单核细胞趋化蛋白1和血管内皮细胞钙黏蛋白水平与脑梗死进展及颈动脉粥样硬化的关系

目的探讨血清单核细胞趋化蛋白1(MCP-1)、血管内皮细胞钙黏蛋白(VE-cadherin)水平与脑梗死进展及颈动脉粥样硬化的关系。方法选取112例急性脑梗死患者作为脑梗死组,其中进展性脑梗死37例,非进展性脑梗死75例;颈动脉内膜中层厚度(IMT)正常19例、IMT增厚17例及斑块76例,同时选择健康体检者49例作为对照组。比较各组血清MCP-1、VE-cadherin水平。结果脑梗死组血清MCP-1[(305.21±32.17)ng/L vs(217.70±23.33)ng/L]和VE-cadherin[(6.12±1.11)mg/L vs(3.95±0.40)mg/L]均高于对照组(P0.05)。与非进展性脑梗死比较,进展性脑梗死患者血清MCP-1[(317.23±29.64)ng/L vs(299.28±31.89)mg/L]、VE-cadherin[(6.53±1.06)mg/L vs(5.92±1.09)mg/L]水平升高,颈动脉斑块检出率升高(86.5%vs 58.7%),斑块以混合回声与低回声斑块为主;斑块患者血清MCP-1、VE-cadherin水平高于IMT正常与IMT增厚患者。结论进展性脑梗死患者血清MCP-1、VE-cadherin水平高,提示其与动脉粥样硬化程度及斑块稳定性有一定关系。     

脑梗死患者颈动脉粥样硬化与血清超敏C反应蛋白水平的相关性分析

目的探讨脑梗死患者的炎症标记物超敏C反应蛋白(hs-CRP)水平与颈动脉粥样硬化的相关性。方法将107例脑梗死患者按颈总动脉内-中膜厚度(IMT)分为IMT正常组、IMT增厚组和斑块组,或者IMT正常组和动脉粥样硬化组,比较各组间血清hs-CRP水平。结果 IMT增厚组、斑块组血清hs-CRP显著高于IMT正常组,差异均有统计学意义(P<0.05);斑块组血清hs-CRP显著高于IMT增厚组,差异有统计学意义(P<0.05)。动脉粥样硬化组血清hs-CRP显著高于IMT正常组,差异有统计学意义(P<0.05)。结论结合血清hs-CRP水平与颈动脉IMT可以预测脑梗死的发生及预后。     

血清CD40、CD40L和基质金属蛋白酶-9水平与颈动脉内膜中层厚度的相关性

目的观察颈动脉粥样硬化(CAS)患者颈动脉内膜中层厚度(IMT)、白细胞分化抗原40及其配体(CD40/CD40L)和基质金属蛋白酶9(MMP-9)变化,探讨上述指标之间的关系。方法选择CAS患者94例,其中IMT增厚的有34例,颈动脉斑块形成的有60例;健康体检者20例(IMT正常组)。采用颈动脉超声检测实验组和对照组IMT,采用酶联免疫吸附试验(ELISA)法检测两组血清CD40、CD40L和MMP-9水平。结果随着IMT的增厚,血清CD40、CD40L、MMP-9水平明显升高(P0.05);有不稳定斑块的CAS患者IMT及血清CD40、CD40L、MMP-9水平较稳定斑块患者明显升高,不稳定斑块CAS患者脑梗死(CI)发病率高于斑块稳定组(P均0.05)。结论血清CD40、CD40L、MMP-9能促进CAS的形成和增厚,MMP-9能增加斑块的不稳定性,导致CI的发生,监测血清CD40、CD40L、MMP-9水平,能用来预测CAS患者的IMT、斑块的稳定性和疾病的预后。     

急性缺血性脑血管病患者血清ox-LDL及PAPP-A水平变化及临床意义

目的探讨急性缺血性脑血管病患者血清氧化型低密度脂蛋白(ox-LDL)及妊娠相关血浆蛋白(PAPP)-A水平及临床意义。方法选择86例急性缺血性脑血管病患者作为实验组,同期入院行健康体检者30例作为对照组。比较两组以及实验组发病24 h内、治疗后第7天、治疗后第14天血清ox-LDL及PAPP-A水平。观察动脉内-中膜厚度(IMT)、不同性质颈动脉斑块的血清ox-LDL及PAPP-A水平。结果实验组血清oxLDL及PAPP-A水平显著高于对照组(P0.05);实验组治疗后第7、14天血清ox-LDL及PAPP-A水平显著低于发病24 h内(P0.05);颈动脉硬化组血清ox-LDL及PAPP-A水平显著高于IMT增厚组,IMT增厚组血清ox-LDL及PAPP-A水平显著高于IMT正常组。易损斑块组血清ox-LDL及PAPPA水平显著高于稳定斑块组。结论通过检测血清ox-LDL及PAPP-A水平,可提示急性缺血性脑血管病早期发生,判断预后,值得临床推广应用。     

