Philippine guidelines on the screening for tuberculosis prior to the use of biologic agents

Aim: To develop practice guidelines in tuberculosis screening of patients and their households and close contacts, prior to the use of biologic agents. Method: A technical research committee formulated an evidence‐based draft, based on existing literature regarding the tests used in tuberculosis screening among immunocompromised patients. The evidence‐based draft was then circulated to an expert panel. An en banc meeting of the panelists was held and a consensus was declared if more than 50% agreed on a recommendation. Issues not resolved by consensus were discussed by correspondence and voted upon. The guidelines were presented in a public forum and feedback by stakeholders were reviewed and integrated into the final draft. Recommendations: 1. Patients for biologic therapy should be screened for latent and active tuberculosis prior to initiating treatment. 2. All patients who are candidates for biologic agents should be screened by tuberculin skin test for latent TB, and a chest radiograph for active tuberculosis. 3. Household and close contacts of candidate patients should be screened for active tuberculosis. 4. All household and close contacts of candidate patients should be screened for active TB using chest radiograph. 5. Treat latent and active tuberculosis according to local guidelines. 6. Delay treatment with biologic agents in patients with latent or active tuberculosis. 7. Administer tuberculosis prophylaxis to the patient for biologic therapy exposed to household contacts with active tuberculosis. Conclusion: These recommendations emphasize the importance of screening patients, household and close contacts for latent and active tuberculosis prior to initiating biologic therapy.     

Role of collagen-adherent platelets in mediating fibrin formation in flowing whole blood

Activated platelets provide assembly sites for coagulation enzyme complexes and in this way can mediate coagulation during hemostasis and thrombosis. In this study, we examined the procoagulant activity of platelets adhering directly to fibrillar collagen, a main thrombogenic constituent of subendothelium. For this purpose, we used a human ex- vivo thrombosis model in which collagen-coated coverslips were exposed to flowing nonanticoagulated blood (shear rate, 65/s) for 5.5 minutes, which led to the deposition of adherent platelets, platelet thrombi, and fibrin. To examine the procoagulant activity of adherent platelets only, a selective antagonist of the platelet GPIIb-IIIa complex, Ro 44- 9883, was infused via a mixing device, resulting in a complete abrogation of platelet thrombus formation but leaving the collagen- adherent platelet layer intact. This platelet layer generated increased postchamber fibrinopeptide A (FPA) levels (203 +/- 33 ng/mL) as compared with control experiments without infusion of inhibitor (95 +/- 13 ng/mL). Concomitantly, fibrin deposition measured by morphometric analysis of cross-sections was also increased, as was the platelet adhesion to collagen. An immunochemical staining of fibrin fibers further showed that the adherent platelets formed the nuclei for fibrin fiber formation. This increase in fibrin deposition was mediated by the intrinsic factor X (F.X) activation complex on adherent single platelets, because almost complete inhibition of FPA generation (9 ng/mL) and fibrin deposition (0.4% +/- 0.2% coverage) was achieved upon coinfusion of the GP IIb-IIIa antagonist and active site-inhibited F.IXa. The large platelet thrombi that were deposited in control experiments contained no significant amounts of immunodetectable fibrin except at the thrombus base, where adherent platelets anchored the thrombi to the collagen surface. These results suggest that the collagen-adherent platelets are important promoters of coagulation during the initial phase of thrombogenesis by providing assembly sites for the F.X activation complex.     

河南省活动性肺结核病人发现状况分析

目的　反映河南省活动性肺结核病人发现水平。方法 根据河南省2000年第四次全国结核病流行病学抽样调查数据中病人发现情况进行分析。结果 结防机构仅登记、管理了5.1%的活动性肺结核病人;88.6%的肺结核病人在非结防机构确诊,其中93.6%未转诊、登记。结论 加强各级综合医疗机构结核病归口管理是提高病人发现水平的关键。     

Effects of Dracaena arborea(Dracaenaceae) on sexual dysfunction in 4 weeks hyperglycemic male rats

Objective:To investigate the effects of Dracaena arborea(D.arborea) on the sexual behavior parameters in experienced type-1 diabetic rats.Methods:Aqueous and ethanol(100 and 500mg/kg respectively)extracts of dried root barks of D.arborea.sildenafil citrate(1.44 mg/kg),trimethylamine-N-oxide(TMAO,20 mg/kg)and distilled water(110 mL/kg.were orally administered to 4 weeks streptozolocin-induced diabetic rats.Mount latency and frequency(ML.MF),intromission latency and frequency(IL,IF) and post-ejaculatory interval(PEI) were measured by ejaculating series during 90 min once a week for 4 weeks.Glycemia was determined at the beginning and at the end of the treatment Results:D.arborea did not show any major antihvperglycemic effects.Compared to the control group,a significant(P0.05-0.001)increase in MF and IF was noticed in rats treated with sildenafil citrate(89.71% and 90.07% respectively),aqueous(500 mg/kg.88.08%and 88.749;respectively) and ethanol(100 mg/kg;89.53%and 89.17respectively) extracts of D.arborea after two weeks(series 1) of treatment.ML,IL and PEI were significantly(P0.05-0.001) decreased after 4 weeks of daily treatment[sildenafil citrate(96.31.96.31%and 34.98%),and D.arborea aqueous 500 mg/kg(94.33.94.33% and 66.609;i and ethanol extracts 100 mg/kg(96.98.97.089;and 64.26%)].Conclusions:These aphrodisiac potentials of D.arborea in experienced diabetic rats could be due to the antioxidant and androgenic properties of phenols,flavonoids.saponins and sterols revealed in the plant extracts.     

