On deaf ears,Mycobacterium avium paratuberculosis in pathogenesis Crohn’s and other diseases

The historic suggestion that Mycobacterium avium subsp. paratuberculosis (Map) might be a zoonotic pathogen was based on the apparent similarity of lesions in the intestine of patients with Crohn’s disease (CD) with those present in cattle infected with Map, the etiological agent of Johne’s disease. Reluctance to fully explore this possibility has been attributed to the difficulty in demonstrating the presence of Map in tissues from patients with CD. Advances in technology have resolved this problem and revealed the presence of Map in a significant proportion of patients with CD and other diseases. The seminal finding from recent investigations, however, is the detection of Map in healthy individuals with no clinical signs of disease. The latter observation indicates all humans are susceptible to infection with Map and lends support to the thesis that Map is zoonotic, with a latent stage of infection similar to tuberculosis, where infection leads to the development of an immune response that controls but does not eliminate the pathogen. This clarifies one of the reasons why it has been so difficult to document that Map is zoonotic and associated with the pathogenesis of CD and other diseases. As discussed in the present review, a better understanding of the immune response to Map is needed to determine how infection is usually kept under immune control during the latent stage of infection and elucidate the triggering events that lead to disease progression in the natural host and pathogenesis of CD and immune related diseases in humans.     

Inactive Fibrotic Lesions Versus Pulmonary Tuberculosis With Negative Bacteriology

This article analyzes the concept of inactive fibrotic lesions of presumed tuberculous origin (old healed tuberculosis), defined by radiological characteristics and a positive tuberculin skin test (TST), and we examine the evidence-based foundation for the indication of treatment of latent tuberculosis infection in these cases. We explore the risk of reactivation in older and recent literature, and the problems raised by the differential diagnosis with active tuberculosis with negative bacteriology. We also analyze data on the prevalence of fibrotic lesions in the recent literature. We examine the possible role of Interferon Gamma Release Assays (IGRAs) versus TST and other molecular antigen detection techniques in sputum that can aid in establishing the diagnosis and we discuss the current indications for chemoprophylaxis and the different options available. We propose diagnostic guidelines and therapeutic algorithms based on risk stratification by age and other factors in the management of radiological lesions that raise a differential diagnosis between fibrotic lesions and active pulmonary tuberculosis with negative bacteriology.     

分期后前路联合手术治疗老年颈胸段长节段脊柱结核

目的 探讨分期后路固定前路病灶清除植骨融合治疗老年颈胸段长节段脊柱结核手术的安全性及临床疗效.方法 对自2006-12-2011-06诊治的老年颈胸段脊柱结核8例均行分期后前路联合手术,术后继续抗结核治疗12～18个月.结果 术后伤口均一期愈合,无结核复发.所有患者获得随访18～64个月,平均39个月.术后3个月内ESR均降至正常.末次随访时神经功能Frankel分级:C级1例,D级2例,E级5例.结论 对于老年长节段颈胸段结核采用分期后前路手术具有彻底清除病灶、矫正畸形、360°植骨、重建稳定等优点,是一种安全有效的治疗方法.     

结核病区医务人员医用防护口罩佩戴现状及影响因素分析

目的了解结核病区医务人员医用防护口罩佩戴状况及影响因素,为有针对性地做好职业防护提供参考。方法对广州军区5所三甲综合性医院的结核病区195名医务人员采用自行设计的问卷进行佩戴医用防护口罩行为现状调查,分析医务人员佩戴医用防护口罩行为的影响因素。结果结核病区医护人员佩戴医用防护口罩的行为得分为(17.93±3.37)分,结核病区医护人员佩戴医用防护口罩细节行为条目得分较低;职业、教育培训、监管机制、经济因素是结核病区医务人员佩戴医用防护口罩行为的主要影响因素(P0.05,P0.01)。结论结核病区医务人员佩戴医用防护口罩的主动意识较强,但较易忽视佩戴的细节行为。职业防护须重视细节行为,加大教育培训、双重监管和经济投入力度,以预防结核病医院感染,促进医务人员职业防护。     

Study of Surgical Emergencies of Tubercular Abdomen in Developing Countries

To study the various modes of presentation, diagnosis, and management of surgical emergencies of tubercular abdomen. This prospective study of surgical emergencies of tubercular abdomen was conducted in 50 patients who attended our surgical emergency from 2006 to 2008. Patients were evaluated thoroughly with history, physical examination, routine investigations, and special investigations such as ELISA, PCR, barium studies of gastrointestinal tract, and diagnostic laparoscopy as required and managed with medical and surgical treatment as necessary. The most of patients were from rural areas, in the third to sixth decades with slight male preponderance. Abdominal pain, vomiting, and constipation were commonest presenting symptoms. About 20 % patients had history of pulmonary tuberculosis and 16 % patients presented with ascites. PCR for blood and ascitic fluid was positive in 72 and 87.5 % patients, respectively. About 24 % patients were managed nonoperatively and responded to ATT. About 76 % patients needed surgery among which one-fifth of patients were operated in emergency. Procedures like adhesiolysis of gut (47.3 %), strictureplasty (10.5 %), resection anastomosis (5.2 %), right hemicolectomy (5.2 %), and ileotransverse anastomosis (7.8 %) were performed in 30 patients and peritoneal biopsy and lymph node biopsy in the remaining 8 patients. Both medically and surgically managed patients were put on antitubercular therapy. Abdominal tuberculosis is a disease of middle-aged rural people, presenting commonly with abdominal pain and vomiting with right lower abdominal tenderness. PCR (blood and ascites) for tuberculosis is much more sensitive than IgM ELISA (blood and ascites). The most of patients required surgical procedures and all patients responded dramatically to antitubercular therapy symptomatically with increase in the hemoglobin level and decrease in ESR.     

结核病专科医院临床护士营养知识态度现状调查分析

目的了解结核病专科医院护士的营养知识和态度的现状,分析其相关性,为针对性地进行营养知识培训提供依据。方法采用方便抽样的方法,对某三甲结核病专科医院的256名临床护士的营养知识和态度进行调查。结果护士营养知识正确率53.74%,得分(16.12±4.56)分,其中良好、一般、差者分别占1.2%、41.0%、57.8%;不同年龄、工作年限、学历、职务、编制、工作状况护士的营养知识掌握情况比较,差异有统计学意义(P0.05,P0.01);态度得分为(94.56±10.53)分,持正性、中性、负性态度者分别占64.5%、33.6%、1.9%,不同职称护士的营养态度得分差异有统计学意义(P0.01);营养知识与态度呈正相关(P0.01)。结论护理管理者应加强对护士营养知识的培训,端正其对营养的态度,从而提高营养护理质量。