A randomized study comparing epirubicin in a 4-weekly versus a weekly intravenous regimen in patients with metastatic,hormone resistant,prostatic carcinoma: effects on health related quality of life

The treatment of hormone resistant prostate cancer) with epirubicin 25 mg/m² (Epi25) on a weekly intravenous regimen may be better in terms of health related quality of life (HRQOL) than with 100 mg/m² (Epi100) on a 4-weekly regimen. A total of 79 patients who filled out the EORTC-QLQ-C30 questionnaire for the assessment of HRQOL could be evaluated. Compared with the baseline, no changes in HRQOL function scales or significant changes in the following HRQOL symptom scales were found. The Epi25 group reported less pain during the first 3 months and the Epi100 group more dyspnoea after 4 weeks and less pain and less insomnia but more loss of appetite after 8 weeks. In both groups, toxicity was comparable, except for World Health Organisation grade II-III alopecia occurring in 82% in the Epi100 versus 31% in the Epi25 group. There were no significant differences between groups in response rates and survival. In this study, HRQOL was not improved which is in line with other studies using only epirubicine. Epirubicin as single agent therapy should not be used in future treatment of patients with HRPC.     

Triple trouble: the role of malnutrition in tuberculosis and human immunodeficiency virus co-infection

Worldwide, the number of individuals who are co-infected with human immunodeficiency virus (HIV) and tuberculosis is increasing greatly. The "triple trouble" of HIV and tuberculosis infection and malnutrition may put those infected at greater risk than those with any of the three conditions alone. Further investigation is needed to evaluate the prophylactic and therapeutic potential of nutritional interventions for co-infection with HIV and tuberculosis.     

MRI features of tuberculosis of peripheral joints

The aim of this article is to present the magnetic resonance imaging (MRI) features of peripheral tubercular arthritis. The clinical presentation of peripheral tubercular arthritis is variable and simulates other chronic inflammatory arthritic disorders. MRI is a highly sensitive technique which demonstrates fine anatomical details and identifies the early changes of arthritis, which are not visible on radiographs. The MRI features of tubercular arthritis include synovitis, effusion, central and peripheral erosions, active and chronic pannus, abscess, bone chips and hypo-intense synovium. These imaging features in an appropriate clinical setting may help in the diagnosis of tubercular arthritis. Early diagnosis and treatment can effectively eliminate the long-term morbidity of joints affected by tuberculosis.     

Sonography of neck lymph nodes. Part II: abnormal lymph nodes

Assessment of cervical lymph nodes is essential for patients with head and neck carcinomas, and ultrasound is a useful imaging technique. Sonographic features that help distinguish between the causes of neck lymphadenopathy, including grey scale and Doppler features, are discussed. In addition to the distribution and location of nodes, the useful grey-scale features are: size, shape, internal architecture, intranodal necrosis, absence of hilar structure and calcification. The useful Doppler features are: distribution of vascularity and intranodal resistance. Ancillary features such as oedema of soft tissue and nodal matting are particularly helpful to identify tuberculous nodes.     

Activity against multidrug-resistant Mycobacterium tuberculosis in Mexican plants used to treat respiratory diseases

The increase of multidrug-resistant Mycobacterium tuberculosis (MDR-TB) demands the search for alternative antimycobacterial drugs. The aim of this study was to evaluate plants used in Mexican traditional medicine to treat respiratory diseases for activity against MDR-TB. A group of 22 plants was screened for activity against Mycobacterium tuberculosis H37Rv and Mycobacterium avium at concentrations from 50 to 200 microg/mL. The antimycobacterial effect was determined by a microcolorimetric assay with Alamar blue dye. None of the aqueous extracts had antimycobacterial activity. Hexane extracts from Artemisia ludoviciana, Chamaedora tepejilote, Lantana hispida, Juniperus communis and Malva parviflora, and methanol extracts from Artemisia ludoviciana and Juniperus communis inhibited the growth of Mycobacterium tuberculosis. Mycobacterium avium was inhibited by Juniperus communis hexane extract and by Malva parviflora methanol extract. The active extracts were tested against monoresistant variants of Mycobacterium tuberculosis H37Rv (isoniazid, rifampin, streptomycin and ethambutol resistant) and the hexane extract of Lantana hispida showed the best activity. Lantana hispida hexane extract was also active against a group of MDR-TB clinical isolates. In contrast, it did not inhibit the growth of non-tuberculous mycobacteria. The hexane extract of Lantana hispida was fractionated by column chromatography and one of its fractions (FVI) inhibited the growth of all the MDR-TB clinical isolates at concentrations up to 25 microg/mL. This study supports the fact that selecting plants by ethnobotanical criteria enhances the probability of finding species with activity against mycobacteria, and our results point to Lantana hispida as an important source of potential compounds against MDR-TB.     