脑梗死患者血清同型半胱氨酸水平与颈动脉粥样硬化的相关性

目的探讨脑梗死患者血清同型半胱氨酸(Hcy)水平与颈动脉粥样硬化的相关性。方法收集该院收治的脑梗死患者60例为脑梗死组,同时期的健康体检者20例为正常对照组,对所有研究对象的血清Hcy、叶酸及维生素(Vit)B12水平及颈动脉粥样硬化相关情况进行检测分析。结果与正常对照组比较,脑梗死组患者的血清Hcy水平较高,血清叶酸及Vit B12水平较低(P0.05)。与正常对照组比较,脑梗死组患者的颈动脉内膜中层厚度(IMT)较高(P0.05)。不同颈动脉狭窄程度患者血清Hcy水平:无狭窄组轻度狭窄组中度狭窄组重度狭窄组(P0.05)。不同颈动脉斑块数量患者血清Hcy水平:无斑块组单发斑块组多发斑块组(P0.05)。不稳定斑块组的血清Hcy水平明显高于稳定斑块组(P0.05)。脑梗死患者颈动脉IMT与血清Hcy水平呈线性正相关(r=0.612,P0.01)。结论脑梗死患者的血清Hcy水平及颈动脉IMT水平高于正常对照组,且血清Hcy水平越高,颈动脉粥样硬化程度越严重。     

急性脑梗死患者血清PAPP-A水平与颈动脉粥样硬化斑块的相关性

目的探讨急性脑梗死患者妊娠相关血浆蛋白A(PAPP-A)水平与颈动脉粥样硬化斑块的关系。方法应用彩色多普勒超声检查79例急性脑梗死组患者和64例正常对照者的颈动脉斑块及内膜中膜厚度(IMT),同时检测血清PAPP-A水平;将急性脑梗死患者依据颈动脉超声检查结果分为颈动脉无斑块组15例,稳定性斑块组20例,不稳定性斑块组44例,比较各组血清PAPP-A水平。结果急性脑梗死斑块检出率、不稳定性斑块检出率及IMT均显著高于正常对照组(P0.01),血清PAPP-A水平高于正常对照组(P0.05)。在急性脑梗死患者中,不稳定性斑块组血清PAPP-A水平显著高于稳定性斑块组和无斑块组,稳定性斑块组血清PAPP-A水平显著高于无斑块组(P0.01)。线性相关分析显示,急性脑梗死组患者IMT与血清PAPP-A水平有明显相关性(r=0.718,P0.01)。结论颈动脉粥样硬化斑块及其稳定性与脑梗死发生有密切关系;PAPP-A与颈动脉粥样硬化密切相关,可能是不稳定性粥样硬化斑块的血清标志物。     

同型半胱氨酸 血尿酸水平与腔隙性脑梗死患者动脉粥样硬化的相关性研究

目的探讨血清同型半胱氨酸(Hcy)、血尿酸(SUA)水平与腔隙性脑梗死患者动脉粥样硬化的相关性。方法选取2012-11~2015-10该院住院的腔隙性脑梗死患者93例作为脑梗死组,根据超声检查结果分为动脉内膜中层厚度(IMT)正常组26例,IMT增厚组22例,斑块组45例三个亚组,另选择同期90名健康体检者作为正常对照组,比较各组间Hcy、SUA水平及IMT值,并分析指标间相关性。结果脑梗死组血清Hcy、SUA水平均明显高于正常对照组(P0.01)。脑梗死组内各亚组之间血清Hcy、SUA水平及IMT值比较差异均有统计学意义(P0.05),其中IMT增厚组和斑块组各指标均明显高于IMT正常组(P0.05),而斑块组各指标则均明显高于IMT增厚组(P0.05)。经Pearson相关性分析显示腔隙性脑梗死患者IMT值与血清Hcy、SUA水平之间均呈正相关(P0.05)。结论腔隙性脑梗死患者血清Hcy、SUA水平明显增高,且血清Hcy、SUA水平升高与颈动脉粥样硬化的发生密切相关。     

