proceed even at
a later date
since not much expertise is required to
carry out these tests it can be easily
used at public and community health
centers
no more than just a drop of blood is all
that the test needs
the beauty of this test is that
all it takes is
very few drops of blood
and that we achieve it through taking it
even on our filter paper which we call
it internally as dried blood spot which
can be even collected by an asha worker
who goes to the remotest location
it's very easy uh when the blood spots
are taken on the card
uh it is just dried uh in over five
seven minutes
and then it is put into an envelope
which can be carried by the asha worker
to the nearest testing site where the
testing happens
and the cards are stable for more than
24 hours so that is not a problem
so even if it is a long distance you can
actually transport the sample without
affecting the
authenticity of the sample
the poor man's disease that tb is
this next-gen test will be cheaper per
test than many other older diagnostic
methods with the instrument which we use
as the platform technology we are able
to do anything between 300 to 1000 tests
per day
now this kind of throughput is not
possible with any other tuberculosis
test and this is the reason why the
total cost of doing the test becomes
much more affordable than any other
technique which is available we use very
little
reagents or even very little
sample
for doing the analysis
so unlike where you use liters of
reagents we use micro liters of reagents
and that's where the whole cost of
ownership of the test comes down so even
the running cost for the lab is very
very less compared to any other
biochemistry or
immunodiagnostic tests which are used
normally when you go to any doctor or
for any lab diagnosis
the doctor starts to eliminate the
possibilities which means he would do
one or the other test to see whether
that disease exists or not and finally
after a battery of tests he would come
down to the specific cause of the
disease
now because we use a multiplexing
approach we combine all such incidences
into one single test
makes it more selective than the tests
which are currently in practice
so that
actually translates into a lot of
robustness because in the first instance
only you will get a correct diagnosis
apart from being robust what makes this
technique especially attractive is its
ability to correctly identify all the 30
different strains of tb in a single go
which scientists refer to as
multiplexing
the entire sample is broken down it says
individual cell components
and the individual cells one by one are
identified through two sets of lasers
which operate at different wavelengths
so when the cell carries a signature
of a particular disease
it is identified by one or the other
laser which gives it as a reading which
we call it as mean fluorescence index
mfi
so what we measure is the mfi of the
cell and through that we are able to
clearly say whether it is above a
baseline
over which there is a active disease or
below the waistline where it can be
qualified as a latent
disease which does not manifest itself
into a
real active disease
and that index was used to read
what is the kind of strain involved
so it's a basically it's a
it's a complex science but very easily
converted into a product for diagnosis
as of now there is no easy diagnosis for
extrapolate to work process and
pediatric tuberculosis it is very
difficult because usually the the
extra pulmonary tuberculosis is possible
acidity when we say possible means
number of bacteria in the sample given
sample will be very less
and for the smear microscopy we need to
have in the smear about more than one
thousand if you even look at the global
product portfolio pipeline
uh there is nothing like this in any
where close to uh validation or even
development so in a way we are the first
ones to have actually
uh be at this point where we are
actually validating it in the clinical
settings which is the real life settings
with clinical validation already
providing clear indications of the tests
being more sensitive accurate and
specific for all forms of tb resulting
in improved treatment initiation
this technology would be the major boost
the healthcare system needs to control
tb
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so
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