Bone involvement in young patients with non-Hodgkin's lymphoma: efficacy of chemotherapy without local radiotherapy

Of 95 young non-Hodgkin's lymphoma patients entered consecutively on the National Cancer Institute (NCI) Protocol 7704, 26 (27.4%) had involvement of one or more bones. The mean age of these 26 patients was 16.6 years, and the male to female ratio was 3.3:1. Tumor histology included undifferentiated Burkitt's lymphoma in 12, undifferentiated non-Burkitt's lymphoma in two, undifferentiated, unspecified lymphoma in one, diffuse large cell lymphoma in three, and lymphoblastic lymphoma in eight patients. Most had extensive disease; two patients had isolated bone lesions, one had lesions of two bones without involvement of other tissues, and 23 had either multiple bone lesions or single bone lesions with involvement of other tissues. Eight of the 26 patients had bone marrow involvement. Of a subgroup of 12 patients with jaw disease, 11 had undifferentiated lymphoma and one had diffuse large cell lymphoma. Only one had primary a jaw tumor, with two quadrants of the jaw involved. All 26 patients were treated with chemotherapy; only two received radiotherapy initially for bone lesions. Predicted survival of the 26 patients at 5 years is 53.2%. The 12 patients who remain disease free have a mean survival of 62.1 months (range, 22 to 100 months). Our results call into question the role of radiotherapy in the treatment of bone lesions in non-Hodgkin's lymphoma.     

Strain-specific differences in two large Mycobacterium tuberculosis genotype clusters in isolates collected from homeless patients in New York City from 2001 to 2004

We studied two large Mycobacterium tuberculosis genotype clusters associated with recent outbreaks in homeless persons to determine factors associated with these tuberculosis (TB) strains. Isolates from all culture-positive TB cases diagnosed from 1 January 2001 to 31 December 2004 were genotyped. Patients whose isolates had identical restriction fragment length polymorphism patterns and spoligotypes were considered clustered. Health department records were reviewed and reinterviews attempted for clustered cases. Patients with the Cs30 and BEs75 strains were compared to other genotypically clustered cases and to each other. The two largest genotype clusters among homeless persons were the Cs30 strain (n = 105) and the BEs75 strain (n = 47). Fifty-one (49%) patients with the Cs30 strain and 28 (60%) with the BEs75 strain were homeless. Compared to patients with the BEs75 strain, patients with the Cs30 strain were less likely to be respiratory acid-fast bacillus smear positive (51% versus 72%). Furthermore, patients with the BEs75 strain were more likely to be HIV infected (74% versus 42%), which suggests that most patients with this strain advanced to disease after recent infection. Cases in clusters of strains that have been circulating in the community over a long time period, such as the Cs30 strain, require additional investigation to determine whether clustering is a result of recent transmission or reactivation of remote infection.     

A survey on clinical presentation and nutritional status of infants with suspected cow' milk allergy

Background  

Cow's milk is the most common food allergen in infants and the diagnosis of cow's milk allergy is difficult, even with the use of several diagnostic tests. Therefore, elimination diets and challenge tests are essential for the diagnosis and treatment of this disorder. The aim of this study is to report the clinical presentation and nutritional status of children evaluated by pediatric gastroenterologists for the assessment of symptoms suggestive of cow's milk allergy.     

Pitfalls in the diagnosis of ventricular shunt dysfunction: radiology reports and ventricular size

INTRODUCTION: The diagnosis of shunt malfunction can be difficult even for the experienced clinician and may lead to disastrous circumstances when misinterpreted. Less experienced physicians may rely more on radiographic reports as a primary diagnostic modality. In this study, we evaluated the reliability of using these reports without accurate clinical assessment. METHODS: All shunt revisions seen at Children's Hospital (Birmingham, AL) between January 1996 and August 1996 were reviewed, excluding patients with brain tumors, supratentorial extraaxial fluid collections, and infections. Sixty-eight patients underwent 100 operations for shunt malfunction. All patients had evidence of shunt blockage, disconnection, catheter malposition, or valve pressure incompatibility. The prospective radiographic interpretation of preoperative computed tomography and magnetic resonance imaging scans was reviewed in each case. RESULTS: Twenty-four percent of the reports made no mention of shunt malfunction. In this group, the ventricular system was described as "unchanged," "stable," "normal," "unremarkable," "small," "smaller," "slit," "negative," and "no hydrocephalus," with no other comment to support a diagnosis of shunt malfunction. An additional 9% of reports contained the same terms, while also hinting at some other clinical or radiographic data that suggest the possibility of shunt failure (e.g., a shunt disconnection seen on plain radiographs), despite the scan findings. In all patients in this group, symptoms improved after surgery. CONCLUSION: We conclude that as many as one third of patients presenting with shunt malfunction will not have the diagnosis of shunt malfunction supported by a prospective radiologic interpretation of brain imaging. Although the neurosurgical community can assess the clinical situation to determine the need for surgery, other clinicians can be easily reassured by a radiographic report that does not mention or diagnose shunt malfunction. Today, more than ever, nonneurosurgeons are being called on to evaluate complex clinical situations and may rely on radiographic reports.     

Renal abscess: a complication of ethanol embolization

The authors describe a previously unreported complication of ethanol ablation of a renal tumor in one case. A renal abscess developed in a patient with preexisting silent urosepsis 5 weeks following ablation. Routine urinalysis, Gram stain, and urine culture are recommended as preprocedure tests to avoid such complications.