急性缺血性脑卒中患者血清ox-LDL水平与颈动脉易损斑块的相关性

目的探讨急性缺血性卒中(CIS)患者血清氧化型低密度脂蛋白(ox-LDL)水平与颈动脉易损斑块的相关性。方法选取2015年1~9月该院收治的经CT和磁共振成像(MRI)确诊为CIS患者224例,根据颈动脉B型超声检查结果将患者分为无斑块组45例、稳定斑块组62例及易损斑块组117例,调查记录研究对象的一般资料,包括血压、身高、体重等,测定血清ox-LDL、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)和空腹血糖(FPG)水平;并采用颈动脉超声检测颈动脉内中膜厚度(IMT)、总斑块面积(TPA)及斑块性质,分析血清ox-LDL水平与CIS患者颈动脉易损斑块的相关性。结果三组高血压发生率、血清ox-LDL水平、颈动脉IMT平均厚度以及增厚率整体和两两比较均有显著差异(P0.05),易损斑块组的总斑块面积(TPA)明显高于稳定斑块组(P0.01)。相关性分析结果显示三组血清ox-LDL水平与血清TC、LDL-C水平以及颈动脉IMT值呈正相关(r=0.376,0.397,0.203,P0.05),与TG、HDL-C、FPG无相关性(P0.05)。Logistic回归分析结果显示易损斑块的形成仅与血清ox-LDL水平独立相关(OR=1.021,95%CI 0.996~1.072,P0.01)。结论急性CIS患者血清ox-LDL水平与颈动脉易损斑块的形成独立相关,提示ox-LDL水平可作为临床初筛易损斑块的血清学指标。     

同型半胱氨酸和胱氨酸蛋白酶抑制剂C与脑梗死病人颈动脉粥样硬化的关系

目的观察同型半胱氨酸(Hcy)和胱氨酸蛋白酶抑制剂C(CysC)与脑梗死病人颈动脉粥样硬化的关系。方法入选2013年1月—2017年12月诊治的动脉粥样硬化性脑梗死病人200例为观察组,同期健康体检人群100名为对照组。观察组病人经多普勒超声检查颈动脉内膜中层厚度(IMT)进一步分组,即IMT正常组(IMT1.0mm)、IMT增厚组(1.0mm≤IMT1.2 mm)和斑块组(IMT≥1.2 mm)斑块组,根据斑块性质分为软斑块组、硬斑块组以及混合斑块组。检测比较各组间Hcy和CysC水平的差异,采用Pearson相关分析和多元线性逐步回归分析Hcy和CysC与脑梗死病人颈动脉粥样硬化的关系。结果与对照组比较,观察组Hcy和CysC水平升高(均P 0.05)。随着IMT的增厚,Hcy和CysC水平也逐渐升高(均P 0.05)。混合斑块组的Hcy和CysC水平高于软斑块组和硬斑块组,软斑块组又高于硬斑块组(均P 0.05)。Pearson相关分析显示,Hcy(r=0.358,P 0.05)和CysC(r=0.462,P 0.05)水平与IMT呈正相关。多元线性逐步回归分析显示,Hcy(β=2.969,P 0.05)和CysC(β=2.369,P 0.05)是IMT增厚或斑块形成的危险因素。结论 Hcy和CysC水平升高是动脉粥样硬化性脑梗死病人颈动脉IMT增厚或斑块形成的危险因素。     

钙卫蛋白与高血压患者颈动脉粥样硬化的相关性

目的探讨高血压患者血清钙卫蛋白水平的变化及与颈动脉粥样硬化的相关性。方法回顾性入选2015年6月-2016年12月住院和门诊诊治高血压患者280例为高血压组,根据血压水平进一步分为3个亚组:高血压1级组、高血压2级组和高血压3级组;根据颈动脉内膜中层厚度(IMT)分为3个亚组:IMT正常组、IMT增厚组和斑块形成组;另选取同期年龄和性别相匹配的健康体检人员80人为对照组。采用酶联免疫吸附试验(ELISA)法检测各组受试者血清钙卫蛋白水平,应用彩色多普勒超声检测颈动脉IMT水平,统计分析钙卫蛋白与颈动脉IMT的关系。结果高血压组钙卫蛋白、IMT和颈动脉斑块检出率高于对照组(均P0.05),并随着血压水平的升高,钙卫蛋白、颈动脉IMT和斑块检出率逐渐上升。在高血压组患者中,不同颈动脉IMT亚组的钙卫蛋白水平存在差异,IMT增厚亚组和斑块形成亚组高于IMT正常亚组,斑块形成亚组又高于IMT增厚组(均P0.05)。Pearson相关性分析显示,钙卫蛋白水平与颈动脉IMT呈正相关(r=0.548,P0.05)。多元线性回归分析显示,血清钙卫蛋白水平(B=0.285)、年龄(B=0.237)是高血压患者颈动脉IMT的影响因素(P0.05)。结论高血压患者血清钙卫蛋白水平与血压水平和IMT呈正相关,是颈动脉粥样硬化的影响因素。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.