Antibacterial and antifungal activity of juniper berry oil and its selected components

Juniper berry oil is stated to possess a wide spectrum of pharmacological activities and its monographs are included in some National Pharmacopoeias. The antibacterial and antifungal activity of the oil was reported by some authors. In our study we estimated the antibacterial and antifungal activity of three different juniper berry oils and their main components. All the micro-organisms used in this experiment were isolated from patients of Regional Hospital of Gdańsk and some of them showed resistance against commonly used antibiotics. Only one of the oils (labelled A) revealed good antimicrobial properties. None of the single oil components was a stronger antibacterial and antifungal inhibitor than the oil A itself. Our data suggest that the antimicrobial activity of juniper oil A is the result of either the specific composition of the oil A (highest concentration of (-)-alpha-pinene, p-cymene and beta-pinene) or activity of a single non-identified compound. The presence of an adulterant in the oil was excluded.     

Multidrug-resistant tuberculosis in HIV-negative patients,Buenos Aires,Argentina

Initial multidrug-resistant (MDR) tuberculosis (TB) in HIV-negative patients treated at a Buenos Aires referral hospital from 1991 to 2000 was examined by using molecular clustering of available isolates. Of 291 HIV-negative MDRTB patients, 79 were initially MDR. We observed an ascending trend of initial MDRTB during this decade (p=0.0033). The M strain, which was responsible for an institutional AIDS-associated outbreak that peaked in 1995 to 1997, caused 24 of the 49 initial MDRTB cases available for restriction fragment length polymorphism. Of those, 21 were diagnosed in 1997 or later. Hospital exposure increased the risk of acquiring M strain-associated MDRTB by approximately two and a half times. The emergence of initial MDRTB among HIV-negative patients after 1997 was apparently a sequel of the AIDS-related outbreak. Because the prevalence of M strain-associated disease in the study population did not level out by the end of the decade, further expansion of this disease is possible.     

由小鼠肺组织病理学改变评价结核DNA疫苗的保护效力

目的 评价结核分支杆菌MPT64和ESAT6 DNA疫苗的保护效力。方法 将BALB/c小鼠随机分为5组,分别用生理盐水(A）、载体质粒（B）、卡介苗（C）、MPT64 DNA疫苗（D）和ESAT6 DNA疫苗（E）免疫小鼠。最后一次免疫3周后以结核分支杆菌H37Rv腹腔内攻击小鼠。攻击5或10周后,观察肺组织病理改变。结果 结核分支杆菌攻击5周后,A和B组小鼠肺组织病变表现为以渗出性反应为主的混合性组织反应;C组表现为以上皮样细胞肉芽肿和肺泡壁结核肉芽组织中度增生为主的增殖性组织反应;D组3只和E组1只小鼠与A、B组表现相似,D组2只和E组4只小鼠与C组表现相似。结核分支杆菌攻击10周后,A、B和D组肺病变主要表现为由许多泡沫样巨噬细胞、淋巴细胞和少量上皮样细胞组成的结核性肉芽肿及肺泡壁结核性肉芽组织中度增生、增厚;C和E组均表现为上皮样细胞和淋巴细胞组成的结核性肉芽肿及肺泡壁结核性肉芽组织中到重度增生、增厚。各组小鼠均未见干酪样坏死。结论 结核分支杆菌MPT64和ESAT6 DNA疫苗能增强机体免疫力,ESAT6 DNA疫苗的保护效力比MPT64 DNA疫苗强,但均未超过卡介苗。     

Knowledge and practices regarding tuberculosis: a survey of final-year medical students from Canada, India and Uganda

CONTEXT: Tuberculosis is one of the most common infectious diseases worldwide and is responsible for the largest number of deaths from a single infectious cause. OBJECTIVE: The objective of this study was to compare the knowledge of and practices regarding tuberculosis in final-year medical students at schools from endemic and non-endemic areas. SUBJECTS: Final-year medical students at McMaster University in Canada, the Christian Medical College in India, and Makerere University in Uganda. METHODS: A questionnaire consisting of 20 multiple-choice questions assessing knowledge, practices, and exposure. A total knowledge score (maximum=13) and a total practice score (maximum=5) were created for each study site. RESULTS: 160 questionnaires were returned; the response rate was 68.4% (65/95) for McMaster University, 39.7% (23/58) for the Christian Medical College and 78.3% (72/92) for Makerere University. Students from Makerere University had the highest knowledge scores but differences were non-significant after adjustment for patient exposure and curriculum time (F(2,153)= 1.80, P=0.16). Differences in practice scores, however, remained significant after adjusting for curriculum time and patient exposure (F(2,153)=5.14, P=0.006). Knowledge score (F(1,156)=5.05, P=0.02), patient exposure (F(1,153)=9.11, P=0.003), and curriculum time and patient exposure (F(2,153)=5.14, P=0.006) were statistically significant positive predictors of the total practice score. CONCLUSIONS: This study demonstrated significant differences in undergraduate exposure to tuberculosis, total knowledge, and practice competency at three medical schools in Canada, India, and Uganda. In general, the knowledge base and practice competency of all three graduating classes was adequate.